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HomeMy WebLinkAboutMiscellaneous - 76 BUCKINGHAM ROAD 4/30/2018 (2)N Date................................................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION e - This -certifies that .......................................................... ................. �allatio ............. ............. lf,4 permission for gas in n ... ............... ...... in- the buildings of ...... .... ............................................................................ at ..... 5...A .................. ... G. ....................... North Andover, Mass. • Fee 'W) ........... Lic. No -I . ....... .............. . ..................................................................... GASINSPECTOR Check G05 9 MASSACHUSETTS, UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY JJV or+k MA DATE 071 12015 PERMIT # JOBSITE ADDRESS I'SC� nl� s� OWNER'S NAME GOWNER ADDRESS Same TEL]-1FAX� TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALE] CLEARLY NEW: RENOVATION: E] REPLACEMENT: ® PLANS SUBMITTED: YES® NDE] APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT' TEST UNIT HEATER UNVENTED ROOM HEATER WADER HEATER OTHER x ------- -------------------------- Re,,lace E Gas Meters x and'Associated Pinin INSURANCE COVERAGE IN, I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Ej NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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: OWNER AGENT 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 w' hall Pe tinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4comiance PLUMBER-GASFITTER NAME I Robert Jose LICENSE # 9185 SIG URE MP EI MGF ® JP[j JGF ® LPGI ® CORPORATION Ej# 3788C PARTNERSHIP[J# LLC # COMPANY NAME: RH White Construction Co =ADDRESS 141 Central St CITY Auburn STATE MA ZIP 01501 TEL508 832-3295 FAX 508-926-4347 JCELLI 508-245-7431 EMAIL / ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES • �t r M Division of Professional Licensure: License Search .r ' The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > ........................-............................ .................................. ....................... ................... Check A Professional License By the Division of Professional Licensure LICENSEE Name: ROBERT A. JOSEY E DOUGLAS, MA NEW SEARCH **This Licensee has additional Licenses, click here to view them.** Licensing Board: PLUMBERS £t GASFITTERS License Type: MASTER PLUMBER License Number: 9185 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Wednesday, July 15, 2015 at 3:20:42 PM. Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... © 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/PubLicenseQ.asp?board code=PL&type class= M&li... 7/15/2015 Date ..,......`..�. J ,l?- ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... . � .. - .............................. has permission to perform Sly . AQ .........� :. ............................... wiring in the building of .................... . at...... e...gvC G?.' ....................._.... ,North Andover, Mass. �.9 Jam. Fee.....Li....�.w...,...... Lic. No......:..................................................... .../..-�! .�.�.►........... ELECTRICAL INSPECIfOR Check.# 3%S� 11406 Owmkl use 0,1y �aja�o�.�rrr Jarviees FerntitNo. �/���i�_ BOARD OF FIRE PREVE"ON REGULATIONS Ocu%mm7 and Fee Cbmkrd APPLICATION FOR PERMIT To PERFORM ELECTRICAL WORK All WG* 10be mknmd'a ==1&mm WA Me MmohmM MmOml CO& ea 4 Sn aft 12th (PLEASE Mau"V fK OR me Au MOM" Tiom Date: 2 CkyerTown ,of6. NOej� Bthis Tbthe1mwe&o.