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Home My WebLink AboutMiscellaneous - 230 LACY STREET 4/30/2018 230 LACY STREET 210/105.0-0030-0000.0 1 9 0 U Date..a6 -+.1. . . . "oRT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING " ;,sSACHUSE� This certifies that . . . . . . . . has permission to performti(?e: . . . . . :. . . . . . . . . . . . . . plumbing in the buildings of . .�cr,r�.t. . rte' ,{�1 �5 . . . . . . . at . . .23 Q 4, S ! . . . . . . . , North Andover, Mass. Fee. . Lic. No.. . . . . . . . . . . . ... . . PLUMBING INSPECTOR Check # LA(,b 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:_ //r�RY�I ,QD��iP MA. Date Permit# Building Location._ G./I(iri �� //JJ Owners Name: //j/� Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential L� NeF� ___ _ : Alteration:❑ Renovation:❑ Replacement:[/ E� E2/ Plans Submitted: Yes❑ No FIXTURES DEDICATED L H Z SYSTEMS > O w Uj Z CL a Z FQ Y 'Q y _, t=i Fes- w in z w C7 z Z Q m v=i a w in ~ w N O z h=- N vQi w w QY LU U2 O = D O w in .wi Z LL S _ Q Q m m D 2 > O O a Q Z N 1w- Fw- w a'f O N Fw- o -SUB BSMT. Cod C-n BASEMENT 1ST FLOOR 2ND FLOOR �. 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name: t/�f'�/}�/ ,Check One Only Gertific to 11 Address:/D / City/Town: Stater u 6orporation � (/(/ he q f7_/f 3 El Partnership Business Tel:-_ / `j Fax: Name of Licensed Plumber: ❑Firm/Company� �� U INSURANCE COVERAGE: 1 have a current Iia_ bility Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy.[� Other type of indemnity ❑ Bond ❑ • OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Si nature of Ower's Aner or Ownent Owner ElAgent E]hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the Gene r i Laws. By • Type of License: Title ❑ Signature Plumber 9 ture o Licensed Plumber L'ity/Town ❑Master APPROVED(OFFICE USE ONLY) []Journeyman License Number: COMMONWEALTH OF MASSACHUSETTS j LICENSED AS A MASTER PLUMBER r ISSUES THIS LICENSE TO MICHEL U CHAPUT {` 21 FLOWER LN r DRACUT MA 01826-4603 s 10.843 05/01/12 75391 LICENSE NO. EXPIRATION DATE SERIAL NO. �I 1 r_ J f= i` COMMONWEALTH OF MASSACHUSETTS LICENSED AS A JOURNEYMAN PLUM I ISSUES THIS LICENSE TO MICHEL U CHAPUT :. ..6 as I 21 FLOWER LN � r DRACUTI MA 01826-4.603 . :' : t 20241 05/01/12 7.5392 `1 1 p, 0252 Date ................6-........ ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS C" This certifies that ........... ................................... ........ . ..................... IgAr-ov . has permission to perform ........ l ............................................. ST wiring in the building of........................... 7251 ES............................. . at..... . ..3.0 .................... ................................e. North Andover,11 S. .......... W. Fee. .......... Lic.No .......... W- 01 ELECTRICAL INSPEC16,R C/ Check # Uf LI? The Commonwealth of Massachusetts Office Use Only Department of Fire Services Permit# 10 7.32— BOARD OF FIRE PREVENTION REGULATIONS Occupancy&Fee Checked Rev. 1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code(MEC), 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: August 26,2011 City or Town of North Andover, MA 01845 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 230 Lacy Street Owner or Tenant Carol St James Tel.No. 978-807-0967 Owner's Address Same Is this permit in conjunction with a building permit: Yes= No = (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd =No.ofMeters New Service Amps Volts Overhead Undgrd =No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Remodel Main Bathrrom Completion of the following table may be waived by the Inspector of Wires. No.of Lighting Outlets No.of Hot Tubs No.of Transformers d No.of Lighting Fixtures 6 Swimming Pool Generators No.of Receptacle Outlets 3 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switches 4 No.of Gas Burners FIRE ALARMS #of Zones No.of Ranges No.of Air Cond. Tons No.of Detection No.of Disposals No.of Heat Pumps kw No.of Alerting No.of Dishwashers Space/Area Heating kw No.of Self Contained No.of Dryers Heating Devices kw Local Municipal r— Other E No.of Water Heaters INo.of Signs Data Devices No.of Hydro Massage Tubs INo.of Motors Telephone Devices Other: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) ,t work to start: August 