HomeMy WebLinkAboutMiscellaneous - 440 WINTER STREET 4/30/2018f
9666
Date.. ...........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that...............................................
............. ............................
has permission to perform ...... ! ..... . 0.0a.". r"16
wiring in the building of .......11. jf t I/ '7 -f" i"
............................... ................
r
at .......Y.....w�i.. ��;.......:.�
.' 1.`�......................... . North Andover, Mass.
Fee ....... e$. ....... Lic. Nod � Y �? /� ~ .. .... ......................
Z' ELECTRICAL'IIYSPECTOR
Check # /� ?�/
,w _y
Rii
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Permit No. l (fib
Occupancy and Fee Checked
[Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELEC RICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Coerw,,c
) 527 CMR. 12.00
(PLEASE PRINT ININK OR TYPEALL INFORMATION) Date: %;
City or Town of: NORTH ANDOVER To the In ecl& of Wires:
By this application the undersigned -pnotice notice f his or her intention to perform thee ectrical work described below.
Location (Street & l nber) (,,(J ,� e Syee;! -
Owner or Tenant
Telephone No.
Owner's Address A `lll�
MA
Is this permit in conjunction with a build) permit? Yes M No ❑ (Check Appropriate Box)
Purpose of Building r6 OtA Utility Authorization No.
3k
Existing Service Amps Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Meters
No. of Meters
Cmmnletion of the following table may be waived by the Inspector of Wires.
-Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:.SZQ (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: 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 proofo ame to the permit issuing offic
CHECK ONE: INSURANCE &J/BOND ❑ OTHER El (Specify:) e jj,� ��,t,� f (� jqr- t as -1
I certify, under d ains_and enalties ofperj� , thig4te inf rtngtign on zrs application is true and comp ete. �-^j
FIRM NAM t LIC. NO.:JJ/ WD
Licensee: �}r/1.i Signature JVy, LIC. NO.: /
(If applicable, enTr„`exempt"in the lic se nu b r line.) Bus. Tel. No.:
Address: ( Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Deparlme t of Public Safety "S" License: Lic. No.
�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th6 liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's
Owner/Agent 1PERMITFEE.-'$
Signature Telephone No.
V
Total
No. of Recessed Luminaires
No. of Ceil: Sus . addle Fans
P (Paddle) _Transformers
Tr s KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
'
No. of Luminaires
Above In-
Swimming Pool rnd. grnd. ❑
o. of Emergency ig mg
Battery Units
No. of Receptacle Outlets 3
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Detection and
No. of Switches
No. of Gas Burners
Initiating Devices
No. of Ranges
No. of Air Cond. TonTots
No. of Alerting Devices
Heat Pump
Number
Numb
Tons
KW_
No. of Self -Contained
No. of Waste Disposers
P
Totals:
'' ........
[�� .........
.....................
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
p g
Local El ❑ Other
Connection
No. of Dryers
y
Heating Appliances Key
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of -No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or E uivalent
Telecommunications Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
OTHER: , r
-Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:.SZQ (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: 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 proofo ame to the permit issuing offic
CHECK ONE: INSURANCE &J/BOND ❑ OTHER El (Specify:) e jj,� ��,t,� f (� jqr- t as -1
I certify, under d ains_and enalties ofperj� , thig4te inf rtngtign on zrs application is true and comp ete. �-^j
FIRM NAM t LIC. NO.:JJ/ WD
Licensee: �}r/1.i Signature JVy, LIC. NO.: /
(If applicable, enTr„`exempt"in the lic se nu b r line.) Bus. Tel. No.:
Address: ( Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Deparlme t of Public Safety "S" License: Lic. No.
�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th6 liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's
Owner/Agent 1PERMITFEE.-'$
Signature Telephone No.
0,- TN
c
i
,V , ,.
The Commonwealth of Massachusetts
' Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
�,4 s• • www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: C Phone # �V 38 0-� 1-1
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. I am or
have hired the sub -contractors
listed on the attached sheet. t
a sole proprietor partner-
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
5. ❑ We are a corporation and its
[No workers' comp. insurance
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. E] Plumbing repairs or additions
12.0 Roof repairs
13.❑ Other
*Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
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. Lic. 4:
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 DTA for insurance coverage verification.
I do here ertify u der the pains andpNalties of perjury that the information
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
4
true and correct.
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 #:
8777
Date. /l/. ? . 3/� �.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
� ,SSACMUS�
This certifies that .. ,%% . . l k 1CG
has permission to perform .... T ``e. k. .c . {.�. .^........... .
J
plumbing in the buildings of ... 6. `r h J.
at ....y.<<.`:(...1 .t.�. r/^.... ........ , North Andover, Mass.
Fee. Lic. No..7.f S. !.. ......'��� ).. - ... .
PLUMBING INSP CT R
Check # Z o 6
A
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING —
(Type or print)
NORTH ANDOVER,MASSACHUSETTS,.-.
�y'�lf`��,nj Date
Building' Location I W l n S� Owners Name Permit #
Amount
Type of Occupancy
New Renovation 0
Replacement 0
FIXTURES
Plans Submitted Yes 1 No
(Print or type) C � ! ^ l NC C ec(rr: Certificate
� �
Installing CompAny Name ( lJ�
_*one:
Corp.
Address a"�S-r Pi-031,-)Pec� �- C,qM'3niAce 6m9 QZ(3F n Partner_
Business Telephone -7 - W- � , � S S n Firm/Co.
Name of Licensed Plumber: !(0 &el / ad S-&- �
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy [a Other type of indemnity 11 Bond a
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature IOwner [:] 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 my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinetit provtstons of the Massachusetts State Plumbing Codeha ,2 of thetQViteral Laws.
Nignature 01 L cmea rillmner
(OFFICE USE ONLY
Type of Plumbing License
-7k93
tcense Numver Master Journeyman 0
Date..0 5!
O;,~0PT:��a TOWN OF NORTH ANDOVER x
PERMIT FOR PLUMBING
j
This certifies that . Yr -1.'.1. 7//.�.�j. �'............ • ... • • • . .
has permission to perform ..........................
plumbing in the buildings of ... .1•f', .� • .............. • • • • .. •
c. ��"^...... , North Andover, Mass.
Fee,?Z .�(.. Lic. No.. .J I .t.. . r ...... .
PLUMBING INSPEC oR
Check # tl
7159
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
O Utt.TMass_ Date Permit #
Building Location_ ��� y� �` ��'�- Owner's Name
C
Type of occupancy esidextt:
New 0 Renovation O Replacement Q9 Plans Submitted; Yes D
FIXTURES
installing Company Name Heri tape Ht -9. &FPlg . Co- Inc. Check one: Cenlfica_e
Address_ 35 p 1 P A s a n t- Street ` [$ Corporation 714
Stoneham ; Ma ' 0216.0 ❑ Partnership
Business Telephone 17 Firm/Co—
Name of Ucensed Plumber Gordon Switzer
INSURANCE COVERAGE_
I have a current liability insurance policy, or its substantial equivaletA which meets the requirements of MGL C
Yes ® No O
If you have checked Yes, please indicate the type coverage by checking the appropriate box
A I"llity insurance policy Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage requi
Chapter 142 or the Mass_ General Laws_ and that my signature on this permit application waives this requiren
Check one:
Owner O Agent ❑
Signature of Owner or Owners Agent
I hereby cenity that all of the details and information 1 have submitted (o( entered) in above application are true and accurate to @he b
knowledge and that all plumbing work and installations performed under the permit issued for Ws appircation will be in compliance �
pertinsnl provisions of the Massachusetts State?Plumbing Codeand Chapl 142 P the General Laws_
BY
Title gnature o u r
Gi /Town Type of License: Master l$ Jownsyman O
License Number 8 3 2 2
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installing Company Name Heri tape Ht -9. &FPlg . Co- Inc. Check one: Cenlfica_e
Address_ 35 p 1 P A s a n t- Street ` [$ Corporation 714
Stoneham ; Ma ' 0216.0 ❑ Partnership
Business Telephone 17 Firm/Co—
Name of Ucensed Plumber Gordon Switzer
INSURANCE COVERAGE_
I have a current liability insurance policy, or its substantial equivaletA which meets the requirements of MGL C
Yes ® No O
If you have checked Yes, please indicate the type coverage by checking the appropriate box
A I"llity insurance policy Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage requi
Chapter 142 or the Mass_ General Laws_ and that my signature on this permit application waives this requiren
Check one:
Owner O Agent ❑
Signature of Owner or Owners Agent
I hereby cenity that all of the details and information 1 have submitted (o( entered) in above application are true and accurate to @he b
knowledge and that all plumbing work and installations performed under the permit issued for Ws appircation will be in compliance �
pertinsnl provisions of the Massachusetts State?Plumbing Codeand Chapl 142 P the General Laws_
BY
Title gnature o u r
Gi /Town Type of License: Master l$ Jownsyman O
License Number 8 3 2 2
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Date .......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that .................................................................... ....................
has permission to perform l .4 ... rz a. I8 ....... w.....w.
?v.� .........
....
wiring in the building of ........................ kn.tv .. .........................................
at ........... 4qq (JJ ( 'V'7 elZ 7'77 North Andover, Mass.
Fee...a....`. .... Lic. No. .3;?/ g ................ ....... .... ................
e�Ui�crmcAL �IiN�;�Ec�roi
Check # -Aaf 22
ALMA
r
I Commonwealth of Massachusetts Official Use Only
is Dapadment of Fire Services Permit No.
Occupancy and Fee CheckedE OAFtI� OF SIR PREVENTION REGULATIONS[Rev. 11/991 leave blanit ^�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he perfonned in accordance with the Mas sachUsetts Electrical Code (MEC), 517 CMR 12.00
(PLEA S.F PRINT IN INK OR TYPF, ALL INFO.RAYATI N) Date: —0 A
City al" Town of. d To the Inspector of Wires;
By this application the undersigned gives notice of his or her :,Mention I.o Pel f07111 the electrical work described below.
Loe ntlon (Street r& Number) 4UO 10 y n 4e4 , SA -.0 vo „-
Owner or Tenant Jh A _ Telepbone No.
Owner's Address a Gist —70_ f_ 0 -<-
Is tills permit III conjunction Ivi 1 a bufldi permit"' lees El, No Ej (Check Appropriate Box)
Purpose of I#uilding< � � l.'tillty Authorization No.
U, xlsting Service Amps _ _ —Volts ON erhead ❑ UI'd grd [ No, of Meters
NNgn 5 ry a Amps / Volts Overhead ❑ Undgrd f___I No. of Meters
Number of Feeders and Arnpacity
Location and Nature of
.• w r.h additional drool if dt rllmd, a•as required by Me bulm for o(wires.
INSURANCE COVERAGE: Unless waived by the n.>ner, no permit fol• the performance of electrical work may issue unless
the licensee provides proof of liability insuranceancludmg "colllpleled opet•al on" coverage or its substantial equivalent, The
undersigned certifies that such coverage rce, and IIaS 00libited proof of'sante to the pert�it issuing offtc
t CHECK ONE: INSURANCE 13OND (] OTFii;R f (5pcclf�:)
t �D)
Estimated Value of Electrical Work; (Expir•ati
_ t1'Jhen required bymullicipal policy.)
Work to Start: Inspections to be requested in accordance `,��ith N. -JEC Itttle 1(l, and upon completion.
!certify, under tlrePah at penalties• of'pet;%ttrlrr tat the ittfnrtttrrtir►rr on t ,c o�tpficmiort is frac and complete.
FIRM NAME:__ PC) G
t_IC, NO.:
Licensee: Signature
(If applicnb/r., eider "e�•en the !icer c runnber lri LIC. NO.:
Address: `Wl�iab
us. Tel. No.•
OWNFaR'S !NSU N .. AIVFR: 1 am a«are tllat the Licensee does nor Lorne ti�su it. nsurance cpveragt norlrlally
required g law. By rnystgllaturt befow, I Ilereby waive this requirc111enr. I am rhe feheck one (1 owner ❑ owner's a rent.
Owner/Agent
Signateri,a Telephone No. _ PE MIT .FEE: $
, e ton a r Ie at awut
table nna ' ue w4rueu b�y. t_Jt_e. fns�ector o Wrrt?s.
No. of (Recessed Fixtures
No, of Cell,•-Susp. (Paddle) Fans
0. o "Tota
Transformers VA
No. of Lighting Outlets
No. of loot Tubs
Generators KVA
No. of Lighting Fixtures
Swltnlnin Pool � U4e ❑ t1^ 1�
a. o > I11 ".: cy g I tIg
_
nd, rrnd•
Batte Units
No. of Receptacle Outlets
No, of Oil Burtte���
o. of Gas burners
No. of Ali, Cond.MR
�ns
_
FIRE ALARMS No, of zones
No. of Swhclles
o. o etect on as
Initiatin Devices
No. of Ranges
No. of Alerting Devices
1lcat unti> IYntrtber Tons
TacAls:
No. of Waste Disposers
o. of a onta�"iaed
Detection/AlertlltDevices
No, of Disbwasbers
Space/Area lleatins KW
Local un Iphe
Coonectlon Other
No. of Diirers
llcating AppliancesKN:
ecurlty ysteins:
O. o akel
I�Ieaters IOW
-
o• of —_. Nn. o
No. of Devices of Equivalent
Data Wit•Ingg
_
Si ns Ballasts
-- --- Asts
No, of Devices or Equivalent
No. 1fy 1`0111 MAge Bathtubs
No. of N-lo€Ors Total HP
elecotntnntt eat oils r Itg:
`� '— --
OT1#fLR: '
— -- --_
No. of Devices or L, uivalent
.• w r.h additional drool if dt rllmd, a•as required by Me bulm for o(wires.
INSURANCE COVERAGE: Unless waived by the n.>ner, no permit fol• the performance of electrical work may issue unless
the licensee provides proof of liability insuranceancludmg "colllpleled opet•al on" coverage or its substantial equivalent, The
undersigned certifies that such coverage rce, and IIaS 00libited proof of'sante to the pert�it issuing offtc
t CHECK ONE: INSURANCE 13OND (] OTFii;R f (5pcclf�:)
t �D)
Estimated Value of Electrical Work; (Expir•ati
_ t1'Jhen required bymullicipal policy.)
Work to Start: Inspections to be requested in accordance `,��ith N. -JEC Itttle 1(l, and upon completion.
!certify, under tlrePah at penalties• of'pet;%ttrlrr tat the ittfnrtttrrtir►rr on t ,c o�tpficmiort is frac and complete.
FIRM NAME:__ PC) G
t_IC, NO.:
Licensee: Signature
(If applicnb/r., eider "e�•en the !icer c runnber lri LIC. NO.:
Address: `Wl�iab
us. Tel. No.•
OWNFaR'S !NSU N .. AIVFR: 1 am a«are tllat the Licensee does nor Lorne ti�su it. nsurance cpveragt norlrlally
required g law. By rnystgllaturt befow, I Ilereby waive this requirc111enr. I am rhe feheck one (1 owner ❑ owner's a rent.
Owner/Agent
Signateri,a Telephone No. _ PE MIT .FEE: $