-6fFru=. Y grm nofte of his or hw'[Mmt'6n to Perkm dft ek=WW Work dcunlxd Maw. LOCRUOR (Street & Number) ��6 1 Owner-orTenaut Telephone No. Owner's Address Is this permit in cOuimcgm With a bu&ftg pernW. Yes F-1 No F-1 (che& Appropriate Boz}Purpose of Umly Autherlmaolm rqo Existing Service /,4rT ---Lql� —8, -9 —5-0 7VI Z�p Volts Overhead Undgrd ❑No_ofMckn New Service //?" �10-14 V01ft Overhead Undgrd ❑ Na. of Meters Number of Feeders andAmpacity Location and Nature of Proposed Electrical Work- 017.- 4 of Rzeessed Louldnair �7 NO. of CdL-SusP- (paddle} Fou; of Lumblake outlets 7 No- of Hot Tubs of Lumhu&es Pool d. Of RecePtade Outlets 1-7 of On Bumen of Switches 15' Na of C.= Burn..., orplauges;— ML Of" Cond. Tons of Waste Disposers j1WPToTom taii. of Dishwashers SomdAm Iffewbg lKW of Dryers Heating Appliances 1CW. of Witter Kms►Nb: HeatersW or . or - m -, Hydromassage Batmub5 INQ- of Motors Total mtws 1KVA CY Uum No. of Zones Device � and •Atertmg Devices !2ELAIergM Devices 11 r1=200. 0 other Estimated Value of 0=ujc;M0& —am aaammmw Mmffdmvvd or = regubvd by Me laxpeaur of wi-m. We* to Stint (When requind by km4cipal policy.) bVeCtim 10 be requested in accordance vath MM p MSURMCK CIDVMAGB-- �Wc 10, and Won cwMlmom Ifir- &Xmm Mmdm proof0f2desswar"d by dw omw' no emit &c Pcrffimmm of electric work my issue unless bft insurgnce imcjudiagop� comap or suWaur umdcmiVwd =W= &gd such coverage is in W eq�� The ftix' , and has =hlbited wWofsam to do penult ming ogice CHEM ONE: MtmANM 5h WM [:I OTfM Cj (Spe., I eadfy, carder &e pafiw =dpmff Win ofpffjkuy MM NAW-- &&&e&TqnmW..n . is tree mrd amr1m. -TZ CAL On Uceusee: DRU to llh LIC. fqo.-- ����64QQ- [if wi'leame -*e&mw- Lic-No.: Address: Aczow Mm Tel. 1% )L *Per KG.1- r- 147, & 57-61, AM TeL naju�smo-:3 01MR-S IWSMAN(* WAY"& I am mare that km afte Lim Lic. No, ftilitYi0surancecoverwnormay By MY sipature bebw. f bmby waive am the (check mpmdbylw the Lken--6.- does iw SIL 0-owacr Qowmes!n Telephone No. P ERAlff FEE.- 8 nrurcr"ANUUVt:N WUL Ulmh Are you as enapbiyer?Check the appropriate bo= 1.0 l am a empbyer with 7 employees (fid )-* 2Q Iamasoleploodororparkw ship and have no employees wdridug fwaminmycapacity- NO wodme comp. 3-0 IaonahomeownrdoingaIIwork mysd€ (No wotckeas' camp insurance require&] $ Phone #.- 97"U-6262 4 ❑ lam anal contractorand I have hired the sub-c�ots Tested onthe att Mum sub -contractors have employees and hawe works' comp. + 5- Q We are a cmpara#ion and its ofircers have eaercased their Tt of onper MGL c 152,§1(4),and wehave no employees. [No writkere comp. insurance re4tiued i TYpeofprdJed(reqdre4- 6_ ❑ New consftuction y- ❑ RemodeTmg S_ ❑ Demolition 9 0 Buildingaddition, 10-0 Electricatrepai s oraddiiions I LQ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other ..t;— --- .n—ULM Cl Lutmamu-uam umSeen! betawshowtugaveq VYoduere compensaimpojjcV iI&� �H07IIei1\M13who submit thisaf&davit>mlicaft they are difmgaA wcuk and they hireaaWe cGnt12CWm mustsubmit8new affidavit indiratmg sum- ;Coi is thatdm* &sbmctatatattached aaadditioml shaashowrogtheirffiaeof the and st2tewhegWernot those enure have emptwyet-- if do sub-cuut 6ois have CMpMye s tky njW pmWe gm worlflets OD1DP- P0hcv mmdier I am ars enipioyer &W is ps&visFqg wm*9rs' co on bumrce formr eWAV� Below it the ireforefio& pefty aizd jehsite Insurance Company Name: THE HARTFORD Policy # or