26,2011 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived b the owner,no permit for the performance of electrical work may issue Y � P P Y unless the licensee provides proof of liability insurance including"completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and the exhibited proof of the same to the permit issuing office. CHECK ONE: INSURANCE 1 ^ ' BOND F--" OTHER F---" (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true&complete FIRM NAME Dumais Electric LIC.NO. 12170A Licensee Mark A. Dumais Signature Q lauLIC.NO. 26665E (If applicable, enter "exempt"in the license number line) Address 8 Newport Street Bus. Tel.No. 978-683-9438 Methuen, MA 01844 Alt.Tel No. 978-685-4553 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: LIC.NO. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage normally required by law. By my signature below,I herby waive this requirement.I am the(check one) F owner owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: Olt € y The Commonwealth of Massachusetts * Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Dumais Electric Address: 8 Newport Street City/State/Zip: Methuen, MA 01844 Phone#• 978-683-9438 Are you an employer?Check the appropriate box: Type of project(required): 1. 1�x I am an employer with 9 4. ❑ I am a general contractor and 1 6. [k New construction employees(full and/or part time).* have hired the sub-contractors 7. ❑Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp.insurance comp.insurance.1 required] 5.0 We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12. ❑ Roof repairs employees.[no workers' 13. ❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: Hanover Insurance Company/N.Andover Insurance Agency, Inc. Policy#or Self-ins.Lie.#: WHN8197927 Expiration Date: 2/2/12 Job Site Address: 230 Lacy Street City/State/Zip: N.Andover,MA 01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine C up to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the Pains and Penalties ofperjury that the information provided above is true and correct Signature: a• o Date: 8/26/11 Print Name: Mark A. Dumais Phone#: 978-683-9438 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.13oard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: Date . :' ...869 ..... ...�. NORTI{ TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACNUS� n I /��This certifies that �i . 7 has permission to perform .. .... .....af74'.... Q` wiring in the building of. F:.. ....................... a at... S ..:.......................... .North Andover,Mass. Fee... �.: Lic. 7 ELECfRicALINSPECfOR J WHITE:Applicant CANARY:Building Dept. PINK:Treasurer qT Office Use Only u of :A(ia1J.5a r4USrtt0 Permit No. r Elepartmient of 'Pub14L _*Ufttq Occupancy& Fee Checked r / BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 390 (leave blank) / 7� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM 12:00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate ( %)j or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) �'> Owner or Tenant L' T 21— T&a L-5 Owner's Address g� L Is this permit in conjunction with a building permit: Yes ❑ No ❑(Check Appropriate Box) c Purpose of Building f KD1(` �A�AA I GV L I&AA�. �Utility Authorization No. Existing Service 166 Amps J__2:.r_�V0lts Overhead Lam' Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In- No. of Lighting Fixtures I Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units FIRE ALARMS No. of Zones No. of Switch Outlets I No. of Gas Burners No. of Air CondTotal No. of Detection and . No. of Ranges tons Initiating Devices No.of Heat Total Total No. of Disposals Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices t Local Municipal r Other No. of Dryers Heating Devices KW ❑ Connection l No. of No. of Low Voltage No. of Water Heaters KW ( Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = NO have submitted valid proof of same to the Office. YES = NO _ If you have checked YES, please indicate the type of coverage by checking the appropKate box. INSURANCEBOND OTHER Z (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: LIC. NO. FIRM NAME Licensee � �� y � Signatur LIC. NO. Bus. Tel. No. 619 9 l� �— Address "` Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S 1 (Signature of Owner or Agent) x-5565 1 � –