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HomeMy WebLinkAboutMiscellaneous - 497 FOSTER STREET 4/30/2018 (2) 497 FOSTER STREET 210/104.6-0027-0000.0 Date......�....� .1. ........... f `=r 0 NORrh TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING t sS�CHU5E This certifies that.......11.....! ..........'! �)kA c � ...................................................... has permission to perform.........�n....�- :.�,,......e..!..�(... ..................................... plumbing in the buildings of......... .Q:.fl.....................1...................................... at............... .�..... .� . ... North Andover, Mass. Fee?-Q.n......Lic. No.l!t .... ................................................................................. PLUMBING INSPECTOR Check# \b?9 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATEH�0 hhv.--12 -_ OI-91 PERMIT# JOBSITEADDRESS LAIJ e r OWNER'S NAME F OWNER ADDRESS TEL 11FAX P TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL [ RESIDENTIALK PRINT CLEARLY NEW., -7-11 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES D NOFJ FIXTURES-1 FLOOR- BSM 1 2 3 1 4 5 6 7 8 9 10 11 12 13 14 BATHTUB GROSS CONNECTION DEVICE _.-- -I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM ...... DEDICATED GRAY WATER SYSTEM_ DEDICATED WATER RECYCLE SYSTEM .......... DISHWASHER Er---E-- E DRINKING FOUNTAIN ....... I F-11[771[77'. --------i=F­­­­j=L J , FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHENSINK ------1 .-.._._1 .._-_.___..l ..___.._-_I ..__-._� ._.__.._ ..-___-_-! .-- _._I .--_.._.I _._.___. ! LAVATORY ------1 ­­­ LAVATORY ......_.._....I= __ _.. ! ROOF DRAIN ---___._i ... -:I SHOWER STALL SERVICE MOP SINK r T' OLET OILET ......j URINAL ------------ WASHING MACHINE CONNECTION -------------- t WATER HEATER ALL TYPES ------7 J WATER PIPING F j F--­ OTHER J E INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO [j] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY gj 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 EJ 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 compliarp with all Pertinent A I Massachusetts State Plumbing Code and Chapter 142 of the General Laws. & 76-0 PLUMBER'S NAME LICENSE# SIGNATURE J, mpm jP[j CORPORATION n# ---PARTNERSHIP(- ]'#[ LLC[JA r-"^,OMPANY NAME ADDRESS CITY --------- STATE ZIP F(31J530= TEL .I.7 --qj FAX [77 CELL EMAIL a� y ' \ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ,` /� Please Print Leaibl Name(Business/Organization/Individual): �Q.�, t��u M to i o G #1 i- m N 13C'r l—'a M P&K A• l s Address: '{O LOex6 ST. (AN tT ZaZ City/State/Zip: 0t*.V blit_` MR 01830 Phone#: '��$-9�`i- ?�9 t C� cls 73_771-4967 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).'' 7. ❑New construction 2.51 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.MPlumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for illy employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address:�q4 City/State/Zip: 1{ ►,ppptS2.1 MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andppenalties of petjuty that the ir:forntation provided above is true and correct. Sig ✓�nature: k�G Date: /� 20/Is Phone#. 91S— It q— -4-4 J q (C � '7-3/— I✓ Y nN Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f ( OMMONWE U 14 OF MAI, �S OHi3SETTS BOARD:4)� PLUMBERS AND GASf,.ITTERS I$SUES THE FOLLOWf'I�1'G LICENSE t,_GEISED AS A.S7ER •PLUMBEF2 ' Q v . 'kk A D I D U C A 40 LOC1(E ST J APT .233 HAVE}YN I L,1.. MA 01830 5514 Location°4 No. -4/ Date ��m P �oRTh TOWN OF NORTH ANDOVER O�O•�•`•O .�,tiC R A Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ JACHUSE Other Permit Fee,/- $ x Sewer Connection Fee $ i Water Connection Fee $ r TOTAL $ ` Building Ins for Div. Public Works " pq YEIZi,, NO. APPLICATION�TOR PERMIT TO,BUILDxx*X*x**NORTH A OVER 1VIA I-,+It _ 7 i.