HomeMy WebLinkAboutPlumbing and Gas Permit - Permits #10692 and 9476 - 38 TURNPIKE STREET 8/18/2014 TOWN VER
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PERMIT FOR dot,
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This cert�ifies,that..,.............. ........ ......... .......
has permission to perform.,. ......
plum'bing in,thebuildings of'...
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North Andover,,Mass.
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Lic. NO ......
PLUMBING INSPECTOR
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MASSACHUSETTS
_ UNIFORM ICATION FOR A
PERMIT TO PERFORM
PLUMBING
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OWNER ADDRESS TEL FAX:
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TYPE OR OCCUPANCY TYP E COMMERCIAL I�� EDUC NAL RESIDENTIAL
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RENOVATION-.t -. REPLACEMENT: PLANS SUBMITTE ,:II YES E] NOD
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CROS SiE� TII E� IE I I F. I�" :: :,Xa
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DEDICATED TE SPECIAL WASTE SYSTEM � I
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DE I TED GI IS II ISSN SYSTEM
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DEDICATED GREASE SYSTEM
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DEDICATED GRAY WATER SYSTEM � I I �
DEDICATED WATER,RECYCLE SYSTEM
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FLOOR AREA DRAIN
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LAVATORYI I I I I
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SHOWER STALL I I
SERVICE MOP SIIN I f I I
TOILET I LI
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INSURANCE COVERAGE.P
m r■ insurance
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havecurrent- I liability ins r nc I'i � � r itssubstantial� i l equivalent which meets-the requirements, MIL Ch.1 , YES ' N, .. ,
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YOU CHECKED YES)PLEASE INDICATE THE TA F COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY I'IIIE POLICY OTHER TE IIIIEIJIIT _P BOND [.._I
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E ' WAIVER,-,-I aware that the II I theinsurance I r� required' r f the
GeneralMassachusetts era t � `I
� signature r ru~� I � IIi n "Iin � t1�� requirement.
CHECK ONE 0 �'
L � , AGENT 10--'
SIGNATURE, E OWNER OR AGENT
hereby certify that all of the details and infarm tion I have submitteldor entered regarding!this,applicatiorLAW, and' ate to the best of rny knowledge
and that all plumbing work and instaliations performedunder the permft Issued for this l tan in It Rte 1 II Pertinent provision of the
Massachusetts;state Plumbing Code and Chapter 142 of the General Laws.. o l`
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PLi
PLUMBERS NAME � �LI RI SE� CA
SI I IATURE
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0 J,P El, CORPORATION[ji,,# ��PARTN E R IS H I,P E, �LLC 131V
COMPANY NAMEI
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FAX ^"�^ tl' CELL �^d K �f�� � EMAIL
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ROUGH PLUMBING INSPECTION NOTES -BELLOW FOR OFFICE USE ONLY FINAL INSPECTION E4
Yes No
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THIS APPLICATION SERVE'S AS THE PERMIT [:1 ❑
FEE. PERMIT 0
--- PL .1 REVIIEW NOTES
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�~ The Commonwealth ofMassaOuse#s
- Department of-hidustrialAceldiiks
Office Of ffivesikafions
66 Washington Street
Boston,MA 02111
;vr ass,go v1dia
Workeis' Compewation Insurance Afrada-vit:Buffders/ContractorsfFIectriciansf-Pliiinbers
-cant formation 'lease Print Legffil
Name(B-asin ssio` ax ation/& -rid-a .: k LL
Address: ................ P
City/State/Zip. Phono#X
.re you an e io c ?check ffie appropriate box; Type of project(required.):
_1.0 1 m a employer with mm -- 1 am a general contractor and 1 6. El New con.struction
mploya 3 M and/or paw tea).* have J.ke d the mb-G outractor t
.1 a a.s D pr pxjetor or P a a QK-
sied on the aache�, t, ` ; oa�v�deg
ship and1avo no.c . loyees Thane sub-contactors have 8. El DamoHflon
oimng �0x e a.m capacity, . ]Buffdffig audition
[No- er D-r 'COMP. surauco 5. Wo are a c orp exagon audits10. C eftleal lop aks or additions
q ' d.] 0 COO have e- I 1)���umbing re airs or ons
01 ate. meo . or d - a - r0x right o c e p en per M �
MYS elf.[No Wgrkals,cOM c.1 ,§1 ,and wo ha o no 12.0 Rooftepaks
13.E]other
comp.t s ance re ed.
