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HomeMy WebLinkAboutMiscellaneous - 24 WENTWORTH AVENUE 4/30/2018._ ` T N A V 0 "'� O _� 0 � G o m l �� 1006 1 Date .? AY5.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .rn!1... e U has permission to perform .y �. �',2. kko e.�,,, plumbing in the buildings of ... :.1. !°� , - . . . . . ... . . . . I . . . . . at ...... �" Q )�%!4 , North Andover, Mass. Fee` .. Lic. No.. !%� .. M.0 PLUMBING INSPECTOR Check #6 3 i p TYPE OR PROM' CLEARLY FIXTURES Z BATHTUB wr•••o� I 10 umrr%P= gt+puCATIOIN FOR A PERMIT TO FERFORM PLUM13INd WORK CITY L.._.. o MA DATE Ej\� PERMIT # JOBSITE ADDRESS ,---_ --- �------� OWNER'S NAME ,o� � OWNER ADDRESS gtfn Q ----�- TE! -1, --a6 � 3 51 9, 4 OCCUPANCY TYPE COMMERCIAL EDUCATE L) RESIDENTIAL NEW: LJ RENOVATION: [j REPLACEMENT: • i1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSI DRIWING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR QNTEI KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING' I PLANS SUBMITTED: YES L' tdO hmaommtftoh iemranos po*q or its su r�tlal "4v"d which msI the MP*Nmft Of W. Ch. 142. YES M NO L AI IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF ODVEXAGE BY CIECKM THE APPROPWATE BOX B&OW LIABILITY INSURANCE POUCY L& OTHER TYPE OF INDEMNITY Ej Bow 71 OWN!EWS INSURANCE WAIVER 1 am Nww* that #w Ilcww" doss r� Itafe the hmrsnc0 owmrepe required by CIS 142 of the Mosew►usetts Gowal Laws, and that my d9nahn on #ds pwn* appgagmNA&M #ft requironenL CHECK ONE ONLY: OWNER Li AGENT . SIGNATURE OF OWNER OR AGENT S -NWWW or srftmd regrdbV Oft illipil:1111C�p�l a16 , ' ,l aCQ:ai i+ I ! }1 E tigSi Of Rfy X11 std the A *—boV work and 41BtYiiWO— Pw mmed oder the Pew issued this app�n wil be In oorrepliarlpe ertlrterlt owkxw- Stale Phsnbhq Code sed 142 d the Genaral Uaws. Provision of the PLUMBER'S NAME LICENSE #— SIGNATURE MP JP CORPORATION ® %i PARTNERSHIP[I L�Lj LLC F:j# _ COMPANY NAME i � �t m� t n --- -- --- -- � SR.r' 3 iC ¢ s 1 ADDRESS - ( � '� £+ � CITY err �. �� STATE �.� ZIP i -- — — _.__ -- _ _ 0 2 ` TEL '�&t-t_� r FAX CELL al e1� yzm MAIL C 2 cra_ I w W U- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians7Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): b ` IF— Address:- o � s_, \\ i h R 6 J City/State/Zip: 6e O 6 ,°' Phone #: O Are you an employer? Check the appropriate boa: 1. Z am a employer with��_ 4. f_1I am a general contractor and I t 31� LLL - Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. ElNew construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling ship and have no employees These sub -contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. r� We are a corporation and its 10.® Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their I I,© plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. 0 Roof repairs insurance required.] t c. 152, § I(4), and we have no employees. [No workers' 13.® Other % comp. insurance required.] -, -Fv ..a.,, ,,,a, ­mnb oux s i musr also rui out the section below showing their workers' compensation policv information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached 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. ! am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: +J p n 1 h SNPq» CQ s & r0 Policy # or Self -ins. Lic. #: w C 6 '31 Expiration Date: i Job Site Address: 2. + W Q h�Cl� a- ` 2 City/State/Zip 'Q>n doV 0 -%— 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 c. 152 can lead to the imposition of criminal penalties of a fine 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 up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under fheTains and penalties of perjury that the information provided above is true and correm Phone #: T a 1 6 I,) "4-�' I- I OfftcW 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. Board of Health 2, Building Department 3. City/fown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other I Contact Person: Phone #: 11 COMMONWEALTH OF MASSACHUSETTS _ AS A MAST R UNRESTRICTED ISiIJES THE ABOVE LICENSE TO FREDERIC" J MOXHAM i� GEM PLUMSING :;ERVICES . 