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HomeMy WebLinkAboutMiscellaneous - 49 CAROLINE WAY 4/30/2018 BUILDING FILE Date..... ......9..."... . .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 88'�CMU9E This certifies that ...........Y...ve'v n. .......... .. .r... ............................... has permission for gas installation .:..... e....�.c f in the buildings of........ .. ..: ..!^.. at..:...` .`1...:.�'. .d.... ::-...... ..........., o Ando er, Mass. Fee 32LSR Lic. No. 12.` J. ................ ..... .....�...... .... ..... ......... . .. GAS INSCF;i 0R Check# 8854 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORT( CITY n/Q,�'7""Ff MA DATE _ _ . -/. .. .._.I PERMIT# JOBSITE ADDRESS OWNER'S NAME 20 �`��ynl - _ OWNER ADDRESS �JJJ)IL TE� FAX PRINT OCCUPANCY TYPE COMMERCIAL( ED ATIONAL RESIDENTIAL CL1EAh2LYPLANS SUBMITTED: YES[] NO NEW: - RENOVATION: REPLACEMENT: LJ APPLIANCES 7. FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER - CONVERSION BURNER COOK STOVE _ DIRECT VENT HEATER - -- - - DRYER FIREPLACE FRYOLATOR r - _- FURNACE - - GENERATORO GRILLE ofai_- ^T --- INFRARED HEATER LABORATORY COCKS - MAKEUP AIR UNIT " '' OVEN POOL HEATER - - - _. _. ROOM/SPACE HEATER - - I i ROOF TOP UNIT TEST _ I _A ._ _--- --- UNIT HEATER � _ - � -- - UNVENTED ROOM HEATER - -_ I , WATER HEATER - OTHER , IN • _ . ... INSURANCE COVERAGE - I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch,142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EY OTHER TYPE INDEMNITY EJ BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee dnp- Massachusc- not have the insurance coverage required by Chapter 142 of the I��13 applicatic lam, •--�--� ����.�--�t..�.._ I hereby :NT certii �lA Vv'`� I C.sZ�I i„ and that all plor �OS i eredfor regEthi owle g I 1 ued / ne Massachusett Qg� of PLUMBER G, vy-\ l LI( �X�'� C�J•�L �� C_ \ MP MGI #, 5 COMPANY N) j Q(1+, pr� , 1' � l� L Lo CESS Glut CITY E - v..�� V\,,-^V FAXM: �n`TI h �... ROUGH GAS INSPECTION.NOTES THIS PAGE Ii OR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No 3 THIS APPLICATION SERVES AS THE PERMIT ❑ E] FEE: $ PERMIT# PLAN REVIEW NOTES Q_` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORIN GAS FITTING WORK CITY MA DATE `f�/ . .._.. PERMiT# _...._- JOBSITE ADDRESS9 'OWNER'S NAME OWNER ADDRESS TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ED ATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: __ REPLACEMENT: � �C/ PLANS SUBMITTED: YES��, N0 I APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ BOOSTER i CONVERSION BURNER - COOK STOVE I DIRECT VENT HEATER - DRYER -.._ ___' i _ .._ _.-..-_. _..._,_J _.....__� I i FIREPLACE FRYOLATOR FURNACE - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS - - MAKEUP AIR UNIT __- OVEN .._ I POOL HEATER ROOM/SPACE HEATER i ROOF TOP UNIT - TEST -.... . .._. I - w! UNIT HEATER - UNVENTED ROOM HEATER : WATER HEATER OTHERmj i , INSURANCE COVERAGE -' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage Massachusetts General Laws,and that my signature on this permit application waithis requirement.qulred by Chapter 142 of the ves SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER Ej AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru d accurate to the bes m nowle ge and that all plumbing work and installations performed under the permit issued for this application will be in com i ce with all ent rovi n of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - .._ MP MGF JP JGF LPGI CORPORATION Z# '%._ - .-.' PARTNERSHIPO#[=LLCE]# COMPANY NAME: 'J,�,� hl� ADDRESS /fo 5V CITY ®r" .. � -,/.