�-�n applicautthat checks bo X mustalso fill outthe seotioa below sho i gtheir or ors"oompensationpAGy i o atio .
7 Homeowners who submit fhig a. tdavit ingoathzthey tiie dp'mg all-work and then hie o-atsido contraotois must su met a now affidavit indfoaffig Muth.
� oitfraoters that chcok 19s box mxist aached Migdlflonal sheet s'hawt g tho name of tho sub-con actors and their workers'comp.policy information.
I am an MY
lover that i ro ing workers'coinpensafion iftsurancefor n,y employeay. Relo the-Tolley andjoh site
inmanc e,C omp my Name:
Policy or 801-f-ing.LIG. ." Exviratloa D ate:
Job Site address: Icitylsteof i
Attach a copy offlio workers"comp P. a on olley declaration page o ing Vie p oNey numb or and expliraVon date).
ao to socure coexge as Taqy1"Tec1undQr Sodion25Aload . eso oc �a pae a
fluo up to 1� o 0.0 and/or onao-Year imprlso ant,as well as civil ponalfles in the form of a.8TORWORK ORDER.and a fts
o u o$250.00 a day against the-10 o Beadvised that a copy offs statementma be fozwarded to the Office of
Juvastigations of tho DIA for ms an c` erag oxi [ca on.
o 11e.e ,y file 8 at es o ' ep ffia the i ormidio rov ec abo lsftue c rro .ee w
re: t7a� \L
Da : _Jt, )I
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Official use ,y. . o not i e 1 area o eon �'etec city ar town offlelal.
City or Town: Permit/License 0
Brig. ntlaity(circle
1.33oard of ealth 2.Building Departmeet 3.CityJTown Clerk 4.Electrical Inspector S.Numbing fuspector
.Other
Contact Per on: phone
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T OWN OF NORTH ANDOVER
S, INSTALLATION
PERMIT FOR GA
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has perrmission for gas i s .......x�.......w..i..ww
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GAS
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I APPLICATION
IT TO PERFORM GAS FITTING WORK
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CITY IVIA DATE
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OWNER
DRESS T E L
TYPE OR
PRINT
OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL
CLEARLV NEB': RENOVATION- REPLACEMENT: PLANS,SUBMITTED: YES N
PPLIA CES 1 FL S--+ BSM 1 2 3 4 5 61 � 7 8 10 11 13 1
BILE
BOOSTER�
CONVERSION BURNER
COOK STOVE
DIRECT VENT T HEATERDRYER
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FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
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GRILLE
INFRARED HEATED
LABORATORY COCKS
KELI ' I' UNIT'
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POOL HEATER
ROOM SPACA
E HE TER7T V,
ROOFTOP UNIT
TEST _ I
UNIT HEATER
" E TE D ROOM HEATER
"ATE .SEATER,
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THE
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INSURANCE COVERAGE
N have a current liaboily insurance policy or,Its substantial equivalent which meets the requirements of'MGL.Ch.142 YES aNO
II IF YOU CHECKED YES,PLEASE INDICATE TYPE OF COVERAGE
LIABILITY IT NCE POLICY INDEMNITY I
OWNER'S INSURANCE WAIVER-I am aware that the licensee does not have the insurance 'der required,
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Massachusetts r I Laws,and that my signatureI r It application wai'vesthis requirement.
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AGENTCHECK ONE ONLY,- OWNER
SIGNATURE OF OWNER
AGENT A A
I hereby certify that all ofthe detall 'and information I have submitted r entered regarding thisapplication are u to the hest of my knowledge,
and that all plumbing workand installations,performed under the permit issued for this application mill h
' _ � µ� �
rt nt provision ision f the
Massachusetts StateJrIn C ter 1 LICENSE E SI TN EPL E -GASEITTER NAB
or
GE P l PARTNERSHIP LI I TI LLB
COMPANY NAME-' AD RESS'
CITY STATE TEL
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