Loading...
HomeMy WebLinkAboutMiscellaneous - 245 SUTTON HILL ROAD 4/30/2018N O_ O Q O O g 0 0 0 0 /�, Date ...�....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION °SACHUSt- A This certifies that ................... has permission for gas installation in the buildings of/./ ... L?r!.././� ...................... at .. Z �r „014 North �4,-nd r, Mas Fee.ZS',P. Lic. No..� Alr ``: / GASINSPECTOR Check # /33�/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY _ _' j a ✓ �' µ MA DATE v- PERMIT # JOBSITE ADDRESS _ �;� �1 S�_.F^c�.���°//_ OWNER'S NAME L'��� G OWNERADDRESS TEI� FAX J� TP�T _ _ ,�_�_ OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: 0 RENOVATION: El REPLACEMENT: �'� PLANS SUBMITTED: YES F1 NOE APPLIANCES -1 _- FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 I BOOSTER CONVERSION BURNER -- _ - -- -- -- _-_-- _ J _....a -.._. -- •--_-..-- =-._. -- _1 COOK STOVEE3 DIRECT VENT HEATER _ •,_ — f _ ____I _J DRYER - FIREPLACE I FRYOLATOR FURNACE 1 GENERATOR 1.-..--- GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TESTUNIT HEATER UNVENTED ROOM HEATER WATER KATER OTHERFE-7-Di - - - INSURANCE COVERAGE have a liability Insurance current policy or Its substantial equivalent which meets the requirements of MGL. Ch.142 YES JOB NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY [,� 13OND 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: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT I 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 ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME .. IAGE'ct'/t�i:1�,ct?�t-c� LICENSE #y'5� SIGNATURE MP E kl' [��_i JP 0 JGF D LPG10 CORPORATION D PARTNERSHIPEI# LLC D# --�� COMPANY NAME:..t2��ePt_ c_vim.-._...�'i/,•_ ADDRESS �/'� c��/a .... _....... _.__.._�_........ ._..._J1 CITY GA?r S-�d=�'S S Jr— II STATECTEL ZIP - -- FAX _.. CELL�EMAIL FAX[_, — �,z— —. 9435 Date. 41WI114 - - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... arr. .. 4-4? meo ....... has permission to perform e? f7 plumbing in the buil ings o... 45Qn 4�.................. . z at ... zw. .Se ............. Nqrth Andover, Mass. —01-ic. No.. MV .. .................. .. Fee .$ . . Xlec 4'*r""("/'4/:'�C" ........ e/ PLUMBING INSPECTOR Check# A -K &I, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - - CITY- z ,...1ff _. _z✓ _e .'✓.,_ __.._.. _._.._ ___.__ MA DATE 1..,5:23 /-... PERMIT # JOBSITEADDRESS - )=7-:7eA/ i' c' OWNER'S NAME C"/�i� _l�i..l..__._-. POWNER ADDRESS --.-.._... _. —_.. - — - - — _ . TEL7 4 .',3 R I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL ® RESIDENTIAL (Jt PRINT CLEARLY NEW: [_] RENOVATION: © REPLACEMENT: PLANS SUBMITTED: YES E] NDE] FIXTURES 7 FLOOR--* BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM , J DEDICATED GAS101USAND SYSTEM ! _ _1 , y ........ I. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN J ... - - --... - -._' _. -- -- J ....... ----- FOOD DISPOSER FLOOR l AREA DRAIN INTERCEPTOR INTERIOR YI _ _---_ ..._ _ _.._._. _ ..._._._W _ . _.._._..- -- ._ KITCHEN SINK ___! —I _ LAVATORY ROOF DRAIN _...._... _ . _ _.. —_J __-- _I .._... _ I .�_..._. -- --.__..J ..... _..... J _J i SHOWER STALL SERVICE 1 MOP SINK ___. _.,..._...-- - __-- ' ...._.._....... __ ... ....--.-._-! _._..._..._.. TOILET URINAL + WASHING MACHINE CONNECTION _.._._...i _...__{ .w_..-- --- ____-.' ........_..... _ �_ ..........: .. .J -.:...... _ ! .__:_... WATER HEATER ALL TYPES WATER PIPING ' ... OTHER _ --._._....... - - — - -- _..._.........._.... _.........-- -._..- -.. ..-- - _._..J -_..__. ... _ _ - ---- -- INSURANCE INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. YES[- ANO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q� OTHER TYPE OF INDEMNITY [] BOND Q 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: OWNER[] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information 1 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 General laws. ,' • ���� PLUMBER'S NAME Z��,gN._...%�_�l�l LICENSE # _f �� SIGNATURE MP 2I'll JP D CORPORATION E]#PARTNERSHIP D i LLC E#1 COMPANY NAME ��n► .. ADDRESS CITY STATE ..lilt14, 1 ZIP _� l,.S % _— TEL FAX I CELL ^� EMAIL �Af3� /b-- -, - J qx il 1 7 51� 4 Date ... lh*�/`01/....... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... S.4? ... ............'..... ... has permission for gas installation . .......... in the buildings of ......................... at ..)�.North Andover, Mass. Fee. 7" .... Lic. No.. AS INSP cT�;w Check #/ 6 L) qL( r] FIXTIIRFS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: )10 i7�y"� �i-'`'�--- , MA. Date: J t Permit# a Building Location: > y S-S -�' d \,-"-Owners Name: C /A � -t? l/O Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTIIRFS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy D"" 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 Owner ❑ Agent ❑ Siqnature of Owner or Owner's Aaent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the nest of my Knowieage and tnat 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 Codg and Chapter 142 of the General Laws. ' � 9 Type of License: By ❑ Plumber Title ❑ Gas Fitter Signature of License( FPlumber/ as Fitter ❑ Master Cit /Town ❑ APPROVED Journeyman License Number: % U 5 City/Town LP Installer OFFICE USE ONLY El � W W � W Q W D W it O to U WO = N M, rn in m= z +- W W U co Z J w Lu H O z w w O ac W H M W W W m Q a IW- o w X W U W U z O W W z = Co O Q H to = W W = LL W z W J I- F- O z J -t Q Q m W O (� z LL O~ ~ W W Q V Iii C9 t�7 = _ O a H > > > F 0 SUB BSMT. BASEMENT 1 FLOOR -i 'FLOOR 3 FLOOR 4 TH FLOOR --i 'FLOOR 6 TH FLOOR 7 FLOOR -i 'FLOOR �� 41-azw--o 141 Check One Only Certificate # Installing Company Name: f ,l11 Address: SZ i 3c, x �` ,2 ,( 17"T City/Town:-'t) 11-41r- 0—. -State: P14 ❑ Corporation El Partnership Business Tel: % i.= F -b C � L -U Fax: ✓l- ©'Firm/Company Name of Licensed Plumber/Gas Fitter: 13 6 %� S/�-%F� a r/L� -•(.. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 0 No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy D"" 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 Owner ❑ Agent ❑ Siqnature of Owner or Owner's Aaent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the nest of my Knowieage and tnat 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 Codg and Chapter 142 of the General Laws. ' � 9 Type of License: By ❑ Plumber Title ❑ Gas Fitter Signature of License( FPlumber/ as Fitter ❑ Master Cit /Town ❑ APPROVED Journeyman License Number: % U 5 City/Town LP Installer OFFICE USE ONLY El Location a y S S(, "w, �L 11 P No. r_( Ca Q, Date 1-1 - j - O L �oRTh TOWN OF NORTH ANDOVER • Certificate Occupancy $ of T_ s�cMusE Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ S i TOTAL $ J Check # 15433 ' Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR. RENOVATE. OR DEMOI.ICH A ANR nR TWn Tis ntrr.v in WELDING PERMIT NUMBER: ) / 6 (S� DATE ISSUED: SIGNATURE: Building Commissioner SECTION 1- SITE INFORMATION 1.1 Property Address: 91y 6-S l" &j A) D a &- Zoning District Proposed Use 1.6 BUILDING SETBACKS_ Front Yard . Required I Provide of Buildings Date 1.2 Assessors Map and Parcel Number: oGo Map Number Parcel Number 1.4 Property i iLotArea(st). Yard I Provided Y. 1.7 water Supply M.G.LC.40. 34) 1.5. Flood Zone information: 1.3' Sewerage Disposal System: Public 0 Private 0 1 Zoe outside Flood Zone 0 Municipal ❑ ort Site Mposil System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT r- 2.1 Owner o Record Name_(Print) - Address for Service: &BA �o�22214 9 Signature U Telephone 2.2 Owner of Record: 2l— 6 ty k Address for Service: SECTION 3 - CONSTRU ON SERVICES 3.=OK)), ConstructionTA"Z) 16 P o� L) Licensed Con ction Supervisor. Ad Signature Telephone 3.2 'stered Home ImP vement Contractor r6,41-wW Company Name 75 NOCjfVtAJ Ofgc Ad e n Not Applicable 0 So75`� License Number Expiration Date Not Applicable ❑ 1Z.�5o� Registration Number �on�f Expiration Date J / SECTION 4 - WORKERS COMPENSATION (XG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building vermit. Signed affidavit Attached Yes :....:.0 No.......0 SECTION 5 Description of Proosed Work check all applicable) New Construction 0 Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ 1 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -T .. n- . 0 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by it applicant 1. Building f j OP (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction /Z a D 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical AC' (� 5 Fire Protection 6 Total 1.+2+3+4+5, .._, , Check_.Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS G`E�NT%OR CONTRACTOR APPLIES FOR BUHDING PERMIT I, �v !�! �� G �" _ , as Owner/Authorized Agent of subject property Hereby authorize wW / " to act on My&,alf. in matters elative to work auth' e by this building permit application./��/ O -Z Signature of er Date ""77 sF.r.TT0N 7h OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief t f Print Name t Si attire of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIMMERS 1 sT 2 ND3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH NINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D w \71- $ Z. § o2�\}\/..\ ■ @ � § � � ��� � § e0 �7� 5 $ k a &: ~ \ � § §`q . \� § S The Commonwealth of Massach usetts Department of Industrial Accidents office oiinvestigi OBS 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit k city / y CJ ��Q,U� �?� phone # CUk, ' dL2— 7 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [],,Kam an employer providing�workn' compensation for my employees working on this job. C3 I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors the following workers' compensation polices: companv name - below who have address•.. city aa— phone # incnranrp rte'_ r._. ii _.. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprismimrent 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 hereby certify r the pains and penalties of perjury that the information provided above is true nd correct Signature Date Q Z Print name Jd)/9A 6 40 a lJ Phone # official use only do not write in this area to be completed by city or town official city or town: permit/license # OBuilding Department oLicensing Board p check if immediate response is required oSelectmen's Office oHealth Department contact person; phone #; 00ther (revised 3/95 P3A) _ Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 a Page of ' 1''1'Op01Sa1 Ron Gagnon (978)689-4448 TRI-STATE Property Maintenance Uh NAME OF OWNER Pt&QaUU, ADDRESSOFJOB alt& -A, " &AIAV.U, TEL. DATE: V�! C� We hereby submit estimates for: .,&kf ad .z� walk luu owul euy U1.1j A"w W ato WW " u) agwi - L&Oaii P1 14 1W /I e A)W) L) 1AA(A) AM" k�fi� . 9V -U u � -�- A* w vAtt&,v "tip kW wI* t4w-IUB &aWWdA-Wclr Uji4 rav�-to d- V wI tom = to " We pNPM hereby to furnish material and labor — gomplete Accordance with above specifications, for the sum of: 00 dollars ($ Q 14L—O Payment to be made as follows~ 614AV 2- -U 0 �J All material Is guaranteed to be as specified. All work to be completed In a workmanlike manner according to standard practices. Any alteration or Authorized deviation from above specifications Involving extra costs will be executed Signature only upon written orders, and will become an extra charge over and above the U estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary Insurance. NOTE: This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us If not accepted within days. �OQ Of PIM — The above prices, specifics Iona and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature will be made as outlined above. Date of Acceptance: Signature Or 90 6 z W W G x W a v U° � O V) a o z z W °13 5 w° p a v U C w a o F+wbo n�' C w a o z n°' c� G w a G w" N d w C ` m' V)U) �e E O O rA u LLJ _0 LU Ir w W IrW .co CO c d� :cam O N C O C CD •dam \: : A 7 O m 1�Ea (^ o a I C.3 � CJ CM V :mc Jm� � N r V > ai co 0 V N A c 2 N •Em p Lco CL = y m m D �dCt •� • CJ y O V •� Z r. O H CS O O rlo� h m C cm C_ •C �O•, h m m W y W Or •N 'co, r Gr O �. ac LU E dt G ��cN Z O amgo•= m a oma O6 s H = m� O eNa =-S s m5; O O rA u LLJ _0 LU Ir w W IrW