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HomeMy WebLinkAboutMiscellaneous - 9 LINCOLN STREET 4/30/2018ion r m 11352 Date ... ......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Thiscertifies that .... M.A.,-'& ..... ............................................................... ....... .... .... ...... ).D(Ae6 has permission to perform .... X CANt-R-0 ... e .. 14) ......... plumbing mffie buildings of .... ............................................................... at ...................... S . ...................... North Andover, Mass. Lic. No....... .................................................................................. PLUMBING INSPECTOR Check # M�' P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY . K.T - .�� ---- -- ----I MA DATE.._��_ - i 5 PERMIT #� v JOBSITE ADDRESS (.. -+h��c �_.� - ----_ .__ OWNER'S NAME -_- OWNER ADDRESS_ -- �l y�-C o L 1 5.._.----------__._____.._ _ TEL r� FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 NEW: 0 RENOVATION: 91 REPLACEMENT: 0 FIXTURES 7 FLOOR- BSM BATHTUB a� E CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTEF LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK WASHING MACHINE CONNE WATER HEATER ALL TYPES WATER PIPING RESIDENTIAL& -- "- PLANS SUBMITTED: YES El NO 10 1 11 1 12 1 13 1 14 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YEQ NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE OF INDEMNITY J:j BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee goes 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 a AGENT .__i 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 oompllance 'th all Pertinent A vislo Massachusetts State Plumbing Code and Chapter 142 of the General Laws.', PLUMBER'S NAME K..._____..._.I LICENSE# -..L.I lsto_a.._ SIGNATURE MPO JP CORPORATIONEI#PARTNERSHIP[]#' LLC _[.-1# �COMPANYNAME (-�N-Q..'-Upc�lt 6 s._Co� ADDRESS - CITY ..._H._ 1L�- - - - STATE ...M.�_._I ZIP b��g.Q... - ...._-I TEL IFAX - CELLF— EMAIL -- r 13 8 %Date ....... ................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ............... .1. 1 ............................................ has permission for gas installation ...... in the buildings of ................... 244 . ........................................................................ at ................ 9 ..... ................ North Andover, Mass. Fee..5b . . ....... Lic. No.jj..(A.j .......... ..................................................................... GASINSPECTOR Check # 10156 •.ROOF MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK G TYPE OR PRINT CLEARLY CITY DP . _ . ,- N�Y4:._ _ MA DATES �}- ---= f PER # t OI JOBSITE ADDRESSLI OWNER'S NAME _ OWNER ADDRESS Lt eco � I� S � • TEL�� —FAX J OCCUPANCY TYPE COMMERCIAL J EDUCATIONAL -_( RESIDENTIAL NEW:- - RENOVATION: E REPLACEMENT: PLANS SUBMITTED: YES NQ - APPLIANCES I FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER r - - =j . I -_ _1 M =1 .. _ BOOSTER CONVERSION BURNER _...J __..J COOK STOVE _TI DIRECT VENT HEATER DRYER FIREPLACE1 - l�i �I r _ 1 rl -� FRYOLATOR FURNACE GENERATOR 1 i i GRILLE INFRARED HEATERi ._ . _71 -_.__I - __-- ___1 . ,_..-.i r...- .._...__. .__.__ LABORATORY COCKS ._ _1(� ...._... J -I -� J _ ._ .__. I __. _J _.._._ I _T J _1 - _a MAKEUP AIR UNIT a _,____ --I]= _J OVEN POOL HEATER ROOM / SPACE HEATER TOP UNIT FEST.,_-,-- "UNIT HEATER UNVENTED ROOM HEATER l- - - -- _____ __ _ WATER HEATER _ _ _ _ _- THER a s f iP l oc 50101 _ INSURANCE COVERAGE have a current liabililyinsurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q. ii NO D 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY (I OTHER TYPE INDEMNITY D BOND �1J 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. CH_ ECK ONE ONLY: OWNER M AGENT SIGNATURE OF OWNER OR AGENT 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 ail plumbing work and Installations performed under the permit issued for this application Will be In compliance -th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws., p��) PLUMBER-GASFITTER NAME ..k4�� A,. ``>)':�c�4LICENSE#�IIG(7 SIGNATURE MP N MGF F. -II JP JGF LPGi © CORPORATION ®# M., PARTNERSHIP D# LLC [.--I#= 1 MPANY NAME: -MoA, D,u?�+!�. 1� e,ZG...�si C��I ADDRESS Loet� 5�'.._..._LI►J�?�33..._..._ ::: ,�XY t-1Aa.1la"il..��- v . ... � STATE ZEPTEL FAX CELL'1v-771-GyEMAIL��r.¢�� -� 10 . .0 t t � � 10 . .0 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: qb Locl_t�-: ST, (, ., t�?�3 I City/State/Zip: lA*0EQAAI �N t ►y1A Are you an employer? Check the appropriate box: co D Phone #: T79 - Fl Y- 77 QTY (C15 78 -TH-W 1 LE] I am a employer with employees (full and/or part-time).* 20 -Lam a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.Q I am a general contractor and I have hired die sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. Q New construction 8. Q Remodeling 9. Q Demolition 10 Q Building addition l L E] Electrical repairs or additions 12.�ftlumbing repairs or additions 13. Q Roof repairs 14. Q 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. tContractors 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 isproviding workers' compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Policy # or Self -ins. Lie. #: 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify undir the pains and Phone #• 2_7n_ % % C G `i J5- i the information provided above its true and t. dccorrec `i mate:- " /t J ^ / Official use only. Do not write in tills 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 #• T. m m A .D. 4oLO "'ST A PTS :42 01830 � t� .� ��§ \ V, 10245 Date ..... ....Z.��-. .-/ / TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... has permission to perform - ��' 2 ..., .......................... �...................... wiring in the building of .......%- �` LO'�' .................................................................... j at .... �...........�fi!� :n-! .............. Sr............... North Andover, Mass. Fee..... Lic.No. ..:?.....Z ..........................................>? s ELECTRICAL INSPECTOR Check, � 7// s 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, § 3L, the -'-,,Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed " n the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall-be limited as to the time of ongoing construction activity, and maybe_deemed_by the,Inspel;tor_of- ii-es abandoned.and_invalid.if he— .. _ or she has determined that the authorized work has not commenced or has not progressed during the precedinb 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of th' Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property, With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. r ule—Permit/DAte Closed: .A* Note: Reapply for new permi rmit Extension Act — Permit/Date Closed: C,ommonwealg of ;Waeeachu.4e Official/Use Only s Apartment of7ire Serviced Permit No. 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 Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I ok 111 City or Town of: 0 0 y- A: k 8 XC, rl e\ y e X- 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) 0\ L- , ,n CO n 5 Owner or Tenant L \,NC; t -�-E p-,\ \ o n Telephone No. 01 Owner's Address 5 O.>M e -- Is Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work:. Install residential security system Completion of the following table may be waived by the Inspector of Wirer_ 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- ❑ rnd. grnd. o. of 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 No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW """ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El other Connection No. of Dryers Heating Appliances Kms, Security Systems:* No. of Devices or Equivalent No. of WaterKit Heaters No. of No. of Si ns Ballasts Data Wiring: 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: !Q L, O O (When required by municipal policy.) Work to Start: 2 1 / [ I 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 E BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Nightwatch Protection, Inc. LIC. NO.: 7 0 2 4 C Licensee: Paul DelSignor Signature �.° LIC. NO.: 7024C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No. 888-722-9282 Address: 22 Briarwood Drive, Westford, MA 01886 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SSC00000969 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ �� Location /--s-�-✓_� No.to Date e0l —A/f" Ot,e TOWN OF NORTH ANDOVER a Certificate of Occupancy $ �� s' •°' E��' Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -00 y Check # 17382 Q %� Buildi.)g Inspe TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE. Building CommissionerAnspector of Buildings Date SECTION 1- SITE INFORMATION I 1.1 Prapetty A dress: �C / 1.2. Assessors Map and Parcel 0 Map Number Number: Parcel Number Address for Service: C' ` T 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Signature Tele one Front Yard Side Yard SECTION 3 - CONSTRUCTION SERVICES Rear Yard Required Provide Required Provided R red Provided License Number Expiration Date 3.2 Registered Home Improvement Contractor 1.7 Weer Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record _ tGZ,� Name (Print) Address for Service: C' ` T Signature Telephone 2.2 Owner of Record: Name Print Y Address for Service: Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M M ic s "q z ms's. SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work checka0 applicable) New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify �'� M , Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRIlCTION COSTS Item Estimated Cost (Dollar) to be IISE ONLY a$F Completed by ��f)FIFICIAL penrdt applicant 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Lu c ; t F� /% V1 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in al matters re hve_to work authorized by this building permit application. f t _ �� Si ature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 1 2 3RD SPAN DEVIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D. Robert Nicetta . Building Commissioner (978) 688-9545 (978) 688-9542. Fax Please print. //�, DA`f E lb -0 V JOB LOCATI "HOMEOWNER Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Number 'Street Address Map / lot 4 I� ril(yj Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Zip Code North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris .will be disposed of in: M (Location of Facility) Signature of Permit Applicant . =0� Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector CA m x C m CO) CO) F) m 0 C2 C � o O Cos Cl) 0 Z y E; O �. r C CL = y O ® ® CD CD CLc CD Er T CD O CD C CD v y —• o co CD �.�. CO) O 10 Z CD O CD C CD ems+. 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