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HomeMy WebLinkAboutMiscellaneous - 1 ArdmoreF, NORTH ANDOVER BUMMING ]DEPARTMENT 1600 Osgood Street North Andover Tel: 978-688-9545 Fax: 978-688-9542 .BUSENESS FORM FOR TOWN CLERK DATE: NAME: ADDRESS; 70NTP DIBTP►IOT : TYPE OF BUSINESS,. S,ej� BUILDINGLAYOUT PROVIDED: YES NO A.VAIL,ABLE PARKMEr' 8I1ACM: ZONING B'Y LAW USAGE: YES NO BUILDING INSPECTOR SIGNATUFIE BUSINESS FORM FORMWN CLERK 2.40 Home Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secandary'to the use- of the building for living ptuposes. Home occupations shall `include, "but notlimited to the following uses; personal services such as funished by an artist or instructor, but not occupation involved witli motor vehicle repairs, beaji4, parlors, animal kennels, or the conduct of retail business, or the manufacturing o£goods, which impacts rite residential nature of the neighborhood, 4. For use of a dwelling in any residential district or multi -f t roily district for a home occupation, the following conditions shall apply: a. Not .more than a total of three (3) people may be employed in the home occupation, one of whom shall be the=OWU'Dr of the home occupation and residing in said dwelling, b. The use is carried on strictly withinthe principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings, - d. Not more than twenty- five (25) percent of the existing gross floor area of ;the dwelling unit. so used, not to exceed one thousand (1000) square feet, is devoted to 'such use. 7n connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood duQ to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design_ not cust6mary in buildings for residential "- use. igaature Date -;QLTLUX-� This certifies that -44. 0 �VA-e. 3. 0 .. ... ..... . ......... I .............. has permission to perform . . 4-6 W6 (Art. t� ..... aN-A-� ..... plumbin�in the buildings of. I ............. Z�-- ............ at ... ......... North Andover, Mass. ................. ... PLUMBING INSPECTOR Check # a 9 -L�D • MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: / MA. Date: Permit# _ Building Location -1 MC Ct Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential y New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [Plans Submitted: Yes ❑ No ❑ FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indi the type of coverage by checking the appropriate box below. A liability insurance policy ❑/ 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 Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ofa General Laws. BY Type of License:A& Title PI ber Signature of Licensed ` Plumber, �. aste citylTown o eyman License Number: APPROVED (OFFICE USE ONLY1 ,. 11 I� "Cu V>1 N W I Ito 0 I+JiU�✓ti-<-e 011) -ham �1��� CXP ;943 � AZ'S1IZ t DEDICATED SYSTEMS W 2i Z CAM u H W Y WWN Q N J V W O DQQ: d+ Z d W Z Z W H Z Q Q 1A Z N Qn (A< W �W. C O m W n ~ O Q: W Z H W N J z V d = J W Q 3: Q Q 'S a Y Z _Zwww W O Q > LU ~ W U i- 2 d V in V! 0 W r1 0 0 Z rC� Q F- Q F Q H L.7 LU is Q Q m m G D Z ]e50X-J<W 'nn F- O Q 0 Un SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8, FLOOR Check One Only Certificate # Installing Company NVWnes Plumbing $ Heating 6 Ruth Circle ❑ Corporation Address: NaverhileA,dQ632 state: ❑ Business Tel: Fax: �PartnCeohip mpany Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indi the type of coverage by checking the appropriate box below. A liability insurance policy ❑/ 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 Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 ofa General Laws. BY Type of License:A& Title PI ber Signature of Licensed ` Plumber, �. aste citylTown o eyman License Number: APPROVED (OFFICE USE ONLY1 ,. 11 I� "Cu V>1 N W I Ito 0 I+JiU�✓ti-<-e 011) -ham �1��� CXP ;943 � AZ'S1IZ t IQ CommonweaRh of Machusetts pepaeM of Public Safety oil Burner Taimiaaa Certificam- Licensu: `� A �c� ri 68075 C conurdsaoner 10 � s-& V�- This certifies that ....................... ��J- +i�p� has permissi onto perform..?>, plumbing in the buildings of ...... at ............. North Andover, Mass. Fee:��. ...Lic.No.16 .................. ... PLUMBING INSPECTOR Check # 2-'l 1 09755 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 10 � s-& V�- This certifies that ....................... ��J- +i�p� has permissi onto perform..?>, plumbing in the buildings of ...... at ............. North Andover, Mass. Fee:��. ...Lic.No.16 .................. ... PLUMBING INSPECTOR Check # 2-'l 1 installing Company Name: g ❑ Corporation Z£81,0 dw • 6 Ruth Circle Address: 91011.0 tv#Pia$32— ❑ Partnership 6ui�eeH � ulqusrq sante Business Tei: Fax: Q f irirniCompany Name of Licensed Plumber: G INSURANCE COVERAGE: insurance policy grits substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ 1 have a current iiabili if you have checked Yes, please indi the type of coverage by checking the appropriate box below. A liability insurance policy 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. w Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A lent ardin this a lication are true and accurate to the bef 1 hereby certify that all of the details and information 1 have submitted (or reg sued for this application will be in compliance with all Knowledge and that all plumbing work and installations performed under the permit Pertinent provision of the Massachusetts State Plumbing Code and Chapter 42 f the General ws. t u By Type of U 6nse: Title j mber Signal re o ice aster License Number: Cityrrown _ urneyman PROVED urrwn U.5 �.. T�t i-� � I ��,� r V0 l 10 % � �%11��'Uw�-e.. V1�1-k��C � � MY APPLICATION FOR PERMIT TO DO PLUMBING MASSACHUSETTS UNIFORM MA, Date• Permit# City/Town- Owners Name:- Building Location: [� Commercial ❑ Educational El Industrial ❑ Institutional E] Residential Type of Occupancy: ' Plans Submitted: Yes ❑ No ❑ New; [] Alteration: ❑ Renovation: Replacement: FIXTURES DEDICATED SYSTEMS ec W 2 C0 v O z W Y z CAQ{A } N J = �+ Q LAJ O z W ac LU F v' Z Z 3 0 oQe �' ae "' oQc Fn > a z N cc z g O a O " & , = °if -+ ict O LLS 3 {i/� Cr © = Q � Q W 3 a � 0 W to , Q = W W W Q Q D ' W Q cc W he V F CL Q F. i V- > > `S C = Or Q ac ac v► v► r 0 E.. 'S 3 3 0 Q ei l7 ti a m m c o U. SUB BSMT. BASEMENT 1 FLOOR eD FLOOR 3 D FLOOR - 4 FLOOR - - 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # installing Company Name: g ❑ Corporation Z£81,0 dw • 6 Ruth Circle Address: 91011.0 tv#Pia$32— ❑ Partnership 6ui�eeH � ulqusrq sante Business Tei: Fax: Q f irirniCompany Name of Licensed Plumber: G INSURANCE COVERAGE: insurance policy grits substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ 1 have a current iiabili if you have checked Yes, please indi the type of coverage by checking the appropriate box below. A liability insurance policy 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. w Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A lent ardin this a lication are true and accurate to the bef 1 hereby certify that all of the details and information 1 have submitted (or reg sued for this application will be in compliance with all Knowledge and that all plumbing work and installations performed under the permit Pertinent provision of the Massachusetts State Plumbing Code and Chapter 42 f the General ws. t u By Type of U 6nse: Title j mber Signal re o ice aster License Number: Cityrrown _ urneyman PROVED urrwn U.5 �.. T�t i-� � I ��,� r V0 l 10 % � �%11��'Uw�-e.. V1�1-k��C � � MY 0 CommonweatM of Massachuse2tS peparUnent of Public Safety - oil Burner Technician Certificate License:-'14ri s �h 'T`v Z Mi Expi coSioner 03F1� Date.17� . 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ) 6 i '*� �-Us� 74 ..... .... , This certifies that ... ... .......... has permission for gas installation ..... in the buildings of e5l. at . / ... North Andover, Mass. Fee7l��.. Lic. Nc�.141��4.al. "tl ........... * VE;,"TrO R Check #.If;�" GAS IN Ti 6 0 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTIN (Type or print) Date Q NORTH ANDOVER, MASSACHUSETTS Building Loc:Wn.1 t�L� (J Permit # `� Ole) Amount $ 1-2 Owner's Name New ❑ Renovation Replacement Plans Submitted Name or type) AA/mss )0/,1,f l: Address Name of Licensed Plumber or Gas Fitter ,/( / Check one: Certificate Installing Company El Corp. Partner. im/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy o�s-uubstantial equivalent. Yes No If