-� - - STATE �°/' ZIP _ TEL FAX C ELLE5KE:2a EMAIL u' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES THIS APPLICATION SERVES AS THE PERMIT ❑ ❑Yes No �� 4 Z FEE: $ PERMIT# Lc1 PLAN REVIEW NOTES ���e _ 1 I��►3 I LtS� c �- �' �� cm � I�� (13 � r L�� �� � Lr� � y� ���� ��� I i R APPLICATIONGEIVERAT DATE: 7/s/3 LOCATION: 9 Ca l'-11:4e, OWNERS NAME: Af,n /`,c Ch4A GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL ESIDENTI COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) j *CONSERVATION APPROVAL J, 6 i - - -- �...�:���ii.; :_1'�.a�i�:•_31'.�7r=tt���S___..:.�5�.Y ��.. _ , PLUL46ERS AND GEISFITTERS INCENSED AS/�JOURKEYMAN P x LEHAVE '�T_A_UA'18R- '3A D28=-"3525_ =1 71 PLUMBERS AND GASI:ITTER5 =° LICENSED AS A GASTER PLUME R = - = ISSUES j�!=•_Ae0�!c LfilSE TU: KEVIt�'�lo[ LEHANE= S •IGH - — TA MA 3549 jun i5r �. t U. Jw- ]f;@li1�9A t=elf, ,,, 255fI1G{IS[REET'}•r .> �� a� n-tom S Date ...... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSE� 4 . This certifies that :.........................:'.. r�... .,.............................. has permission to perform ......... .:.................................................................. wiring in the building of ` r' .. ..... ........... .... �...`Ct North L. dover,Mass. Fee. :,-�. ............ Lic.No?��:?/l .......... .......................... ........ ...�' �! ELECTRICAL INS CTOR Check # f 8769 I c Commonwealth of Massachusetts Official Use Oniy Department of Fire Services Permit No. �7,9 Occupancy and Fee Checked. BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,S�/.r,/,r,��O cl City or Town of: -A)j�IJV'ERZ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) YS r_Ae!zZ_ k)1E (,L,i►9 y Owner or Tenant E '=\1ffE'(v-%Isr�,,t Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building _ZA�VZW)J6 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service 3Lj &) Amps i'Aa /a,40 Volts Overhead❑ Undgrd ZF No. of Meters Number of Feeders and Ampacity L 2©6 gfhan Location and Nature of Proposed Electrical Work: W j e j:u 1EIt) s 1 SGL' rwrn a) b( L2/.AJ& Completion of the following table may be waived by the Inspector of Wires. No.of Total No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting No.of Luminaires 0 b Qrnd. -rnd. Battery Units No. of Receptacle Outlets s No.of Oil Burners (FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners / 11 No.of Detection and Initiatinji Devices No. of Ranges No. of Air Cond. Tonal No.of Alerting Devices No. of Waste Dispose Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alertin Devices Municipal • No. of Dishwashers Space/Area Heating KW Local y] Connection ❑ Other Heating Appliances Security Systems:* No.of Dryers g PP ' No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: • Heaters I Sims Ballasts 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. CHECh ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) ' I certify,under the pains anti penalties of perjury,that the information on this application is true and complete. FIRM NAME: Interstate Electrical Servi s rporat ', LIC.N .:A-5217 Licensee: Pasquale A. Alibrandi Signature I (If applicabl rater "exe n t"in the license number line.) Bus.Tel.No.-978-667-5200 Address: �� Tre��le Cove Rd. , N: Billerica, MA 01862 Alt.Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here: 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 PERMIT FEE: S -�.9 Signature Telephone No. y I C.9 � I Date... pORTM TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING �v 7W ,SSA CHU This certifies that . ...::... :: .:. . .6... has permission to perform .......-...d.. .11.�................�e............................................. wiring in the building of....... ....................... .................... North Andovgr,,-Mass. at....../.Fz�, Fee. ..... Lic.No. ............... ... .......... 14) ELECTRICAL INSP Check # -4 ' 8763 ; -� Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (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 INFORMATION Date: S---1-7— 1 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) q -q Owner or Tenant ["!�-e wc-e e-0 IA,'/ - 00,-7/4 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of Building Res"41) 7"I'A/ Utility Authorization No. Ezisting 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:, Completion of the ollowin table may he waived by the LnsEecior of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans NO.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool �e ❑ Eighting d. ❑ No.Bato Emergency No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS Na. of Zones No.of Switches No.of Gas Burners o..oDetection and Initiating Devices Ttal No.of Ranges No.of Air Cond. Tuns No.of Alerting Devices No,of Waste Disposers eatump r ons o.of a ontained Totals: _ Deteettion/Ale Devices No.of Dishwashers Space/Area Heating KW Local❑ Muniap ❑ Other al Connection No.of Dryers Heating Appliances KW Securityf Devices or Equivalent No.o Water KW No.o o.of Data Wiring: • Heaters Signs Ballasts I No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunications No.of Devices or E u�ivaglent OTHER: v i y /`% ��b "•f'� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: d; /ey)- fv- (When required by municipal policy.) Work to Start .--L ,� & ections to be requested Inspections eq in accordance with MEC Rule 10 andup on 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 cow exhibited moffice. a is in force, and has exited proof of sae to the permit issuing oce. CIECK ONE: INSURANCE p BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: S"i Vtt LIC.NO.: 8y-5-C Licensee: -a A-e r# D. So Ihya n Signature LIC.NO.: .2 2 V 7J (If applicable, enter"exempt"in the license number line.) // Bus.Tel.No.: ` V 7y Address: 2 _/t'f/Q L J./Ub S7: L,4AI,ef/V6 o%i ler Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department o Public Safety"S"License: 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 one No. Signature Telephone PERMIT FEE: $ � p M 4 4 A �� � ��� �� P' • i �'. The Common wealth of Massachusetts ? s ! Department of Industrial Accidents Owe of Inveskgations 600 Washington Street Boston, MA 02111 ` - www.mass gov/dia . Workers' Compensation Inseirance Affidavit: Builders/Contradors/Eiectricians/Plumbers Applicant Information Please Print Legibly Name (Business/owizationAndividual):_ JJ���y An IPn/};t ,o /�//!�/Z Address:_ ,2. 7 ItLII'WA A-e( City/Stale/Zip:_ LOi-V rer4-< Phone# . �l 7�- G�o1 -(f Y Are you an employer?Check.the appropriate box: Type of p leetre (requires: 1.Zl aro a employer with J 4. ❑ 1 am a general contractor and I 6. 2"New construction employees(full and/or parttime).* have hired the subcontractors 2.❑ I am.a.sole proprietor or partner- listed on the attached d mt I 7. Remodeling ship and have no employees These sub-contractors have S. ❑Demolition- working for me in any capacity. workers' comp.insurance. g, ❑Bw1ding addition [No workers'comp. insurance 5. ❑ We are a corporation and its *e1��) officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Phanbing 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.] tanY aPpitcant fiat checks ba#1 M=also fill out the section below showing their workers'compenntion policy infin,,udion. Homeowners who snbmtt this of irvit indicating they are doing In work and then hue outside contractors must atthmir a new affidavit indicatiag etch. 4Contractnnr that check this box nurstMatched an adcritional shear showift the name of the m6-eortlraetoa and dwir wn rim'ca.mp.policy• � mfrsrsabott. !am an employer that ispr?W&ng:workers'compensation insurancefornr employees: Below it the ' 6 site information. Pow end p Insurance Company Name: G i'a n �,rGc72 Policy#or Self-ins. Lie.#: WC- Z,3,5-9S-'1j' Expiration Date: Job Site Address: y �! ro//%c, 4-1 Z— —City .tp. Attach it copy of the w rkers' compensation-policy d i ration 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 51,500.00 and/or one-yew 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. do trereby catty under the pains andqWff / of perjury that the Lnformabon provided above is true and come 5i tura: rG(/,' Date- CY ' Phone#: 4) �- Z � Y 7 7 t,� y =Other only. Do not write in this area,to be contlpletsed by city,or town offla L 77777 er: Permit/License# ority(circle one): Health ? Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector son: Phone# ate. rr. . o?c�- ��� . .. °F NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACMUSEt This certifies that . . . . . . . . . . . . has permission for gas installation. . . . . . . . . . . . . in the buildings of . . . . . . at . . . �_� , North Andover, Mass. /3 Fee l�:v. . . . . Lic. No. . .`.�=,�. . . . . , . . . . . . . . . . . . . . GAS I S CTOR Check# 6861 • __ - • _ j T * T \T \ t ■ D �,,,,,II�, T • WATER HEATERS / g ; Date. . f NORT►�, ) -�-- . do TOWN OFA-ANDOVER PERMIT FOR PLUMBING i�D�I•��.�5 ,SSACMUSE� L j/ This certifies that . . . . .. .�. . . !. .f!'�. . . . . . . . .r . . . has permission to perform . . . . . i¢ c. . . 1.... . -Q plumbing in the buildings of . . . . ��. . . at . . .... . . .��:« /''` . . . .1�✓. . . . . , N _Andover,Mass. c� s /��X Fee . ... . . .Lie. No../. y 7 ` . . . . . . . . . . . . . . ... ... • . k PLUMBING INSPECTOR Check # 8136 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Cityrrown: "/ " MA. Date: l Permit# Building Location: C�Gr Owners Name:-1 r19 hk 7i'� Y . Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential, New: Alteration: ❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES z z O Y C) W Z N �- J V W to IL Z t- Y W Q Q 3 z — Z_ N Z Z _ W 1- .O m V) uj 0 a F z >' oc CO) Z N o C) A. x .J W O Z w W Z u. Y = 3 o p i- 3 = z Q � 3 d Y a = w w w cf I- s d 0 rn > > 0 o O z z v, �- _ 0 O Z .� Q Q Q Q F Q ;mmnov_ c� _ �cggwv, mZ) 3: R 0 SU9'eSMT : - BASEMENT.'. 2 fLOOR is 3:. F.tflflR 4 FLOOR 6 FLOOR:;: 7 : I=LQOR 8 .00R Check One Only Certificate# [nstailmgCompanyName Mansfield Plumbin`g&Hea#Ing Int. 25#i1=C j,$Corporation Addis- 363 Jackman St. Ci�yrrawn:Georgetowri sate : ❑i'artnersnfp Business Tel {978.}352-5493 Fax. {978)352-5410 ❑FrmlCamparry NameofticerrsetiPiumberTimothy J. Mansflei INSURANCE COVERAGE. i have a cunerrt liability insurance policy or its substantial equivalent which meets the; { of MGL Gig.1 2.-Y :No if you have checked Yes,please indicate the.type of coverage by:checking the appropriate txx A liability insurance policy ❑ Other type of indemnity ® &arrd tj OWNER'S INSURANCE WAIVER:i am aware that the licensee does not.it�e thei�arce 'byChapter'142 of the Massachusetts General Larios,and:that my signature on t#tis pemiut aFp[catron tq . 2ti[re ofef of UWi; s,Agerit I hBn3tly certify that aU;of the details and istfonnatron hdV Sites(Gi 6ttY836d}t£Sard[t3g 5 a r t*best.of#rty' Knowtedgs and thataii_fgwn6Mg,wark and instat}aSions under the Permit v6be b..,. e - Pertinentprovision otthe Nlassachus�f s state 04ir i Code and Ctra r 142 0 3 3 ayes Hyl of license: Tice " Si nature 0164d,Plum Plumber Master, CdylTovm Ja man License Number. 13437 APPROVED OFFICE USE ONL - ...uY