HomeMy WebLinkAboutMiscellaneous - 51 MILLPOND 4/30/2018 ' 51 MILLPOND
2101095.000.0
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Date../09-/
o?; ~009 TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
sSACHus�
This certifies that .. . . .
has permission to perform ...........�12R_ ��-� �............ �+ .^SQ-�- .
................ `" .. . .
wiring in the building of.... .. ..
h1 ................ ................................................................
at ... .1.......... .,.1...............f...... .......,North Andover,Mass.
Fee..... .'..........Lic.No.L � ..........:.
:.............................................
( ELECTRICAL INSPECTOR
Check# q. 337 I
l,ommonweallh of Mai6ac4aselta Of'cial Use Only
c�
Permit No. �j`9—�
'r 2epartmenl ol5ire Servicee
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11071
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(1v1EC),527 C 12.00
(PLEASE PRINT IN INK OR TYPE ALL I_NFOP Date:
City or Town of: )nl?� AIAJ( A,,AtTo the Inspecto of res:
By this application the undersigned gives notice of hi or he intention to perform the electrical work described below.
Location (Street& Number) �,G (�
Owner or Tenant rl 1 Telephone No. r
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building -LNI � 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: R
` I1AA f—A rd
om letion o the ollowin table may be waived by the Ins ector of Wires.
No. of Recessed Luminaires No.of Ced.-Susp.(Paddle)Fans TransTotal
Trsformers KVA
No.of Luminaire Outlets No. of Hot Tubs
Generators KVA
AboveIn- L mergency ig ting �—
No.of Luminaires Swimming Pool rnd. ❑ 'o.o rnd. ❑ Batter 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
TotaInitiatin Devices
No. of Ranges No.of Air Cond. Tons l No.of Alerting Devices
of Waste Disposers Heat Pum Npmber T s KW No.of Self-Contained-
No.
...................................
Totals: ��� Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
31
No.of Dryers Heating Appliances KW Securitystems:*
y
No.of Devices or Equivalent
Heaters Si s Ballasts No.of Water KSiW No. No.asts Data Wiring:
No.of Devices or Equivalent (�
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
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 certify, under the pains and penalties ofperjury,that the informatio on this application ' ue and complete.
FIRM NAME: LIC.NO.:Zlo(o(o r_
Licensee: r i Cr�n / Signature LIC.NO.: gi13+9
(7applicable, enter `exempt"in the Alcense number line.) Bus.Tel.No.:'118 ]5n 6100
Address: Alt.Tel.No.:
*Per M.G.L. c. 147,s. 57-61,security work requires Department of 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
Signature Telephone No. PERMIT FEE. $ _
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The Commonwealth of Massachusetts
Department of lndustrialAccidents
Ogee of Investigations
1 Congress Stree4 Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name(Busins/Organization/individual): Cranney Companies
es
Address: 10 Rainbow Terrace
Cit 1State/Z :Danvers,MA 01923 Phone#.8DO-559-7000
Are you an employer?Check the appropriate box:
Type of project(required):
1.M I am a employer with 72 4. ❑ I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. El New construction
2.E1 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' 9 Building addition
[No workers'comp.insurance comp.insurance.: g
required,] 5. We are a corporation and its 10 Electrical repairs or additions
3.❑ I am s homeowner doing all work officers have exercised their ILEI Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.❑Other
comp.houanee 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 contra tots must submit a new affidavit indicating such.
rConttactors that check this box must attached an additional sheet showing the name of the sub-contmetom and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that 1s providing workers'compensation Insurance for my employees. Below is the policy and,job site
information.
Insurance Company Name:New Hampshire Employers Insurance
Policy#or Self-ins.Lic.#:ECC60040004772015A Expiration Date:03125/16
Job Site Address: i I City/Sta&Zip: — AMO V M 1 Ma
a
number Attach a copy of the workers'compensation policy declaration page(showing the policy and expiration date). O 1 Bt5
Failure to secure coverage as required tender Section 25A of MGI,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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert fy under the pains and penatldes ofperjury that the informationprovided above is true and correct
Si tore: Date:
03/26/15
Phone#: 597000
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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Date....................d.........
TOWN OF NORTH ANDOVER
0
'A
PERMIT FOR WIRING
SS C'4US
This certifies that ........ ..... ........................................
has permission to perform .......... . .... ..........................................................
wiringin the building of.......�:........................................................................
at.....-5/.........'............ ..........
................................ ,North Andover,Mass.
Fee. ................. Lic.No �w....................
Check #
7523
Commonwealth of Massachusetts Official Use Only
Permit No. ;70
Department of Fire Services
1 Occupancy and Fee Checked
lug BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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 IN INK OR TYPE ALL INFORMATION) Date: 7 --1 ;7
—�7
City or Town of: d!/, 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) c-,57
Owner or Tenant �/ �' �, '/�/ Telephone No.
Owner's Address S'
Is this permit in conjunction with a building permit? Yes EJ--No ❑ (Check Appropriate Box)
Purpose of Building w Z, Utility Authorization No.
zria
Existing Service Amps Z" /Z c.® 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:
w
Completion of the followin table may be waived by the Inspector of Wires.