Self-ins.Lic. #: 08 WEC C18293 Expiration Date: MARCH 1, 2013 Job Site Address- -Al, City/StatetZip N S— Attach atopy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of M($, c. 152 can lead to the fine up to $1,500.00 and/or one- ear ' imposition of criminal penalties of a Y as well as civil penalties in the form of a STOP WORK ORDER and a fore Of UP to $250.00 a day against the violator. Be advised that a copy of this statement may be forwardedthe Office of investigations of the DIA for insurance c overage verification Idaa e i i it Provhred above fs Mie and coned. 7 /.3 Plmne#- -978-682-6262 L/ tiiciatusenalL DouotwriL—isthisGmumbeco 4cgy,orimm oOYdmL CILY or Town.- Arrmority (circle one): Perm uc ense# 6. Boma of Head 2- resit 3. CStyffown Clerk 4 Electrical Inspector S Plumbing Inspector Other centactPerson. Phone#: The Commonwealth of Massachusetts Prinit Form P{'.-.�-.1 �/j��j(.e (�%{jam �f ��. _ _J aIfo - J I Gangress Mee; suite IN '-= Bosi=& SIA 02II4-2017 Iwww mas&goy/lira Workers' Compensation bmurance Affidavit: Bm7derdConimctorslElectridmns/Ph mbers alicant Information Please Priori `bls Name (Business/Organrrrati nndmdnal): DAVID ELECTRICAL CONTRACTING LLC Address. 87 BELMONT ST nrurcr"ANUUVt:N WUL Ulmh Are you as enapbiyer?Check the appropriate bo= 1.0 l am a empbyer with 7 employees (fid )-* 2Q Iamasoleploodororparkw ship and have no employees wdridug fwaminmycapacity- NO wodme comp. 3-0 IaonahomeownrdoingaIIwork mysd€ (No wotckeas' camp insurance require&] $ Phone #.- 97"U-6262 4 ❑ lam anal contractorand I have hired the sub-c�ots Tested onthe att Mum sub -contractors have employees and hawe works' comp. + 5- Q We are a cmpara#ion and its ofircers have eaercased their Tt of onper MGL c 152,§1(4),and wehave no employees. [No writkere comp. insurance re4tiued i TYpeofprdJed(reqdre4- 6_ ❑ New consftuction y- ❑ RemodeTmg S_ ❑ Demolition 9 0 Buildingaddition, 10-0 Electricatrepai s oraddiiions I LQ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other ..t;— --- .n—ULM Cl Lutmamu-uam umSeen! betawshowtugaveq VYoduere compensaimpojjcV iI&� �H07IIei1\M13who submit thisaf&davit>mlicaft they are difmgaA wcuk and they hireaaWe cGnt12CWm mustsubmit8new affidavit indiratmg sum- ;Coi is thatdm* &sbmctatatattached aaadditioml shaashowrogtheirffiaeof the and st2tewhegWernot those enure have emptwyet-- if do sub-cuut 6ois have CMpMye s tky njW pmWe gm worlflets OD1DP- P0hcv mmdier I am ars enipioyer &W is ps&visFqg wm*9rs' co on bumrce formr eWAV� Below it the ireforefio& pefty aizd jehsite Insurance Company Name: THE HARTFORD Policy # or Self-ins.Lic. #: 08 WEC C18293 Expiration Date: MARCH 1, 2013 Job Site Address- -Al, City/StatetZip N S— Attach atopy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of M($, c. 152 can lead to the fine up to $1,500.00 and/or one- ear ' imposition of criminal penalties of a Y as well as civil penalties in the form of a STOP WORK ORDER and a fore Of UP to $250.00 a day against the violator. Be advised that a copy of this statement may be forwardedthe Office of investigations of the DIA for insurance c overage verification Idaa e i i it Provhred above fs Mie and coned. 7 /.3 Plmne#- -978-682-6262 L/ tiiciatusenalL DouotwriL—isthisGmumbeco 4cgy,orimm oOYdmL CILY or Town.- Arrmority (circle one): Perm uc ense# 6. Boma of Head 2- resit 3. CStyffown Clerk 4 Electrical Inspector S Plumbing Inspector Other centactPerson. Phone#: + y v ���, ' •ryA yet..' u •! �o- V • 11��� �Jµ�u�y1