1 WELLINt;TQN F,D LINCOLN RI 02865-4411 5875 05/ 162523 COMMONWEALTH OF MASSACHUSETTS REGISTERED ASA .PLUMBING CORP 14-3S1JES THE ABOVE LICEIuSE TQ ' FREDERICK J MOXHAM -GEM PLUMBING & I-iEATING,,SERVI 9.91 WES-T ST ATTLEBORO MA 0270.5-3-339 2899 OS/01/14 .144742 COMMONWEALTH OK MASSACRUSEM PLUMBERS AND GASFITTERS LICENSED AS A:_MASTER PLUMSER ISSUES THE ArQV= LICENSE TO: i FREDERICK J MpXHAM 991 WEST ST ATT! EBNO -MA 027b3—:5339 -9.628 05/01/14 i5831s COMMONWEALTH OF MASSACHUSETTS PULIMBERS ARID GASFITTER.S LICEI*SED AS A JOURNEYMAN -PLUMBER ISSUES THE REOVE LICENSE T -t3 i EDEPICK J MOX -HAM q Z l ,a1 WE, 'T ST ATTLEBQPO MA 02703--3.339 r. 1, 6:?i6 05./01114 1SE3314 9 -== :mss �ianaril n! ��Egtstrattcn of ()EEC �'lEtdt �Ol'IiPI'5 �9f �4auutr, sa;re(IeD rhC req�I(t-emtints a(�f1a„achuser> �ztcs,at t1s EllavEt:112 i�>finati23%through251 Gent Plumbing &'eating (EiD Inc la bmUp grawr4 i! Lz f?t'tt(tfai; lto. 4913 n5 �U;Zeigq to pra Glft dS a f ttPIYSPb beet Metal Eivatne55 as Ots c” Dap c::Vc0ntary 2_012 8n LL. Gwonp oy he r(g(, IS Urt[omo 7th):t9 IN 1041r of the t%rT'4 UP ]il'PQOr of tt)r Mart Location No. 216Date Co TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ F un; ation Permit Fee $ rmit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ - - / 194 11:37 73` uilding Inspector 52. 0o 116 Div. 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O D =y n A ti- O O 0 m p y A m 006-> N 2� A 0 0, 3 m T Z D 3 3 A 3 o o 0 2� F H O� 0 Z z { 3 0 Z 0^ s T m > m Z N Z H 0 _ 0 11L 11J� I I N O D D O W > A T m?? m c T A D S m D Z (_ O r N 0 D S =m Z pv yam! Z N nm Z ZD -13 `p�T D H� �Zv x m Z O O Z p D D D A A Z J�L_LJ�L I I I Iw JAI_ I I I IN I III C) -105; N tmnrN `z m n (A D0 yZZ roc rn �XN -I D fl 0�0 tno* mim m -t ZD _x on u►Oo mz- mox fMOZ DmN mw0 ws z r N r20 -�Zn r pN0 aga ?-z -+ v xo '0N Ms 0 z x mm mm � m 00 3 A.J. Walsh & Sons Inc. Mass. LICI:NSI: h 022690 55 I'leasant Strcct North Aiidmer, MA 01945 Mass. 1:FGISTRATION K 103359 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home Improvement contractors and subcontractors engaged In home Improvement contracting, unless specifically exempt from registration by provisions of Chapter 142aofthe general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name: This agreement is made on 'J — /y J 7_7 (DATE) hereinafter called "Contractor" and hereinafter called "Owner". 714_� cyl-14W cywl�_' (CONTRACTOR) cPiloNE NUMBER) (OWN)'R) (PHONE NUMBER) DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contracjpr„egrees,tq perform in a good and workinanike manner all work detailed below. Sucl�ork consim of the following: _Q&/)L1 DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described wo consist of tl}e following: ll. PRICE Contractor agrees to do all work described in Section I for the total price of $ 7�� QU W. PAYMENT Payment will be made as follows: i33 1131 % (a ) ulwn signing Contract; upon completion of ` %(S ) upon completion of , and the remaining % ($ 900uponv,rification of the work by Owner and Contractor as having been satisfactorily completed, which verification shall take place promptly after completion. Notice: No agreement for home Improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, In advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount Is greater IV, COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials befgre the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on or a400ut JR 14X20 (date). 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