Loading...
HomeMy WebLinkAboutMiscellaneous - 89 BRIDLE PATH 4/30/2018V TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............................ V has permission to perform ............... plumbing in the buildings of at. . North Andover, Mass. Fee N .............. PLUMINIZ INSPECTOR Check # 97? 8324 FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: ZVO i A. Date: – Permit# Building Location: ✓ y(. / e -A Owners Name: I jQ ki to Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No FIXTURES z z a Ix z Y z N Cn ~ Y o v In rn iii N Q� 0= 0 4 a a� w -~ w to Z �a a Q Y N °• K tr OJ Q Y= � co 3 w o ga 0 f- z W 0 3 i z LL� X z W rn z m %J a LL w w wol 0� Q ' O='m Y Q= M Q w Q Q 0, Q m m D O (7 = Y g o: Q to m t- X 3 3 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3KO FLOOR 4 FLOOR -T 'FLOOR '6 FLOOR 7 FLOOR 8 FLOOR -^ ff h j („ P d �Ct Installing Company Name: � C� h Check One Only Certificate # � MC.�CclC1� / w � r_ � Address: C own n /� heC5 Aj1 H' ❑Corporation —Stale: 0 � O 7� Business Tel: 6 U 3 - 300 ` yO31 Partnership Fax: ❑ Firm/Company Name of Licensed Plumber: J-061 tevi✓ in.,rd INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes)K No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy qr Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 Aaent 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 Knowieage ana 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 ❑ Plumber �Qn oZcen�sed u r City/Town Master 411, i 4 APPROVED OFFICE USE ONLY []Journeyman License Number:—/ `T t7 �,. AS A f. ASTER PMIEWMB r�+ JtlHt A LEONARD 6 TAMARACK LN r' M;IERST NO 030-31- 2 26 1, CERTIFICATE OF LIABILITY INSURANCE NCE EYP ID _ 1t�T�I�d11G*Tt/09 �'Whittemore Insurance 501 Vlami oth Road 'Londonderry RTN 03053 Phoria. 603-432-2577 Fax : 603-932--4`]04 John Loonard 6 Tamarack Lan(k Amherst MR 030111 TRIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TI E COVERAGE AFFORI .E0 BY THE POLICIES BELOW, I T �' :RS ,AFFORDING CO - Slut°RA NCS! Insurance Company _tiv—k I:R C4 i ;HE POOCIES CF INSkMtRw1F T.1-5TFo i3ER." t1AW KEN WAJEO TO THE INSURES NRWiiNiU'iE 1-08 3HE POLICY i EKN7[3 rff7t Al Eti. WINVIiKSIANUNG ANY FaE}e i4£1df . 1 ERV OR i 34dTt4tt OF ANY G(JRIl7Ud t}R 47TiER OQGIJP#LATd e+fiH f CwPi 7 T4" t Nf'Ct1 THIS GERTI3 pC Ai 111Y 9E CSSUE°J OR I,IAYPERTARI. T44F p*UPAJCF ArFJROECi BY THE PP0iFCII-S DISCRISE0 KnEI,"4fSfiUBJECT #0 ALL Off, TEktd-'s,TY{;il SIONS AND C€:Mt4IGN451+ SXH, PC3.Qf..S, AD%+REOAT€ LIMITS u1T6'AM UAY HAVE G'EJEN K17W-EV BY PAID CLAIMS. 4NTR 1®� OF 1 _ — _ -_ `..its} I� �C"I4� Polity T A�lidfaTC�SF3. LTA -1TYPEAPfNSURANCE Pi3LFGYNil9l,SEii SATE UMM-]fYYI ABATE IdRiPDQriY s i3AtIT'3 GENF-ML LIADII.ITT ?COMN�I£iiTi=L t CALH oCr- Twricr i 5 1€ 00000 a }'ERfsLLSVBTLM MPOO5706 t.I,�3/1(;f l) ' �F (3SI1 sIf Q FT fA+SES Eeasbta !et*).� f S50000 _ OCCUR j VEU E x (Ani a_evS5000 _ 6_0 �l4 by, 0 GENLIiAlAG RELATE ;2000000 S u �G S 2000000 I'fN.�iFJf d-CO�4�C? -C r r I t'i_tPL A^ UP.ECATE L"IT AF11JES FIR., i AUTGMOBILE Ltt-LT1 Y -, cs r�Q Tr t?,caLF',LtkfFi '11000000 A ;ANY AUTO B1005766 09/12/09 09/12/10 (3c rwy 4°d3F_)PY € T X ' SCHEMIILES AUFt4.5 (NiREFi ilif " €iobkY 1.1}13iFf # g {t•t0NQ?iT'4FT3daVt0.f Fd�Fgco4�Pt3 $ t f'ROPEP.TY LSAht?GiC ;& _ {P�r tRp;c;Hl GnlmrlU-Ai3WTY __._.._ _..._.. { .I AUTO COKY-r-AAMLIEUT !I I R cc r I !! ANY A1jTV } AUTOOOLY: JSSSF91ASiF3?ELLALkhT3IFJTY {iC}1R i CLAIMSMAM f A. sREs4TL I $ WPLOYEftV VAINUTY _ .. _. _ _ SAG}4ArGIF4T 5 fPfTOP3et'Tt7itPlTTaEKCXEGfatt2 T r£.L -.