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HomeMy WebLinkAboutMiscellaneous - 225 BRIDLE PATH 4/30/2018 225 BRIDLE PATH 210/104.C-0084-0000.0 I Date... • NORT" °tt"`° '•�"° TOWN OF NORTH ANDOVER 3? �,� _. '• of o p PERMIT FOR WIRING ��SS�cHusE� I1 / 'is certifies that ..... ...................Q:............................................. ......... / had permission to perform .........._.Q.............. .... .... ......................... wiring in the building of... at................. ...... :. ,N ,rth Andover, s.. ��....... 9 y Fee.. ' .......... Lic.No.�..�.. ................. ........... .. ........ ECTRICALINSPECTOR Check # 5U2 � Official Use Only Permit No. V DEQ Pam Saadg Occupancy&Fee Checked"" BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT �A PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 10 tg-4 To the inaakctor oftlii s: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. /� J Location(Street&Number 0 ijr 1� Q��� H e Y`111UO�e Owner or Tenant _ A 1(1 ry 5�n 1 t S� JC VA(-e_ nn . Owner's Address d3'5- Q-r i Ale— P ek�� 1"A. A�doy<>- Is this permit in conjunction with a building permit Yes 1V No 0 (Check Appropriate Box) Purpose of Building a e5 i Ac J ,LL Utility Authorization No. eAsting Service ck)0 Amps 12o a2 gO_Vofts Overhead 0 Undgrnd No.of Meters I Now Service Amps Voits Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TLe mc, L Ir p F Ki \ 3 ���� r`n'►, S i°' Y CLvt a + �o h Y u^(.0 CA_. Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA l No.a Lighting Fixtures ,r S Above 0 In a �?rOnm KVA �),� g g^� �`1 Swimming Pool and 0 and 0 C..r?. No.of Emergency Lighting No.ofReceptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets 57 No of Gas Burners. FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices 1 Heat Total Total No.of Di sal 1 No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Device 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Si ns Bailase Winng__ No.Hydro Massage Tuft No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws .:I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO -,A pve-subn1J*ed valid proof of same to the Office YES= NO - If you have ch YES please indigate the type f coverage by checldng the appropriate box. INSURANC BOND - OTHER - (Please Specify) It?/Pr�y�ti- !/��v (7 (Ex0ifaticrh Date) Estimated Value of.Electrical Work$ Work to Start Inspection Date Resquested Rough Firial Signed under the Penalties of perjury: FIRM NAME LIC.NO." SILVEIRA ELECTRIC Licensee Signature LIC.NO. Lic. 7 16095/36388E Bus.Tel No. Address 27 Conant Street Alt Tel.No, r OWNER'S INSUR.VIA&IQ45that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And th iu&Mhis permit application waives this requirement. Owner Agent (Please Check one) SILVEI,RA ELECTRIC Joseph Silveira 1.iC.-AA 115j995�863$B�Telephone No. PERMIT FEE $ 5o, 00 (signature of Owner or Agent)_ 27 Conant Street; BEVERLY, MA,02915- (978)927;1200 Cel 4�9-7,r g1s "�?i, The Commonwealth of Massachusetts o Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit w,s Please Print Name: Location: City Phone am homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity x 0 I am an employer providing workers' compensation for my employees working on this job. r Company name: Address City: Phone#: Insurance Co. Poligy# i Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept [-]Check if immediate response is requked Building Dept ❑ Licensing Board _ ❑ Selectman's Office Contact person: `` Phone##:` Healtfi�epartmenf ❑ Other FORM WORKMAN'S COMPENSATION Date! !,/4.� . .... .. WORT6.H TOWN OF NORTH DOVER • PERMIT FOR GAS.A14STALLATION �9SSACHUSEt This certifies that . . . . �. . �'.r. . !. .! . . < has permission for gas installation . . //!:�. A.��? �. . . . . . . . . . in the buildings of . . ,. '�.'111 1L.f ' `. . .. �. . . . . . . . . . . . . . . . . . . . at . .? .�. . . . ��!'. ' 1 �' I"'L. . . . ., North Andover, Mass. Fee. . . . Lic. No..,). . . . . . . . . . . . .�, . .. . ... . . . . . . ,GAS INSPECTOR Check# 1)1C 7026 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASI`ITTING (Print or Type) /J ,Mass. Date i� d Permit# 7 ZG I Owner's Name Building Location Owner Tel T"e of Occupancy New C] Renovation Replacement Q. Plan Submitted: Yes No FIXTURES J zN r � � BASEMEM 113T F ao f 3�O FO R. TM Bn'F R r"FLOOR 8TM FLOOR Installing Company Name fl r ! Check one: Certificate . Address �'f f}t./� o Corporation ! 1..=E t C� 1:3Partnership Business Telephone':# 77�, -.3'0 q� �0 o irm/Co: Name of Licensed Plumber or Gas Fitters I INSURANCE COVERAGE: f have a cubility insurance policy or ns substantial equivalent which meets the requirements of MGL Ch.142. Yes : No 0 if you have checked yes please indicate the type coverage by checking the appropriate box. A liability lieu policy Other type of-Indemnity v Bond a OWNER'S SU NCE WA :I am awa the licensee does'not have the insurance coverage required by Chapter 142 of the Maass.Ge ral ws,and tha sig re permit application waives this requirement: Check one: Owner:❑ Agent Signa re of Owner orOwnec s Agent I.hereby certify thaYall of the details and Information 1 have Submitted(or entered)i ove a ca on are true a ,akxa�ra�to the best of my knowledge and that all plumbing work and installations performed under the pe ssued for is application will in compliance with all )am provisions of the Massachusetts State Gas Code and Chapter 942 General By Type of Ulcense: .`� Mau •-Plumber. .5i¢nature of Uoanseedd P er or Gas Fitter Title fitter Ucense Number. CityiTownumeyman APPROVED(OFFICE USE ONLY) i I a _ Qf i151pt}cf F Y:g " Board o1 Pit;::o +1ra4 MA t� RAW�.IA 14'VIIAYN1=.Rf` PEABOC. ,.ia 196f1 JoLmeyl a^ y I Lcer§e No; Expiry,cn.r * . 4 �i,f.��rrhu•c'tt• - I)c�u t�hi�rnt ,r1'Y�+fili: �;tl�1• firr it.ii rr1 [it A ul.ttu,n, iri,! �St►s,F1 trrk Remocted to: ROPOP,DM f2EEVAN' PARMA 14`WAYHE ROAD PEABODY,MA 01960 —' rr,r�rr.,..irr r 100997 ;;s .��/te ��ntt�lt��ul�P,t�,l��t � ..,'I•��irftacs�z �. uoella- Board of Buitding Reguiationa and Standards HOME IMPROVEMENT CONTRACTOR Regiatrotion: 160945 Expiration: wi5/201tf Tr# .274T28.. type: fridividusl REEVIE PARMA. REEVIE PARMA 14 WAYNE RD. � PEABODYi MA 01964 AdroiMatrRtor I i I i ' oA�tl>�►upolr+rrvl , 1 '1r+CAT 4 L1�► IL " INSURAN HnDuceR AX Vm C1 RTIFICATE 0 ISSUED AS.AMA`fTE �INisCi�tMA'i'�1 ONWARD CONVEN 140 fAmm"UPON TNfz i�ICA'1'S ti41Am.THO�PCi'�ICAy"t CQEB NOT AN fi�gt OK' A- c >a gty: > I►.0614%3 INSUMM AFFOROW12 COVOME MAIC�l #SURER A, 247 1��� � �II:�111 INSURER C: INSURER D. MSURER.E i HE NOLICI 3 f!F INSURAN0 LISTED SELOW HAVIti'9HEN SSUEn'rQ 7W&•MSilftSd IJAIIASn Ag01 1 12'fF16 pO1: Y PEgIOb tI�D10ATagD NdtWrtw rANOINO ANY"R6QUIRSMEPIT,TLRM GR GONDITION.CO ANY CONTRACT OR OTMLR DOoumeNT WITW RE$PECT TO WHICW THIS CERttf�ICA7E MAY gE 18&UED OR MAY PSRTM-7H@�18UIiAHCE AFFORDED 8Y 1 HE POLICIE8 094 CRIggD.HaREIN IS$u9jaCT To ALL THE TERMS.EXCLUSIONS"ANO CONDITIONS OF SUCH POt,1Ci 8 Ati