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HomeMy WebLinkAboutMiscellaneous - 487 WINTER STREET 4/30/2018N_ O o� A b O v O O O O O 7504 Date 1Z1C,11�........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 'q �.� .............. has permission for gas installation 40. ............ in the=buildings of . ,�.�9. �4p c! ............................. at ... ... . i . Z u ...... ... . , North Andover, Mass. Fee. .?..... Lic. No.. GAS INSPECTOR Check # ) )' �1 lylid117=? co Of W MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING J Signature d Plumber/Gas ' City/Town;, 2 •Z!!4"2 MA. Date:,/? --�7l/ 4/Permit# Title , Building Location: `�/<�✓ J'� ; Owners Name: tel// cen eS Q� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New:Alteratii❑ E] Replacement: Renovation: Replacement: Plans Submitted: Yes No[] } City[rown L1ourneyman �1 lylid117=? co Of W Type of License: r❑,, Plumber ®�s Fitter J Signature d Plumber/Gas ' y Title Elm- aster cen eS Q� City[rown L1ourneyman N w OPPRnvFn fnFFEF i ICF nNi vi E]LP Installer 1 Z I.—WWU aW co _ 1— le o 0 LU W U w 1--U) z 0 W W Z Q N W W m 0 Q a H W W r �' V W W Z = W W F- W o LL 9 U W Z 0 J I- J !- 0 Z J U' LL U co W W ~ W W r'Z Q 0 ' V o o Q _ Q z m 5 W O O as QZ O >>>� Q O I� )(� \`l a W° SUB BSMT. BASEMENT 1 FLOOR 2 NuFLOOR 3 FLOOR --4 'FLOOR r)TH FLOOR .6 1 H FLOOR 7 FLOOR 81HFLOOR c Check ne Only Certificate # Installing Company Name: /YI o,G2i,�-reg, /' �//��� �� r� Address: .J aid �%� City/Town: o � State: Corporation ❑ Partnership Business Tel: ��/- % Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy LJ' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 Owner's Agent By checking this box ❑; 1 hereby certifv that all of the details and information I have submitted for 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 Stgt&44embiug Code and Chapter 142 of the General Laws. By Type of License: r❑,, Plumber ®�s Fitter J Signature d Plumber/Gas ' Title Elm- aster cen eS Q� City[rown L1ourneyman License Number: 0--n OPPRnvFn fnFFEF i ICF nNi vi E]LP Installer lk f N Z. of Ol . w,: o orGO a; 'DZ m m� ' m m Om ° D 2 m CN _ s o a o ;a o 1 G) m Z o; Z r m i F zcn N o Zu .� 'm J :: • Ci w err : mi W 70 1 "'9 to � 1i L 9824 NORTH 'i'°°° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SsAcmU This certifies that M'4. G L.0 I,- x `.............. ............................ has permission to perform l,& /.LE. r... �' 7 r� � « wiring in the building of ............ .�7. kob.a�b ............................................. at ... � 7....w�.� Y"�=2--.....5.�............... North Andover, Mass. Fee ..-?...... Lic. No. 4 ,,.z-.. AV ......... 4CAL �E :2E R Check At F5, 76 I Commonwealth ®f Alassachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank 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 WINK OR TYPE ALL INFO TION) Date: City or Town of: To the Inspector of Wires: By this application the undersi ed gives ndtitle ofhis or herintention to perform the electrical work described below. Location (Street & Number) . f� 7 W % 1V T .6 R C 7 - Owner or Tenant 16/ / L/./AM H A 0 b ,l} D Telephone No. Owner's Address / A Z 17b r,01- R S 3— Is this permit in conjunction with a building permit? Yes ❑ No [6 BLDG PERMIT # 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: I- /QST A'bL D V 7"204 R O E.p T-vG�-ti /-� N 17 wlRIN& 001t CA -5 �V11tx f LacF- prVSvRi- Co lefinn nffl— f II ,.,,H , 4„ 1.1,. ,.,.,... 1 ... :.._� _ r_--- � 7,• No. of Recessed Luminaires -_.. �_____.. , -J,,..,,..,,.6 No. of Ceil: Susp. (Paddle) Fans ,,,,,, -` r „� rruo vcu ay uce tris ectur UJ rr 1res. No. of Total . Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- Elo. o mergency ig mg rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and ll Initiatin Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number "" Tons KW """" """ No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Municipal Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No. of No. of No. of Devices or E uivalent Heaters KW Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (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 proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties of perjury, that the information on this application is true and complete: FIRM NAME: elt H y A E,. LIC. NO.:�J'�1 Licensee: ,p / C//,4 /f D A4 /s -I -o � Si nature�� 6 M g LIC. NO.: It AA (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: is 0 9 } 1 }• t � Address: $ S Hd R D R i i/ F— Alt. Tel. No.: Gd 3 9Zg&5 *Per M.