HomeMy WebLinkAboutElectrical, Plumbing and Gas Permits - Permits - 52 COMPASS POINT ROAD 5/26/2015 l�
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TOWN OF NORTHANDOVER
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PERMIT FOR, WIRING
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Commonwealth ofHassachusetts Official Use Only
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Permit N .
OccupancyDepartment of Fire Services
and Fee,Checked
BO
AR OF FIRE I' PREVENTIONREGULATIONS� R (leave blank
APPLICATION FOR PERMIT TO PERFORMEL CTRICAL WORK
All work to,bo perforTnedin,accordance with the Massachusetts Electrical Code C, 2 C 2. ,
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"ALL �" 5
.SEAS
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ORIMTION) Date.. ...................
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Location
rNumber) e,'00?71
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II md, II
hone NO.
Owner or,Tenant t"-
s permitthis (Check.Appropriate Box)
Illm�,
ing Uti'llity Authorization-No. :11P 0 70 8
Purpose of Build.* VfZ14101 G.0 7
Exist
iW�-- Meters
New Service l r� ,erg
Number of Feeders and Ampaclity
Location and Nature l- p Isar i r �"
e�� Le2
II Ilol
i
Cow f " table t f Wi .
No.of RecessedLuminal"res No.of e .- s .(Paddle)Fans No.,of 'Toto
s Hers V
OutletsNo. of Lurninaire.
Above I n-
No.,of Luminaires roll Swimming Pool r
ReceptacleNo. of No.of'011l Burners FjORE ALARMS NO. 6f ZonIesNo. of SWitches !No.of Gas I urRers
�I
No.of Detectlan eind
Y", I 002,00le Initiafing DevicesTotal
it Cond.
!.
—No.of'Self-Contained
eat Pump . � � F�
No. of Waste r
i. ei r
Muiliiclpal Other,
ishwashersof'D Space/Area Heating KW Loical
Connection,
urn y *,
No. of ' a gating Appliances of d
Ala i r �
No. of He Berl Data
Wiring—KW
ateris Signs Ballastsi ' t
i
u i on, it
s Bathtubs Devices d
., or a,
e, t a h additional d t l d d � quire b the Inspector o, Wires.
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Estimated Value of l ri n required by municipal policy.)
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Work,to,start., tll.:2
rnspectlons to'ble,requestedmi accordance with C Rule ,and upon completion.
n.
INSURANCE W : Unless waved by theowner, em for r the performance elect,r1 ,l wore may issue unless
the liceinsee provides proof of liability insurance includmig"'completed r oif"coverage r its 1 u n. The
r '�ned certifies that such coverage Is . force,and has exhibited proof of same to the permit Issuing office.,
C : NS A SCE BOND S lry'.
s o el�ju ,,Yie rythat � n n �' icy �true a cow .
I � � � ,I � I��5e -P7 c:-,; r*5, oo� LIC,III
FERM NAME:,,1111,, �I 7/7' co-,
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�II Licensee: '"' "l
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(Iflapplicable,enter
mp't in the license number ane)
Add - '11
2-—az �,� � I ^lumolum
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*Per .G. . 147 �� - ,B rit work eq D � � � ��� Safety�aS�' � � Lie.No.
OWNER'S INSURANCE . :. R Lam aware that,the Licensee does not have the liability insurance coverage normally
required by,law. By my si19 nature b elow,I hereby waive this r . - m nt. farn the'(che one) v.�.owner 11 is L90.nt.
er end ) :
+. fvtrith the rovx ions of . r.L,o.143, 3L,the
0� Massachusetts �ectr��al ads .xnndrrtent� '� � .� �. � Rule aceordar� P
penit application form to provi notice of inst
allatian ofvrin shill uniformtlrouhoat omraoaealth,end applications shall Filed
an
permit application has been accepted by an Insp etor of�'� fires appointed pursuant to 1. . l 3 ,
on the prescribed form.After a F Pp
electrical permit shall be issue to e person,the 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.
t the time of on oin construction activity,and may be deemed by the fnspeeto�r of Wires abandoned and in.�valid if he
'permits hll.be l�rn�ted a � �
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period,Upon written
application,an of time for completion of word shall be permitted for reasonable cause. permit shall be terminated span the r�xtte
request of either the owner or the installing entity stated on the pernxit application.
Act way created b ctio� 7 of ha ter 40 of the Acts of 01 and extended b ections4 and 7 o Chapter 38 of
The Permit Extension .
the Acts of 2012.The purpose of this act is to promote job growth and long-terra economic recovery and the Permit Extension Act farthers this
l lishin an automatic four-year extension to curtain permits and licenses concerning the use or development of areal property. it
puzpose by esta permit or approval that was
limited exceptions,the Act automatically extends,for four gears beyond its otherwise applicable expiration date,any p pp
"in effect or existence"during the qualifying period beginning on August 1 ,2008 and extending-through August 1. ,2012.
— it at Closed: Dote:Reapply for Dew permit El
0 Permit Extension.act— Permit/Date Closed:
Trench Y tion
Pass Failed
e-Inspection Required{ . I
Inspectors Comments: ,
f
t..r■
Inspectors Signature.
SERVICE INSPECTION:
Pass ENI<alr d ? e-Inspection Required� .� D
Inspectors Comments:
Date;
Inspectors Signature:
AR ML ROUGH INSPECTION:
Pass
Failed e-Inspection Required .
InspectorsComments:
Inspectors Signature:
Date:
.ry
ROUGH INS IN,
� File � e-Inspection Required� El �
Pass
Inspectors Comments:
:,
Date:
Inspectors Signature.
� � �
FINAL INSPECTION:
Pass
Pe-Inspection RequiredEl
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InspectorsComments:
Z.
(6L)LA
Date.
Inspectors Signature.
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DEB WE1NH OLD ...TOWN OF MERRIMAC,M . .......dweinhold a@townofinerr mac-COM
oe Commonwealth Massachtfsetts7 Devartinent of IndustrialAceldents
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Boston MA 24-2
W .ma . v d a
aetorsf��er
Workers tp olxpe a i rx Ins T om .
T QED WI11 THE�' �,T
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'-P jeftntinformatiort
Name(Businoss10rgai&atjonftdj
Address: - -�
Phone . t ,
citysa /zip■
x• xx e p �r`?Check tfie appropxi e
1. 1 am a employer with �rr� to eas(fall and/or part tii e).�
ersb an no e p o c es or it forme in . � e o deli]
2.[]1 aan a solo proprietor or p� �
any ca ace R o wor zs,comp.i surar�ee required- x o o f
homeowner doing alb wor � 'se It To workers'comp. surancc arequired.1 T 1� � �dx g addition
. I am
co��rac�ox �a co� uo�a�' orlc on my propel. I iri�l al . ,
. am a harcowner and hiring r are o I cot rim 'addx
cox t ac ors r workers compens tioa insurance,o 1 i
]ns a s tC].PI g repay s o additionpropzI tors,with ,o a ipb �s.o t a for vs
and I have hid the sub-contractors list d o e attached 1 -, Ro i re a
S-Eate.a general ,, t. . . .-.�
These'sub-contractors hav e ploy haveworkers"co a ra c . 14. Other
. We
are ora r ids,o ECUs havc e excised their right o amp on fez o.
1
X� and � ��no er�•pYt� .�, o Corers'comp.i�,�ura .co require .
a ply cast that cheap bow 1.-
u t .s out the section below showing their worker"comp sa .an pclic informat'on:�davit dicat g such.
davit indiratin they ar doing all work and then hire outide contractors must submit a now r or not�ha an�iti� have
r o��noonar who sttb� Ixs Cho as olc sub4ccnacor and stp. vt� , , ,
T ont�actol that chec thz o must attached be t s ow g ors'oo . . oli number,
a to yes. pub-contractors have amplo es, e xn pro xd their
air P ;
- pro -workerscompensaviding sr c�c or m cfNp ees. Pe low _ •po le ,a d ob site
m can eM
information.
Insurance Company Name:--1
xpiration D 4t0:,
policy 4 or Self ins.Lie. : .
city/s
fob Site Address:_. compensat'on i lion a (showingthepolicy number and expiration a .
*. 5 5 .i gri n /violation punishable .fifth np to 155 .0
Failure t ecur coverage a �rcgwc �� � �a d .
a�.� ox o� �re ap�� o
nt. as well s cl ll penalties x�theform o STOP WOE
day aga . iolato�r. .copy o this t tcra a a `or yarded to-axe Office o e tig ons o he IA.for suranc
coverage-verification.
do hereby u d t pains d era .
erjury a i information PrO ded above� � co�� e�
Date: C9 13
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Off,geol Dnot wri i th s area, o be completed b city o o f o c
City or To
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Authoy ity(circle one): k
Clerk 4. cspc �r fxxrzeco�r
�., aid o � l .Building Jepartr�. x� City/Town
.Other
oxL-� t arson"
Phone
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This, certifies that...
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has
Plumbing in the buildings of,
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"' °' nw,w,...w.wro•...w PLUMBING INSPECTOR
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MASSACHUSETTS, UNIFORIVIAPPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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CITY NORTH ANDOVER MA. DATE 1515 PERMIT
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ESITE ADDRESS 52 COMPASS POINT OWN E 'S NAME T AT CONST CTIO ..
OWNED ADDRESS: 51 ITT JOY,DRIVE TEWKSBURY 01876EL# 50832,109337 FAQ: ..
TYPE OR
OCCUPANCY TYPE: COMMERCIAL LJ EDUCATIONAL: 0 RESIDENTIAL
PRINT
CLEARLY' NEW: RENOVATION:F1 REPLACEMENT:, El PLANS SUBMITTED: YES,El N 0
FIX' TR,ES FLOORS Bsmt 1 2 3 4, 5 6 7 8 9
_ 1 _ 11 `12 1
BATHTUB
CROSS CONNI DEVICE
DEDICATED SPECIAL WASTE S S
IDEDICATED GAS/OlUSAND SS
DEDICATED GREASE SYSTEM
DEDICATED,GRAY WATER SYS
DEDICATES WATER_ REUSE,SYS—
DISHWASHER
DRINKING I ING FOUNTAIN
FOOD WASTE,GRINDER UN IT
FLOOR IAREAI1
INTERCEPTOR INTERIOR. j
KITCHEN SINK
LAVATORY 71
ROOF DRAIN
IWO%
tl,
SHOWER STALL
SERVICE MOP SIN'
TOILET 1
IINL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATERPIPING
SPIGOTS
INISURAN
equivalentwhich ee th requirements
'I �rrr�t 1iabiIM insurance� IIic r it substantial � ; � NO
�,
If I. indicate the type,of coverage by checking appropriate below.
LIABILITY INSURANCE POLICY
INDEMNITY BOND
I J I r the licensee t ve t rcoverage r required r the
i
Massachusetts, a n d Laws,a that my signature on this permit It l ication waives this requirement.
SIGNATURE OF OWNER OR AGENT CHECK ONE,ONLY-. OWNER AGENT
I hereby certify that all of the details and information I have submitted(car enter regarding this a lic ti re true a rate to the best of my
Knowledge and that all plumbing,workand installations performe under the permit issued for this a, Pli ti will b i� ol Hance ith all Pertinent,
provislion of the Massachusetts State Plumbing ode and Chapter 142 of the General Laws.,
PLLI M BE,R NAM E.I MII E B,U R ,E LICENSE#113127SIGNATURE
COMPANY E' LPOWERHOUSE PLUMBING AND HEATING CORP ADDRESS: PON 11
C1T P' IST STATE: ZIP: FAX. L60337800140
TEL: F��780020 CELL. 1,97849019385 EMAIL: LAU RE,NC 10!2 POWER,H OUSE PLUM 13,1 N G.COM
NI-A/7j
MASTER
Lli_ NE MAN 0 CORP TI P I TI E SNIP LLB El#
0
R-AOUGH PLUMB!NG INSPECXAON NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION N -ES
YesLO
APPLICATIONTHIS
PERMIT
REVIEWPLAN
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07 TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies es
emx'or hasmxwr
m a on rs m � r 5
tion gas, installa, f �/r �%� r/.mom rrrRa�, l
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. . .ebuildings, ......,,...re...:�..�. :�.'...�....:..........m.. �a...��.� ��..'e.......'........°;....�..�..o.....�..�...
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GAS INSPECTOR
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_ MASSACHUSETTS UNIFORM APP1LI I II R IPERMIT TO PERFORMGAS FITTING WoRK
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CITY TNT DO ER IAA. I TE =5-15,-15 PERM
IT
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JORSITE ADDRESS, 52'COMPASS,POINT OWNER'S,"S NAME TRUST CONSTRUCTION
1T J OY DRIVE � � 1 TELI- � �� �' SS FAX.
TYPE OR OCCUPANCYTYPE: RESIDENTIAL,
PRINT
CLEARLY M FmC RENOVATION: E L CEI IEI' T: PLANS SUBMITTED: YESE] NO�ElI
FIX
i
LET s t 1 21 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE 1
DIRECT VENT HEAT E
DR�YE,R
FIREPLACE
FILT
FURNACE
GENERATIII
ILL
I
LABORATORY COCKS
MAKEUP AIR UNIT
E
' IPOOL HEATER
ROOM 1 SPACE IDEATE
ROOFTOP,UNIT'
TEST �
UNIT HEATER
UNVE 1 TE ,ROOM HEATER,
WATER HEATER
INSURANCE COVERAGE
I have a current insurance,policy, or,its substantial equivalent which meets the requirements, f MGL.► h.,142 YES NO
If you have chec�k,ed YES,,pluses indicate thee,type of coverage by checking the appropriate box beIlow.
LIAB,ILITY INSURANCE C POLICY OTHER TYPE INDEMNITY ] BOND, El
OWNER'S INSURANCE W II' I are,aware that the licensee does not have the insurance coverage required Chapter,1 f the
Massachusetts General Lis and that my signature n,this armilt application waives this,requirement.
