HomeMy WebLinkAboutMiscellaneous - 427 WINTER STREET 4/30/2018 (2)f
J
Office Use Only
ohe Tnmmonwealtfl of Iffingachluutt Permit No.
yC¢irtIITE1IY OfJtittlit'iio i�J Occupancy & Fee Checked ` l
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 l 3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OP TYPE INFORMATION) Date �� ;z
City or Town of-- —- - 7b the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work descri ed below.
Location (Street & Number, --
Owner or Tenant �J� __--_—__—
Owner's Address
is this perm; in conjunction vJth ar building permit
Purpose of Building
Existing Service Amps Volts
New Service _ Amps 1 _Volts
Number of Feeders and Ampacity
Yes ❑ N ❑ (Check Approp r, `e Pox
Utility Authorization No. —
Overhead ❑ Undgrnd ❑ No. of Meters
Overhead 1 Undgrnd ❑ No. of Meters
Location and Nature of Proposed Electrical Work—bk)ex-:
PlrV \ si lJ�71
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Complet perations Coverage or its substantial equivalent. YES I�ru I
have submitted valid proof of same to the Office. YES NO C If you have checked YES, please indicate the type of coverage by
checking the appro a box.
INSURANCE u BOND u OTHER E (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start _. inspection Date Requested: Rough Final
Signed under the Penalties of periury:
FIRM NAME �"l�etrNLU_ etc C7:1/ J LIC. NO.lffQ �'
Licensee l4v+n P—S G . `'t-J4Qy -f Ll_ Signature Lu —_ LIC. NO.
Bus. Tei. No. 576
Address Alt. Tel. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner_IAgern
• (Please check one)
Telephone No. _ ___ PERMIT FEE $ (/
(Signature of Owner or Agent)
x•6565
Total
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
KVA
No. of Lighting Fixtures (
i
Swimming Pool Above In -
grnd. ❑ grrd. LJ I Generators KVA
I
I No. of Emergency Lighting
No. of Receptacle Outlets I
No. of Oil Burners j Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS : No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond.
tors
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
LocalMunicipal Other I
L_;
No. of Dryers
Heating Devices. KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
-
PlrV \ si lJ�71
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Complet perations Coverage or its substantial equivalent. YES I�ru I
have submitted valid proof of same to the Office. YES NO C If you have checked YES, please indicate the type of coverage by
checking the appro a box.
INSURANCE u BOND u OTHER E (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start _. inspection Date Requested: Rough Final
Signed under the Penalties of periury:
FIRM NAME �"l�etrNLU_ etc C7:1/ J LIC. NO.lffQ �'
Licensee l4v+n P—S G . `'t-J4Qy -f Ll_ Signature Lu —_ LIC. NO.
Bus. Tei. No. 576
Address Alt. Tel. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner_IAgern
• (Please check one)
Telephone No. _ ___ PERMIT FEE $ (/
(Signature of Owner or Agent)
x•6565
rYi�-•�•k �.i,,,.e-+�, -•.fir..: i,- ' � � .��i'.r.:^ .-. "r:.�-� ..v - � � .. ti1-,• �`•" _ _
Date ......3/.
112 771 ii _ y.
A
NORT" F,y
TOWN OF NORTH ANDOVER,,
o _¢
PERMIT FOR WIRING
,SSACHUS�
X1(�e�
This certifies that .....�..1 1�
L
.!1 �c.......................................:.....................
has permission to perform ...
civ
wiring in the building of ......'.......................:.......:.........; ................ .
M
........... S
6
at ........ �a.. 7.......W. vt %............................... , North Andover, Mass.
Fee. / u.. Lic. No.3�
.......�..o....'f..`.j..............E..L.E........................................
