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HomeMy WebLinkAboutMiscellaneous - 67 MAIN STREET 4/30/2018 /%/N 4 ` i I I Date.����. °. . HORTI{ 3?�.<� •�;..��oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SA HUS This certifies that .���,�.?. �. . .��. 1. .,7. . . . . . . .�. . . , . . . . . has permission to perform r. . . . . . . . . . . . . . . . . plumbing in the buildings of . . .� .. . . . . . . . . . . at. . . . „. ? . . ./:�;,.�-�./. . . .� 14... . . . . . . . , North Andover, Mass. r- Fee.��'U. . . Lic. No../Ul.^�. .�. . . � . . . . . . . PLUMBING INSPEC OR Check # dt 8565 MASSACHUSETTS UNIFORM"PLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS � Date Building Location G1 1 Permit# Owner Amount _�Q rS � New Renovation ❑ Replacement, • ❑ • � Plans Submitted Yes ❑ No FIXTURES r RSF1MW 1ST IIOdt M lQOCR 6MELOM 7M110M gm Him (Print Check one: CertificateInstallingComPCompany �.Corp. 741r Address i i �49 Partner. Business Telephone p (��� Name of Licensed Plumber: C 1 Insurance Coverage: Indicate tthhe t of Insurance coverage checking the appropriate box: Liability insurance policy 'C�' Other type of indemnity Bond Insurance Waiver: L 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 I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: Igna e ot LicensE7715—rnT7 Type of Plumbing License Title �© S City/Town Icense NEFF= Master Journeyman APPROVED(OFFICE USE ONLY i I The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 ky www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �c Address: / l,, l / City/State/Zip: �o,.., vice,✓( / �� Phone#: 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 erwloyees(full and/or part-time).* have hired the sub-contractors h. ❑New construction 2.211;m 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.insuran ! [No workers' comp. insurance 5. ❑ We area corporation Cr.and its 9. ElBuilding addition ,frequired.] officers have exercised their 10.[1 Electrical 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,❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.[]Other Any arflicaut that checks box 41 must also:ill out the section beia r. shoe:n ri erss e their xro comp: sztiar.poFicy informaticn. 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. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: —'4— I Policy#or Self-ins. Lic.#: 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 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. I do hereby certify u er the p ns Aj of peraurthQt the information provided above is true and correct L� Si ature: ---r' Date.: Phone#: I f Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# [1. ssuing Authority(circle one):Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ntact Person: Phone#: ro 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 4 Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if y necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cerdficate(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 may be 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 the,the application for the pernait 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 permittlicense 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 Investigations 600 Washington Street Boston,MA 02.111 Tel. # 617-72.7-4900 ext 406 or 1-877-MASSAFE Fax#617-72.7-7749 Revised 5-26-05 . www.mass.gov/dia Commonwealth of Massachusetts Official Use � Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGU ATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT T PERFORM ELECTRICAL WORK All work to be performed in a cordance with th Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK 0 T A A ) Dater City or Town of: To the Inspector of Wires: By this application the undersigne gives tic of his r er intention to rf rm the e trical work described below. Location(Street&Numb Owner or Tenant Telephone No-W/ - / 95 F q6 Owner's Address Is this permit in conjunction with a building permit? 'Yes.❑ . No (Check Appropriate Box) Purpose of-Building Utility uthorization 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: Installation of Security system Completion 9f the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- Elo.o Emergency Lighting rnd. rnd. Battery Units, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipal [I Other _. Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.o No.of Data Wiring: Heaters Signs Ballasts No..of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: - Attach additional detail ij'desired,or as required by the Inspector oj'Wirim 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:) (Expiration Date) Estimated Value of Electrical Work: F f (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Security ces LIC.NO.: 1 q j-jr Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable,enter"exempt"in the license number line) Bus.Tel.No.: 603 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licl9fisee 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: $ i :1 Location ' No. 7 Date /A� NORM TOWN OF NORTH ANDOVER O�tt�•o ,•1{. 0 F p b Certificate of Occupancy $ * i � * Building/Frame Permit Fee s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $/-!D I 06 Check # J 19965 / Building Inspector s NORTH 01 T%.10 16 q~DO0 to s` c �e � O cocci t ewKM �' SSAC HU`�'f� TOWN OF NORTH ANDOVER Sign Permit Date: February 27, 2007 Permit Number: 017-07 THIS CERTIFIES THAT, Rack Reahv - C�roomtown Has permission to erect a 3x4.5 Wall Sign Non Illuminated On 67 Main Street provided that the person accepting this Permit shall in every respect conform to the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings Location e� / No. Date a 7 NORTN TOWN OF NORTH ANDOVER F - 9 Certificate of Occupancy $ Building/Frame Permit Fee $ s4cMus Foundation Permit Fee $ Other Permit Fee , I J $ TOTAL �' $ `� Check # 20L. bj1 Building Inst e66tor �--. -ate SIGN PERMIT APPLICATION 1600 Osgood Street Building 20, Suile 2-36 TOWN OF NORTH ANDOVER r Site Owner c Applicant M Tel CS 7,e �ti Site Address &3� (X- C�� Size of Proposed Sign �! s ' May Parcel Illumination: a)Not illuminated b) Internally illuminated How attached: a) Against the w Externally illuminated b) Roof c) Ground Materials: V,_��� w Ot d) Other Proposed Colors: Backgroun (,,Y WL Lettering