HomeMy WebLinkAboutMiscellaneous - 67 PROSPECT STREET 4/30/2018 67 PROSPECT STREET
210/080.0-0013-0000.0
/I
9335 Date.
i
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
,SSACMUSE�
This certifies that . Xcl?.19-S. ./.'.".4-.4cv n. . . . . . .
has permission to perform ./40/ C�h?P`f. 4', . .1t 4JC;
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plumbing�i-nn the buildings of/. . .c��r�k..'q. . . . . . . . . . . . . . . . . . . . . . .
No/r�th Andover: Mass.
Fee`34! v.Lie. No.. �„�3. , !-� ✓.
PLUMBING INSR CTOR #.
Check #
Date. .a14.hz . ..... ..
Of.NOFTM ,�
o� °p TOWN OF NORTH ANDOVER
- PERMIT FOR--GAS INSTALLATION
9
SACHUSEtt
This certifies that . . 7,-P;?. .A p r�!7. . . . . . . . . . . . . .
has permission for gas installation . . .zp A-".//,ow e7. . . . . .
i in the buildings of . . . .cWq!7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . �. . `0,.� �E' . . - . . ., North nclover,�,Mass.
Fee. �!bU. Lic. No.N44- . . ��4 � . .
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GASINSPECTOR
Check# /D
'8084
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IMASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: NORTH ANDOVER , MA. Date: Permit#
3Y
Building Location: /1 W e e 5 Owners Name: jeyeltl
Type of Occupancy: Commercial ❑ Educational ❑ Industrial❑ Institutional ❑ Residential ❑✓
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No ✓❑
FIXTURES
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3 FLOOR
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Check One Only Certificate#
Installing Company Name: HALLORAN PLUMBING '
❑Corporation
Address:826 DALE ST. City/Town:N.ANDOVER State: MA
❑Partnership
Business Tel: 978 6859504 Fax:
❑Firm/Company
Name of Licensed Plumber/Gas Fitter:TOM HALLORAN
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 0 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
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Signature of Owner or Owners Agent Owner ❑ Agent ❑
By checking this box Lj;I hereby certify that all of the details and information 1 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Type of License: /
By 2 Plumber
TitleEl Gas Fitter Signature of Licensed Plumber/Gas Fitter
❑Master
Cityrrown OJoumeyman License Number:
APPROVED OFFICE USE ONLY) ❑ LP Installer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: NORTH ANDOVER
MA. Date: c;Zv�I Z`Z.. Permit#
Building Location: C� / / /�(� �tL�� � Owners Name: �/ ���``� CO/-
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ✓❑
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑✓ Plans Submitted: Yes❑ No❑
FIXTURES
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SUB BSMT
BASEMENT X
1 FLOOR
2w-FLOOR
3 FLOOR
4M_FLOOR
5 FLOOR
6 FLOOR
7 FLOOR
81H FLOOR
Installing Company Name:
HALLORAN PLUMBING Check One Only Certificate#
Corporation
Address:826 DALE ST. Cityrrown:N.ANDOVER State: MA
❑Partnership
Business Tel: 978-685-9504 Fax;
❑Firm/Company
Name of Licensed Plumber.THOMAS HALLORAN
INSURANCE COVERAGE:
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 21 No❑
ff 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 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
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
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 performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License: ,.
Title 21 Plumber Signature of Licensed Plumber
Cityrrown ❑Master u G��
APPROVED OFFICE USE ONLY)
�Joumeyman License Number: ! !J
J/ The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d 600 Washington Street
Boston,MA 02111
QM 5� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information _ Please Print Le6bly
Name.(Business/Organization/Individual):
Address: S''l
City/State/Zip/-/a/1/7,,' }e 1),-P' e1L Phone.#: 97,�
Areyou an employer?Check the appropriate box: Type of ro ect re wired
' 4. I am a general contractor and I yp p ( q )`%
1.❑ I am a employer with '. ❑ g 6. E]New construction '
employees(full and/or part-time):* have hired the sub-contractors
2.,X I am a sole proprietor or partner- listed oil the attached sheet. 7. E]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.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1�Z Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
1(4),and we have no 12.❑ Roof repairs
c. 152
insurance required.]t ' § 13.❑ Other
employees. [No workers'
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.
xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am 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. 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.
s' g
I do hereby certify under the pains and penalties of perjury that the information provided aboveistrue and correct.
/
Sinnature• �l i����--- Date 3 � 12—
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#:
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,opera'te�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-contiactor(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/heense 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 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:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext.406 or 1-877-MASSAFE
' Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
Date...... .-...1-7--�.1.`C
f AORTH,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACMUS�
This certifies that ........................................�> �';t ` , ........................
has permission to perform i 44L
er. ..........
wiring in the building of................ 4 f.v........
at..........k-7.....TARP..5. i..... ...............,North Andover,Mass.
�f .r Fee.... Lic.,Nos.W3.! ...... . s' .............
ELECTRICAL INsPECPOR�
A Check # y �{ q(7
8`i � 4
�"� Commonweal o�I'!'Ja3lachu�ef Official Use Only
Permit No. Flo
o
a1JePar1`ment o�,}ire�ervices �
II
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massacbusetts Electrical Cod (MEC),5 7 CMR 12.00
(PLEASE PRINT W INK OR TYPE ALL FO,gMATION) Date: .t. /m_
City or Town of: D I To the inspector of Wires:
By this application the undersigned gives notice of his or her intention perform the electrical work described below.
Location(Street&Number) �----6 r7 _t 5
Owner or Tenant �7.� tJAtli,, Telephone No.