-__-.....T OFF 4F;+.'7i EIW,,Rf-ACLWCO? i E.L. 3A t • EA Eb9e €);'EE 4 - TtVL FRO^ R,SIOAS Wow I E E 1)*5(-ASE - POI IC°.` LIMIT S OTHER 0E MPTION W 0KRA'nON5 t LOCAT7G+T#S f VEKCtES P EXCIMION3 ADMV BY ENVORUCMENT P &PECIAL PRQ%n$14tis Plumbing and heating 2006 Dodge Ra= 1500 QUAD 3D7K519D56G239293 CERTIFICATE OLDER CANCELLATION SHW V ANY OF THE A•SWE OESCIFUM POLICIES SE aCA*CfLLM BEPOU THE iRAT _ DATE THEREOF, THF t55UV&C-If45VRER Wk1L FRkI£A%(GT€10 MAK 1 O DAYS wRirwu NOT}C[ TO TFFC GT RM- CATC 14OLDER NAAi 4 TO T'HE LEFT. LUT rAILUR.E TO DO 9O SHALL IMPOSE t100SUGATION OR LIABILITY OF ANY KIND UPON THE INSURER FTS AGENTS QTR REFR€S NTt}Tt',PES. AiTTHORIZE'f d3 WMESEI1ThTtVIE 11 1 ', /r (2001108) Date . .. ....... . ! * NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that �4 4 17 T �'... �� .. ` ................. has permission to perform ... �r� .'. `... r ......................... plumbing in the buildings of ... s ..................... at ...................................... North Andover, Mass. Fee. �.''. Lic. No.. `?. .l.. .......'�... :....- ....... . ,PLUMBING INSPECTOR Check # 5629 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Lo Date Permit Amount 1 Type of Occupancy New Renovation Replacement d Plans Submitted Yes ❑ No ❑ FIXTURES (Print or- - -1 Installing Address Business Telephone ' Check e: Certificate Ld rp• ElPartner. rl Firm/Co. Name of Licensed Plumber: afD�jy Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ . Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature i Owner El 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 perf rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S to tubing C dde�cil C�a�er 142 of the General Laws. ���.�_ Title Type of Plumbing License Ifs License um er Master Ell"' ,�jr Journeyman APPROVED (OFFICE USE ONLY��� rrr ��� 90`/ Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............. has permission to perform. �!'?�'"......... . plumbing in the buildings of .Xi,�i 7 .. ....... at"J . . ............. , No h Andover, Mass. Fee. yr'..J...t . Lic. No..%.L.d Lf! ..... ....... � PL MBING PECTOR Check # /% INSURANCE COVERAGE: I have a current Iia_ bility 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. A liability insurance policy- E41, 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 5i nature of Owner or Owner's A ent Owner ❑ Agent ❑ t hereby certify that att of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of miji Knowledge and that all pi�mbing e:ork 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 742 of the Generai Laws. By—% lC f i Type of License:®"i Title l 17 ❑ Plumber Signature of Licensed Plumber Master p ) L' City/Town / G APPROVED (OFFICE USE ONLYI ❑Journeyman License Number: 0 " �[S / MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING s� City/Town: ° �` �� V C MA. Date: S Permit# 11 Building Location: 6 �'\ �1 C 96� Type of Occupancy: Commercial nn ` Owners Name: 1"� H r` S.� t A ❑ Educational ❑ Industrial ❑ Institutional ❑ ResidentiaV New: ❑ Alteration: ❑ Renovation: ❑ Replacement:' Plans Submitted: Yes ❑ N6-§� FIXTURES DEDICATED H Z SYSTEMS z H z �TffY 11, Z �n a V z FQ- Y Q - W z Ou D U F w O ❑ n ¢ a R' W ❑ W G~ W Ln O m v=i it oac I— N �, Q ", Y w ❑ W Lt. r"' '$ N Q W 0 O ❑ W Z W g Z m W O 0. F- n� to w r... (7 -� X Q F z i.1 C LL = Q a U H a 00 V Q LL_jiS 3 a Z m m o o LL s° Y g 3 X-3 v=i H ul W oLn O h 3 Fw- v -SUB BSMT. �° 3 o a Q O O 3 BASEMENT 1ST FLOOR 2"D FLOOR 3RD FLOOR 4' FLOOR ST" FLOOR 6T" FLOOR 