Loading...
HomeMy WebLinkAboutMiscellaneous - 32 WEST BRADSTREET ROAD 4/30/2018 (2)Date..../.: `:..f�-a�?....... °f,•``° :•'"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...........6.`J. l ....TC............... has permission to perform ....... / � % C pow. /A?�2. n.......... wiring in the building of ........... 7?!I-nf4c............................................. at ....3..........�1�s % ,,,, , North Andover, Mass. — t n Fee ...v�-'-.. Lic.No..T.�Z:�!:.....:... �+ ELECTRICAL INSPECTOR Check ttS/r It 8330 r Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME ), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his orintentio to perform the electrical work described below. Location (Street & Number) e�r� 6A , V < / -- Owner or Tenant Telephone No. Owner's Address Is this permit in conjunc ' with a b ' ding permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpsVolts Overhead [Z[--- Undgrd ❑ No. of Meters i New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work; -.- 1 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons J.KWNo. ........... of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (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 �)�OND ❑ OTHER ❑ (Specify:) I certify, under the p and penalties of perjury the information on this application is true and complete. FIRM NAME c' �i¢x�l,r✓�� /`�R I G— ld= LIC. NO.: c);'— Licensee: LIC. NO.: (If applicable, enter "exempt "in the ense n her line.) i Bus. Tel. N Address: � � �`�f &ogi 6 V-- �� ,R 1"L — Alt. Tel. N *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 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 Signature Telephone No. PERMIT FEE: $ � ,d The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: 7? ), Q A(J e— City/State/Zip: w4t,--,e,qrL L Phone Are you an employer? Check the appropriate bog: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. U/fam a sole proprietor or partner- listed on the attached sheet. : ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6..❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 4� 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t~s app penalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: AORTM .$ O P s o a TOWN OF N PERMI� Date !� . . ... TH ANDOVER PLUMBING ss/1CNU`�� This certifies that t...�..tet......... vrn . . +... .. . i' has permission to perform !''! ���'V�`�� ©� plumbing in the. buildings of ./1571.'4%!�{!'' r� 1- �`" ,North Andover, Mass. Fee. Lic. No. �41 . l .. ................ ......... . PLUMBING INSPECTOR r Check # 782 M MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FrrnNG (Type or print) Date y NORTH ANDOVER, MASSACHUSETTS c Building Logations� Permit # Amount $ Owner's Name /G� r I , New D Renovation Replacement D Plans Submitted (Print or type) ,�y Name_- K1VA6-:A- N. Address Ge.jiN Name of Licensed Plumber'or Gas Fitter ©� Check one: Certificate Installing Company Corp. Partner. DFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 0 No� If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: l 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 13 Agent 13 I hereby certify that all of the details and information I have submitted (or entered) in above a lication are true and accurate to the best of my knowledge and that all plumbing work and installatio s performed der Pen -nit I ed for thi application will be in compliance with all pertinent provisions of the Massachusetts St C0 a �d Chapters the Geral Daws_ By: City/Town, APPROVED (OFFICE USE ONLY) ® SU B -BASEM ENT BASEM ENT IST. FLOOR `x 2ND. FLOOR Master 3RD. FLOOR Journeyman 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H. F L O G R. 8TH. FLOOR U OU a F O O cq rp F F W dF 04 > p O p Z 4 EW V U d W x z W F Sy y Cd o. % > d CW7 Z F d Z W F: Z4' x F Gail W UOQ > cc U m a 4 W > d W % E, NrA O y Z N O rA (Print or type) ,�y Name_- K1VA6-:A- N. Address Ge.jiN Name of Licensed Plumber'or Gas Fitter ©� Check one: Certificate Installing Company Corp. Partner. DFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 0 No� If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: l 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 13 Agent 13 I hereby certify that all of the details and information I have submitted (or entered) in above a lication are true and accurate to the best of my knowledge and that all plumbing work and installatio s performed der Pen -nit I ed for thi application will be in compliance with all pertinent provisions of the Massachusetts St C0 a �d Chapters the Geral Daws_ By: City/Town, APPROVED (OFFICE USE ONLY) ® SU B -BASEM ENT BASEM ENT IST. FLOOR `x 2ND. FLOOR Master 3RD. FLOOR Journeyman 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H. F L O G R. 8TH. FLOOR (Print or type) ,�y Name_- K1VA6-:A- N. Address Ge.jiN Name of Licensed Plumber'or Gas Fitter ©� Check one: Certificate Installing Company Corp. Partner. DFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes 0 No� If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: l 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 13 Agent 13 I hereby certify that all of the details and information I have submitted (or entered) in above a lication are true and accurate to the best of my knowledge and that all plumbing work and installatio s performed der Pen -nit I ed for thi application will be in compliance with all pertinent provisions of the Massachusetts St C0 a �d Chapters the Geral Daws_ By: City/Town, APPROVED (OFFICE USE ONLY) ® Signat Plum a of er Gas Fitter ® Master Journeyman sed Plumber Or Gas Fitter (cense Number A fi-" Date./..' ate. .............. .. H°RTH 1 TOWN OF ORTH ANDOVER 3? s PERMIT FOR GAS INSTALLATION SSACNUSEt ,� 1Y This certifies that ........... !'j"�'.. .%� .......�. ........ f ' . has permission for gas installation .g in the buildings of . h? .".-- ......... ....... . at North Andover, Mass. Feer<�!;.—',�..�. Lic. No. ...... .......................... GAS INSPECTOR Check .# d 650 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS os �! 6J , 1 �/2T---`-' Date Building Location Owners Name I I e LG-- permit # Amount Type of Occupancy New Renovation ® Replacement "n Plans Submitted Yes ❑ No FIXTUR FN (Print or type) aa (- Check one: Certificate Installing Company Name- R&—'Zl v� &-V _TVAW ❑ Corp. Address l.� �` �` �Y ❑Partner. C9f $ usmesselephone 7 9 2 9 77 Firm/Co. Name of Licensed Plumber: �b�j2��j IACs' -s' A` K Insurance Coverage: Indicate the type of ms rance coverage by checking the appropriate box: Liability insurance policy S Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installatiQRS perforn compliance with all pertinent provisions of the Massachusetts StV u b Title By: igna ure o r s Type ofD t umbi g ice City/Town rce se um APPROVED (OFFICE USE ONLY Agent ❑ entered) in above 1* ti true and accurate to the i d u der Permit ss ed for thplicat�on will be in �n de and lqb' oL eiremera.Laws. Der Ise Master© Journeyman ❑ AO DTIC Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies,,that . ........... has permission for gas 'installation in the buildings of at..... ....... Fee Li No 3 I � ww�c�W. . .. . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check # 'd 4660 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING / (Print or Type) ,z r,/,,Oe` wMass. G Permit Type of Occupancy R e5I i---) N T i r-jL Installing Company Name '�3r�. (Z T A • �►-lM Ma T ri X20 Check one: Certificate Address 30 OnA C H ih igno - i-Nf . ❑ Corporation M E T H U E 0 01 ra U( y ❑ Partnership Business Telephone to 92 - 9 9 -7 f 2-lirm/co. Name of licensed Plumber or Gas Fitter --R o a E P T A- S A m m t9 i A PLS INSURANCE COVERAGE: el have a current f biltty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ou have checked Yes. please Indicate the type coverage by checking the appropriate box V A liability insurance policy 0"* 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: Owner❑ Agent ❑ Signature of Owner or Owner's 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 pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of 7neLaws. By. T of License: WA Plumber n ure of Licensedu or Gas Fitter Title tter er License Number City/Town Journeyman O IC NL SEEK Installing Company Name '�3r�. (Z T A • �►-lM Ma T ri X20 Check one: Certificate Address 30 OnA C H ih igno - i-Nf . ❑ Corporation M E T H U E 0 01 ra U( y ❑ Partnership Business Telephone to 92 - 9 9 -7 f 2-lirm/co. Name of licensed Plumber or Gas Fitter --R o a E P T A- S A m m t9 i A PLS INSURANCE COVERAGE: el have a current f biltty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ou have checked Yes. please Indicate the type coverage by checking the appropriate box V A liability insurance policy 0"* 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: Owner❑ Agent ❑ Signature of Owner or Owner's 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 pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of 7neLaws. By. T of License: WA Plumber n ure of Licensedu or Gas Fitter Title tter er License Number City/Town Journeyman O IC NL N W S W Y N 3� LL O Z� 1- H � W N Q � - O O O O F- ¢ O W Z d ' O W Z 0 a v J d d Q W W LL 3� LL