Owner's Address r 4'r w
Is this permit in conjunction witha buildin ermiL
Yes No 0 (Check Appropriate Box)
Purpose of Building yvt t 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:
jhu R`nj�.� SOD
Com letion o the ollowin blemaybewaivedbythe Ins ector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot TubsGenerators KVA
No.of Luminaires Swimming Pool bove In- ❑ o.o mergency ig g
d. d. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of Detection an
No.of Switches No.of Gas Burners No. Initiating Devices
No.of RangesNo.of Air Cond. Tons Total
No.of Alerting Devices
- No.of Waste Disposers eatump Number ons_ o.oSelf-Contained-
Totals
.
: Detection/Alerting Devices
- No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wuw :
No.of Devices or E uivInt
OTHER:
Attach additional detail if desirert or as required by the Inspector of Wires.
Estimated Value of Electrical rk: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
o 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 cove a is in force,and has exhibited proof of same the peelRit office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �0
I certify,under ihepai penalti ofper ury,that th info on on this application is true and complete
FIRM NAME: (/ 4 VoeCI C �6 LIC.NO.'
Licensee: 57T,- J Signature LIC.NO.:
(If applicable,enter"exe ` t"in th li ense umber line. Bus.Tel.No.• . ! (3J
Address: Alt.Tel.No.:
*Per M.G.L.c. 147,s.57- 1,security work req es Department 6f 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:$
i
� r
TOWN OF ANDOVER Commercial: Sewer Ejection Pump: $25.00
ELECTRICAL PERMIT FEES a)including photovoltaic& -Signs: $25.00 each ballast
(Effective March 12, 2003) generating Equip Per KVA $1.00 Smoke&,Reat Detectors&
=" b)un-interruptible power systems, Initiating"Deviceq:
per KVA$1.00 Residential:$1.00 each
5 c batteries over 100 amp.hours,per Commercial: $60.00 up to 10
NO SE CABLE ON cell$1.00 devices over 10-$1.00 each
OUTSIDE OF BUILDING � Heat Devices: ' $1.00 each Space Heaters:
Aar Conditioners•$40.00 each Heat Pumps: $40.00 each. area heating$1.00 each
Hydro-Massage Bathtubs/Hot Sub-Panel: $25.00
Alarm Systems Security:(for fire
Tubs: $20.00 each Swimvning Pools:
systems see smoke/heat detectors) Lighting Fixtures $1.00 each Residential:
Residential: Lighting Outlets: $1.00 each Above Ground: $25.00
Commercial::uup p tto o 10 Devices Major Appliances:(not listed) � Inground:$50.00
$60.00 additional devices over 10- $20 each Commercial Pool: $100.00
$1.00 each Motors: (per hp or fractional part Switches: $1.00 each
Carnival Equipment:$50.00 each
thereoo $2.00 Temporary Service:
Ceiling Fans: $1.00 each Oil/Gas Burners: Must have.Utility Authorization Number
Commercial New Construction or Residential$20.00 each Residential$25.00
Alterations: Commercial$20.00 each Commercial $100.00
$100.00 per 1,000 Sq.Ft.of 0 Transformers:
Construction Space Office Furnishings:per circuit$1 a)capacitors,Per KVA $1.00
Commercial Service Change/ elocatable Partitions/Cubicles
Outlets&Fixture: $1.00 each b)ducts,conduit&conductors
Repair: O (Associated w/Padmount Transformers)$25
Must have UtilityAuthorization Number Ovens Built in/Counter Top Units: ;00 r
c)each manhole$10.00 � �
$100(first 100 amperes or fraction,one $10.00 each d)each handhold$5.00
meter) Panel Change/Circuit Breaker: e)per KVA$1.00
a)each additional 100 amperes Residential:$20.00 0 primary feeders,$25.00 each(over
capacity or fraction. $30.00 Commercial: $25.00 600 volts,non utility owned)
b)each additional meter$25.00 Phone Jacks: See vaults and a ui . $25.00 each
Commercial Temporary Service: data/telecommunications Washers: $15.00 each
$100.00 Ranges$15.00 each Waste Disposals:$5.00 each
Must have Utility Authorization Number Receptacle Outlets:$1.00 each Water Heaters:$30.00 each
Commercial Repair and/or Recessed Fixtures: $1.00 each
Maintenance Permit:(Blanket Re-inspection Fee: $25.00
Permit)up to 2 Electricians$150.00Repair to Service Residential: "For Multi-Family&i
per pair of Electricians over 2$50.00 $20.00 Large Commercial Project
Data/Telecommunication: Residential New Construction see Wiring Inspector for
Residential:$1.00 per port (Dwelling): $220.00
Commercial: $30.00 up to 10 pricing:
(with service up to 200 amps) Paul Kennedy(978) 623-8306
devices over 10-$1.00 each Must have Utility Authorization Number
Dishwashers&Disposals: for services over 200 amps see below (Office Hours 8 am to 10 ani) +;
$5.00 Each a)for each 100 amps capacity or
Dryers: $15.00 Each fraction add$20.00 *Inspection Schedule: r
Emergency Lighting(Battery Units) b)each additional meter$10.00 1 ROUGH
$ 1.00 each unit c) each additional panel/sub panel 1 FINAL
Feeders or Sub-feeders: $25.00
each 100 amp capacity of fraction Residential Additions/Alterations: I TRENCH (if applicable)
thereof $220.00 maximum
Residential: $5.00 each Residential Service Change or ADDITIONAL
Commercial: $15.00 each Underground Service: INSPECTIONS *$25.00 (if
Gas/Oil Burners: $40.00
applicable)
Residential: $20.00 each
Must have Utililh Authorization Number
Commercial$20.00 each a)one meter,up to 100 amp capacity.
$40.00 (revised 07/05)
b)each additional 100 amp capacity
or fraction$20.00