7" FLOOR 8T" FLOOR Installing Company Name: ULIJU/ 1 l� �- �� nS Check One Only Certificate # Address:` v Q> (%?5 )-:J' ��{ (�(� City/Town: IAWIv L4.4te: 71� Corporation el❑ $' ,d� G Business Tell ? � 5 a U , Fax: J' qw_�15 Partnership of Licensed Plumber: BName B h /, pCtw & - ( ( ElFirm/Company I_ INSURANCE COVERAGE: I have a current Iia_ bility 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. A liability insurance policy- E41, 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 5i nature of Owner or Owner's A ent Owner ❑ Agent ❑ t hereby certify that att of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of miji Knowledge and that all pi�mbing e:ork 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 742 of the Generai Laws. By—% lC f i Type of License:®"i Title l 17 ❑ Plumber Signature of Licensed Plumber Master p ) L' City/Town / G APPROVED (OFFICE USE ONLYI ❑Journeyman License Number: 0 " �[S / 1029 Date ...... ".. --�. Z/..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................... M f...................................�1...D��......... has permission to perform ............... �l ....'.'��Gs'1p.. wiring in the building of.. ..............Sy. .�........................................... c _ at .....Ff . .....i*ECTRICALINSPE . . North Andover, Mass. Lic. No....,?q.. Q. .Fee.... ....... �1.:G...707 Check # �63� Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank L 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 gives notice of his or her intent' n to perform the electrical work described below. Location (Street & Number) �/ ,62E�� ,q..�/I Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service New Service Amps Volts Amps / Volts Number of Feeders and Ampacity Telephone No. Yes Q No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: 09y6le �X1-51 71A) 1F1X"uv<4-S '-% ,v9,a,J F>,--rv-L,-e xA-)c/S/-- A44Z-mac. a#i-W Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- E] rnd. grnd. No. o Emergency L ghting 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 No. of Air Cond. Total Tons No. of Alerting Devices 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 ❑ Municipal ❑ 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 9 1/ 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: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and pe alties of perjury, that the information on this application is true and complete. FIRM NAME: -5N41t } J'F, F( -9Q -tV Ati LIC. NO.: 3 001 E Licensee: Signature LIC. NO.: 13 q 7©2 (If applicable, enter "exemp " in the license number line.) us. Tel. No.: Z?r ZZ2 7S— Address: Address: 4600 JiL)/�; Alg- �.p¢,-7 aw� �. 01 rs-� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of 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 Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 by www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly) Name (Business/Organization/Individual): SWF.A) Address: J n U�+�✓lJC>/`-e t= City/State/Zip: �o:ell Phone #: %7 _ ,`/- Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.J I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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. $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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 'f 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 penaltie/r of perjury jJ}at the information provided above is true and correct. Q)�— /( Phone #: 97e- - �'� �.� /y 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 #: