Loading...
HomeMy WebLinkAboutMiscellaneous - 96 CASTLEMERE PLACE 4/30/2018ME This certifies that ................... .. ................. . has permission for gas, installation :.. 2 `''0J0.! ' ............. . in the buildings of�.1�" .... . at . ,64- 6 � `, 0, e. vo f e ! '�.N-x ver, ass. r ��i�7 M Fee .... Lic. No.............. . n GAS INSPECTOR Check #' `r 8616 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ..- __<w . ` �_� _• -- MA DATE - PERMIT # JOBSITE ADDRESS gy-_ _- OWNER'S NAME _ OWNER ADDRESS_ - - -, - _._.___.... TE L o FAX f J TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL F] RESIDENTIAL CLEARLY NEW, 911' RENOVATION: [ REPLACEMENT: ❑ PLANS SUBMITTED: YES ..I NOIR APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 1 6 7 8 9 10 11 12 13 14 BOILER_ - BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - -�_1 J _.. ___( _-- —J - --J •- ---_I1 -� J . _._.,J __T I _.. 1.,_�J DRYER —,J ._.T �� J - -•-� - _____� . CJ =..-._ 1,i C-_ I _ 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE i ---j INFRARED HEATERS - - I I-.. _...._. _-_ - --J -- -1-- LABORATORY COCKS MAKEUP AIR UNIT S-7-1= C_ . 1 . .,_. ___.I __. --------- ---OVEN OVEN POOL HEATER (r-._ JJ , _., .- [�`✓ _ ROOM/ SPACE HEATER 4 _ r,� r- C __1 - ---.•' Cmµ [ T_ wJ _ ._( .. _ _-.1 . _ _, I _ .__._,1 .:. ___--._. ROOF TOP UNIT TEST............. I=== UNIT HEATER -i 17 ATER UNVENTED ROOM HE WATER rEATER OTHER LT_ I INSURANCE COVERAGE I have a liability Insurance Its current policy or substantial equivalent which meets the requirements of MGL. Ch.142 YES No ❑I I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA BY CHECKING THE APPROPRIATE BOX BELOW 3( ,'. "" LIABILITY 40— LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY (� SOND 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 . JJ AGENT 1-7-3 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and Information I have submitted or entered regarding this ap 'cation true and a urate to the bask of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application In plian all Pertinenvi of Massachusetts State Plumbing C e and Chapter 142 of the General Laws. PLUMBER GASFITTER NAME (CENSE #I +. t SIGNATURE - MP _ v MGF JP ( JGF J) LPG(© CORPORATION -❑# PARTNERSHIP 0#[ LLC COMPANY NAM CITY -.- .......�._ TEL FAX CELL1-�.W-- EMAIL r Stag of New Hampshire GAS FITTERS �Vct[, NAME: JONATHAN CO T ENDORSEMENTS STNS P DATE ISSUED: 04/09/2012 DATE EXPIRES: 03/31/2014 Ad LICENSE M GFE0700413 STATE OF NEW HAMPSHIRE BUREAU OF BUILDING SAFETY 8 CONSTRUCTION PLUMBING SAFETY SECTION NAME: JOHNATHAN C C086TT LIC #: 4067 ,,EXPIRES: 03/3112013 I ,cepa ...+c r r,sf� FM2F-319810 JOHNATHAN C'ORBETr I V ENDOME ST MERRIMA(:K jMA 018 03/2312014 Co t* _',', n nN7tGnyy 8r h Uf %18S,A,Gt'tUSP,1tS Px €' �' A 'wstoi O ��P-,13irg{fiJt k� x g��: Board or ¢rumbij b ' JOHNAi`W{t 1 VENO Master Pluriii�r PL15967-M 0510912014 4004955 Elpil'�JiiCt^.. t'%8(8. ;vE!?8.' 3L`t?. a f t COI#Iu10NW�dEAETH OF MASSACHUSETTS ; AND � {.ICF: SEtI A"<' A JOU NEYMAN PLUMS R THE Af OVE LiCFta _ TO JO HNA VAN C-013BETT 1 VENDL t•E ST !k MERRIMAC ISA 01860-143!3 0849 05/01114 147881 DEPARTMENT OF PUBLIC SAFETY "1 Oil Burner Technician Certificate r(' Number: BU 130867 Expires: 03/2312013 Tr. no: 3672.0 Restricted: JOHNATHAN COBBETT MERRtMACK, MA 01860 CommissIOner Co t* _',', n nN7tGnyy 8r h Uf %18S,A,Gt'tUSP,1tS Px €' �' A 'wstoi O ��P-,13irg{fiJt k� x g��: Board or ¢rumbij b ' JOHNAi`W{t 1 VENO Master Pluriii�r PL15967-M 0510912014 4004955 Elpil'�JiiCt^.. t'%8(8. ;vE!?8.' 3L`t?. a f t COI#Iu10NW�dEAETH OF MASSACHUSETTS ; AND � {.ICF: SEtI A"<' A JOU NEYMAN PLUMS R THE Af OVE LiCFta _ TO JO HNA VAN C-013BETT 1 VENDL t•E ST !k MERRIMAC ISA 01860-143!3 0849 05/01114 147881 Feb -28, 2013 3:55PM No, 7614 P. 1 GENERATOR APPLICATION DATE: e'3-1 OWNERS NAME: IX4 GENERATOR kw 0 NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* I . /' / . _ . CONTRACTOR: PHONE NUMBER: &/z 5� ELECTRICAL GAS —�J�i tc�u'u sur 1 C- C0 RESIDENTIAL ) COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVAL North Andover MIMAP March 7, 2013 #28 7.A 011 7A 10 7.AxM1 03a.A- 054 7(A-'0030 /�/ �� 7:A=0026 03ZlA 04 #10 0 7:A-0031 064.0-0 03 7: 0 06 037 A-003 125 # 8#84 03 A-0044 IX704 103 A=00// #143 v/0C A-7 33 �Ojl tl e ere C 037.0-0051 �' j "- j --_ - -:- '-: ZA-Uua 37.A-0045 3 - Rl � /%%%j 1#9 VJ,1.AA046 #$5 / water/Pro C 037�G X 9 #100 . #105 37.B-0070 0 7r 071 37 B-0062 03 37.B 11 71' VIM UV/7, 0 3 0 fie /j A 037� -00 1 037M 0,7 W0 /037r, A 7:B-000 Rail Line Wetlands Zoning Inlerstates, Exempt Lands Interstate ' Busi— 0Busine! a 1 District : 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Major Roads C3 2usine! 13 Businei 3 District a 4 District Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads t7i Easements Gene re Planine, C', Corrdo Business Districtneo 0 I Commercial De . v1. Development Dist North Andover. Additional data provided by the Executive Office, of Environmental Affaim/MassGIS. The information depicted on this map is C3 MVPC Boundary L3 Municipal Boundary 'M Corrido C3 Corrido Development Dist Development Dist for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation, THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning Overlay Indus I D�::nc THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY E3 Adult Entertainmen r-. lnc!Z� 0 Industr :� 2 District 11 3 District OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT 0 C3 D wntown OvertaytDislri�t C3 Historic District 12 Industr 11 S Dis rict ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION C3 Water Protection Reside Reside ce 1 District ce 2 District SACMUS D Parcels C2 Reside d't ce 3 District it Hydrographic Features V = 192 ft de dece ce 4 Dls'ric 5 District Streams de. 6 District ge sidential District r Date... /C1./jL)..... 0 o - ,o ryo TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . f.` . 7TJ .... ... ... ..... . has permission for gas installation .!.`�..�.pT ` .. .� in the buildings of . S / !v 01' 4 wfu ! at .. C�...�¢ .�-.� ,7�t,�'!�! P'� -P . , North Andovr, Mass. J Fee.i?? `... Lic. No.. INSPECTOR / Check # % ) S, �? ` I 'f X43 t MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FTr ING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations �% (,� /Vb� e Permit # Amount $ Owners Name G —_li A/� � /v IA WN ` New 11Renovation Replacement Plans Submitted (Print or type)f Corp. �� Check one: Certificate Installing Company _ Namep1d��/Ji'P �� L7 ❑ Address a ��� Partner. Business Telephone �irm/Co. Name of Licensed Plumber or Gas Fitter 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � No O If you have checked yes, please in ' ate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. � W � a U N a o o Z H Gw7 F zF a F f w � p � 0 A U a v, w z o z c x w o x w 3 0 a z > a F o SUB -BA SEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLO O R 6TH. FLOOR 7TH. FLOOR STH. - FLOOR (Print or type)f Corp. �� Check one: Certificate Installing Company _ Namep1d��/Ji'P �� L7 ❑ Address a ��� Partner. Business Telephone �irm/Co. Name of Licensed Plumber or Gas Fitter 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes � No O If you have checked yes, please in ' ate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner E Agent 0 , , .,, ,, 4lili anuimaL vii i iavc JUU111ILL- kor emereal in above application are true and accurate to the best of my knowledge and that all plumbing work and installatio ormed under Permit Issued f r this application will be in compliance with all pertinent provisions of the Massachusetts tat Gas o e and Cha ker 142 of e Gener aws. By: Title City/Town APPROVED (OFFICE USE ONLY) I- Signature of Licensed Phh2 ber Or Gas Fitter [3' Plumber ' Gas Fitter icen NumbeY 0 -Master MJourneyman SThe Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations 600 ff,ashington Street Boston, AM 02111 www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le--ibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole have hired the sub -contractors listed proprietor or partner- on the attached sheet. I 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.) 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.) t employees. [No workers' comp. insurance required_) -L1 W1 'JUL iuc Semon rrm w S.^..04'!.^.^ t:L` � nn.i.....' 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 t Homeowners who submit this affidavit indicating they are doing all work and Hien hire outside ontm ors 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 isproviding workers' compensation insurance for my employees information. Below is the policy and job site 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 Simature: Dare.: Phone #: 11 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 #: It Information and Instructions 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 notbecause 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-contractor(s) 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 Depart -.rent 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 permit/license 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 02.111 Tel. # 617-727-4900 eat 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 v rvm, mass.-gov/dia 35'13 Date..~/.. ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ^a _ F This certifies that ...... n -:r......... ....... has permission for gas installation,---. " 4e— .. ................ in the buildings of ./-- .............................. at/('.. :: � '� "� ' `` .. .`��� ..... North Andover, Mass. Fee Lic.No.". �� ..... �.� �-off-/ .......... Q ) �9f3 —GAS INSPJE G� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UIINVORM APPUCATON FOR PERMIT TO DO G� yType or print) NORTH ANDOVER, MASSACHUSETTS Building Locations `,ew [7 Renovation ❑ Owner's Name Replacement Plans Submitted ;.G Date'' _19 ?rinl or type) Check it: Certificate Installing Company ,:ame Andover Plba. & Mg. Co.. Inc. , Corp. '?a= ddress 20 Agean Dr. , Unit -10 ❑ Partner. Methuen. Ma. 01844 Business Telephone (978) 685-8383 ❑ Firm/Co :ame or Licensed Plumber or Gas Fitter N S t; R.-k,NiC E COVERAGE Check one: have a current liability Insurance policy or it's substantial equivalent. Yes Nod ou have checked ves, please in to the type coverage by checking the appropriate box. eiiiroin,iurancePolicy Other type of indemnity ❑ Bond ❑ 11"t ner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe :lass. General Laws, and that my signature on this permit application waives this requirement. Check one: S ,,nature of Owner or Owner's Agent Owner ❑ Agent nerebv certify that all of the details and information I have submitted (or entered) in above application ap oi'my knowledge and that all plumbing work and installations performed under Permit Issued for this .” _omDilance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gare Title C; IV; Town .-�2PRO L-Di()FFK:F.111EONI.Y) Signature of Licensed Plumber Or Gas Fitter w++ ❑ Plumber 9983 ❑ Gas Fitter License I umocr ❑ Masier ❑ Journeyman and accurate to i cation will be in 'inl kl En W G.z C W .�+ `• 96 lL.�li m n L :: n z :� C C C �l W N �7 Z -t ^ 5 .. iJ 'r7 i:. �+ " C. C -t Z w — it t Z — ` 'z 'v !' 'c s7 :0 r in �s ^, - =t i z s. C c V', CU a fal c " _ •s i L c v 5 i C U B t3: SE.NI ENT SE." EN'r I `' 6r. F L 0 0 R N U. FLQ U R ] R 0. F L 0 0 R r 11 . F L O U R 6T 11. F1,00 R >' ;T 11. FL0O K F y„.,. ?rinl or type) Check it: Certificate Installing Company ,:ame Andover Plba. & Mg. Co.. Inc. , Corp. '?a= ddress 20 Agean Dr. , Unit -10 ❑ Partner. Methuen. Ma. 01844 Business Telephone (978) 685-8383 ❑ Firm/Co :ame or Licensed Plumber or Gas Fitter N S t; R.-k,NiC E COVERAGE Check one: have a current liability Insurance policy or it's substantial equivalent. Yes Nod ou have checked ves, please in to the type coverage by checking the appropriate box. eiiiroin,iurancePolicy Other type of indemnity ❑ Bond ❑ 11"t ner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe :lass. General Laws, and that my signature on this permit application waives this requirement. Check one: S ,,nature of Owner or Owner's Agent Owner ❑ Agent nerebv certify that all of the details and information I have submitted (or entered) in above application ap oi'my knowledge and that all plumbing work and installations performed under Permit Issued for this .” _omDilance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gare Title C; IV; Town .-�2PRO L-Di()FFK:F.111EONI.Y) Signature of Licensed Plumber Or Gas Fitter w++ ❑ Plumber 9983 ❑ Gas Fitter License I umocr ❑ Masier ❑ Journeyman and accurate to i cation will be in Date f . a. . N2 4 5 1 3 TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING • `� 'S/1CHUSi This certifies that has permission to perform..... —'...... . ................ plumbing in Ahe buildings of .... ! .....'........................ . at,.� .. c�l.................`........ '.., North Andover, Mass. Feer.. .. Lic. No.FYf-3.. , �:� ............... P U' NG INSPECTOR Check # q WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR P MIT TO DO PLUMBING (Print or Type) I& Mass. DatZ;ZOwner's 19 Permit #� Building Location Name r Type of Occupancy New ❑ Renovation ❑ Replacement 91 Plans Submitted: Yes O No O B•P•7--rl SEWER# FIXTURES SEPTICm N- z OV<Y d Qj J = 60 cc Cl OQjy J WNH ca N W S UJ Wm H X 0 t N U. CL O K ZOWhy 0 cc 2 W O < N a•W O Gsa >F- �. < O _ N y O a IL Vr F- Z a O G y Z Z d W W Y Y J m to -- Q D J a J 3 x �., to u• V � O < S e m a � sue—BSMT. BASEMENT I I — 1ST FLOOR 2ND -FLOOR I I 3RD FLOOR. 4TH FLOOR STH FLOOR I 6TH FLOOR 7TH FLOOR STH FLOOR Installing. Company Name Adover P1bg. & Htq. CO., Inc. /Check one: Certificate # Address_ 9Q Aaean Dr Unit -10 Q Corporation 2122 .�%M 01844 p Partnership Business 19phone (97 s 8) 685-8383 O Firm/Co.s Name of Licensed Plumber George LaRose INSURANCE COVERAGE: I have a currenUlability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 0 No ❑ If you have checked Yes, piease i Icate the type coverage b checking the a Y g appropriate box A liability Insurance policy Other type of Indemnity ❑ . Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the In coverage required by 'Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of O(� Owner or wnar'c ertont Owner Agent ❑ 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, :nowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all rtinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 'y Ile Signature of License J Plumber = tyaown Type of License: Master C] Journeyman O PPROVED OFFI US ONLY) license Number 9911-1 C