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HomeMy WebLinkAboutMiscellaneous - 87 BUCKINGHAM ROAD 4/30/2018N s oV. o W r C11 C o Z ' Z: (P D O O O 0 Av' I 8/15/2016 Y 21075 This is an e -permit. To lea more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/21075 OF NORTII qti O A .5 �4SSA C HUSE�� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that Paul E Martin has permission to perform Replacing plumbing fixtures. plumbing in the buildings of HOUGHTON.E GEORGE at 87 BUCKINGHAM ROAD, North Andover, Mass. Lic. No. 12380 Date: August 15, 2016 1/1 8/15/2016 Date: August 15, 2016 210%% This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/21077 OF NORTif qti OOG O......... , A * � a'•� t .ty �9SSA C HUSES� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that Paul E Martin has permission for gas installation Reconnect gas stove and install new dryer in the buildings of HOUGHTON.E GEORGE at 87 BUCKINGHAM ROAD, North Andover, Mass. . Lic. No. 12380 1/1 Date..... ...................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . ............................. �V ......... r has permission for gas installation .... Y.`�:A ............ ...... ..... . .. ......... in -the buildings of ................................................................. at ...... ......... I .............................. . North Andover, Mass. Fee.. W..." ...... Lic. No . ..... .. .................... GAS INSPECTOR 'Chec'k # 611 G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY�Iti MA DATE PERMIT # JOBSITE ADDRESS OWNER'S NAME ,J OWNERADDRESS Same TE ci FAX OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL® NEW: ® RENOVATION: El REPLACEMENT: Ej RESIDENTIAL PLANSSUBMITTED: YES® NDE] APPLIANCES 7 FLOORS- I BSM 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 10 1 11 1 12 1 13 1 14 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TORUNIT 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 NO I 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 El 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 co1m ance w/I/ it/h all Pert' ent nprovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / Z I U �' � // �� - PLUMBER-GASFITTER NAME 1,Robert Josey LICENSE #1.9185_ SIGN RE MP El MGF JP ® JGF 0 LPG[ ® CORPORATION # 3788C PARTNERSHIP®# LLC ®# COMPANY NAME:j RH White Construction Co ADDRESS 141 Central St CITY Auburn STATE MA ZIP 01501 TEL 508 832-3295 FAX 508-926-4347 CELL 508-245-7431 EMAIL ` A 4w ROUGH GAS INSPECTION NOTES I THIS PAGE FOR INSPECTOR USE ONLY I FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES Division of Professional Licensure: License Search 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 Et 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. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board code=PL&type_Class= M&li... 7/15/2015 Date ....... 7."-:../...-.�7......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... ........... ....Q. has permission to perform ..... /.&..6`....1 X44 ...... wiring in the building of ......................... ........................................................... © of..North Andover, Mass. ,,..`...?/.�l.c../�.......R . i Lic. No......j).. `/ .�6 ,6............... _.,................ t [, LECTRICAL INSPECTOR!/ Check # (0 49 _ Y 09 ®P�16➢D®®tll/Uea%$h of Massachusetts Official Use Only Department of Dire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank 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 ININK OR TYPE ALL INFORMATION) Date: `7 /i // V City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant �,9 ,�/(� / ° ✓ �� :"� Telephone No. z ®6 acs Owner's Address .5�'- Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead [4 Undgrd ❑ No. of Meters — New Service Amps / Volts Overhead Undgrd ❑ No. of Meters Number of Feeders and Ampacity Ice Location and Nature of Proposed Electrical Work: On latinn nrtho fnllnwina tnhly mrry hp wnivad by the Inspector of fires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans y No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 1:1o. Swimming Pool Above ❑ In- rnd. rnd. IN o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices � No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pum Totals Number Tons j.KW ............ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Municipal ❑ Other Local ❑ Connection No. of Dryers Heating Appliances KW SecuritNo. o Systems:* es or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors Total HP WirinNo. Telecommunications No. of Devices or E u valent OTHER: Attach additional detail if desired, or as required by the Inspector qj wares. Estimated Value of Electrical Work:.09 0,0 (When required by municipal policy.) Work to Start: X1°7 // Inspections 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA=NCE ❑ BOND ❑ OTHER ❑ (Specify:) X certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: 422g c& Signature C. NO.: (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 9 i-4 `/Z.3 `/2p9� Address: Alt. Tel. No.: 'Per M.G. c. 147, s. 57-61, securi work requires Department of Public Safety "S" License: Lic. No. OWNER'S INS E W R: I am aware that the Licensee does not have the liability insurance coverage normally required by la y m si e below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent y -7 y e S,1 a! -s S PERMIT FEE. S_S— Signature Telephone No. v The Commonwealth of Massachusetts Department ofIndustrial Accidents 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/Organization/Individual): Address: City/State/Zip: 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 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. �• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9 E] Building addition [No workers' comp. required.] officers have exercised their 10.❑ Electrical repairs or additions 3111 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 12.0 Roof repairs insurance required.] t employees. [No workers' 1311 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 anew 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:. 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 under the pains and penalties of perjury that the information provided 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 #: Information and Instructgons 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 -contractors) 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 permittlicense 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. 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 eyt 406 or 1-877rMASSAJF'B Revised 5-26-05 Fax 4 617-727.7749 www-mass,gov/dia COMMONWEALTH OF MASSACHUSETTS i • • -• e BOARp.Of F I .,G 0TD t r i"n KI,C