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Home My WebLink AboutMiscellaneous - 44 MARK ROAD 4/30/2018 44 MARK ROAD 210/098.A-0027-0000.0 N° 9644 Dateb. L ".O�T"��o TOWN OF NORTH ANDOVER y �r •`'� �' 0 =' a MAIM PERMIT FOR PLUMBING } cHUS�t , , ,, This certifies that . .Lr . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . �. . . . . . . . . . . . . . . . . plumbing in the buildings of . / '/ . . ..-. . . . . . . . . . . . G, . . . ./ e(t . . . . , North Andov , Muss. Fee.�. 0 . . . .Lic. No.. .UK6. . . . . . . . n PLUMBING INSPECTO Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ALO l�!V VL'll � � MA DATE =11PERMIT# JOBSITE ADDRESS FQPb OWNER'S NAME "l P 6Q 1/ZLer- POWNER ADDRESSt TEL 85`- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: m PLANS SUBMITTED: YES EQ NOF FIXTURES'l 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 GASIOILISAND SYSTEM ! _. -_(I 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ._! -.._...._.{ ..._-__J ' I - .I -----.._.1 I ..,._-- _._..� __._.-.._f -._....__! l — I ....._..�` FOOD DISPOSER ! 1 I ...__-( _ _J ( I 1 -1 FLOOR FLOORIAREA DRAIN --.__-_� .___E RI _..__.-1 _._____J ...._._f __. _._..I ..--__._.I __-._ .____l i INTERCEPTOR(INTERIOR 4 1 I _ .....__J _! _-_-_.-.J _,--. J KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK ( 1 ! ( _._: ! J J __......_._J f � ..-�II ..__ J ..-- I b TOILET URINAL WASHING MACHINE CONNE ON -- -.1 WATER HEATER ALL TYPES __( r .___._ I _I ____! ..._.__ .....-.- s _-___J — --.-.► _- i __--- WATER PIPING i -_ J __-__! OTHER _; ( _J i .---------.- _.__..___J I i .__._._..I __-_....1 .____1 _._.._..-_J J INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY [I 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 [j 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 ccurate the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co lance with all rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S AME�� _._. _. i,LICENSE# SIGNATURE MP _'. JP[I CORPORATION 0# PARTNER _.!# t LLC I --1111112 .. _._ COMPANY NAME °A O° lumbinp 1ADDRESS i --. —r16= o— ---- — CITY Billerica, MA 01821 STATE ZIP TEL 'Gt'b ` FAX L CELL ��EMAIL _. - -- - --- - _. - - -------.._.._.............. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ v FEE: $ PERMIT# PLAN REVIEW NOTES n 9 C 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 Applicant Information Please Print Legibly Name (Business/OrganizaW&Q&Rl�l umbing 1 Utopia RD. Address: 801 ffTes'�T821 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I a employer with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet.$ 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *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. #Contractors 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.Lie.#: 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). 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 s and penalties of perjury that the information provided above is trite and correct. Signature: Date: Phone#: 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#: t ' 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 occupantjof�tUP,;,V dwelling house of another who employs persons to do maintenance,construction or repair work on such;dApljing house or on the grounds or building appurtenant thereto shall not because of such employment be deemed t 4� *A &yer." 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 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,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 burn 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 02111 Tel.#617-727-4900 ext 406 or 1-$77-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia N� - COMMONWEALTH OF MASSACHUSETTS _ COMMONWEALTH OF MASSACHUSETTS- - . _ moo:.• -. . SHE. METI►L WORKERS PLUS 9BERS AN171! ASFITTERS AS A Il k.STER-JNRESTRICTED - LICEN:iED AS A MASTER ER PLUMB _ ER ISSUES THE ABOVE LICENSE TO: -- � 'S - ISSUES THE ABOVE LICENSE TO: ' a a . JAMES R LPNN :m _ Ji ICES CANN WILMINGTO'r PLB� i AND HTG Ic`' � ,. �,m OPIA QD 1 UTOPIA tD BILLERICA IIA 01821-5249 £ BILLCRICA MA 01821-5249 5404 05/28.+14 156508 1'.;150 05/01/14 147648 ` -- _ �'' ", �►� fir. -COMMONWEALTH OF MASSACHUSETTS I: COMMONWEALTH OF MASSACHUSETTS` . �.., moo:..-. . - -. `-. . . --. moo:.•-. . PLUMBERS AND GASFITTERS PLUMBERS AND .30ASFITTERS REGISTERED ASA PLUMBING CORP "f -LICENSED AS A JOUi i!EYMAR PLUMBER ; ISSUES THE ABOVE LICENSE TO: = ISSUES THE ABOVE LICENSE TO: JAMES CANN = W;ILMIN JAMES CANN GTON PLUMBING 3 HEATING L - I , i UTOPIA RD t T UTOPIA RD B'ILLERICA MA 01821-52491�\ t'-, BILLERICA MA 01t411-5249 ' 3305 05/01/14 147647 — 22805 05/01/14 147646 FAY Massachusetts-Department of Public Safety � 4Q p ' •: Board of Building Regulations and Standards Plumbing&Heating construction supcn;snr License:CS-078569 .. tir T7:s U.. JAMES R CAP4i� 1 Utopia Rd r Q BiQerica MA1821 978.663.0092 , 978.988.0003 email:rickwph@aol.com www.WilmingtonP[umbingHeating.com Expiration -� Commissioner 05/10/2014 t Date14.3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . k( !l —z. `�. . . . . . . . . . . . . . . . . has permission for gas installation . . .J�ZP in the buildings of. .,/. f '!-i . . . . . . . . . . . . . . . . . . . . . . . at . . . . . �,��. .�'!'1. !}- .1!� -. . . . . . . . . . .North ndover, ass. Fee .a.?. . . . Lic. No. "4�' .,11jP . . GASINSPECTOR Check# �3 8409 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY nt t7 t$i� �ra�9c - �� MA DATE ®� Z PERMIT# JOBSITE ADDRESS OWNER'S NAME r /�Z�fi /11 Ce✓ � GOWNER ADDRESS TE Y"7h� `s2G — FAX ( TYPE OR OCCUPANCY TYPE COMMERCIALEj EDUCATIONAL DI RESIDENTIAL l PRINT CLEARLY NEW:Q RENOVATION:E] REPLACEMENT:[J PLANS SUBMITTED: YES F---jI NOD APPLIANCES 1 FLOORS BSM 1 1 2 3 4 5 1 6 7 8 9 10A— BOOSTER 12 13 14 �m-r. �I BOILER �I. _� ,1 1 1 I �_=_._.I J L - I ,m- l I _ �__L� ( _ r-^ _ -..�.,. _ CONVERSION BURNER `.�J __ �1 .�— -f _ �; __-1 �r .�_ �! _ A___j COOK STOVE DIRECT VENT HEATER �j --J —a L DRYER - L= - FIREPLACE .. _j i- ( �I h_._ (l- - =_ ! _ -_.I L�a FRYOLATOR _ _ FURNACE - 1 -- --- ---- =J - _ GENERATOR A GRILLE INFRARED HEATER LABORATORY COCKS r_:T I -_�-�( -_. r. MAKEUP AIR UNITI _ OVEN j 1... POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _..__ _-1, ---------- .__. TEST __I 1____. UNIT HEATER UNVENTED ROOM HEATER WATER HEATER -_.._ _ [ _—...f.I ._ . I 1_ (~ OTHER l_ II_ INSURANCE COVERAGE � 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES- N'0 D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAG CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BONDI�]_( 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 [---jl AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - PLU7-GASFITTER NAMEw 4 LICENSE#`_ �1,_I SIGNATURE MPF t-_-.fl( JP 01 JGF[�]_( LPG]� CORPORATION Q#�PARTNERSHIP0#=LLCE3# COMPANY NAME: Wilminptdn Aluinbin ADDRESS is 111110 CITY t3ghN�. _� STATE=ZIP TEL I " EMAIL FAX ..r�- CELL.-- /��_� ----- - ---- - — - — 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 art ,a u r 'k- i E 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): Wilmington Plumbing Address: 1 Utopia RD. dHNriaa,MA 01 821 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I amployer with 4. El have am a general contractor and 1 6. El New construction ployees(full and/or part-time).* have hired the sub-contractors 2: 1 am a sole proprietor or partner- listed on the attached sheet. # ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.E] I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *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. tContractors 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). 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. 1 do hereby certify it the pains d penalties of perjury that the information provided above is true and correct. Si ature: q Date: I A9 — Phone#: Official ttse 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#: a• 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 an 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 occu ant of the, p , rf�E fi j + •rltft. t iasr s f, dwellinghouse of a o t. another who employs s persons to do p y p maintenance,construction or repair work on such c�we Img�ouse or on the grounds or building appurtenant thereto shall not because of such employment be deemed'to b`e aria' " 11.M ARMC .wiser. 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 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,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 fl out in the event the Office y f ce 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 burn 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 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www,mass.gov/dia CQMMONWEALTH OF MASSACHUSETTS.. :COMMONWEALTH OF MASSACHUSETTS SHE," METAL WORKERS PLUMBERS AND GA SFITT,ERS AS A 14:P.STER JNRESTRICTED s LICEMOED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: ISSUES THE ABOVE LICENSE TO: -.-JAMES R CPNN Im` `Jj HES CANN WILMINGTO'J PLB :. AND HTG :.1 1' ;OPIA ?D ;C, :':q UTOPIA 10 BILLERICA IIA 01821-5249 ` BILLERICA MA 01821-5249 5404 05/28."14 156508 : 1'.850 05/01/14 147648 • •• Imo: � COMMONWEALTH OF MASSACHUSETTS` ":;_ COMMONWEALTH OF MASSACHUSETTS;-' PLUMBERS AND GASFITTERS PLUMBERS AND -8ASFITTi RS REGISTERED AS A-PLUMBING CORP LICENSED AS A JOUi i 1EYMAR PLUMBER ISSUES THE ABOVE LICENSE TO: }' ISSUES THE ABOVE LICENSE TO: J=AMES CANN JAMES CANN `WILTtINGTON PLUMBING HEATING °LsR UTOPIA RD �;� I -_ -`:1 UTOPIA RD B:ILLERICA MA 01821-5249 I " BILLERICA MA Olt 21-524') 3305 05/01/14 147647 ; '� 22805 05/01/14 147646 IMassachusetts -Department of Public Safety F Board of Building Regulations and Standards a Xt!!!Iumling&Heating Con%[ruction Super%kor License:C"78569 .. JAMES R CAN_9 ger 1 Utopia Rd ' Bilierica MA`01821 " 978.663.0092 s 978.988.0003 email:rickwph@aol.com Expiration www.WilmingtonPlumbingHeating.com � Commissioner 05/10/2014