lltE?OAfiE i:IMtTR SHOWN MA_Y WAV :GLEN REDUCOOSYPAiD:Ct:AtMB. TYI�OVIIi N]lAtStR LMpTE / Iq/ M "eACHRENCE 8 R COMM@RCwt t1ENERAL LM91UlY - 8 � i I GLAIMS MADE ��OCCUR' MEG EXP(Aiy one pdnod) 5 ({ A' PERSONAL&AW INJURY 6(iNERAlA6fiRE0ATE,; S.; 06HiAf�tiREGATE_tMitA#pCIES�Rs PRODUCTS-COX7PidPAOd E t; $ AW POLICY. T LOC 1NI1bNlOMGRtdAitlUW 0 SO $161/ �SINgLEUMft E ANYAUTO . (Ea�oeweat) ALL OWNEO AUTOS 80011 Y INJURY S �i SCHEDULED AUtO$ IPet pN6on). A 8 .]M*9OAUIrj; BODILY WMY 'X NON•OWNEDAUTO$ ` (f W Jk4t dh rtN S `PRpP&j"j*MAW S {PatYccMlad) QAhI�iE AUTO ONLY-EA ACCIDENT $ ANYAUTO- OTHER THAN EA ACC S AUTO ONLY.. AGG S 15XClt3blUtvl6gE!#A(iAfpL17YgW* SACH OCCURRENCE 8 OCCUR CLAlMSMADE AQGREGATH ;n 3 1 A- R. '. OEDUOTtBLE 8 gL7ENTION S $O• S WORKORS OOMPZNSA?i0N AND 1I 43 01/98 01/ m"o ISM 'UA4%ft S.L EA�'!�/k`CIDENT A. A��}}yyppppppppRIETOR7PAIVRiEXECUTI E tX+FICERIEMKI EX . D! B E.I:OISBASE•EA NM !pYE S yep E.L DISEASE•POLICY UNIT S � i ,01MHR 0@AORIH fON O!'OiHfRATWNB/4OCAitONS/VBFItC1 gi/BXClUs10N>l ADO$R109'lINdOR!lhtlNTf tsOZZ PROVNHONB I SHOULD ANY OF THC ASOVII OESCRI>D POUCMS BE'CANCELLED SMMO1tE 7611E EXPIRATION DAYS THIIRHOP,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAY$WRIT�N.M'=TO 7W OBRTHhOATE HOLDLq NAMED Ya THE LEFT, BLI1'FAIWRH TO#AIL SUCHNOvm SK&L IMPOSE NOOl6K1ATNfN Oft:UAfltLITV >yf ANY-HNip URON THE IN#UR6R.ITS AG�ITS OR RHPR@dlNTATWEB:: AUtHOt�ffip R61 $ECow NTATA7 ftral ACORD 25(SEM 1108) "cow CORPOWON 1911$ P©1= created with..pdfFaCtoq. tr1aE vers on. I tIFICATE.-OF.-LIA N oAmowppnrm CE INV F S SB•!!78 - MATE iS la$ ED AS A MATt t CF' CIRMAfiION #1 ra '+ Amy Iwc. . ONLY ANIS COl Nq t i'S t1pON THS-tM— A' NOT tDMOR INsUR6p R060b INBURER/l ;_. iNBURER s: att�litbt m MA sl84S INsu►:t�o: : _ IN$INiER E: THS PqL rE$pF lNBURANm119TED 9OLfWH HAVE 99EN ISSUED TQ THE INSUR60 NAMEuD ABQVE FQR THE POLICY AERXm$IDICATBD.NOt NNTH$rANtiM1f� ANY REQUIREMENT,TERMOR COMDITION OF ANY CONTRACT OR ONM DOCUMENT MM RESPECT TO WHICH::TH13 CERTIFICATE MAY SE ISSUED C?R MAY�ERTAiN,THE IN19t1RANCE AFFORDED BY THE POLiRan DLBCRIBER FIEREIN t$SUI;JEOT TO ALL YME TeRMei EXGI tl3tON$ANE1 CONDfYIONB OF SUCH POLICI6$�AC3Z#fE(�,A1 E i.IMiT$;SHOWN MADV IIAVNLSMN DEDUCED HY PAID Cl : TYasCa 1iIlIMWfY' : `taNbTIB - Il EACHOCCURREf10E.. � .:: C.dl1HNERCIAI.QNWERALLWSRm. X: FM D E CU1MiB MADE Q OCCUR i /� Person) E": :`to' AIED EXp(A V PEA"AL'&MW INJURY Q: 1, GENERALA UMMATR QENL'At3DRE0A7EUMItAgPLfHBPER ARODUCi6-COMPMPAM S PtTIJCY P G7. LOC AUICIAWMIL�JApiLITY '` , D$MK;LELIW $ , ALL OWNED AUPDB a $GNEDULEDAUTO6 HIRLD A(lTUS i N0N4WNLD AtlTDS $ODILY MIJURY (Per ec M") $ E OAf+G1tiR tJABILIIY AUTO ONLY. EA ACCIDENT i -- THAN EAACC 8 AUT1D ONLY:::. AM E EACH OCCUitRt?NC@ : OGCUR CLAIM8 MADE AOgREOAT£ i. bLDUCTTBI:H.. 8. . RE'tEN1TON g g WDRN81is COMPMAIM AND S . .. NMPLOY 'LUItlILITY:. ANY P1iQPg1E fORlp XECUTIVE E.L EACH ACCIDENT - OFFICERNIMBER UDE +•�-.-�.�,.... E E deNxlb6uttdet E:L.IJISCAN•EA<;MpI OY E g pq 8 below e.L.00EASE-atuloY LIMIT s oTTIR oe BCNMrJIONDRCasRA710Ns►LgCA71pNs./YBihO lB>iCLuslowADDEDDYBNOW MI[NTIMOM PROIps10Ns SHWILO ANY OF THE ASg11E ps6CRipsq POi 1CNTs 8E IiANCIEtl. - M1D EXPIRAMON Wa tHEREOP.ITB ISMXNO MURM WW:ENOIAVOR To MAIL "DAYB WRIT"NDMI707NE CERTIPICATB HDLgBR NAMMD IYSTN818aTr eur luuraeTOMftSUCHNoT=sNAmjAUP Sgtj6oSU"IMORUA911r1YY' rOPANY KIND UPQN fHt�UltB tTs IbbiNTs OR RlPf""NTAj%"' Ali1tlfD9EP1�81NTA'tNE WOM CMPORATION 1986. 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