Loading...
HomeMy WebLinkAboutMiscellaneous - 31 BRADFORD STREET 4/30/2018/ 31 BRADFORD STREET - - - 210/061.0-0031-0000.0 ----` Date. . . .. . .. .. .. 5 h HORTM ,'u; Of, 6 0 L TOWN OF NORTH ANDOVER O m PERMIT FOR GAS,INSTALLATION SSACHUSE 7 This certifies that . . .e n?. . . . . . . . . . . . . . . . . . . . . has permission for gas installation .0177614 /�''.i`. le in the buildings o Or%s i%� j. .. .'-. . . . . . . . . . . . . . . . . . . 3 ,;IWr s — at . . . !. �. . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. U Fee. .orf Lic. No.. .?'c•. . . . � ! '. i? . . . GAS INSPECTOR Check s 7954 I ,k%,ov I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER ,Mass. Date DEC. 15, 2011 permit# �' Iy Building Location 31 BRADFORD ST. Owner's Name CHRISTINE PARKS Owner Tel# 978-407-8691 Type of Occupancy RESIDENTIAL New F71 Renovation❑ Replacement F-1 Plan Submitted: Ye[]NC FIXTURES W a o ° F x x S d a S a1 v M W d x ° a0• a j J j J 1^ w w rn w z Q x x a �w �a w H A H J U) � S Lu Z H O > w 2 0 (D = w A Cd7 .Ql U a > A a O w S SUB-BSMT BASEMENT 1sT FLOOR 2ND FLOOR j 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street ZCorporation Danvers, MA 01923 Partnership Business Telephone# 800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter JOHN MARSHALL INSURANCE COVERAGE: I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No CiIf you have c ecked yes,please indicate the type coverage by checking the appropriate box. 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 Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above 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 provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen aws. BY Type'of License: lumber Sigi a re of Licensed Plumber or Gas Fitter Title as fitter s. ••Master License Number 778 City/Town •-Journeyman APPROVED(OFFICE USE ONLY) Aug. 12. 2010 9 36A N3r19E, F. a ne Commonwealth ofmassachusem -Department of Indus&ial Accidents Office of Investigations 600" Washington Street BDSIO Iv- 02111 Workers' Compensation:InsurancE d2vit: bwiicir:-s/.ContractorsTAe,-tneiansipiulaibers Applicant Information - Phase Print Lt ibly Name fBosiness/DrganizatiotJIndividual). -/! Address: /StatelZi o�y City p; �/i�/��S�r Phone.#: ���- ��¢� Are you an employer? Checl:_ahe appropriate.boa: Type of project.(required) _ l_lff I am.a mnployer-,Mth 4. I am z general contractor and 6. []2Jcw eoastructiou employees(full and/orpart-time), have hired the sub-contractors I listed on the attached sheek $ !�Rem.odcling Z.Q 1 atm a sole-proprisfor:or partner- - ship and have no employees These sub-contractors have S. []Dennolition workingfor me in an capacity. workers' comp.insurance. y P tY� 9. 71 Building addition [No work:rs' comp.insurance 5. :Q We are a corporation and its required.] officers have ex--mised their 10.[]Eleci;i l repairs or additions 3..� I atm a homeowner doing all work right.of exemption per MOIL 11.17 numping.repaim,or.additinns.. . myself.(No workers'comp: c. I52,§1(4),.and we have no12:[]Roof repaiis insurance required.]t employees. [No workers' T �1 comp:7i1rn*ance required.] 13. Other �Aag'azrplicaasttnt ehr3a boa#1 must also our the s=w below slowing their wad='mon PoBY mf0zm3doa 1 Hw&own=wk submit this aSidaw,huH=mg-thoyam doitg atI Wort mid taco has aside a=unc=mast aubmtt s ttw 2543vit iadi=stg sUCL 'Coatta=m that cho*11 s box=ia at=Lad an sdd maast ahwt sbnwmE die nem:04 thr sub-conna.=r..and tacdr Wcoag.PoBc�'arf6nU82ian I ant an employer that is pravidir,�workers'campettsation k=ranceJor-my:employees Below tis ihe.poiicy and job.site Insurance Company Namc: Policy tor Sett-ins,Lic:ft; .�, C Ezvi-ation Date: ?/l'S�Z�I f Job Site kdd-ss CitylStaterLip; AtEach.$ co of the workers :compett m iart camber zpd e- lrstlon tints ; I Fail=to secure coverage as requited under Section 25A ofMGL.c.1S2.can lead-to the imposi6an of criminal pena1bM:of.a fine up to S 1,500.00 and/or ane-year itaprisonmeun as well as civil pealucs in the form of a STOP WORK.ORDE&:and s.fine- of up to MOM a day against.the.vioWot: Be advised that a.copy,of this statement may be forward--d.to the Ofnec of Investigations of the DIA for in�covmiage verificabon I do herrbp.i�rtiJ�undPr.thepatns and p perjrQr3 a<fxfvrmatfort proved oma.ts:ttv.e and.enrrert . i 1 0 lit/use only. Dc not write in this area;to he completed by city nr town official Clty or Town: 1?e*�nlslLicense,# i Issuing Authority (circle one): ' 1.Board of Healtb 2.Building Department 3.CltylT own Clerk Q.Blecirical Iaspectar S.Plumbing.Inspe.ctor 6. Other Contact Person Phone f i i 40H� F �T� M � lit o9ro.l;r1 4tj f i'. , i 'e i ` Date ..,�.