tuJ (A•R- Cost of Sian DC7 Border Note: No permanent/temporary sign shall be erected, or enlarged until an ^ Required Attachments: application on the appropriate form furnished by the Sign Office has been 'Photographs of building filed with the Sign Officer containing such information including t Material sample photographs,plans and scale drawings, as he may require, and a permit Color sample for such erection,alteration, or enlargement has been issued by him. Site or Plot Plan (Required for all free-standing signs) Such permit shall be issued only of the Sign Officer determines that the Drawings of proposed sign sign complies or will comply with all applicable provisions of the By- Other, specify. Law. Will sign overhang any public road or walkway Yes ( ) No If Yes, Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: Receipt# Check # Revised 10.31.2006 Form Sign Permit Application SIGNATURE OF APPLICANT 1 • o •n V roo 09 e Pet Boutique & Spa e "WHERE YOUR PET IS THE TALK OF THE TOWN' b 978 - 6009 —PAWS .� ....... NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ......... .... ...... . ....... .... . ...... ...................................... has permission to perform ...... ...... L) W06- wiring in the building of..........e�?e T at.... .................... .North Andover,Mass. F --w .. Lic.No. . . �... ....... ELECTRICAL INSPECTOR Check # IP0 Y 7217 Commonwealth of Massachusetts Official Use Only �-7 +' Department of Fire Services Permit No. W y BOARD OF FIRE PREVENTION REGULATIONS Revccy and Fee Checked 9/05 � 1 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: U City or Town of: NORTH ANDOVER To the In ect r of Wires: By tois application the undersigned gives noti e of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant L t I'de,e Telephone No. ?T,j Owner's Address L c'f-I` ``J ft a4� ce g� Is this permit in conjunction wi h a building permit. Yes R2' No ❑ (Check Appropriate Box) Purpose of Building 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 e,�& m 1AJ/L/ un Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Inspector of Wires. } No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of TotalTransformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E] o.o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones �iNo.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat PumNumber Tons K No.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mun'c'pal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 2 '-' 1, e e y r C �I Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: irddw C�'!; When required by municipal policy.) Work to Start: InspAtions 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 covera plein force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) !certify,under the pins and penalties f p rjury,that the/nformati non this application is true and complete. FIRM NAME: qp h r/ -Iecxlu LIC. NO.:A 15-390 Licensee: h y� Signature LIC. NO.: c3/33 r (If opplicabl .enter "�(xempt" n the li nse umber line/) Bus.Tel. No.: Address:- �41 w� S ,� 2!� piv--1 Alt.Tel.No.: *Security System Contractor License required for this workTapplicable,enter the license number here: 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. I I P r, x !., =� 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 J / Please Print Legibly Name(Business/Organization/Individual): ,�°��j',(/Jed es(, 9t��' �. Address: City/State/Zip: /(IA to ��J� G /�� `� Phone#: C/ 7-d AYl an employer?Check the appropriate box: Type of project(required): 1. am a employer with l 4. ❑ I am a general contractor and I 6. ❑ e construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling 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.❑ Electrical 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.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other 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 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: (�r�✓��' (tol �-y Policy#or Self-ins.Lic.#: S rV (1[1 - �r 7? �Q 9 0 expiration Date: 0 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 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 insura ce coverage verification. I do hereby cert'y n r e pai and enaltie of perjury that the information provided above is true and correct. Si nature: Date: d Phone#: r 7 — 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. '� !. . . . NORTH TOWN OF NORTH ANDOVER y 3? 0 oc 0 PERMIT FOR PLUMBING Y CHUS This certifies that . . has permission to perform . . . . .... . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . � at. . . . . . . . . . ... 1. . . .-. .. .. , North Andover, Mass. Fee Lic. No.. /BS's!/. / /�� �'?. . . . . . . . . . . . PLUMBING INSPECTOR Check # 7265 MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING (Print or Type) Mass. Date_ 7.' 20�_ Permit # Building Location �9� 1' tS� Owner's Name_ Type of Occupancy New 0 Renovation/ Replacement ❑ Plans Submitted: Yes❑ No ❑ FIXTURES B.P. # -SEWER # SEPTIC # z Z Y c1� Cn Z z cn _I >_ 0 Q z > w OO z to Q c U ~ z O z tui o I W— I cn to U) = to U W to to u- z 10--1 z a Lu ��— � w O . : W ¢ .U) QY ¢ w n cn z ° O !�— U_ g ~ o < 0 z o o L0 z z � � . 0 u o = m Ln o o � o ¢ v, � o ¢ m o o SUB-BSMT BASEMENT 1ST FLOOR / q 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR nstalling company Name +- � � Check ong: Certificate 4ddress ❑ Corporation 3usiness Telephone J ') -W — 3 7 ❑ Partnership 0 flame of Licensed Plumber or Gas Fitter Firm/Co. INSURANCE COVERAGE: I have a Curren lability 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. A liability insurance policylp/ Other type of indemnity 0 Bond ❑ 7 OWNER'S INSURNACE 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. Signature of Owner or Owner's Agent Check one: Owner 0 Agent 0 hereby certify that all of the details and information I have su mitted (or ente d)In ab v pl ca on re ue and accurate to the best of .y knowledge and that all plumbing work and installations perfo ed under t e permit d for t is ppl' 'tion will be in compliance with .1 pertinent provisions of the Massachusetts State Plumbing Code a ha t 142 of t ene al La By u'. Title Signature of Li nsed mber Tit Ciry/Tow•n i 'PROVED(OFFICE USE ONLY) Type of License: P.Paer!aster ❑Journeym an License Number_ �633v