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Home My WebLink AboutMiscellaneous - 467 SALEM STREET 4/30/2018 467 SALEM STREET 210/038.0-0097-0000.0 i Date.....�WU4 P..��1 ..... . 10789 3? .`.'�pT":!tiaoL TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 'yam'�• ;.o"�t��' This certifies that.................(!W��'--} d.. :.. ............... has permission to perform... ? - � ................................................................................ plumbing in the buildings of.... ,S.M............................................................... .....e........ ... � at..... ]....... c�..�:o.'.'.1........... North Andover, Mass. .:Fee......:............... Lic. No,2:1. y? ... ................................................................ PLUMBING INSPECTOR Check# �.--� mr+vvwr wva.r r v vr�u vr�m r�r r crura r wee r vr�e+r �r�m r r v r Iry vr�rn r rwmvuw •wrv♦ CITY NORTH ANDOVER MA DATE /0`/—/ Y PERMIT# d1 JOBSITE ADDRESS S-T OWNER'S NAME/)ANa t G TM OWNER ADDRESS SAME 6 TEL FAX if TYPE OR OCCUPANCY TYPE COMMERCIAL ' EDUCATIONAL L'j RESIDENTIAL✓ PRINT -P ' CLEARLY NEW: RENOVATION: REPLACEMENT:✓ PLANS SUBMITTED: YES ✓= NO FIXTURES Z FLOOR— 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIL1SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR INTERIOR Q. KITCHEN SINK Q LAVATORY ' ROOF DRAIN s SHOWER STALL SERVICE/MOP SINK T01 'T URINAL WAS JING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ✓ NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW j LIABILITY INSURANCE POLICY 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 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. PLUMBER'S NAME THOMAS HALLORAN . LICENSE# 24833 SIGNATURE MPF JPL`!.i CORPORATION# PARTNERSHIP# LLC['# COMPANY NAME HALLORAN PLUMBING ADDRESS 826 DALE ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-685-9504 FAX 978-208-0540 CELL EMAIL tomhailoran@comcast.net 1 b JH I y T� Date.. ........V%�....................... '40A TOWN OF NORTH ANDOVER I W PERMIT FOR GAS INSTALLATION Thiscertifies that .................................................................................................................... has permission for installation ....(�� a..-, \r��, . - 9 ........................................................ in the buildings of C j at........... North*'...'"'....Andover,*","****'"Mass."*"**" Fee..... ............. Lic. No.,.u.�h�5. ...................................................... GAS INSPECTOR Check# 9567 li A.— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE�® - V PERMIT# �� 1 JOBSITE ADDRESS �f rJ SA J&- j S' OWNER'S NAME J4A-A1&L -V OWNER r , OWNER ADDRESS SAME TEL FAX TYPE OR OCCUPANCYTYPE COMMERCIAL=--, EDUCATIONAL;v RESIDENTIAL'✓ PRINT CLEARLY - NEW.--. RENOVATION_ REPLACEMENT l- PLANS SUBMITTED: YES y 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1' NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY v_4 BONDT7 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=.uti AGENT'` y 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 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 p vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �` �✓r'______. PLUMBER-GASFITTER NAME THOMAS HALLORAN LICENSE#24833 SIGNATURE MP;== ` MGF JP`s JGF LPGI` - CORPORATION 3-# PARTNERSHIP r „# LLC COMPANY NAME:T.HALLORAN PLUMBING ADDRESS 826 DALE ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-685-9504 FAX 978-208-0840 CELL 978-685-9504 EMAIL tomhalloran@comcast.net 1 The Cora monweakh ofMassachusedts Deparfinent ofIndresta•iaZAecidena O•f,five q f"Vesagations i 600 Washington Street Boston,MA 02111 . wWw massegov1iUa ' Workers' Compensation Inman ce Affidavit: Bufldeirs/Contractors/Blecfric /Plumbers Applicant Information Please Print Legibly Name.(Business/orgmftationandividnai): 7Wm-7,o- Address: _V,-2 City/State/Zip:./ / Phone.#: !�7Y 6,S—^_S�952P Y Are you an employer?Check the appropriate box: 1.❑ I am a employer with ' ; 4• ❑ I am a general contractor and I Type of project(requiredy-_, employees(full and/or part time):r have hired the sub-contractors 6 ❑New consizuction ' 2 jq I am a-sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp.insurance.t' 9. [1 Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ l am a homeowner doing all work officers have exercised their 1 l,[]p1umb; repairs or additions myself.[No workers'comp. right of exemption per MGL 12-EIRoofrepairs insurance required.]t c. 152,§I(4),and we have no . employees.[No workers' ` 3.❑Other comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation ply irtfotma8an. t Homeoevners mho stbmit this a£irdavit inditxting fluffy are doing all work and then hire outside eontraetors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number; I fo anrmatxoas.employer that isprovidtng workers' htfcompensation insurance for tray employees Below Is thepolky and job site Insurance Company Flame: Policy#or Self-ins.Lie. Expiration Date; Job Site Address . City/StateiZip: • 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 tine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of- bgestieations of the DIA for ze verification- Ido hereby cergify sander the pains and penalties of perjztry that the iatformation provided above is true and correct? Sitmatur'e• Date: 40— /y Phone# 5`,7f� -l„ S� -e-- ; ffcgw-use only. Do not write to tats area,tb be completed by city or town offickL City or Town:—Permit/License# Issuing Authority(circle one): ' I.Board of Health 2.Building Departlneht 3.City/Town Clerk 4.Electrical inspector 6.6ther 5.PIumbing Inspector - Contact Person: Phone#: C MASSA o "kit AF I`I'TERS PLUM �t " ISSOLLOW .N�* I�1,CENSE " LIiGkN E#1 Aga 'A, OURNE`fM(AN RLUMB THOMAS M HALLORAI� e ,t i L Tfif :ANDOVER MA 01845= 1422`' NSR � IQ1/1�' 223446. 24833 • N2 2706 Date..... /... ...f ,l v� NORTH °f "`°:•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING US This certifies that ..... r.......S.C.(........ ..` f?°!r?. ................. has permission to perform .... . �1 a.1e1?.?..........?.�!� �1:.................... wiring in the building of......... 1.................................................. at.........` .....5..�-,Jx.al.....�.v....... .............. .North Andove Mass. Fee..��..�..: J... Lic.No..IS J�.Z............... ... .. V..�1�.�................ LECTRICA2iI S*PECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massac usdtts 61&ial Use Cally Department of Fire Services Permit No. �(J BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank 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 IN INK OR TYPE ALL INFO TION) Date: t 1-9-0 City or Town of: Q 0 C� I dJ-T-�>6ye(C To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location (Street&Number) a(-e m S,-. Owner or Tenant e c sun Telephone No. Owner's Address 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 Senice Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ()�( �f' LCR f rn � Completion qfthefibllowing table may be waived by the Inspector of[Fires. To.of Recessed Fixtures No.of Cei1-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No. of Hot Tubs : Generators KVA bove n, o. o mergency ib ting No.of'LightingFixtures Sivimming Pool ornd. ' E] oi`nd. ❑r Batten Units' No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones a No.of Switches No. of Gas Burners No. of Detection and Initiating Devices No.of Ranges No. of Air Cond. Total No. of Alerting Devices Tons No.of Waste Disposers Heat Pump Number ITons IKW No. of Self-Contained Totals: IDetection/AlertingDevices ' No.of Dishwashers Space/Area Heating KW . Local ❑ Municnee ioln [I Other HeatinZ Appliances curity ystems: 00 No.of Dncrs PP KW r Equivalent !d No.of Water KW o. of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER .4nDch additional detail ifdesired,oras required by the Inspector of lVires. 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 proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work (When required by municipal policy.) Work to Start f (!I 4� Inspections to be requested in accordance w illi MEC Rule 10,and upon completion. I cert fig,under the pains and penalties of perjury,that the in,formation on this'aj�plication is true and contplete, FIRM NAME: ADT Securitv Services 111 Morse Street,Non o MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Signatur LIC. NO.: 1533C (If applicable,enter"esenipt-intlie license number line.) Bus. Tel. No.: 7R1- — 1 Address: Alt. Tel. No.: 603-594-.59 resi OWNER'S INSURANCE WAIVER: I am aware that die Li ensee does not have the liability insurance coverage normally ONLY required by law. By my signature below. I hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's a0ent. Owner/Agent Signature Telephone No. [PERMIT FEE: S,,5,