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" Licen 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL 1. ROUGH INSPECTION: Passed — [ ] Failed — ( ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date 2. FINAL INSPECTION: Passed — Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: (Inspectors' Signature - no initials) �. Date 3. UNDER GROUND INSPECTION: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date 4. INSPECTION — SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed — [ ] Failed — ( ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date 5. INSPECTION -OTHER: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. A The Commonwealth of Massachusetts Department of Industrial,Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 �� s,• www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectricians/Plum.bers Applicant Information Please Print Legibly Name (Business/Organization/Individual): F RR Z M A C k ff y A C Address: F4 S H v R f D R l Y City/State/Zip: _5A1,6-,44 i-!, a l a Z 9 Phone #: 6 G 3 9 9 3 Zt7 o S Are you an employer? Check the appropriate box: I. [ I am a employer with ( 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 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.] i 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 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. T Homeoiyners 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. lam an employer that isproviding workers' compensation insurancefor my employees. Below is the policy andjoh site information. Insurance Company Name: 1A A/ l'/ o IN S V R A M G 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certify un der the pains andpenalties ofperjury that the information provided above is true and correct. Phone #: �i 6 3 9 9 3 i4e 7 0 S 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): Y. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: .. .-..,. ., .-'-.,iy �(.�..,,..,,r.,,s�:,w,..._»('._`n�}.—i'w�.-.�.-5.,,,N„;..�.i�-..ter-�-r.�•-+-+=w Location V 0Jt Jt No. Date �aRTM 1 -44 Cis - TOWN OF NORTH ANDOVE6 oho Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fe 1 $ Sewer Connection Fee $ ; Water Connection Fee $ TOTAL $(00 _ 3 ( Building Inspector 8577 Div. 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This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: C �,-r A r I o E u i 1' h Phone 6-0 '?6 `$ �), g 9 q 2 LOCATION: Assessor's Map Number Parcel 2 -'2.').3 Subdivision Lot(s) 19-t-6 Street tV 197 �A �, St. Number q1 7 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health -If���a�� Septic Inspector -Health Comments . Public Works - sewer/water connections - driveway permit VFire Department �`� e Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved � Date Rejected Received by Building Inspector Date av'�/Wjur V1995 �- -_ The Commonwealth of Massachusetts Department of Industrial Accidents affm11/Orestl�9L/inS 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit name: 9 7- Creative Builders, Inc. location: 58 Water St. cily No. Andover, Ma. 01845 phone # 6A2-4948 [:] I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity loll I I am an employer providing workers' compensation for my employees working on this job. _......._ _........ . _........".__...... ..... ....... ...._._........... ........... _ .......... .............._ .........................._ _ ........... . cmmnanv-name_ _„ . I do hereby certify under the pains andenalties ury that the information provided above is true and correct Signature Date 6-23-95 af Printmmne Robert K. Daigle, resident -Creative -Builder's; ids# 682-4948 official use only do not write in this area to be completed by city or town official city or town: permit/liccnse # nBuilding Department []Licensing Board [] check if immediate response is required []Selectmen's Office []Health Department contact person: phone #; nOther (revised 1/95 PJA) J r„t;��w�:, c j7.