No.of Recessed Luminaires �' No.of Ceil.-Susp.(Paddle)Fans o.o Total
l 6 Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- o.of Emergency Lighting
No.of Luminaires Swimming Pool rnd. 1:1rnd. ❑ 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 an
InitiatingDevices
No.of Ranges No.of Air Cond. Total Tons g No.of Alerting Devices
No.of Waste Disposers Heat Pump umber Tons K -
No.of Sel Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Munic'pal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.o Water No.o No.of
Heaters KW Data Wiring:
Signs Ballasts No.of Devices or E uivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
i No.of Devices or Equivalent
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: .7 f7 ,/ 7 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 certify,under the pains and penalties of perjury,that lite information on this application is true and complete.
FIRM NAME: ��, c LIC. NO.:
Licensee: 1X f ,,, Signature LI C,JN O.: /,�FS'y 3 3
(If applicable, e e`'"exempt"in the license number line.) Bus.'Tel. No.:
Address: ,.c Alt.Tel. No.:
*Security System Contractor License required for this work; if applicable,e er the license number here:
OWNER'S INSURANCE WAIVER: 1 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. $1-4y �
Signature Telephone No.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' d 600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information �A Please Print Legibly
Name(Business/Organization/Individual): ,Z -4. s "/
Address:
City/State/Zip: Phone#: �Pj.v,— cd
Are you mployer?Check the appropriate box: Type of project(required):
1. ' am a employer with 4. ❑ I am a general contractor and I 6. New construction
I!I employees(full and/or part-time).* have hired the sub-contractors ❑
p 7. emodeling
2.❑ I am a sole proprietor or partner- listed on the attached sheet. #
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.[1 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.❑ Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.F1 Other
*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.
+Cont actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: %�/�N o /��/ti •L,�•�s'_
A Policy#or Self-ins.Lic.#: (%/��/ , 'l�3 t� 3 Expiration Date: G
Job Site Address: S—/ 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
f 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 may be forwarded to the Office of
J Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and pal ' sof per'u that the information provided above is true and correct.
Si nature: enDate: -7
Phone#: Z 7J—' J—_ — ZZ d
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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Date
TOWN OF NORTH ANDOVER
10
PERMIT FOR PLUMBING
�sS�cMUSE�
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
s has permission to perform . . . . . 64 .....`. .. . . . . . . . . . . . . . .
plumbing in the buildings of C. l . . . . . . . . . . . . . . . . . . . . . .
1
at . . . .l?.r.<. t. l��� . . . . . . . . . . . . . . . . . . North Andover, Mass.
Fee. . .—Li c. No.. .. . . . . . . . . 4j-r :.t..!--- . �--e.. . . . .
PLUMBING INSPECTOR
Check # �l
7444 :'
i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Loqation 114L`` —j Owners Name ( r r Permit# :2qcty
/ Amount t..{U
Type of Occupancy
New Renovation Replacement Plans Submitted Yes El No El
FIXTURES
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7IH FLOQ2
SIS FUM
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(Print or type) ,L Check one: Certificate
Installing Company Name (/U G < f t� Corp.
Address L Partner.
O �
Business Telephone r ? Firm/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate bo)C
Liability insurance policy Other type of indemnityElBond ❑
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 er Agent
I hereby certify that all of the details and h&rmati I have subm' ed(or ent in above app' o true and accurate to the
best of my knowledge and that all plumbing work d installatio s performe der it Iss fo pplication will be in
compliance with all pertinent provisions of the Mass tate Cod and Chapter o e General Laws.
r
BY o ICe er
Type of Plumbing icense
Title
City/Town LICCIMINUMUer Master Journeyman El
APPROVED(OFFICE USE ONLY
` Date. .. ..... .
AO oT*4
OE 11,
TOWN OF NORTH ANDOVER
• - PERMIT FOR GAS INSTALLATION
h
�9SSACMUSE�t
This certifies that . fir A-V A,. :�. . . .��'� /. . . . . . . . . . . . . . . . .
has permission for gas installation . .j. !1!t .l y f. . . . . . . . . . . .
in the buildings of . . .f. . . . . . . . . . . . . . . . . . . . . . .
4 at . . . . ./. . �.! .�. . . . . . . . , North Andover, Mass.
Fee. . v . .. Lic. No../.U.-��. . .
F AS INSPECTOR
Check# p 6
6060
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER, MAASSSACHUSETT
BuildingLocations r UCO
Permit# G
v O Amount$ ?C,
Owner's Name G
c
New Renovation Replacement D Plans Submitted
Ea
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W � G � = O w EW"
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A SUB-BASEMENT
B A S E M ENT
IST. FLOOR
2ND . FLOGR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or A �^ �� j Ch ck one: Certificate Installing Company
Name / k8 , faA - ( Corp.
Ad ress Partner.
usmess lelephone - (� �`Firm/Co.
Name of Licensed Plumber or Gas Fitter/ A
INSURANCE COVERAGE Check one:
1 have a current liability Insurance policy or it's substantial equivalent. YesNo�
If you have checked yes,please Indic he type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 0 Bond 13
Owner's Insurance Waiver: I am aware that the licensee does 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 13Agent
1 hereby certify that all of the details and infor ation 1 have submitted(o entered)i bove applica' n are t e and accurate to the
best of my knowledge and that all plumbing work a i s pe rf med un e i Issue or this plication will be in
compliance with all pertinent provisions of the Massachusetts State a pter 142 o he eral Laws.
By: nature of Lic sed Plu r Or Gas Fitter
Title Plumber 1
City/Town Gas Fitter (cense um er
Master
APPROVED(OFFICE USE ONLY) Journeyman