HomeMy WebLinkAboutMiscellaneous - 83 SANDRA LANE 4/30/2018 (2)A
This certifies that. ................
has pennission for gas installation. ..............
in the buildings of. S� A Y5 /*
at. . . ............ I North Andger, Mass.
GASINSPECTOR
Check # /2 9�
8555
11/4//3 w:
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY: N ANDOVER MA. DATE: 01/14/2013 PERMIT#
JOBSITE ADDRESS: 83 SANDRA LN OWNER'S NAME: CHRIS LARD
GOWNER
ADDRESS:
TEL: 978-984-5253 FAX:
TYPE OR
OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL C
PRINT
CLEARLY
NEW: 11d RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO P
APPLIANCES FLOOR Bsmt 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
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCK
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
,TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY 0 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 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 the General Laws,
PLUMBEWGASFITTERNAMEI%C11G%S`G.t% LICENSE# �3,3 SIGNATURE
COMPANY NAME: OSTERMAN PROPANE LLC ADDRESS: 321A Merrimack St
(�
CITY: Methuen STATE: MA ZIP: 01844 FAX: 978-738.0118 \`
TEL: 800-368-9956 CELL: EMAIL: INFO(a.OSTERMANGAS.COM
MASTER ❑ JOURNEYMAN ❑ LP INSTALLER ORP RATION ❑# PARTNERSHIP E1#_LLC E]#45-326-3311
11/4//3 w:
4
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i
Date .... ...... ... ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... (� 0*-rL-
...............................................................
has permission to perform 44 ... 4�1 ............................
..... .. . ...........
wiring in the building of .......... 4 4,.-r ...... 5-�r77 ..........................
at ...... 93 ....... . . . .............................. . North 'er, Mass.
Fee... �.5 ........ Lic. No . ............. ............ ... .. .................
cA003-4--- 119LEcrRICAL INSPECTOR
Check #
7565
� 'IZ
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. -7.5-e,,—
BOARD OF FIRE PREVENTION REGULATIONS [Rev.
and Fee Checked
R
• � 1 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned ives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) sad d. -q lahc
A
Owner or Tenant (,p fir- /7
Owner's Address
Telephone No.
Is this permit in conjunction with a build' g permit? Yes Se No ❑ (Check Appropriate Box)
Purpose of Buildin T � [ tc� t �.�de Utility p g � Utili Authorization No.
Existing Service 2 Amps 110 l 2 -Yo 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:
e
rm—lotinn of ih, f-11--;__ 1_L1_ L_ . _ 11_
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
-f May ue wuiveu by the inspector o Yvires.
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑In- ❑
o. of Emergency Lighting
rnd. grnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches Q
No. of Gas Burners
No. If Detection
titia es
es
Devices
No. of Ranges
No. of Air Cond. TonTots
No. of Alerting Devices
No. of Waste Disposers
Heat Pum
m
Nuber
...... ...
Tons
KW
No. of Self- ontained
/
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 Water
No. of of
No. of Devices or Equivalent
Heaters KW
Bal
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER: �� L
0
Ll A ttacn additional detail i/ desired, or as required by the Inspector of Wires.
Estimated Value of lectrical Work: • Q (When required by municipal policy.)
Work to Start: 1 11; Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAG : 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 `Jg� BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalti s ofperjury, that the information on this application is true and complete.
FIRM NAME: Cror, arp( �j v G( I'va e\ LIC. NO.:
Licensee: .9^4 -p( `(t"vowN =_ Signature ZV_�' LIC. NO.:
(If dpplicabl enter "e. 7pt" in the li ense n ember line. Bus. Tel. No.4 7 �—
Address: � 0 C.✓ t'.S ,�
Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public tafety "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: $
fy_0 P
9
11 s
V,
Y
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Workers' Compensation Insurance Affidavit: Bui de s/Contrac
palicant Information tors/Electricians/Plumbers
Name(Business/OrganizatioMndividual): l'eo.'lq,.-d f 1 c
Address: V d
r
City/State/Zip: D1'541 1 Phone.#: ------------
Are you an employer? Check the ro ri b
pp p ate o=:
L ❑ I am a employer with 4. 111 am a general contractor
2.Wemployees (full and/or part-time).*
am a sole proprietor or
and I
have hired the sub -contractors
listed
partner-
on the attached sheet
ship and have no employees
These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
employees and have workers'
comp,
required.]