C..T.RICALINSPECTOR
CAL
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer j
t
1
Locations %
.. No. Date
7260
d
TOWN OF NORTH ANDOVEFF
Certificate of Occupancy $
.Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
$ 21,.d
/�/e�� /l
Building Inspector
Div. Public Works
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
P
NORTH ANDOVER
Mass. Date 2/20 1 g 97 Permit # _?P2 V
Building Location 427 Winter St. Owner's Name
Isquith
Type of Occupancy Residential
New ❑ Renovation ❑ Replacement N Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage- Htg. &Plg. Co. Inc. Check one: Certificate
Address_ 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 • [-1 Partnership
Business Telephone 617-438-7776 F1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes (RJ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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 ❑
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 rn •_''
knowledge and that all plumbing work and installations perfofined undecthe�permit issued -for -this application will be in compliance with all i
pertinent provisions'of the Massachusetts State Plumbing Code and -Chapter 142;of_the_Genera[.Laws. - - - ---6- - - - - f
By Ir` acs
_
Title ' a Signature of Licensed Plumber i
Type of License. Master Journeyman F]
City/Town 12 1667
APPROVED (USE ONU) ' License Number 8322
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4TH FLOOR
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Installing Company Name Heritage- Htg. &Plg. Co. Inc. Check one: Certificate
Address_ 35 Pleasant Street IX Corporation 714
Stoneham, Ma 02180 • [-1 Partnership
Business Telephone 617-438-7776 F1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes (RJ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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 ❑
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 rn •_''
knowledge and that all plumbing work and installations perfofined undecthe�permit issued -for -this application will be in compliance with all i
pertinent provisions'of the Massachusetts State Plumbing Code and -Chapter 142;of_the_Genera[.Laws. - - - ---6- - - - - f
By Ir` acs
_
Title ' a Signature of Licensed Plumber i
Type of License. Master Journeyman F]
City/Town 12 1667
APPROVED (USE ONU) ' License Number 8322
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. 3247
Date.
, -.. 6 -S TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
SA MUS
This certifies that ..............
has permission to perform ... ........................
plumbing in the buildings of . . 1 .5.- 1. ....................
at. .0. i.. 7 r!) ... 5.6 ........ North Andover, Mass.
Fee .�7.... Lic. No-.,5'j..Z.2
LUM13ING INSPACTOR
03/03/97 12.58 27.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
G
JNl.riuJC i i a uNir'uriM Arrt_il.M 1 iury r'ut's t'CtiMl i i u uu umor"11 1 11N � p
(Print or Type)
",,1400te , Mass. Date 17 19_ /I Permit,#
Building Location)rl!U/N/i� �C Owner's N Mme
Telephone, % 6�5'3 Type oft ccupancy
New g�/ Renovation ❑ Replacement ❑ Plans Submitted: Yesp No C
Installing Company Name Yh PA O V C% f ' -,Lh c. J Check one: Certrrtcate
Address o� Coo �I/eit /�A/t/� D R i v e 5adc'
Sop l� Corporation C_
V e & h1; A o a9/i%% _ O /,5 8 / • ❑ Partnership
Business Telephone _ SO g ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter 1�✓/LL,/.g H� i�c�r� C'�i2 5&4 • _
INSURANCE COVERAGE:
I have a curren iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
fw1A Yes No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy M 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 Owners Agent
1 hereby certify that all of the details and information 1 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
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By T of License: 2��=�%Cu
Plumber Signature of Licensed Plumber or Gas Fitter
Title asfitter
Master License Number % O •% .
City/Town Journeyman
APPP4YVED (OFFICE US . ONL
MEMMEMOMERE
MEMO
0
MEN
MEN
Installing Company Name Yh PA O V C% f ' -,Lh c. J Check one: Certrrtcate
Address o� Coo �I/eit /�A/t/� D R i v e 5adc'
Sop l� Corporation C_
V e & h1; A o a9/i%% _ O /,5 8 / • ❑ Partnership
Business Telephone _ SO g ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter 1�✓/LL,/.g H� i�c�r� C'�i2 5&4 • _
INSURANCE COVERAGE:
I have a curren iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
fw1A Yes No ❑
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy M 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 Owners Agent
1 hereby certify that all of the details and information 1 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
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By T of License: 2��=�%Cu
Plumber Signature of Licensed Plumber or Gas Fitter
Title asfitter
Master License Number % O •% .
City/Town Journeyman
APPP4YVED (OFFICE US . ONL
I
Date..... T.. lli2 .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............ ......
has permission to perform .... ...................... ......................................
wiring in the building of .......... ...................................................................
at 4 .......... 2-....7
.. ................. e:A.. , North Andover, Mass.
Fee..�O.. 49- ... Lic. NoJ.Zz�o .........
i. ...........
Check #q—/3 'E'LECMICAL INSP .