you have checked .Yes, please in 'e the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity EJ Bond El 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 0 Agent n I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installations perforr compliance with all pertinent provisions of the Massachusetts State Gas - own OVED (OFFICE USE ONLY) S'fnr ature of Licensed Plumber Or Gas Fitter Plumber �%L L �L6 ? s_ yl\ Gas Fitter License INUMDer aster MJourneyman are true and accurate to the isapplicatiofwill be in x w � a w c U a z o° H w d w Q H F o > w -• > Q o 0o o in w > x w 3 D Cal a U x w > O a cw. C SUB-BASEM ENT BASEMENT. 1ST. FLOOR 2 N D. F L O O R 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8.Tfl. •FLOOR Name or type) AA/mss )0/,1,f l: Address Name of Licensed Plumber or Gas Fitter ,/( / Check one: Certificate Installing Company El Corp. Partner. im/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy o�s-uubstantial equivalent. Yes No If you have checked .Yes, please in 'e the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity EJ Bond El 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 0 Agent n I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installations perforr compliance with all pertinent provisions of the Massachusetts State Gas - own OVED (OFFICE USE ONLY) S'fnr ature of Licensed Plumber Or Gas Fitter Plumber �%L L �L6 ? s_ yl\ Gas Fitter License INUMDer aster MJourneyman are true and accurate to the isapplicatiofwill be in a, .... `�.. ,4.. All The Commonwealth of Massachusetts Department cif Industrial Accidents Office of investigations 6.00 Washington Street Boston, h14 02111 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: u Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole or have hired the sub -contractors listed proprietor partner- on the attached sheet I ship and have no employees These sub=contractors have working for me in any capacity. [No workers' comp. insurance 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.] :ti `ny applicant that checks box 4l must alsa ilII out the section beiu f o, shnwia_ th , r ccmpenson policy info.mateon. Type of project (required): 6. El New construction 7. [1 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.[] Roof repairs 13. ❑ Other b .. ztr 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 information. employees 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 Signature: Date.: Phone #: F ial 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 Z. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 ox- 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 whoemploys persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because 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 acceptableevidence of compliance with the insurance requirements of this chapter have been presented.to the contracting authority." Applicants Please all out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) 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 affidhvit should be mturned to the city or tovm that the application for the pernait or license is being request; d, not the Department 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would Like to thank youin 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 lnvesfdafons 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900.ext406 or 1-877-MASSAFE Fax # 617-72.7-7749 Revised 5-26-05 www.mass--gov/dia I 3472 Date.'�/- C-11.415:� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................ ....... has permission for gas installation-.,e-.�.-.-C,�.' ................. in the buildings of at North Andover, Mass. Fee-:� Lic. No./,. "7 GiS INSP&T-6 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer iV1ASSACHUSETTS UN`IF'ORM APPLICATON FOR PERMIT TO-DO GAS FTFMG ✓Type or pant) NORTH ANDOVER, Building Locations ASSACH US ETTS Owner's Name New ❑ Renovation ❑ Replacement Date %�%1/�f9c2—v(A( Nwdv I E Permit 9 w.P- Amount S pVf Plans Submitted ❑' (Print or 2� Name AW l !O dl o4 j jLi � r Addre s _:�r _ff`cb ��lG�'✓ 9 � u D 3 D 7 Business Telephon Name of Licensed Plumber or Gas Fitter /(.A /4 /�� ( 9L IT�w Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ F'rmiCo. INSUR-kNCE COVERAGE Check tow I have a current liability Insurance policy or it's substantial equivalent. YesNo ❑ Ifyou have checked Nes, pleas i dicate the type coverage by checking the appropriate bo. . Liability insurance policy 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Arent Owner ❑ Agent ❑ I herebv terrify that all of the details and intbrmation I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation erf e under it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St_ e and Chapter I e ene, {Laws. By: Title CitviTuwn ,'kPP R0 `'•ED (UFI'ICii USE' )M. Y) Signature16f Licensed Plumber Or G- Finer Plumber `Z Z Gas Fitter u.ense Numoer Master Joumeyman ,r (Print or 2� Name AW l !O dl o4 j jLi � r Addre s _:�r _ff`cb ��lG�'✓ 9 � u D 3 D 7 Business Telephon Name of Licensed Plumber or Gas Fitter /(.A /4 /�� ( 9L IT�w Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ F'rmiCo. INSUR-kNCE COVERAGE Check tow I have a current liability Insurance policy or it's substantial equivalent. YesNo ❑ Ifyou have checked Nes, pleas i dicate the type coverage by checking the appropriate bo. . Liability insurance policy 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Arent Owner ❑ Agent ❑ I herebv terrify that all of the details and intbrmation I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation erf e under it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St_ e and Chapter I e ene, {Laws. By: Title CitviTuwn ,'kPP R0 `'•ED (UFI'ICii USE' )M. Y) Signature16f Licensed Plumber Or G- Finer Plumber `Z Z Gas Fitter u.ense Numoer Master Joumeyman 0 Date.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING "�Ilul'� This certifies that ............ ........ ..................... has pejr' J mission to perform ......... ...................... .... ....... plumbi ... ....... .�g in the ".ildings of at. / . . . ... Coh Andover, Mass. Fee:P6- Lie. N A ........ P��B,G - LU I.TOR Check # 6825 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location % ' �`,,6AQr-c ('OVl� Owners Name Type of Occupant) f Date Y1 Permit # Amount New0. Renovation Replacement �. Plans Sued Yes No (Print or type) Installing Company Name a Address Business Telep one Check one: Certificate ❑ Corp. Partner. 0--r Name of Licensed Plumber: Insurance Coverage: Indicatff�� coverage by checking the appropriate box: Liability insurance policy 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 rgnature Owner ❑ I hereby certify that all of the details and information I have submitted (or entered best of my knowledge and that all plumbing work and installations perfo ed u compliance with all pertinent provisions of the Massachus:L� By: rgna u e or Licenseuum er Typ of Plu bing License Title City/Town rcenseum er Master APPROVED (OFFICE USE ONLY Agent ❑ eve application are true and act to to the ed for this app ' at' wil be in Cha of th eralI aws. 13Journeyman rj • MMMMMMMMMMMMMMM MM MM �VylMMMMMMMMMMMMMMMMMMMMW©AMM MMMMMMMMMMMM mmmmmm MM W11 111 a FIT :a ------------------------- -.l MMMMMMMMMMMMMMMM mmmm MM W311-18r-F-V-zMMMMMMMMMMMM MMM MM WM M�M-1-11MMMMMMMMMMMMMMMMMMMMM MM W-j1110MMMMMMWMMMMMNMMMMMMMMMMW--- (Print or type) Installing Company Name a Address Business Telep one Check one: Certificate ❑ Corp. Partner. 0--r Name of Licensed Plumber: Insurance Coverage: Indicatff�� coverage by checking the appropriate box: Liability insurance policy 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 rgnature Owner ❑ I hereby certify that all of the details and information I have submitted (or entered best of my knowledge and that all plumbing work and installations perfo ed u compliance with all pertinent provisions of the Massachus:L� By: rgna u e or Licenseuum er Typ of Plu bing License Title City/Town rcenseum er Master APPROVED (OFFICE USE ONLY Agent ❑ eve application are true and act to to the ed for this app ' at' wil be in Cha of th eralI aws. 13Journeyman rj 6340 Date ..... .. .... ... ... ... . ORT TOWN OF NORTH ANDOVER PERMIT FOR WIRING Z, _-7 This certifies that ............. ................... has permission to perform ... Aep'---f-A, ... - W.r. -wiring in the building of ....... Aof?2) ... &.1. /-)74� ..... .............. F ......................... . North Andover, Mass. at ............ KI APR.a Fee..�� ..... . ...... Lic. No. Slt:� e4 ............. EL&RICAL INSPECTOR --i Check#- -tl\- Commonwealth of Massachusetts Official /Use Only Department of Fire Services Permit No.ANEW kvi BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] 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: 01/24/2006 City or Town of. North Andover 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) 1 Ardmore Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive, North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Repaired loose splice on hallway outlet, 2nd floor Completion o the followin table maybe waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. El No. o. o Emergency Lighting 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: I.NR I Tons KWNo. ........... of Self -Contained Detection/Alertin2 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 Heaters No. of No. of Signs 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. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information o this ap If tion is true and complete. FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature LIC. NO.: 9743 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-3828 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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 PERMIT FEE: $ 5.00 Signature Telephone No. SAN D E RS ELECTRICAL CO.,INC. Wood Ridge Homes ATTN: Gary 10 Wood Ridge Drive No. Andover, MA 01845 INVOICE June 30, 2005 INVOICE # 050108 03/24/2005 1 Ardmore, hallway outlet Repaired loose splice on outlet, 2"d floor Material & Labor: TOTAL DUE THIS INVOICE: $ 107.50 $ 107.50 TERMS: Net Due Upon Receipt of Invoice 2.0% Per Month Finance Charge On Balances Over 30 Days THANK YOU 3 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL (978) 686-3828 FAX (978) 682-1646 �i A 6360 Date.... ........................ 03� TOWN OF NORTH ANDOVER PERMIT FOR WIRING C:7 '- P�' 0(.? / zt-c ? This certifies that ............. e'q� ..... f ;� ......... .............................. has permission to perform ......... .............. wiring in the building of ........ 0 S7 - at .......... / ...................................... . North Andover, Mass. Fee.��'5' ................ Lic. No..I:U.J?eq .......... A Check # v ., Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS E� y` Offici 1 Use Only Permit No. Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL 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: 01/24/2006 WORK City or Town of. North Andover 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) 1 Ardmore Street Owner or Tenant Wood Ridge Homes Telephone No. 978423-7867 Owner's Address 10 Wood Ridge Drive, North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replaced ballast in street light No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- 1:1o. rnd. rnd. o mergency Lighting Battery, Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS rNo. 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 ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs 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. 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 X BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ofperjury, that the information oo this ap cation is true and complete. FIRM NAME: Landers Electrical Co., Inc. ,/ //) LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature LIC. NO.: 9743 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-3828 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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 PERMIT FEE. $ 5.00 Signature Telephone No. NDERS ELECTRICAL CO.,INC. Wood Ridge Homes ATTN: Gary 10 Wood Ridge Drive No. Andover, MA 01845 .i INVOICE June 30, 2005 INVOICE # 050274 06/28/05 Street Light, 1 Ardmore, replaced ballast Material & Labor: $ 298.60 TOTAL DUE THIS INVOICE: $ 298.60 TERMS: Net Due Upon Receipt of Invoice 2.0% Per Month Finance Charge On Balances Over 30 Days THANK YOU 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL (978) 686,3828 FAX (978) 682-1646.