AGENT'CHECK ONE LY-9 Ej
SIGNATURE OF OWNER AGENT
�' M M M j°
I'� r� that III�f the details ur�frrr� tlon I have,submitted r entered)regarding this lati are rug are ur to,the et of my
Knowledge and that all plumbing work and installations perf rm dl sunder the rmit issued for this applil fi rs, ill be i ce with all Pertinent
provision of the Massachusetts State PlumbingCode and Chapter 142 of the General Laws.
PLUMB E G SFITTE R INANE: MIKE BIURKE LICE SE 3, 2 I I I
COMPANY NAME LPOYVERHOUSE PLUMBING AND HEATING CORD ES PO BOX 896
CITY ISTOW STATE., NFL ZI R 103865 1 FAX6033780040
T'EL: :6033780020 CELL 3185 EMAIL J.L. I iI 'M POWE, H, SE L IIIG III E I G,,
MT
MASTER.STEf JOURNE LP INSTALLER LLE CORPORATION #L��2' PART E SHIF LL�
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,,"510UGH GAS INSPECTION NOTES BELOW 1 OFFICE USE ONLY FINAL INSPECTION NOTES
'{ Yes No 2 4`7)
THIS APPLICATION SERV S THE PERMIT ❑
or
FEE: PERMIT
PLAN REVIEW NOTES
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The Commonwealth ofMassachusetts
Department ofIndustrialAccidents
1z ,
W Office ofInvestigations
I Congress, Street, Suite 100
Boston,MA 02114-2017
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4S wwwmassgovlaia
Workers" Compensation Insurance Affidavit: Builde,rs,/Contractors,/Electr*ic�"lans,/Plumbers
Please Print LegLbI
Agpficant Information
POWERHOUSE PLUMBING CORP
Name (B,usiness/,Organlzat'lonndividual):
Address- P,O BOX 896
0
Clty/S,tate/Z1*P-. PLAISTOW, NH 03865, Phone 6033780020
Are you an employer? Check the appropriate box. Type of project(requlired):
L I am a employer with, 6 4. [:] I am a general contractor and 1 6. New construction.
employees (full and/or art-time).* have hired the sub-contractor's
2 1 am a sole proprietor or partner- listed on the attached sheet,. 7. Remodeling
ship and haveno,employees These sub-contractors have 8. Demolition
'working for me in any capacity. employees and have workers" III
+ 9. E]'Bui-Iding addition,
[No workers" comp. insurance cornp. insurance,.+red 1 10. Electri cal.repairs or addi ti ons
r 5. We are a corporati.on and its
equ .] 1 4 't"
3.0 1 arn a homeowner doing all work officers have exercised their 1,L Plumbin,,g repairs or addi 'tons
myself. [Nio workers' comp. right of exemption.per MG L 12.,EJ Roof repair's
6 d, C. 1 512, §](4),and we have no
insurance required.] t employees. [No workers' 13.[:11 Other
comp. insurance required.]
*Any applicant that checks,box#I must also J''111 out the section below showing their workers'compensation policy information!.
t Homeowners who submit t�his 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 s; t showing the name of the sub-contractors and state wbether 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 1"Sproviding workers'compensation,.insurancefor my employ,ees,. Below is the poliq andjob site
informad'on.
Insurance Company Name: HARTFORD UNDERWRITERS INSURANCE COMP
E p
Policy#or Self-ins., Lice #:I 04WECIT2480 x iratlon Date*7.28,-15,
52 COMPASS POINT C'ty/State/Zo N ANDOVER MA 0,1845
Job Site Address: I I ip..
Attach a copy Iof the workers' compensallion policy declaration page(showling the policy number and expliration date).
Failure to secure coverage as reqm1red under Section 25A ofMGL c. 152 can lead,to,the imposition of criminal. penalties of a
fine up to $1,500.00 adn.d/o ne-yjear,o�fi prisonment, as well as civil penalties in the form of a STOP WORK ORDER and a flne
'Y
of up to$250.00,a day a st the,�A, altor. Be advised that a copy ofthis statement May be forwarded,to the Office of
f r
Investigations off e or in r,a ce coverage verification.
Ido hereby certi n r th al' andpenalties ofperjury that the Mformati6n provided'above i's true and correct
5-15-15
Date r e:
Phone 6033740,2_ 0
Official use only. Do not write in this area,to be completed by city or town,0 Icial.
City or Town: Permit/License #ff
Issuing Authorlity(circle one):,,
1.Board of Health 2. BulildIng Department 3. ClitylTown Clerk 4.Electi-lical Inspector 5.Plumbling Inspector
6. Other
Contact Person: Phone
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