3. ❑ I am a homeowner doing
insurance.#
5. [] We are a corporation and its
all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. (No workers'
comp insurer-
Type of project (required):.
6. ❑ New construction
7. (%emodeling
8. (] Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
*My applicant that checks box #1 swat also fill out the section below, showing Ce required.]
t Homeowners who submit this affidavit indicating they g their workers' compensation policy informst on.
g ey 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 subcontractors and state whether or not those entities have
employees. if tliesllb-contractors have employees, theymust
provide their workers' comp• policy, number.
r
•- .• J'* Vvr «as rs provia[ng workers' compensation insurance for my employees
informadoBelow is the policy and job site
n.
Insurance Company Name:
Policy # or Self -ins. Lic. M
Expiration Date:
Job Site Address:
Attach a copy of the workers' compensation policy declaration page (showing the City/State/Zip:
numbe
Failure to secure coverage as re Policy r and expiration date).
g 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 nRnFu .-A a r.__
of up to $250.00 a day against the violatnr r1a e,t.a. A .,._.
k I
N2 2331 Date ... k6.771i�� ......
I -
0, ' , .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... ................ q . . . ......................................
............ .............
has permission to perform .... ...............................................................
wiring in the building of ....... :7.1.
...................................................
at ..... il-:f
............. ................................ . . .............. North Andover, Mass.
Fee -?� ..... . ..... Lic. N60��2q?
.. . ...............
ELECrRICAL INspEcrOR
Check
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
I.
w
a
�\ Office Use Onl
Of 4t TaInt unwralo 1f usur4asetts Permit No. /
ME}tIIli'lrilEItt of Public _AIIfEtg Occupancy &Fee Checke
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 2: 0
(PLEASE PRINT IN INK OR TjY�PE %INFORMATION) Date �
City or Town of /��uTo the Ins ec or of Wires:
The udersigned applies for a permit to perform the electrical work d scribed below.
Location (Street & Number) �l4"
Owner or Tenant
Owner's Address
Is this permit in conjunction wit building permit: Yes ❑ No V (Check Appropriate Box)
Purpose of Building 1i� Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work _ 0 b'
No. of Lighting OutletsI
No. of Hot Tubs
I No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑
I
grnd. grnd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
r
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local ❑ Municipal ❑Other
No. of Dryers
Heating Devices KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER: Ke. w
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO V I
have submitted valid proof of same to the Office. YES K NO G If you have checked YES, please indicate the type of coverage by
checking the appropriate box. T
INSURANCE X BOND ❑ OTHER ❑ (Please Specify)
fExoiration DaW
Estimated Value of Electrical Work $
Work to Start Inspection Date Requested:
Signed under the Penalties of pedury:
FIRM NAME �✓�j��� AEG/:C TiP1C t�J
Licensee .T2 Signature
Rough k Final
LIC. NO.
LIC. NO. 1S%3 S'
s. Tel. No. Cv IF _X_ /
Address CfliG'.rC�s/�,/Y6 l�� �/✓lin,/�-%�/,f �/ Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one)
(Signature of Owner or Agent)
Telephone No. PERMIT FEE $ &f�
x-6565
Location A3
't?7
No. o Date
TOWN OF NORTH ANDOVER
imimMMIL Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
her Permit Fee $
,L-_ _ ' 1
Sewer Connection Fee $
�A Water Connection Fee $
G T&AL $
6378
Z -
Building IA�Mf—
Div. Public Works
Location
No. -1. / ,
01
, wqlpmw
S
o
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
F�mndation Permit Fee
$
Z7:- �:, "
�J�her Permit Fee
$
,—$6�er Connection Fee
$
-'Water Connection Fee
$
TOTAL
$
Building Inspector
Div. Public Works
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KAREN H.P. NELSON, DIRECTOR
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number 37O is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The debris will be disposed of in:
-::2� - � A- !-Q�
Signature of Permit Applicant
Date
VOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
TOw11:0" - ' •
I 2 Main Street
OFFICES OF:
: i
•.
NORTH ANDOVER
North Andover.
APPEALS
.. , y;
Massachusetts O 1845
BUILDING
DIVISION OF
(6 1 7) 685-4775
CONSERVATION
HEALTH
& COMMUNITY DEVELOPMENT
PLANNINGPLANNING
KAREN H.P. NELSON, DIRECTOR
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number 37O is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The debris will be disposed of in:
-::2� - � A- !-Q�
Signature of Permit Applicant
Date
VOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.