�: �..,� :fie , t�:p'.r � �l�F x y'. a a >j. _x�d, �� - �.F �a) .a ,�� ,X (+r- Al e . L r aaa aria' a S as 4�i +' , Yn �, •r `� i Y� f+! 6b rJ P t i- � ,ala t�' a -o, ��,� h }�' T�.�. � / y � ry a �� '�� ' �: �w �/ "i:l��."°+� : ,�+'S�" :�,l��W"a t� 7*�,s �'.-€P'"Ta ,:q } s+;:fit �.,v-s�.•-.�. _'�� r'rt7'ti. F �� x i s3 xy .,.a ��{ C 4� _ r ps e .' tr yrs � i r,�•A r�.- ! b�Y:�,�2 . �i� r`Jr,I i A 4 � 1 �j,. ti .1ti 3 q' f? 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G'; 5, A'^ ',y,: �:. yw+; J,� �:. .•Y , ^'�A'i Y 014c Tatnntonwealtll of Massar4usetto Office Use Only Department of Public Safety Permit No. 2 f BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy &Fee Checked 3/90 (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 INf (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of b__ /7k 0 /J U C To the Inspector of Wires: The undersigned applies for a permit to /perform the electrical work described below. r7 Location (Street & Number) (/9-7 I/q/ /1/ r�712 5 Owner or Tenant C f2 E7% )4-1 V C (3U 1 L JJ L -I2 S 57U 1 Vr Owner's Address Sg W A -1 -L -D -L _�:, L k -)C9 • /I- /U 170 U t72 Is this permit in conjunction with a building permit: Yes U No Purpose of Building S� Existing Service 0 0 Amps I�L_o_d-(0 Volts $0 New Service� 0 Amps J �� / �y Volts I�/ (Check Appropriate Box) Aility Authorization No. �� �� Overhead M Undgrd ❑ No. of Meters Overhead ® Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ()PG ltd D E P96 M d -o 0 4-X4 f S MW d E'tt- A OD1 OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO O !.have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked ES, please indicate the type of coverage by checking the appropriate box. INSURANCE l� BOND ❑ OTHER❑ (Please Specify) _ Estimated Value of Electr'eal Wor $ Work to Start � � Inspection Date Requested: Rough Signed under the p alties o perjury: FIRM NAME /i" "0 2 E ( _ Final LIC. NO. (Expiration Date) .Licensee A AJ 7- {'UX) % JI- til0 /7- _ Signature LIC. NO. Address ep 15 CO 12- p I�lq U t C / L C fl O/ 3 Bus. Tel. No. 509 - -5-7d- Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement., Owner Agent (Please check one) t Telephone No. PERMIT FEE $ (Signature of Owner or Agent) D TOTAL No. of Lighting Outlets lo No. of Hot Tubs No. of Transformers KVA A oveIn- ❑ ❑ No. of Lighting Fixtures Swimming Pool gmd. gmd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices. No. of Self Contained No. of Ranges No. of Air Conditioners Totns No. of Disposals Heat Tota Tota No. of Pum x Tons KW No. of Dishwashers Space/Area HeatingDetection/Sounding KW Devices. Municipal ❑Other No. of Dryers Heating Devices KW Local❑ Connection No. o No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO O !.have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked ES, please indicate the type of coverage by checking the appropriate box. INSURANCE l� BOND ❑ OTHER❑ (Please Specify) _ Estimated Value of Electr'eal Wor $ Work to Start � � Inspection Date Requested: Rough Signed under the p alties o perjury: FIRM NAME /i" "0 2 E ( _ Final LIC. NO. (Expiration Date) .Licensee A AJ 7- {'UX) % JI- til0 /7- _ Signature LIC. NO. Address ep 15 CO 12- p I�lq U t C / L C fl O/ 3 Bus. Tel. No. 509 - -5-7d- Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement., Owner Agent (Please check one) t Telephone No. PERMIT FEE $ (Signature of Owner or Agent) D i .� 4 h NoRTp pf ��ao ,e�ti0 O 9 f s # ;,SSACMUSEt Date.3:.?... t........ ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .A..1,.?...s.,,�................................................� 7 �t t -�^ l A. t1 3 c M has permission to perform:.............................:...............1.........-' wiring in the building of ... ...... )..................................................... ,......�T........................... . North Andover, Mass. .. Fee.. . ......... . Lic. No.MP7112........................................................... ELECTRICAL INSPECTOR ujk L-, i! zZ- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File