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HomeMy WebLinkAboutMiscellaneous - 55 ELMCREST ROAD 4/30/2018 55 ELMMST ROAD 210/055.0-0026-0000.0 kDate.` /!Sly.Z. . . . . ... .. MORTM o� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION •,.�,��'�to �9SSAC HUSE� This certifies that . �'��+?` . . S . . . . . . . . . . . . . . . . '. has permission for gas installation in the uildings of . . . ,/.v9 /�gU�S at - . /m. .!. . .. . . . . . .... . . . . .d North Andover, ass. ,Z1 Fee. Lic. GAS INSPECTOR Check# � 8099 E y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:-/V' a(/ �� MA. Date: / Permit# Building Locatio n Edo ��� Owners Name: /r q/ ;9 Ui Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional❑ Residential-0` New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ' Plans Submitted: Yes❑ No❑ FIXTURES - - - - - - - - - - CO - ui Lu z w Cd co W Q m C) i W - tYF- m = 0 W W 0 m 0 = co w 0 z Z o w w Z W W O m C CO Z m o Q a HQ W W w N U m a o Lu i� g W O2: W O W LU = LL Z W W Z C7 J I- H O Z --I 0 u. fes,. = W � W W O >- W W LY W W - m W O Z 0 0 H > Z H = V O o LL (7 O Z Z O a Qf I- M > O •' SUB BSMT. BASEMENT 1 FLOOR 2NDFLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR ' 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# _%�.��.� ��y/��h�j�S � �h� j /) ❑Corporation Address pjaz City/Town: C'Y?-J Stater El Partnership Business Tel: ly /y ` Fax:�d J p 103-e ❑Firm/Company.3 GName of LceS d�mb �r/ �tter: '� 47-1111<12 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ElNo ElIf you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIV R:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts G eral La ,and that my signature on this permit application waives,-this requirement. Check One Only Owner ❑ Agent ❑ Si na ure of Owner or Owner's A ent By checking this box❑;1 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 perfor ed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code an hapteri142 of the General Laws. ,b TyRe of License: • By Plumber " -K ° Title El Gas Fitter loo B Master Signature of Licensed Plumber/Gas Fitter Citylfown ❑Journe ma Y n License Number: %�s APPROVED OFFICE USE ONLY ❑LP Installer ' L The Commonwealth of Massachusetts Department ofIndustrial Accidents Office ofinvestigations ..600 Washington Street ..IF Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizafion/Individual): - - 'Address: - - -- - - - City/State/Zip: Phone#: Are you an employer?Check the appropriate boa: F7. Re ject(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).V have hired the sub-contractorsconstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 odeling ship and have no employees These sub_contractors have olitiOn working for me in any capacity. workers' comp.insurance. in addition [No workers com .ins 5. We ar gp urance ❑ e a corporation and itsrequired.] officers have exercised their ical repairs or additions 3.❑.I 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,Q Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *�sy applicant that checks box rl must also gil out the section below shon^ag; u-worl:�:s'c;mp,=,sadon 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. #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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.M 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 ofMGL 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 certify under the pains and penalties of perjury that the information provided above is true and correct: Sip-nature: Data: Phone#: Official use only. Do not write in this area, to be completed by city or town offzciaL City or Town: Permit(License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"'an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employe=,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than•three apartments and who resides therein,or the occupant of the _ _..._..dwelling house of.another_who employs persons.to do_maintenance,construction or-repair work-on such dwelling-.house or on the grounds or building appurtenant thereto shall not because of such employment be.deemed to be an employer." to er." MGL chapter 152,*§25C(6)also states that"every state or local licensing'agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coinpliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work i mtil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es) and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be.advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date-the affidavit. The affidavit should bE' � et'�1_�'vd to the pity or t+�Gdu t3aha-c the application for the p2rxait'oF EcensY is berg reques*.ed,not thee IJepartrs'e-1t of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be-used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would'like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth. of Massachusetts Department of Industrial Accidents Office of Invesfigat ons 600 Washington Street Boston,MA.02.111 Tel. #617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#6.17-72.7-77449 wvm,.mass...gov/dia. Date. 9344 . . . . . . . . . . . . ORTN TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING ,SSACHUS This certifies that . . . . . . . . . . . . . . . . . . . . has permission to perform Adel �. . . . . . . . . . . . . .?*??o. . . . . . . . . vz�* plumbing in the buildings of . /*?�. . . . . . . . . . . . . . . . . . . . . . . . . 57— at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . .North Andover, Mass. Fee.'-:�4,-��.Lic. No..4V.0-3 PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK V-4 CITY ��• �d(O- MA DATE] 'PERMIT# JOBSITE ADDRESS L��ic/c�� j OWNER'S NAME1 J i� Jr OWNERADDRESS�/fir l�ir('/e TELJ 373 5`� IFAXI I TYPE Ofd OCCUPANCY TYPE COMMERCIAL( I EDUCATIONAL RESIDENTIALAF PRINT CLEARLY NEW:I I RENOVAT1014:I I REPLACEMENT;,( PLANS SUBMITTED: YES l ( NQ FIXTURES T FLOOR- 13SM 1 2 3 4 5 h 7 ti 9 10' 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I . DEDICATED SPECIAL WASTE SY$TEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I . ....;.., __.:. .. I ........ :..::.. _ .....:..... DEDICATED WATER RECYCLE SYSTEM DISHWASHER f . . . . . 1 . . DRINKING FOUNTAIN ` FOOD DISPOSER FLOORIAREADRAIN INTERCEPTOR INTERIOR) KITCHEN SINK I ... 1 LAVATORY i , . _ ROOF DRAIN { _ [ - I' SHOWER STALL SERVICE/MOP SINK( URINAL WASHING MACHINE CONNECTION — WATER HEATER ALL TYPES. WATER PIPING .OTHER J, ' f T _ __---L INSURANCE COVERAGE: have a ctirrent,liabilit iiisitraiice policy.or its subtantial equivalent vrtiich meets the requirements of MGL Ch.142. YES! I NO ( I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY I BOND(, j OWNER'S INSURANCE: � VER:I ai lane that the licensee does not have the insuralice coverage required by Chapter"142 of the Massachusetts Gene aws,and t any signature on this permit application waives this rettttireinent. _ CHECK ONESNLY: 0 ER ( I GENT.I ( - - SIG TU E bF OWNER OR AGENT 1 hereby certify that all of the details and infonnallon I have submitted of entered regarding,fhis applicatio;1in ate true and acc a to the be of my knowlddge and that all Plumbing work and Installations performed under the permit Issued for this application Wll be compliance •' i a7'lee revision of Massachusetts State Plumbing Code and Chapter 142 of he General Laws. I PLUMBER'S NAME %��cs� ,��'T j LICENSE#k31a3 SIGNATURE I mp_, I JPI I CORPORATIONIJ#' JPARTNERSHIPI (#j ,LLCI j#I COMPANYNAME /, . f g /I/.),?164/P e,ItC")ADDRESS(/ OX CITY STATEll �,#1 ZIP 1. <53—/�6 TEL 1 l0,5 FAX CELL�� 31 EMAIL OUG, 1[?M.. .. G rNSPJC'C N'NOTE, L 3t. T'bNAL INPE,CTtON NOTES Yes No THIS APPLICATION'•SERYES AS THE PERMIT ❑.' ❑ � FEE:'.$ PERMIT 9- j � •�,�,,�/���ifC'r— /�irJl.� PLAN1IBym5x1..N0� - r I - + r. �a I F r i Yrpjylif..i"o.'aj[>�efltllt b, Nfir`s {(chtfs�tls =� D��{rx�luterifo�`Xt(tfrtslt�t�rl.•�tce«leitfs 4C N 6.�U:�vrslclrrgloitSYt�ef Boston,MA 02111 '`� ►t�tl►,�tr�rssgot�/trrt N-It4[=tccrs�'Comae►istn[tTtt4ttnii�t;Aft�tlnt�eiTai[ifitcislLTfe�atos�rle [rlcin)tsl�' ti[ilel� 4 ••'tt[tlielt(tfT�tforiuttli6ie . •._ ....... _ - • Ptens�a'ii[�.�.`il'►•� € I1�EtttiO(13ii$'utcsi�Ui��lriiiitiontJititividualy: aT arose 4}t��l�t�iCe��i�c .. ... .. . .. .l'�ostt �rr�• .. ,. . . .. . -... . .. - - Atirk6jt0iteillyol:cr?etteclr(ltctt(iitiolninteGor: 7'' bf tto ecE rc utre�i; } 1�E][aittaeurglb1'erWilli .- rl.[�tant0getteralcoittrdctormitt16, Ke ttoiistriiwott I,aipto�ecs(GllCnnLrorpctit (74-11 = IkaeedttrcdtitcsuLcoritrnclors f •D�ttntl5oit:ttraprietororttat�ncrlisteettititiiettltacitecis�ree(,g 7. dRctttoti-cii»g f r sliiPnudhat�cuoeaipiogces 7:ties¢su6•coEitrnciotstinro $t �Di:iuolitioit t` viorkhIg Foriucfttt<nycnpttcttyt ttioikers'cotttp.insinnuce:, h Q`]3titftliogt<dtliEion {l�a_teori ct��coritp:in5utttttct; �:❑WO Are a cbiporattgn and its [ (cc it i'�ercise<�liicfr 10 aIs'led hteal rQ irs.oracidi[iotis 3.[]I,not.ritionicotetiertt6ii>Si11Wotl: it�fiEofcteatt�tiolt�ttMGL iI X�Ituubtugnptir'sorndditio»t } E 110telQuo worker count). �.[S2r 1101),Out I10 t'2.0 Roorrepairs itisurmicorequieed.]'t oil ij)toj�ces.[hiol orTtci's' j cotltp.tnsurtiltcc►enutrctfj 1 ,Q'Otiter 4�Snsrt±pkg�,}tt4�teTi;cfx[+.�['Iratittr]sofiilc•uttTttsecii�nictou•sfwningt[rticurd;.r;`tutit�y+lallOnpalicSlufukmitiar. ` `i;;at+t;atvtci>tthc+sutmitlt+isetlii�rit Inrlic,�lin lcep rr�Qa'n�r�1[oa�il�:rrd Itten[dreouGt<fcEeu(rca�is uiu;lsu�:irii niit»pE;ti�uit iiJit�:ina nr,G_ ' [Clacis;4ialiulGutktfiu[uzraut[a:GitLt�tanra3itia�;ttlsiactshatci+>iglF._tuntt{ift5tsrib•ray;t]r;taa+r�,�clllciitiii�ikcr nti:�s�c�ticr[nfnuvio,r_ lricfOprreurl,Ivtic=FtlrRllrlcurtrlittbrn�nrlc°rs'cvitl,c�tcsalivicLtsrcrrictceforntlleir,ptvirc�s 13e(vu�lrllrr'l,e,(lci�nuclfnUslf���u li Orrttor(all. 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I'tltsuattf fatiiiss[aftlfe:•an eit��oy��is it'e£iilect as.`::,el�esypersou•iitilte sen=ice o€ailothcr iticl�r;itlyconCract of�lite•,, 8kpi£�orinliplied,.prnlok 119nftt;IL'k . ??eri I03erisif�irte$as"ons iniliviticfz.l,yaitiiers�lip;,a saOlatioh;epxp�rtionprotfierle hleittiGyrolraitjr[�i�ck riiora E1)1efO1%O g;Cigageclit aloinPeriterprise,nililiPlilclingihe:Iegal orthe recenOrornnsteeofalrtilcliF=id�lal,iiaFGlersLi „associittibn:orotlterleg,len7ttY,J%�Ayibg-.04!aye HotvelerfiiC .olLile,ofadtvelliinglnouse having uoffliar`o iliac tfiree:apart»nellis:and�ivlio resides ffierepl;:or:the occupant of'fhe diselilifglionseofnnoftier•ntlloei11p1uylslnersonsto,da»laiinhnalice•,eonsfnictiano��repairCEori:onsucllcilt�lliuglitiiise lit pin:titLgrotntdso bl►itcliilg:iJnpurfenautthereto,llallhlotbeealiSeofsuch.61ploymentbecTeeune(V6be ra, I1'GL cliapicl.IS2; 25G{6)also'states fllat'``escl s f'a[c u I oenT lteensing Aketic<<sltalf iYftliTlolil lite jsst(altee or- i•otletv�l•oi'fl lieelisi<o�•permltto-opertfc a lnfisiuessol�iucotlsfriict bliiWings in fhe conlrioilnealth Ibi•ant 1pnlrcallf�v, Jlas.l�otrrniluceciticcepfnblecEitl'epeeorcompliattcelyith,filehistii•iiuce,Vdven. geKepired's Addiloually.,MGI:bh4pferIS-%§25C(7)states"�leither iheeonnranlveaitlt norariy obs politicalsubctivisIza oilt�t•into any contractfortimperfomlMite ofpurlisivorl;lltnfitaecejifabTeeviclenceofcompliancesub fhFision$nst sh, e i�.�iiuelnenfs oftivschapterliat=a U;;etlprezriteclto tIieeotitractingautltorit};" ' �iliiilicfritls- .. ... . ... t . -- • .. • .... I?Jease til tout.lily lti QFi:�CS''GO)ll�eilsatiou�Tfii}twit t 6niplctalY,p�t.7tec1)g the doses fhafappl�=�q yUtir sittiatioillri?,if tlecas�tit};suppig silo contiacor{s)flalue(s),attciiess(es)'aiidpllonenulhb�r(s}along with iheu cectiCeaie(s}pf fn'stiraucc-,MmifedTiabiiifs=Colnpaflies(GLC)orLimifcdLi bi[it PttYtnoiships(LLP}lvitltno entytayeasotller#listriite e�ifelplillnLyereseso,fapparohlilcesrrsi;sair�eqlulairferde.q-uBir@e:didfroiseeadlyth(wafofrhkiserisi(`ficclnanvlipfeunlsaay,ti6ensiinibsnrneIfaLLCoarLLP does have ittediotheDep• tmentof industrial Accidents forconfirnnatiollofi�lsluanca&overage. Aisoltestt[efasigtfnticldutetlic;lffid'-wit ThetifficlaWsliould be refurried to fila ci[�or folvn that the application for file pe-l-mit or license is being requested,not fhe'Departnietatt o il indrrstria!Accidents. Sllotild y=oil have aatY'gaeslions regardillg:the lalc br if y6t►are required to.•obtriinn a workers' �utiiptogaflonpolioy,please call tine*1,iiatfine5 zatthenfnnber istedbeiotu. elf-irfstltctl.coinpait'iessitouiti"ter their pelf=fristitance license numberolttheslppropriate Iine. CFt4 orToll?i Officials Pie;iseElvsmrethat the aftiilavhIscaiil�rletoafu-printed.legibly. 71ieDepstfftnthas. rovideda.s ace at bo ;, P If .. e. ltoilt ;oFtRc,afticTal=it£or}=ofe fo fl[olif'in fiteevetltthe Ofticetif Int=estigatians has fo colttiicLyouYegaa�lulglhh flppl[cant, Pleasebesur@ to fill in(he pMIlifllicensentnnberwiiich tvili.he.ltsed ma.reference-;i11111ber,.Inadditio►l,an appliceat r Gat must'sublllit millfiple pemniJliceilse-applicaltoris-iit ally*given year,meed-only ttibnrit one aftrdavit indicating enront Nolle-yinfontiation(ifnecessaty)andmidei"Job SifGAdclrass"tineappIicalit'sholricltvrite'fat[Iocaliorls3u . (cif-oi >fq�Vh)"Acopy o£thea[tUnit thathasbeenofricialrystampedoinrarkeclbytilecirj=o:fo117tuiaybe-provideclfo Ile aliplicantasprooflhafaYaliclaftidat'itisolifrleforfir[urepernlitsorliceuses.A1ie1v.Aidavitmust6efilled outeach ve<�r:li7nereaJronleoll°nerorcizertisdbtaimg.aiceeofpeiitlnsrashim orcoimercial i voiltuto Oe:a dog.license or pernniito berm Eaves efe)said persoitis NOT rzquired to compiete.this alfidalif. The dOet oflid like twhukyoiaiiiait—- fdC otu coon l`�tio tainctsliolj d =oftlnli'e?ii}�o�tiestions, l p6sa do.not lnesitafe to.give lis it call- fiinc Dsparli,tent'saddrrss.telepliolle anvil faz utlntt?zr; The CQAlf)1f1L4Y? (;fj �\ § �Lt�setis - D61jalftllelllOf11�duM fal COM-wits v l Offiee of Iil�'c t%g t oilir 6Q0'ZVashifigtoll Sffect = Bosl'oit,MA.ON 1.1 Tc1. Gl?727- t)0 W406 of 1.877:MASSAT-b �evis,ni! A101 W,727 47'44 �t►�i�l�.il'l�ss,got'tclta Date.A/.�Y. ........ NpRTM - o= TOWN OF NORTH ANDOVER • PERMIT fS INSTALLATION . � SACHU`�E�t This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . in the buildings of . . �� Pr., �'fU/ . . . . . . . . . at . . .,�a. . . !?� �., Nort `/A7ndvMass ass. Fee. Za: Lic. No.. (I!Eh� is � . . . . GAS INSPECTOR Check# 7938 9217 Date.ghk. . . . HORT1y ?�..�•°;+��ooTOWN OF NORTH ANDOVER O V. PERMIT FOR PLUMBING 41 0 SSACH ,Q ! This certifies that . . . . . . . '+ has permission to perform . . . , +!?. ?!9 !�! R j . . plumbing in the buil ngs of . .. .. .... .. ... at . . . . . . . . . . . . o 4hn;Adover, Mass. Fee. . "r PLUMBING INSPECTOR Check # z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUMBING CITYITOWN: _- A1647`' . odE/1_ —.- _} APPLICATION DATE.`.12 JOB ADDRESS '-- - S— utitC✓ S i -,-_ .C�/J-.- --.-- PLANS SUBMITTED: YESQ N0 POCCUPANCY TYPE: COMMERCIAL RESIDENTIAL 6��REMOVAUDEMOLITIONQ NEW ALTERATIONE] REPLACEMENT t PLUMBING:PIPING—FIXTURES-FIXED APPLIANCES—APPURTENANCES Z ENTER TOTAL AMOUNT FOR EACH SELECTION WMITED TO FIVE 5 NUMERALS ALTERNATIVE TECHNOLOGY DISPOSER _ SINK: MOPLJ SERVICE ASPIRATOR DRINKING FOUNTAIN STERILIZER DRAIN: AREA FLOOR Via.. l EJECTOR STORAGE TANK BACKWATERVALVE 'Fy EMBALMING Lj AUTOPSY URINAL BAPTISM:FONTLJ SACRARIUM Ei FOOD CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM BAR SINK GLASS WASHER WATER CLOSET BATHTUBLJ WHIRLPOOL ICE MAKER L=I WATER HEATER:ALL TYPES G 7� BIDET S INTERCEPTOR:ALL INTERIOR [µ--------. .I WATER PIPING: CROSS CONNECTION DEVICE _. KITCHEN SINK 1 r OTHER NOT LISTED Z DEDICATED: ACID WASTESYSTEM LAUNDRY CONNECTION DEDICATED: GASIOILISAND SYSTEM _ LAVATORY DEDICATED: GREASE SYSTEM ._... PIPE RELINING WORK ONLY DEDICATED:RECLAIMED WATER r a ROOF DRAIN DENTAL FIXTURE I EQUIPMENT SINK: 1.2.3 BAY PREP. DISHWASHER = SINK:CLINIC FLUSH RIM PLUMBING INSTALLER—FIRM-COMPANY INFORMATION CHECK ONE ONLY _- potation Business P H D Plumbing 15 Dorian Drive E]Cor # NAME: -, „9 'ADDRESS s :- r �_r. �Partnership Business#E=...—= Bradford MA ZIP:'01835 CITY: _- — STATE: _ LLC Business#��-�� 978-556-5617 'phdplumbing@ver net ry TEL: �nM FAX.` _... ... .m: EMAIL: TEL: �.. El DBA I Unincorporated NAME OF LICENSED PLUMBER: H v7 i Avv i INSURANCE COVERAGE I have a current liability insurance policy or,its substantial equivalent,which meets the requirements of MGL.Ch.142 YESa NOR If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. El A liability insurance policy Q✓_ Other type of indemnity a 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 CHECKONE ONLY OWNER❑ AGENT Q Signature of Owner or Owner's Agent OWNER'S NAME. �l cc/f __ _ .. _ TEL. ._ M1 — . FAX: I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of th Laws. (OFFICE USE ONLY) TYPE OF LICENSE: Permit# [l Plumber Signature of Licensed Plumber Inspector 0 Master License Number 13471 Fee: Journeyman -- i r— L'TH pF iAA.SS CaMMpWEA MASTER: LtCEN5:ED $ NSE ISSWES THIS LICE : F P, V 04 "�ptA GAJ „plg'�c� 8 11 , �.p.5 jpl/1 l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING CITY11 OWN �Y®!�>� ,�✓/apt ,�-. STATE: APPLICATION DATE. I 02.1/ JOB ADDRESS: GOCCUPANCY TYPE: COMMERCIAL RESIDENTIAL PLANS SUBMITTED: YES E] NO NEWQ ALTERATIONQ REPLACEMENT[3--'REMOVAUDEMOLITIONEj l NATURAL&LIQUEFIED PETROLEUM GAS:PIPING-EQUIPMENT—APPLIANCES—SYSTEMS Z ENTER TOTAL AMOUNT FOR EACH SELECTION JUMITED TO FIVE(5)NUMERALS AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER:ALL TYPES GAS PIPING THERMAL OXIDIZER BOOSTER 7= GENERATOR STATIONARY ENGINE F_ TURBINE i BROILER ILLUMINATING APPLIANCE UNIT HEATER BURNER: ALL TYPES INCINERATOR WATER HEATER: ALL TYPES CO-GENERATION UNIT INDUSTRIAL AIR HANDLER EQUIPMENT OVER 12 500MBH COFFEE ROASTER INFRARED HEATER rOTHER NOT LISTED? COOK APPLIANCE HOUSEHOLD KILN I GLORY HOLE I CRUCIBLE _ COOK APPLIANCE COMMERCIAL LABORATORY COCKS i DECORATIVE APPLIANCE MAKEUP AIR UNIT - DIRECT VENT APPLIANCE MECHANICAL EXHAUST EQUIPMENT DRYER: ALL TYPES OVEN: ALL TYPES - FIREPLACE:VENTED 1 UNVENTED POOL HEATER _ FRYOLATORa ROOF TOP UNIT FUEL CELL ROOM HEATER-VENTEDNENTLESS p PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY ' - t Corporation Business# NAME: P H D Piumbing ADDRESS 15 Doran Drive T_ = . []Partnership Business # CITY: Bradford MA ZIP01835STATE:, LLC Business# -� TEL: 978-556-5617 FAX EMAI1 Phlumbin9venz-.on net EI- DBA I Unincorporated NAME OF LICENSED PLUMBER I GAS FITTER: R662An EVA 1 INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy El Other type of indemnity E] 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 Signature of Owner or Owner's Agent OWNER'S NAME. - ul.�� ... ._ .� �..,. ...._.. , _ FAX:--- _ << TEL I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with f h Massachusetts Uniform State Plumbing Code,and Chapter 142 of the Gener all pertinent provisions o the 8 Pt (OFFICE USE ONLY) TyP e of License: Permit# ❑Plumber F�Gasfitter Q✓ Muer Journeyman S e of Licensed Plumber I Gas Fitter Inspector 13471 ❑Undiluted LP Installer License Number Fee: Limited LP Installer /��8�� A ip Date./.....................1A 4ORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ACHUS Thiscertifies that ............................................................................................. has permission to perform .......... .0.5 .................................... wiring in the building of.......... .............................................................. 7- 5 .................. M at...... ................................. ,North Andover, ass. 0 7id .. ......... T . ........... . . ........ ....... ........ .T.......... . . Fee..................... c.No.. -I PLEcrRicAL INSPECTOR 'Check # 07 '14 Commonwealth of Massachusetts Official Use Only - a Department of Fire Services permit No. 7J BOARD OF FIRE PREVENTION REGULATIONS [Revc10�1 (leavy and e blank) ed (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 CMR 12.00 (PLEASE PRINT.ININKORTYPEALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Ins ctor Of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) S y �6M � Owner or Tenant ��e4o S •P /{ 1,1/ Telephone No.t 7r &,Po'- 9 6 Owner's Address Is this permit in conjunction Yyith buildin ermit? _ yes ❑ No ❑ (Check AppropriateBox) Purpose of Building �/ .,7,9' ��/ Utility Authorization No. Existing Service /G U Amps A`k>Volts Overhead 1-1 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 ofthe ollowin table inay be waNedhy the Inspector o 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 Above ❑ In- E] o.o mergency Lighting nd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS Into,of Zones No,of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No,of Air Cond. TotaTons l No.of Alerting Devices No.of Waste Disposers Heat Pump Number•Tons KW _ No.of Self-Contained Totals: Detection/Alertina Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:*- ' No.of Watero. No.ofDevices orEquivalent Heaters KW No.Si Bal as Data Wiring: Si s Ballasts No.of Devices orE uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No,of Devices or E uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectrical Work: (When required by municipal policy.) Work to Start: 3 / 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless waived by the owner,nb 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 Covera is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [ BOND ❑ OTHER eci ❑ (Specify:) I cerfify,under thepains andpentalties o?f 'Pry,that the biformatior on this application is true and Cor piete. FIRM NAME: L /f,P!/LC-C Gec7/lt C LIC.NO.: Licensee: t Signature LIC.NO.: (If applicable,e t "exemp "'n 'cen,�e number lined / �� Bus.Tel.No.: -3 60-7LI,2 7 Address: Il,r J4,/ Alt,Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department ofPublic Safety"S"License: Lie.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 a ent. OwnerlAgent Signature Telephone No. PERMIT FEE:$ - JUJt•+.Lf L r�J..�1Jf..+-.-(��•L•�(Y rti V. Y.•� ' • .. � I -, k• . .. •c sP �'• � Tx PAssei - - - YAM-[ � �e-xuspectzon xequixec�(��O.OU)•-( ) inspectors'comnze�nfs: - (u'voectore Signa -no s Wals) date I. MROIAL )Alctol • (Crispectoxs', igna a -no' ials) date ' F�sed �3OM INSPNTION: , omments: Cimpectoxs't;ignatuxe•-no initials) Date 4.- DNA U CAVA RD,NAT+OI•A C-90-131 : WA_ M. rassed--f ) ?`♦'ailed--j Xze-inspection required($60,00) �'nspectoxs'eo�nm.eptfs: � (Znspectoxs',�igttatuxe��o�initials} bate 'assed � ) +ailed j )- 'ate-inspectionxeq*ed WHO -[ )' aspectaxs'cozizanents: - �l;�specioxs' zgxzatuxe no initials) .Trate D®OR TAGS..APX TO.BE FMID OUT An j EFT d X SITE.`TM•A.p"A T()3E INSPECTED IS NOT A.00ENSISLEAND A.MNSPECTTONOff`S5.0.00INTO R'H,[ffAR(YFn. -