•l + '`1 2. RECORD OF 011'NERSUtP DA BOOK PAGE OZONE SUIT DIV LOT N0 f ( ' n: R! ri tl �J tt'0c 1710N 1 ' O ✓ PURPOSE OF BUILDING t Z.O11idEYhSNAMt *_ s i _ 7 `r' `` NO.OF STORIES SIZE j 1f11N P1!S ADDRESS BASEAIENT OR SLAB ): t � y((,, ^� i, h 11�E cx SIZE OF FLOOR TIMBER$ i - 2 111ICNFFECI'$Nei. ,�,. 'RUILDEOS NAME- t ri i f 't l ' , SPAN , 'GI. I .ISTANCE-TO NEAItEST 1101LDINC # + j1'; i. DIAIENSION$OFSIL LS.'i I `' I .t 'IIISTANCE FROM STREET I' q. DIMENSIO(ISsOF�U57S DISTANCE FROM LO'I-LINES-SIDESB.EAII " ! I' DIMENSIONS-OF GIRDERS . I _ AIIEAOF1.0T FRONTAGE I' t sl:'l'}i: IIEIGIITOFFOUNDATION THICKNESS IS BUILDING NE1V SIZE OF FOOTING IS BUILDING ADDII ION ! li MATERIAL OF CHIMNEY IS BUILDING ALTERATION j.. IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTS TO T0117{WATER BOARD OF APPEALS ACTION, IF ANY 1S BUILDING CONNECTED TO TO}VN SEWER ` f is BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PItOPERTV 1NIF0161ATION LAND COST EST.BLDG.COST PAGE 1 FILL OUT SECTIONS 1-3 EST.BLDG. COST PER SQ. FT. EST.BLDG.COST PER ROOM ELECTRIC METERS AIUSF BE ON OUTSIDE OF BUILDING SEPTIC PERAl1T NO. t AT'I'ACIIEII GARAGES AfUST CONFORM-10 STATE FIRE REGULATIONS 4. APPIIOVED IIY: PIANS NJ UST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR D,17'E FILED 011NERSTELN ��� ^' 3 CONTR.TELIl CONTR LICH SIGNATURE Or. OIYNEIIORQUTIIORIZEDAGENT/—�r4� A e9Gt FEE II:LCA, PERMfP-GRANTED Su S' 1 d +1r at ;r t t 1 I j i� 1,': l ci 1 f I is II II Revised 5/5/99 'J.111a l t "ll AORTH o of g.. Andover 0 No �__�,Y:= .: ������ � ��z � ify/ 401 it dover, Mass., YtOw t,) /999 0"?A7ED P'? Cl H BOARD OF HEALTH Food/Kitchen PE I D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ........ ..... ....................................... Foundation COPWA110110 0& Rough has permission toe .7.... buildings on .Y..? ...... .. ...*x4W.0..... .................... to be occupied as....s.*D!!!. Chimney P provided that the person accepting th'ili I in every rq*' ct conform to the terms of the application-on n'file in Final this office, and to the provisions of the Codes and BI O'n'g"*t*o***t' Inspection,*****''*' *''* 'A­ft­e­r**a*t­io­n....a'n"d'...Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S) S ELECTRICAL INSPECTOR Rough .......................................................................... Service 4!5�... ................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR R Display in a Conspicuous Place on the Premises — Do Not Remove Finalough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 6144 � r4ORTH °`t•`'° "° TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING ,SSACMUS� This certifies that ....... A Ue...'........m --CAA�.." ........................................ ! ..... r � has permission to perform ....'.��..jf . . /5.... .�1. ..................................... 4 wiring in the building of......G e�.......... ....................................................... 6. Fd S r n �c� ................ .North Andover,Mass. Fee......:�157. Lic.No.r�.IoZ. A6 ........ l V.? '��/ ���uL'✓�... �,, �, ELECTRICAL INs't'ECTOR Check # Commonwealth of Massachusetts Official Use Only Permit No. �O Vq Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/99] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfortned in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL FORMATION) Date: /0 -/3- Q5 City or Town of: p .� To the Inspector of Wires: By this application the undersigne gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 493 F05'-er usf e'?4 Owner or Tenant V/M &AC-010A Telephone No. Owner's Address SA t--)-e Is this permit in conjunction with a building permit? Yes F-1No (Check Appropriate Box) ti Purpose of Building <IJLiQ�It�a� 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 Ul2C stAil�C �s, r�lu�,� Completion of the following table may be waived by the Inspector o ;Vires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.ot Emergency Lighting rnd. grnd. Batten•Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No. of Gas Burners o.f Detection and Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons K�V No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sec No of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Beaters Signs Baiiasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HPTelecommunications Wiring: /!e No.of Devices or Equivalent t i OTHER: Attach additional detail((desired.or as required by the Inspector of Wires. 