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HomeMy WebLinkAboutMiscellaneous - 43 BRADSTREET ROAD 4/30/2018 /. 43BRADSTREET ROAD J! 210/043.0-0019-0000.0 / �l Date......:0?/ ........... - i OF r►ORT/1,� J TOWN OF NORTH ANDOVER f 9 PERMIT FOR WIRING �gs�cINU This certifies that .4/� �- _l f t ' C„ ........ ............. I has"permission to perform .......1.k :. .1?t!1 ',......�t'l '+"—....•��..,r 'e'ilC-,�C._.- wiring in the building of........ . . ., ......................................... led at...:.. ...... ���...... .. orth Andover,Mass. Fee. r. ........Lic.No. h17f ELECTRICAL INSPECTOR Check# t. ` 1.1 824. 1 i offici.l.Use my ,r C F mit No. ®parfinant o�.}iro.�srukee upancy and Fee Checked I PREVENTION REGULATIONS 1/07) leave blank BOARD O FF IRE PR APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 C U OR PE ALL INFOZolvelt TION) Dal �� l (PLEASE PRINT IN INK TZPE ) 1 City o•r Town of. AV PA4 To the Inspector of Wires: S By this application the undersigned Ives notc of his or er intention to perform h'e electrical work described below. . Location(Street&Number) Q. e � M . Telephone No9� �• �• ����� Owner or Tenant Owner's Address Check A ro to Box) n Is this permit.in conjunction with a b ilding.permit? Yes ❑ No ( PP . w e1� Utility Authorization No. Y Purpose of Building /� No.of Meters Ams / 0voits Overhead Undgrd❑ O P ervtce 0 � Existin S l ter g No,of Met Und rd New Service �- Amps / y'Volts Overhead g Feeders and Ampacity Number of Feed � 0 osed Electrical te& .S Location and Nature of Pr p /c=` " • r\ Com letion o the ollowin table may be waived b the Ins ector o Wires. L i V.o KYA No.of Recessed Luminaires No.of Cetl.:Susp.(Paddle)Fans Transformers No,of Hot Tubs Generators ��` No.of Luminaire Outlets ove n- o.o ors ncy tg tug swimming Pool 0 .BatteryUnits II No.of Luminaires g gr rnd. l FIRE ALARiVIS No.of.Zones i No..of Oil Burners No.of Receptacle Outlets o.o e ect on an . I 'No.of Gas Burners Initiatin Devices y No,ofSwftches o a •No:of Alerting Devices No..of Air..Cond, Tons No,of I4nges –IT o,p e - onta ne I, i eat um um , ons .,,......... Detection/Alertin Devices P No,of Waste Disposers Totals, un cipa OtherLocal❑ No.of Dishwashers Space/Area Heating KWConnection ecurcty yystems: 1 Heating Appliances KVV No,of.Devices.or Equivalent ` No.of Dryers o,o Data Wiring: 1{vy ° Ballasts No.of Devices or E uivalent o.o ater Si ns Heaters a ecommumcations } No,of Motors No:Hydromassage Bathtubs Total HP No.of Devices or E u valent i 'OTHER: Attach additional detail!f desired,or as.required by the.lnspector of Wires. I l� (When required by muniolpal policy.) Estimated Value of Efectrical Work: 075 a Inspections to be regnested:in acs fo cthe lrf ancel of 0electrdtcal wok may issue unless u on completion Work to Start /1 /_ p INSURANCE COVERAGE: .Vn°less.waived�y the owner,no plet d•� ration'.'.c&6rage or its substantial equivalent. The the licensee provides proof of'liab:ility i�tis.urance ineludthg comp ., 4pe undersigned certifies that such cover is in force,and has exhibeproof of sa to ` 1 � CL - BOND .0 OTHER [].(Specify:) !a/ / CHECK ONE: IN er u that the informatton-on.this application is true and complete I�Jc 1 certify,under the !ns an penalties of p ) ►7'� LIC.NO.:to J���-=� FIRM NAME; LIC.NO.: •/�f� St. gnature Licensee: ! Bus.Tel.No.: _ (Ifapplicable;en "exempt"�he license n:tn r line.) 7— Alt.T 'el.No.: 5770 Address: *Per M,01.c. 147,s. 57-61, se rity work requires Department of Public Safety"S"License: Lic.No. CE 4YAIVER: I am aware that the Licensee'does.not have the he k one)liability i❑ownernsurance _r owner OWNER'S INSURAN . I hereby waive this requirement, I am the(c ' required by law. By my signature below,. Y Owner/Agent Telephone No. PERhIIT FEE: $ .� jignature 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 of 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 necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)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,not the 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 number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. 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 Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will 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 I Congress Street, Suite 100 Boston, MA 0211.47201.7 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 7-2010 www.mass.gov/dia Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ........................................................................................................................................................................................................................................................................................ Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change _ Contact the Agency % LICENSEE More... Name:MICHAEL J. BOLDUC REFERENCES& Business: BOLDUC ELECTRICAL CONTRACTORS INC RELATED INFO DANVERS,MA Disclaimer Regarding Website License Searches "'This Licensee has additional Licenses,click here to view them." Enforcement Process Glossary i Licensing Board: ELECTRICIANS Glossary of License Status Codes License Type: MASTER ELECTRICIAN TYPE CLASS:A More... License Number: 15957 Status: CURRENT Expiration Date: 7/31/2016 i Issue Date: 6/28/1982 Exam Date: 6/1/1982 +1' School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Friday,August 30,2013 at 10:48:42 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/PubLicenseQ.asp?board code=EL&type class=_A&li... 8/30/2013 Date.. . . . . . . . N°RTM °f 3j TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 00 SAC HUSEt This certifies that . . . . . ..I.. has permission for gas installation � �jt✓f',L in the buildings of at .'� '/.( �.� .G �' :'. . �% North-Andover, Mass. Lic. No.,/Z07 . . ' . . . . . . . . . . CGAS INSPECTOR Check# ✓,,/ �� 4525 MASSACHUSETTS UNIFORM APPLICATION FOR'PERMIT TO DO GASFITTING _ (Frust ce Type! � ��✓ �-�/1 A171b, Mass. Date �a ia) Pemat it BuOding Location `7 LkaZ& -"1 Owners Name IV-- G� Type of OecutpaMy kwt New ❑ Renovation Repiac�atnent 0 Pians Submitted: Yap .No ! a m ti a Y S C ai W G? s rn sr: o 0 W W M• C O V m � � = 7r Z O CJ < C C. O 0 O F 2 1" W O C sv o or t- s m m a 'J = < = W a Q > }H. m z < rsu t a = E C Im z- Q i 0 n x u. 3 0 0 col C > c n tp- o sue—BSUAT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR r STH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR Installing Company Name YANKEE GAS Check one: ` Certificate Address 140 SOUTH MAIN STREET [X Corporation 103C MIDDLETON, MA 01949 0 Partnership Business Telephone 978-774 ' 2760 0 Frrn/Co. Name of Lkensed Plumber or,Gas Fitter W I LL I AM R HARRIS i - INSURANCE COVERAGE: I have a current liability Insurance policy or As substantial equivalent which meets the requiiinements of MGL Ch 142 Yes IR No O If you have checked yes. please Indicate the type coverage by checking the appropriate box A Iiabiliity Insurance policy 0 Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAVER: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 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above app4calicn are true and accurate to th best of my knowledge and that all plumbing work and installations performed under the perm for osis appy n will be in co a with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 at al taws c gy Tj of license: Plumber Stgnature b or mer Titre Gastitter master License Number 3785 City/Town Journeyman APkUVED tONLY)