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HomeMy WebLinkAboutMiscellaneous - 6 WALKER ROAD 4/30/2018(0 T- 0 N � • 0 U o LL m Q c M � U t0 a) U a) C a) c 0 o72 Y 72 W o U � 0 0 N Q ` o 6 Z 0 o co � U c o TTQ 3 iL r LL > 0 L ca E 0 L o 0 ` F- -0 -0 � C LL 5i5 t 0 0 - Y 0 y .N Z W U) o 70 J O 0 > a F -a > co CO Q W M U -Cm a) w Z U of E d U E O 4-- O O E C'r co L d a) Q_ 0 Q • - • U)Q o a) o 0 t U •� Y m N J Q .2) • L) a U 0 Z CN • N LL L U SCD 3 ca J ,U 0 N M Date'.C99,: °9 . TOWN OF NORTH ANDOVER PERMIT FOR*PLUMBING This certifies that . . P . Z ............................. has permission to perform ................... plumbing in the buildings of .. ... ................ at ................��.�..:� .��-H-��.� .... ,North Andover, Mass. �PLASPECTOR Check # GGa 8125 -- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING , City/Town: � �" `�� , MA. Date: e,119Permit# Building Location: Owners Name: & X Type of Occupancy: Commercial Educational Industrial Institutional Residential New: Alteration: Renovation: ✓Replacement: Plans Submitted: Yes No FIYTtIRFS 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 have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy V . Other type of indemnity Bond OWNER'S INSURANCE WAIVER: l 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 I hereby certify that all of the details and information I have submitted for 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 issu d for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 o eneral Laws. By Type of License: Title ✓ Plumber Signature of Licensed Plumber Cityfrown Master APPROVED (OFFICE USE ONLY) Journeyman License Number: 13471 �cj Z Z N Y O V (n a Z ~ N Y �' rn —i a V W N O LU LU Z W w a a a z� rn . z 9 X W z 9 OZ v if i- 4 0 a z = 0 as W N z a QG Y= t ti V I— 3 = a Q vt 1— V>> z a LL O 3 O a O Y Z a= z W W i— W I— W _ a m m o e i i Y g °a: 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 KLFLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR WTWFLOOR Check One Only Certificate # Installing Company Name: Robby's Plumbing.Heating.Draincleaning, LLC. Corporation Address: 15 Dorian Drive Cityrrown Bradford State: MA Partnership Business Tel: 978-556-5617 Fax: 978-372-6139 Finn/Company Name of Licensed Plumber: Roberto Flaiani 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 have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy V . Other type of indemnity Bond OWNER'S INSURANCE WAIVER: l 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 I hereby certify that all of the details and information I have submitted for 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 issu d for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 o eneral Laws. By Type of License: Title ✓ Plumber Signature of Licensed Plumber Cityfrown Master APPROVED (OFFICE USE ONLY) Journeyman License Number: 13471 �cj 05v�' Date .:'�1..3v&/t.�.......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that. .A14. + ............. d Le -1 ...:....:... ............................... . has permission to perform'..VA r�x�l�4 yQ J plumbing in the buildings of ................................................. ............................................ at ..�a. a...,b i is 4d.....z- a h Andover, Mass. Fee w Lic. No. /3`? ....... ,............................................. !,' (PLUMBING INSPECTOR Check# �bf©U �j wigo'l Rn m las Icam I a a W��p� _r_1 INWIMI Kiwi WMINNOWIMP M 'JERI , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE L 5' 1.b� i, PERMIT # JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS if TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL J�K PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES 01 NOF -I FIXTURES 1 FLOOR- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM J _JI -1111 _j I DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM L.I== f DISHWASHER DRINKING FOUNTAIN J! FOOD DISPOSER _1 FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK ILAVATORY ...... .... - ------ 7_J ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL 17-1 WASHING MACHINE CONNECTION wigo'l Rn m las Icam I a a W��p� _r_1 INWIMI Kiwi WMINNOWIMP M 'JERI , .. . - _-1 __J L-11 ---._ OTHER .1 if Ir I INSURANCE COVERAGE: I have a current liability insurance its policy or substantial equivalent which meets the requirements of MGL Ch. 142. YESI NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE OF INDEMNITY BOND [__J1 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 JEII 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 PertinentOf the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. CIA Z7 PLUMBER'S NAME �-�PJILICENSE # i i I SIGNATURZ�� MP 59",JP01 CORPORATION MJ # PARTNERSHIPD-I# LLC COMPANY NAME ADDRESSI CITY :l/, zip 0 1ffq,$- TEL 63 --5 FAX CELL H °z F U W 7�7 W o z hhh N ❑ O N W w O W a Z _ ~ F- W O Q w r" iWW O � a CO aco w O z a W � P� Q U J IL a B � x w LL H Z O H U W Pi rA C7 a a p O , a ry • X The Commonwealth of Massachusetts - Department oflndustriglAccidents Office of Investigations 600 Washington Street .Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance .Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization4ndividual): Address: City/State/Zip; Phone M Are you an employer? Check the appropriate box: - Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• [J Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, D Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their 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.] employees. [No workers' 13.0 Other comp. insurance required.] xAny applicant that checks box4l must also fill out the section below showingtheir workers' compensation policy information. 7 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 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 Policy # or Self -ins. Lie. #: 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 requiredunder Section 25A of MGL 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. Ido hereby certlo under the pains and penalties of perjury that the informationprovided above is true and correct Signature: - Date: Phone #: 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 IN 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 employer, 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." 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 compliance 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 until 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 certificate(s) 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 returned to the city or town that the application for the permit or license is being requested, not the Department 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. Anew 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 burn 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: Tho CoMrAmmalth of Massachvsotts Depaxtme.at offadusidal Accxdouts • Af�ee o�Igyedtigatio�,s 6.04 WasbiiVoa Strout ]Boston, MA 021 X Z TQI, # 617-72.7-4100 oxt 406 ox 1,-877,�MASSAFF, Revised 5-26-05 Fax# 617"727-7741 v�t�w_mace anc�fi�;a September 23, 1991 North Andover Board of Health 120 Main Street North Andover, MA 01845 Good Morning - I am hoping that you can help us in this situation. My husband and I live at the Meadowview Condominiums on Walker Road. During Hurricane Bob, we were flooded in our basement condo with approximately 34" of water. Meadowview was quick to respond to help us out and replace carpets. They are not, however, acting quickly to fix the problem with the water. We have had the building professionally surveyed by a couple of construction people and both told Meadowview that the only way to fix the problem of water ever coming in would be to put perforated piping around the entire building and run the water off someplace else. The idea was well received until they found out the cost - approximately $20,000. I was told that they do not have the money and are not going to fix it. There is an electric pump outside of my neighbors unit which they feel will take care of the problem. Neither of the construction people felt this was the answer. One thing that one of the construction people did tell my husband first thing is that this water coming in from the ground is a big health hazard. Because it is ground water, it is not sanitary. We do have two young children, age 4 and 19 months. The youngest has Cerebral Palsy and is unable to walk or crawl, therefore he does spend a lot of time on the floor. It is also an electrical problem, because the water from the hurricane came in from both below and from our wall (you could put your hand on the wall and feel the water rise). I do not want to think of what could happen with mixing two young children and water and electricity. We just want to be able to live in the condo safely as does everyone. Is there anything that you can do for us? Since this is a health hazard, can you put any kind of "pressure" on the board of trustees to get this fixed? We are going after every and any angle possible to get this problem fixed. I would sincerely appreciate any help you can give us. If you need to contact me, I can be reached Monday, Tuesday and Friday at (617) 942- 2000 x2228 or Wednesday or Friday (after 1:00) at 683-9526. Thank you for your time and help with this situation. (a l�atiK�1� �cl �i ` Noln� �ciouik -5o Sincerely, Darcy W. Hildreth C P IN1 CO LAIN ADDR SS C OCCUP T PR NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street • North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Housing Inspection Report INSPECTOR Form MHIR•1 Action Press 8857000