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND F1 OTHER [I (Specify:) QIP/ I"i !f ` (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NIEC Rule 10,and upon completion. L !certify,under the pants and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ipr bi A7111A414 LIC.NO.:F/1Q 6 jQ_ Licensee: Signatur / V LIC.NO.: (Ifapplicable,enter "erem fj cut the license number lin .) Bus.Tel.No.-97a -= -7 OLI Address: U bE Alt.Tel.No.: 177- s35-4o,L OWNER'S INSURANCE W VER: I am aware tha he Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. tam the(check one)❑ owner ❑ owner's agent. Owner/Agent —� Signature Telephone No. PERAMIITFEE: S45, I i Commonwealti-i of Massachusetts Olfilcwd ';,�C Only Department of Fire Services WVIXIL' ;Ind Fee Checked , .11 BOARD OF FIRE PREVENTION REGULATIONS i(Rev. I U99] hlank) APPLICATION FOR PERMIT 'ro PERFORM ELECTRUCAL WORK All work to be L)erform,d in-im-C.1"dalicc with the Nfassachu ctts Electrical C,xic(f,111C),527 C'MR 12.00 (PLE.,ISE PRINT IN JMti OR TYPE/ILL _z_',,T__O1?Af4 TION) Date: /3- R5 City ocrown of: 6L- AAjd I o L,�ye To the Inspectoi-oe`Hlires: Y By this application the undersip ric ncd gives )ticc of his or her intention to perform the electrical work described belov- Location (Street& Number) Owner or Tenant &AC-01 ON�ner's Address S q r� Is this permit in conjunction with building* vrniiO Y es L No 'Chie, kAppropriate Box) Purpose of Building Utility Authorization No. Existing Service .amps Volts OverheadEl U,n d,,rd F1 No.of Nluters New Service Amps r Volts Overhead❑ Ud,,,d rj No. of deters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A'� V /Aktnq-M,./c of the following table may be itvived by the Inspector of ff ires._ No. of Total 'No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans laransformers KVA kNo. ol'U,htincy Outlets No. of Hot Tubs Generators KN7A Icy rung INO. of Lightin-Fixtures Swimming Pool Above 0 In- ❑ N o�_of Kmerge n nits grnd. �irncl. BattU en -1 1o. oReceptacle1 Nf Outlets No.of Oil Burners IFIRE ALARNIS No. of Zones 1 NNo.of o. of Switches No. of Gas Burners Detection and Initiating Devices Total 1,No. of Raru,,es No.of Air Cond. No.of Alerting Devices Tons 0.of Waste Disposers Neat Pury)p t' KN No. of Totals: Detection/Alerting Devices Municipal ;No. of Dishwashers Space/Area Heating KW Local 0 Other I Connection lHeadw,Appliances Kw Security Svstems: of Drvers NoloCDevices or Equivalent Ffi -�of Water R", INo. of No. of Data Wiring: fi-eaiers S ig n s Baliasts I No.of Devices or Equivalent Telecommunications Wiring: jNo. Hydromassage Bathtubs No.of.Nlotors 'Total HP V14 1"'e'ec No.of Devices or Equivalent 1 OTH ER: L— ( "itach adihoan,:! IN'SURANCE COVERAGE: Unless waived by the o�%-ricr, no Permit for the performance of clertrical work rt-lay issue unlet;.; he licensee provides proo[ofliabiliLy insurance including"completed operation'' c.o%eragc or its substantial equivalent, t hc such covcxa,.�,e is in force-orld has exhibited proof ui[IL,odic::. .in(M'.�w,ncd certifies that to the rermit iss CFIECK ONE: INSUR-A-NCE [V Fi_OiND I- OA/ ;, Af i 01-1-IFIZ 0 (Specify:) D:ile jIjI',1LC,j Vaiue of d Work- \V11':I In,qu rcd by inun I-:ra I C. �hc% hlspcctlon5 to 1)% reouc:,t�:kl M Z!cco-rdallce vilh N-lf_C fulc 10. and tirkri Collmicrion. 13us. Address: 0W1tr,11. iNSURANC!, i Jil 0o'S 1:0il­;-CIhC owlicl S By III.\ 1 :in; nit: (�:nc i: ncr S 45,