���......... kORTp 6 TOWN OF NORTH ANDOVER Y PERMIT FOR WIRINGTOO *r` �SSAcmUs� This certifies that ./�". .�h.d�...TA7.v. 2v `5- 7�.�.......... . . ...... ...... has permission to perform ... �• C p� rl ��� � r r. .. wiring in the building of.C,, ........ .. .........�a .. ;North Andover,:M Fee...t,,! Lic.No. ,�a�oto//� ."".. w LECTRICALINSPBCCOR :.• z Check #� --- 050 fi Commonwealth of Massachusetts Official Use Only Department ®f Fre Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PNNTININK ORTYPEALL INFORMATJOA9 Date: AZA 11 City or Town of: NORTH ANDOVER 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) 3 Owner or Tenant iSS Telephone No. G7 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building (��j� Yc.-�>�, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: C s,,9 -C_ ("? P d� Completion of the following table maybe waived by the Inspector of Wires. Recessed Luminaires c No.of Total - No,of__�_�ss d No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ Jn- ❑ o.o Emergency Lighting nd. rnd. Batter Units -— No.of Receptacle Outlets No.of Oil Burners FIREALARMS No.of Switches No.of Gas Burners No.Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained P Totals:P _... . ........................ ........... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Municipal Connection EJ Other No.of Dryers Heating Appliances KW Security Systems:* r3' No.of Devices or Equivalent 'j No.of Water No.of No.of Data Wiring: KW Heaters Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: i Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: I()3.5_ CO. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue 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 has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and pen 'es of perjury,that the information on this application is true and complete. FIRM NAME: Le LIC.NO.: i L2,i Licensee: Pc;3r, Signature LIC.NO.:z 5 66 (If applicable,ente "exempt"w4e license n ber lin Bus.Tel.No.: i5 0 Address: Z K ,V0-ke r-Gcb;4( 7 Alt. lel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent CiannhireTeleuhone No. I PERMIT FEE:$ The Commonwealth of Massachusetts ! Department of Industrial Accidents ' S ' Office of Investigations Washington ton Street g Boston, MA 02111 , www.haars gov/Via . Yorkers' Compensation Insittrance Affidavit: Builders/Contractorsx1ectricians/Plumbers Applicant Information Please Print Le�bly Nar11e(Business/organization'/Individual):_A-G--f' q LX' `V Address': City/State/Zip.'_ gL�/'LC J . NH'p5W 7Phone#:_. Arl: an employer?Check.the appropriate box: 1. n'a employer with 4. ❑ I am a general contractor and I Type of project(required): (full and/or part-time). have Hired the sub-contractors 6' ❑New construction 2.J� I am.a.sole proprietor.or partner- listed on the attached sheet.1 �• ❑Remodeling ship and have no employees These sub-contractors have 8. [:j Demolition working for me in any capacity. workers' comp.insurance. [No workers'comp. insurance 5. �• E3 Building addition p ❑ We are a corporation and its required.] 10.El Electrical repairs�l ) officers have exercised their p >s or additions 3.❑ 1 air a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself•[No-worke'rs'comp. c. 1.52, §1(4),'and we have no 12,❑Roof repairs insurance-required.]t .employees, [No workers' comp. insurance required_] 13.❑.Other. TAny applicant that checks boa'#I mint also [lout the section below showing their workers'boinpenwion policy information, Homeowners who submit this affidavit indicating they aredoing all work and then hire outside contractors must submit a new affidavit indicating such. - #Contractors that check this box must attnched an additional sheet showing t-hc name of the sub.contractors and their ulerke!3'comp.policy infa,;,aNan, I aura as~employer fkat is-providing:ivor&eps'corApeyasatiora IM informadova aerance for rrxy employees- Belowis Ilse policy andjob site Insurance Company Name: ' J� 1,C 5 J to Policy#or Self-ins.Lie.#: Expiration Date: 2 �` Job Site AddressCity/State/Zip: ,�1rj��,, •,�-;X195 � Attach a copy of the workers',cornpens ition 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$250.00a 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 cerfify under the pains and persalt' s of ped`ry that the infnrrnatiovt provided above is true and correct. 5iznature: t Z C G Date: Phone#: Official use only. Do not write%."tilos area,to be cangpl�,ad by city or town official City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: