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HomeMy WebLinkAboutMiscellaneous - 324 HILLSIDE ROAD 4/30/2018 (2) J 324 HILLSIDE ROAD 210/025.0-0055-0000.0 Date... ......... iiL 1-0 J OF NORTM,h TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING g3,�CHUS� kn� �i� N This certifies that. 1.�..................... ............................ .................................................... has permission to perform...�^-�.A r w—:......V`A?- ........................................................ plumbing in the buildings of..... �,.u. .................................................. at......�--� .`��.- .�s:.� A'A......�`!C.:.................... North Andover, Mass. Fee �' Lic. No. ,�n b 1`� 'M ...................... .................... ................................................................................ PLUMBING INSPECTOR Check#A�(g i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY North Andover MA DATE 10/24/2014 PERMIT# JOBSITE ADDRESS 324 Hillside Road i OWNER'S NAME Kin Wai Kwong POWNER ADDRESS 324 Hillside Road ; TEL 978-&82-1152 - FAX F-- TYP - TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:E3 REPLACEMENT:n PLANS SUBMITTED: YES[] NO[.,] FIXTURES'1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM ... -. _., _e_:__ DEDICATED GRAY WATER SYSTEM _ --- DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ^ tel/ FLOOR/AREA DRAIN AI INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL - WASHING MACHINE CONNECTION –"' -_– WATER HEATER ALL TYPES _... WATER PIPING OTHER -- 1 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL C as RANCE COVERAGE: — t L P Y q � h.142_ YES C1 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L-+I OTHER TYPE OF INDEMNITY BOND [� OWNER'S INSURANCE WAIVER I am aware thatthe 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 [IAGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicatio re true da! to the best of my k ledge and that all plumbing work and installations performed under the permit issued for this application will Fornpl' ce al ertinen proyicia P._ Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I Richard Martz LICENSE# PL-16014 SIGN URE MP[�' JP0 CORPORATION D# PARTNERSHIP[]#��LL7r7-, 3617 COMPANY NAME I Rooter Master Plumbing&Drains ADDRESS198 Mishawum Road CITY I Woburn STATE MA j ZIP 01801 TEL 781-760-6601 T FAX 781-933-6439 CELL� EMAIL nchiem1229@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: S PERMIT# PLAN REVIEW NOTES Date �1`\.......................... �NowrN TOWN OF NORTH ANDOVER ' `"e PERMIT FOR GAS INSTALLATION 83ACHU`3� -This certifies that .... ►.... .! q.......'......l �.K.2.................................. has permission for gas installation .1 .t. .c.2......V ?......................... in the build gs of........... ..�...^...........��.............................................................................. at....... U: .... ..:..................................... North Andover, Mass. Fee..�.�...... Lic. No. �b.4!a........ M!r-a....................................................... GAS INSPECTOR Check# 2,S9 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING! WORK CITY North Andover MA DATE 10/24/2014 PERMIT# 65 JOBSITE ADDRESS 324 Hillside Road OWNER'S NAME Kin Wai Kwo_ng GOWNER ADDRESS 324 Hillside Road TEL g78 682 1152 FAX[ TEYPP NOR OCCUPANCYTYPE COMMERCIAL[] EDUCATIONAL RESIDENTIALE] CLEARLY NEW RENOVATION:© REPLACEMENT: E :i -❑ C PLANS SUBMITTED: YES[{ N0,�1 APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 67 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - — --- - - — COOK STOVE DIRECT VENT HEATER DRYER _ FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE ___. - INFRARED HEATER "— LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _ I - - OTHER] --- - - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ONO [I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND �1 OWNER'S INSURANCE WAIVER 1 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 SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER E. AGENT [-] I hereby certify that all of the details and information I have submitted or entered regarding this application are tr;q and a rate t e est of my knowle and that all plumbing work and installations performed under the permit issued for this application will be in ance all erli nt ro ' ' n Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMERia S� MarSnez }LfCENSE# 1fAr 14 SIGNATU MPFT' MGF[7 JP F JGF n LPGI D CORPORATION E7,#[ �PARTNERSHIP(—.# LC # 3617 COMPANY NAME:i Rootar Master Plumbing&Drains ADDRESS I 198 Mishawum Road CITY I Woburn STATE FT�ZIP 01801 iTEL I 781-760-6601 FAX 781-933-6439 CELL EMAIL richiem1229@yahoo.com t ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth ofMassachusetfs Departrnenf of Industrial A&t&nts 4f•J`ice of Investigations 600 Washington Street Boston,MA 02111 www*mms gov/did ; L ` 'Workers? Compensation Insurance Affidavit:Builders/Contractors/Eledtricians/Plumbers . Applicantlidormation, Please Print Legibly. Name(Business/Organization/lndividuat): � " Address- I q sj�k(t,i)11y►'! t - • City/8tafe/Zip:1� j�a", OV901 Phone#: t" (1 LiJ U-1 t Are• ou an-emlrloyer?Check the sppropriate box: Type of project-(required): I. I am a employer with `l. Q I am a general contractor and I 6. ❑New constructiotL employees(full and/or part time).'' listed'on the attached sheet. 7. ❑Remodeling 2.Qm-a I•asole proprietor or partner- _ ship and.have no employees £hese sub-cflntractoTs have 8. []Demolition waiking for mein any capacity, employees and have workers' 4: Q Building addition : (No workers'comp.insurance comp.insurance . iequired:] 5.'Q We,are a corporation and� If?.[} lemcal repairs or additions 10 I am a homeowner doing all work officers have exercised theme 1 F. Flumbitig repairs or additions . myself.[Nd-vorkerff'comp. right of exemption per MOL 12.Q Roof repairs' insurance rbgtfired.]t. 0.152,11?4.),and we have no employees,[No worktrs' 13.Q Other • .� ::insuranceuired.] _ "'�r�alicant:til#tcf> :�isiliji�t�S�o�oa�oect� w�tutic�:p�ifi�i�o�sda: • - .t.Hoin4���?.autosiflfdsai�dsvlt-mdigatueg:thoY_mi7oingazl-eemit�d�cnCnia6irisldaaeiif�acLcrs�inmAut3nbmlttr�V�i'fidavlt�satin�a h. . �t►b -- .tti�-etaunaofII�s,.�+�-a�Td:sta�tvl�edu;`nrnot�ou '-tfsauttael�ii�::tlier�ciiticictfiis�tio�zixutaen.�its �. .t9!a8 _ employees. If rho sib-contractors have employees,they provide thonr�workers'co�.poRcynuiuBcr.� - . I arx ttrt¢raployer that ds provldirrg tvarkdrs'co�rrtrerrsatiorr insunrrlrc+eformy�mptoyeee BeJotr fs thepolicy and/ob.stte infarneatlon. Insurance Company Name Policy#or Self-ins.Lic.-#i Ad N(.1-4M.-'2039 9871 a0f Espiratioal)ate: •lob Site Address• C3�"T tTt I,cSl ri - City/StaielZig: %� ar Attach a edgy,of the workers'compensation policy declaration page(showiag the policy number and expiration date). Failure to st.C148 coverage as required undek-Section 25A of MG`L c:152 can lead to the Jmposfion off'criinmaT penalties 6f's fine up to$1,500.00 andlor one-year m4msbnme as weWas crudpenalties mthe form of a STOP WORK ORDER and a fine of up to$250.00 a day agatnst the violator.--Be advised that a copy of this statement maybe forwarded to the Offite of nyostigatiom-of*e IIIA for-imn=ewcoMMeyeiificatfou. I do hereby e -an ofped wy that the information provided above Is true and correct Si tures• Date• d gee# i.:. .;use only. - o not w- otn M area,to a comp y t3'or town oJFXW City or Town: PermitUcense# Issuing Authority(circle one): 1.Board,of Health Z.Buiidfug Department 3.City/Town Clerk 4.Electrical Inspector.5.Plumbing Inspector 6.Other.. Contact Person: Phone#: s ONES souls s Von U.S.,[J. AA SI ieY {1k 1..1;y1pYt�pC r' �i s 7 � 4- atY :- t fl The Hingham Group 11/2/2011 Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 Insured: Kin W. &Lai Sim Kwong Property Address: 324 Hillside Rd.,North Andover, MA 01845 Policy Number: HO 9803799 Date of Loss: 10/29/2011 Claim Number: HM 2011003148 Form of Notice of Casualty Loss to Building Under MASS.GEN. Laws, Ch. 139, Sec. 3B Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000 or cause MASS. GEN. LAWS, CHAPTER 143, SECTION 6,to be applicable. If any notice under MASS.GEN.LAWS, CH. 139, SEC. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location,policy number, date of loss and claim or file number. Claims Department The Hingham Group 800-341-8200 3 6 4 Date.. RT TOWN TOWN OF NORTH ANDOVER pF into ,s,�O 3? '� PERMIT FOR GAS INSTALLATION O � F 9 ♦ s� ,SSACHUSEt This certifies that . . . . . . . . . . . . . . . . . . .. . .. . . .. . . . . . . . . . . . . . . . . has permission for gas installation . . . ... . . . . . . . . . . . . . . . . 7. . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . �. ?North Andover, Mass. .g Fee. . . . . . . . . Lic. No.. . .: .: . . ... . . . . . . . . , !. . . . . . . .. . GASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSE1TTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) . Mass Date2,Q0 Permit # � Building Location : `�!/S—/ �'' Owner's Name/9Y ki // Type of Occu7Su cy 17X=N 71 rq -/ New E] Renovation ❑ Replacement Plans ed: Yes❑ No ❑ y N W N Y = ¢ y y ¢ y ¢ O z y = s W W O 010 LU to t = 71 tlcc1 Z O W F- < ¢ O < ¢ C O !- < r0 y F- y W O d C ¢ W < t- y > <J= tl W = Z O W W Z ¢ 91 W tl t- Z j H Z �. r N 0 Z 0 Z W O #AS Z < W < ¢ ¢ V ¢ > O SUB-8SMT. BASEMENT 1 ST FLOOR 2140 FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name 't e-2A (Z T A . :elm mA T x1120 Check one: Certificate Address oAH 1h A.ry `tJ ❑ Corporation ME Nueri 01 r1 0 ( N Ll ❑ Partnership Business Telephone_ 45,f —9 9-7 f 2--firm/Co. Name of Licensed Plumber or Gas Fitter "i 0jjF-P T A- 5AtylM 19-TA 0 — INSURANCE COVERAGE: I have a current}I ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C�' No ❑ If you have checked ves. 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 [3 1 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 underthe pe i ed for this application be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. By Tof License: f3 Plumber n ure o n u or Fitter Title iter ,;or License Number 8333 City/TownJoneyman 1 V BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING I NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER • LIC. NO. PERMIT GRANTED DATE 19 OAS INSPECTOR