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HomeMy WebLinkAboutMiscellaneous - 422 WAVERLY ROAD 4/30/2018I Q I I ,q6,t I '41 Z- -An a I 9526 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING A M I This certifies that ................ has permission to perform plumbing in the buildings 01. V4.: . . ........ a t . 4� Z;L �� pwp- lei . ........ g. . , 4N /A ver, Mass. Z� Fee.O.Z-!�Q . Lic. No. ......... P PLUM sp LUMBING SPECTCR Check # 2 Date ... A ......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .......... I ............... has permission for gas installation t:kV.9-A.. in the buildings of ............... at ..42-.-2,. - W (-� ......... North Andover, Mass. Fee 1O.K%q- Lic. No. MiD ....................... (Do, -i'o GASINSPECTOR Check# I;IAV 8287 --- r . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK / OF CITY North Andover MA DATE 08/06/12 PERMIT # JOBSITE ADDRESS 422 Waverly Rd OWNER'S NAME Seaport Homes LLC OWNER ADDRESS 422 Waverly Rd TEL 508-5094018 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIALK] CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1. GENERATOR GRILLE r INFRARED HEATER LABORATORY COCKS + MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ® NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHERTYPE 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 ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true d� best f my owledge and that all plumbing work and installations performed under the permit issued for this application will be in c eent isi the ffactea Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `CL PLUMBER-GASFITTER NAME Robert Frazier LICENSE # 13425 SI 7UR MP Pq MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME Bomar Plumbing & Heating ADDRESS PO Box 694 CITY Derry STATE NH ZIP 03038 TEL 603-325-8958 FAX CELL EMAIL Bob&BomarPH.com �rres SN_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK U'r TYPE OR PRINT CLEARLY CITY North Andover MA DATE 08/06/12 PERMIT # JOBSITE ADDRESS 422 Waverly Rd OWNER'S NAME Seaport Homes LLC OWNER ADDRESS 422 Waverly Rd TEL 508-509-4018 FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: REPLACEMENT. ❑ PLANS SUBMITTED: YES ❑ NO jX] FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 _. CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER j FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK 1 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES 1 WATER PIPING 1 OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES )gl NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X1 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 ❑ 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 a curate to the b of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be — mp�thine rovision o Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Robert Frazier LICENSE # 13425 SIGNA URE MP ® JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME Bomar Plumbing & Heating ADDRESS PO Box 694 CITY Derry STATE NH ZIP 03038 TEL 603-325-8958 FAX CELL EMAIL Bob@BomarPH.com AD This certifies that ..... � ............ has permission to perform wiring in the building of .... 7 7 at .... 9. 69c;L. f North Andover, Mass. gee. Lic. No. 14.4.9�3. % G ,�,heck # 10967 jy/ ...... ... ELECTRICAL INSP7E�CR W Official use only MESSOM PerrcltNo.__] Ll BOARD OF FIRE PREVEN-nON REGULATIONSOccWancy and Fee Caked (tcavc h>enk APPLICATION FOR PERMIT To PERFORM ELECTRICAL WORK Ali wait to be m W& tam code (MECj, srf cm 12-00{PLEASE PRl1VTINiNff DR TYPE�ILL INFORLJAT7D11� Date:�l. � / � tfty or Town of BY this application the nal Erns notice of his or her iatant"'a to To the Lector oft desc : escn MUM (Street & Number P the electrical work bed Wow.I. )- OwnerorTenaut T& /41�2 r Telephoee No. Owner's Address is this permit in -- Innctfon with a burg peruw. Yes Purpose of Buildingt Appropriate Box) Utiliti► AuthLItorization No._ i 5 2!1 �© 1 .Eristing Service �,� U Amps Zd%Volts New Service Amps %L 12-Yy Voks Number of Feeders and Ampacity - Overhead L1i n gr Na of Meters _L Overhead a' Uudgrd ❑ ' No. of Meters � Location and Nature of Proposed Elaetrieai Work: - /per-/T��/s' Hvi7y tidevuw he ngivad bv die f or oWires. No. of Recessed Luminaires L/ No. of Cell. -Burp. {paddle) Phar Transformers KVA No. of Luminaire outlets No. of But i ubs Generators KVA No. of Luminaires S�rimmiag poolAboveQ 4L ecy . Units . No. of Receptacle pallets UING.0foilBurners ALARMS lNeorzones of Switches No. of Gas Baruers a of an Devices of Ranges NiL of Air Coud. Tons ta o. of Alerting Devices of Waste Disposers Heat Totals: SpaceiAres HeatingKW °f tai Q . Devices of Dishwashers id GrmleCtiQn � Other of Dryers . Heating Appliances KW. orwater Heaters KW °' ° o. o _ N0. Of evices oC Equivalent }VMW S Ballasts Na arnevices or Equivalent Hydromassage Bathtubs No of Motors Total HPeeommamcatious_ ' g; Wires. Attack add and or by the le detcllifderiret; rrgrorerl speelor of Fstv�ted Value of Eleciriwl Werk: mend by Policy.) Work to Start / 7 / bVccdaus to be impested in as oulance with MEC Role 10, and upon wrnpletiot , INSURANCZ O VERAGM UnkSS waived by the ower, no permit for the performace of deeftW work may issue Unless the hccmm provides undersigned certifies that such iachrdiog p or its substantial equivalent. T];e emge is in farce, and has cd&i d pmaf ofsame to the permit issag office CHUX ONE: INSURANCE fibBOND [) OTHER ❑ (Sje _) in 111411*, under the pains mrd peanA*x ofperjwy, that the informadbu an this app&a&w is true and complete. FIRM NAME: 17AN! F !7 I: Zc GTjei CAL. Co"T Ott: l';�3t�, LIC NO.: Licensee:ti! D iia► E, Ea. Signature �" LIC. NO.: j2f,'1 L 3 — t7fopplicabfe �rer ase r' in tlrelroe►uie aaarberlare� Bus. Tel. No.t `i 7i` !- -tom 2 k -2 - Address. f l MA -r �r Nt�RYi�' hilUpYr:� tllR . *Per IvLG.L c 147, s 57-61. seetaity wodc Alt Tel. No:: �1£- 5 7 3 -- 73 requires Department of Public Safety "Sa Lion Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Lim does trot have the liability itmmu� a ooveragc rrormally Ow by law. By my signadnre below, I hereby waive this regeriretzcu gent. I am the (check one) ❑ owner ❑ owner's agenL Signature .' Telephone No. PBRMIT'ITRE: $ r rVVtC In tarvUVvr-m, MK U-1040 Phone #: yId'et5l-(i`L6Z Are you an empleyer? Check the appropriate box: The Commonwealth of Massachusetts Print FoF71 A �_ Department oflndashialAccidents : Office oflnve&*atians 10—Y C _E-.� I Congress StreetSuite 100 Pr � r;4:� Fes;,• Boston, MA 02I14-2017 -� WWW.nUKMgoV1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lmjbh 9- ❑ Building addition [No workers' comp. irmurei cce Name (Business/Organization/Individual): DAVID ELECTRICAL CONTRACTING LLC Address: 87 BELMONT ST .rewire&] 5. ❑ We are a corporation and its 10.2 Electrical repairs or additions rVVtC In tarvUVvr-m, MK U-1040 Phone #: yId'et5l-(i`L6Z Are you an empleyer? Check the appropriate box: Type of project (required)-- required):1.Q 1.0I am a employer with 7 4. ❑ 1 am a general contractor and i 6- E] New constructionemployees (fulland/or pari�ime). $ have hired the sub-cotmactors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling shipand have no y employees These sub -contractors have 8_ ❑Demolition working for me in any capacity. employees and have workers' 9- ❑ Building addition [No workers' comp. irmurei cce coin ' p• insurance_4 .rewire&] 5. ❑ We are a corporation and its 10.2 Electrical repairs or additions 3- ❑ I am a homeowner do' all work � offie�s have exercised their 11. Plumbing ❑ ng repairs or additions myself [No workers' comp- rigbt of exemption per MGL 12.❑ Roof repairs insurance required.] g c. 152, §I(4), and we have no 1311 Other employees. [No workers' comp- insurance required-] -A" aPPncant mat 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 sutler. +Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees_ If the subcontractors have employees, they must provide their workers' comp. policy number. I atm an employer that is providing workers' compensation insurance for my employees. Below is the policy mrd job site informadon. Insurance Company Name: THE HARTFORD Policy # or Self -ins. Lic. #: 08 WEC C18293 Expiration Date: MARCH 1, 2013 Job Site Address:Z Gt/q �2G %'47 City/State/Zip:_ 111 Lt9" . 6T(K— 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceryfy ana►er tl�rPertalP�TorJ'tha� the information � provided above is arae and correct e-- lr—.1 - //-7 Phone #: 978-682-6262 t/ 11 0$ciat use ontR Do not write in this area, to be completed by city or town ofjtciaL City or Town: Permit/facense Issuing Authority (cirde one): 1. Board of Ilealtb 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5- Plumbing inspector 6. Other Contact Person- Phone #.-