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HomeMy WebLinkAboutMiscellaneous - 51 COCHICHEWICK DRIVE 4/30/2018 U� c� �— � ' 0 ) / 23 Date . 12. 7.� �-- . ywTTGF�irya • TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . Z. .Z1 7. . . . . . . . . . . . . . . . . . . has permission to perform . . plumbing in the buildings of. �c . . . . . . . . ^.'�.� . . . . . . . . . . . at . ... . . .( C.`. . . . � `` ... . .... �'`. .I . . . . . . . . ,North Andover, Mass. FeeLR-Sn . . . Lic. No.!45�cf. . . . . . . . . . . PLUMBING INSPECTOR Check 4 S 67 Z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r CITY _ MA DATE fl zai z-) PERMIT# � I JOBSITE ADDRESS f C wc�< �, L K1 e.�� OWNER'S NAME av c OWNER ADDRESS w.. I TEL FAX i TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: �]{ RENOVATION: REPLACEMENT:2" PLANS SUBMITTED: YES 0 NOD I FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 � 14 BATHTUB CROSS CONNECTION DEVICE �j DEDICATED SPECIAL WASTE SYSTEM =111 DEDICATED GAS/OILISANDSYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I I I _ ..1 —___j ._..__I _J ( ____! f DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ! __._...._.! I .-- E l f 1 _I FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR f I _.l ......_ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK __._.i _.__.-_f __-_J _.....___-f _—f __.____I _.._.-! TOILET URINAL WASHING MACHINE CONNECTION _i _ - I _ I _ � ' i _ _. L.1 ......+ _ - .. WATER HEATER ALL TYPES ED i i { l ..._...__.J .-_._.._! __ ....Jl= ._. ._ _I WATER PIPING __._._1 OTHER —_ + J i I 1 _...__.__.1 I I f __.._._...I .-...._.__i I _....-.-__i 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 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0i BOND 0 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 0 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 ertinent provision of the i Massachusetts State Plumbing Code-anted Chapter 142 of the General Laws. PLUMBER'S NAME L- °N I LICENSE# Ja9ti,Y ANATURE IMP JP Q CORPORATION - f�# D ;PARTNERSHIP P_i# LLC I COMPANY NAME ADDRESS ,�l ��F✓:(1 G CITY }STATE ZIP TELd3.3 ?�7O _._. n FAX X 9-_Yb4Z CEL .. �d. .. EMAIL fig I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 j www mass.gov/dia I Ii Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leh><bly Naffi0 (Business/Organization/Individual): �J p C_ �� � � �/V I ' Address: ,� Csf ✓��(� 1 ✓,, i City/State/Zip: Phone _ I AFI;ou an employer?Check he appropriate box: i Type of project(required): 1. am a employer with 7 4. 111 am a general contractor and I i employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. I [No workers' comp.insurance 5. ❑ We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,0 Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.[:]Other i *Any applicant that checks box#I 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. 1 I tam an employer that is providing workers'compensation or insurance %nformation. f my employees. Below is the policy and job site j Insurance Company Name: 1 0 I ?olicy#or Self-ins.Lic.#: Expiration Date: , 'ob Site Address: L(� ��` C City/State/Zip�j� yGr kttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). "ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. I I do hereby certify under the pains and alties of perjury that the information provided above is true and correct. I i nature: Date: < hone#: 7 ?'�70_e) Official use only. Do not write in this area,to be completed by city or town official. I City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other II Contact Person: Phone#: Date. . :!��.K!<... . ,ORTk Of it�to ,e1'O I °` TOWN OF NORTH ANDOVE • - PERMIT FOR GAS INSTAL ION �9 N6 ,SSACNUSEt This certifies that . . . �� o.t l./ . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . � in the buildings of . . . ! r` . , 1.h. r.j . . . . . . . . . . . . . . . at . . . J.f-. t�. . . . . ., North Andover, Mass. Fee/G<<. . . Lic. No.;l.cf.(I. W . . . . . . . GASINSPECTO Check# / )c, i 565 1 I c TVM%ACHUSEM UNIFORM APPLICATON FOR PERNIrr TO DO GELS G '1 (Type or print) Date ll NORTH ANDOVER,MASSACHUSETTS I Building Locations cls tc6 wle✓` Permit Owner's NamAmounts_ !vo Name---"* ; New❑ Renovation Replacement ❑ Plans Submitted ❑ w w W x o 0 � Z GF a > U F W z 4 W w o w° x 0 o � w .��" 3 aa° � 0 SUB -BASEM ENT 4- B A S E M ENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR I 7TH . FLOOR STH . FLOOR i (Print or type) ` Check one: Certificate Installing Company Name-- Corp. Address �F. \ Partner. El Business Telephlone ,_ RqU�- Firm/Co. Name of Licensed Plumber or Gas Fitter-2nd INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 Noo If you have checked Yes, pleks2lindicate the type coverage by checking the appropriate box. - 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 Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted Bred)in above application are true and accurate to the best of my knowledge an , � d that all plumbing work and installations rfor ie i er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St: e Gas d Chapter 142 of the General Laws. � I i By. Signature of Licensed Plumber Or Gas Fitter Title Plumberj 9/Q City/Town Gas Fitter License um er Master , APPROVED(OFFICE USE ONLY) Journeyman I I i Date. <,"•��T:�tio TOWN OF NORTH DOVER 0 49 PERMIT FOR PLUMBING ,sSACHUs� This certifies that '. . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . .P.('A-.o . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . at . C .&. . . . . . . .. North Andover, Mass. Fee. Lic. No. `. . . . . . . . . . .�'` PLUMBING INSPECTOR Check .7 165 i I • i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) I NORTH ANDOVER,MASSACHUSETTS 1 Building Location6 `� Date Owners Name \ � n/' .� Permit# ?a0 r- Tvpe of Occupancy t& Amount 1 New Renovation Replacement I P Plans Submitted Yes ❑ i o I ❑ FIXTURES al r Z A 3 F Q ° I sMagvE z isr:>H Bm M MOR FLOOR 41H FLOOR srH FLOOR 6IH FLOOR 71IH FLOCR 81H HD(R I i (Print or type) I Installing Company Name_ W" 7l�/rh���) �Check one: Certificate ;� '7 Corp. Address Vl° 2\ Partner. t�et ,i r ❑ BusinessTelephone SA w — I OA 3A S ❑ Firm/Co. Name of Licensed Plumber: h` / Ode ' t �9.J «� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy91 Other type of indemnity Bond 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 Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have sub e (or entered) in above application are true and accurate to the best c;f my knowledge and that all plumbing work and instal ions p ed under Permit Issued fur this application will he in compliance with all pertinent provisions of the assachu, �tts ing Code and Chapter 142 of the General Laws. By: iIna arc L, nsc um cr I'YPC n Plumbing License Title � i I City/Town_ i�Cc'ase 1 um(�er 'vlaster ❑ Iourne,man ��PPROV ED(CI=FiCF.USE ONLY I I I I 1 Date.................................. NORTH "° TOWN OF NORTH ANDOVER o. p PERMIT FOR WIRING ,SSACMUSE� This certifies that ....... �^ � .......:: z................................ ... has permission to perform ..................::.. ............=". ..' wiring in the building of. (..�:-*... . -s -r. ........ ', -..... .. ... .. r atm .........-:''Lt -X � ...................................................e �`%; ,North Andover,Mass. Fee.......-:............. Lic.No.=.7M? l n . �.... ...... ...................... `'� ELECTRICAL INSPECTOR �f � Check # �> //lI (/' , r 65 i Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. o� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank ` APPLICATION FOR PERMIT TO PERFORM ELECTR CAL WORK ! All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 MR 12.00 (PLEASE PRINT IN INK OR TYP AL INFORMATION) Date: / Q i City or Town of: / 14 DDV49 To the Ins edor of Wires: I By this application the undersigned gives notice of his or her intention to perform the electrical work describ below. Location(Street&Numb_er) f 1 C lZnl/� 4/x SF Owner or Tenant C C / // lephone No. I Owner's Address Is this permit in conjunction with a building permit? Yes)9 No ❑ (Check Appropriate Box) I Purpose of Building l)8DD Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service �= Amps /26 J0 Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Am pacity i Location and Nature of Proposed Ele rical Work: (^ a/ Completion o the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Sus No.of Total P �addle)Fans Transformers KVA ! No.of Lighting Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool d. ❑ rnd. ❑ Battery Units I No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o. Inof itiating and Initiatin DevicesTot � No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump _Nu ber Tons KW No.of Self-Contained P Totals:I Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local ❑ Municipal El Other P g stems: � No.of Dryers Heating Appliances KW Sec No of Devices or Equivalent No.of WaterK�, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or EquivalenIt I Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: ! Attach additional detail if 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 , exhibited roof of s e to the permit issuing office. .1 undersigned certifies that such coverage is m force,and has e p Pe g ! CHECK ONE: INSURANCE ) BOND ❑ OTHER ❑ (Specify:) 6I'�12 Wxpirat Date) C Estimated Value ofI 'cal Work (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under t e s and penalties o ury,that the iinnf�oL o this application is true and complete FIRM NAME: / c j r / LIC.NO.: Il Licensee: eS .Signature LIC.NO.: 03 TA c (Ifapplicab ter` empt"in thelicensen line.) Bus.Tel No- -2b61) Address• �� d Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am a are 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 on ❑owner ❑ owner's agent. Signature ature ent Telephone No. f PERMIT FEE: $ Receipt 9