8867
�l
-%-N Commonwealth of Massachusetts
Department of Fire Services
UST BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only `�
Permit No. C� � /
Occupancy and Fee Checked
[Rev. 1/07] (jeavP hlanlrl
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 PRINT W INK OR TYPE ALL INFORMATION) Date: 2-1-0
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her iin-teen—tion to perform the electrical work described below.
Location (Street & Number) a. � 7 W/ / Y / {� S `
Owner or Tenant—:1 ve/ P /�/1J j O Telephone No.
Owner's Address 111,%11qAC�,_ J
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building 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:L�elb t'C%%el rrG )tole
n..u�.uuuaoou.lul ueiau y aesirea, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: . (When required by municipal policy.)
Work to Stark' •- -67 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVE GE: 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 e BOND ❑ OTHER ❑ (Specify:)
I certify, under the ains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: S 214 C
Licensee��rp 5 �y1��f f/2�J� Signa LIC. NO.: %D�
(If applicable, nter, remp " in the license number lin .) LIC. NO.:
Address: jJ% nGtl e LL �j�— �% / l��►� j�%/ISS C Bus. Tel. No.:
Alt. Tel. No.:
*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 13 owner's agent
Owner/Agent
Signature Telephone No. I PERMIT FEE. $
,r
www.mass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibiv
Name (Business/Organization/Individual):
Address:
City/5tate/Zip:
Phone #: .
Are you an employer? Cheek.the appropriate box:
!. ❑ I am a employer with 4, ❑ I am a general contractor and I
The Commonwealth of Massachusetts
k� !
Department of Industrial Accidents
Office of Investigations
' ` •'
600 J rashington Street
Boston, M4 02111
www.mass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibiv
Name (Business/Organization/Individual):
Address:
City/5tate/Zip:
Phone #: .
Are you an employer? Cheek.the appropriate box:
!. ❑ I am a employer with 4, ❑ I am a general contractor and I
Type of project (required):
employees (full and/or part-time).*
have hired the sub -contractors
6 ❑ New construction
2. ❑ I am a:sole proprietor or partner-
listed on the attached sheet" t
7. ❑ Remodeling
ship and have no employees
These sub -contractors have
8. ❑ Demolition
working for me .in any capacity.
[No workers' comp, insurance
'workers' comp. insurance.
5. ❑ We are a corporation and its
g, ❑ Building addition
required.]
3. ❑ I am a homeowner doing
officers have exercised their
10•0 Electrical repairs or additions
all work
right of exemption per MGL
11.❑ Plumbing repairs or additions
myself. [No -workers' comp.
c. 1.52, § I (4),'and we have no
12.❑ Roof repairs
insurance required.] t
employees. [No workers'
13•❑ Other
comp. insurance required..]
U1=" oox s i must also till 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.
;Contractors that check this box must attached an additional sheet showing, the name of the sub-comi actors and their workers' c0mp. policy information.
14m an employer that is prgWing:workers' compensation ursuranee for
information. my. employees: Below is the polieg and job site
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Expiration Date:
Job Site Address: City/Stateop:
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 e. 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 the pains and penalties ofperjury that the information provided above is true and correct
Signature: Date. -
Phone #:.
Official use only. Do not write in this area, to be completed by city or townn official
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk
b. Other
4. Electrical Inspector 5. Plumbing Inspector
Contact Person: Phone #•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, 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, §25C(6) 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.oir compliance with the insurance 'coverage required."
Additionally, MGL chapter 152, §25C(7) states "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 out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if
t
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit 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, notthe 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 numberlisted below. Self-insured companies should enter their
self-insurance- license number on the appropriate dine.
City or Town Officials
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 lnvestigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which wiII be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating -current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your 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 €12111
Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE
Fax # 617-727-770
Revised 5-26-05
wvvw.mass.gov/dia ��
U Date J.A �,Ar .,'..... .
TOWN OF NORTH ANDOVER
p`4t° ,see pL
p PERMIT FOR GAS_ INSTALLATION
s O
1SSA� 5 <� trGfe
This certifies that S
has permission for gas installation.:..!- : !? : �'��' •
in the buildings of..A!4 4 �?. .... • . •
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at ... .... ............. . , North Andover, 1 ass.
Lic. No...?. 19 . .
GAS INSPECT R
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer