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P
Date ... /.— - ,!J- —/
'71P
..........—.................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...................... ..am.....
has permission to perform .............1 .......................................
wiring in the building of .......,::.....pi v?A...............................
at .............../,(:?/......D .,.,vn. &J ... YNK ............. . North Andover, Mass.
%Fee .3 ... Lic. No "I ........ /'
................
ELECTRICAL INSPECM]k
Check#
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. % Z
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: 7 r ,
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention tR perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a buildink-permit9 Yes ❑
Purpose of Building
T
Telephone No.
No L�r (Check Appropriate Box)
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: e
Completion of the followingtable maybe waived by the Inspector of Wires.
No. of Recessed LuminairesNo.
of Ceil.-Susp. (Paddle) Fans
o. o Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of LuminairesSwimming
Pool Above ❑ In- ❑
rnd. rnd.
o. o mergency 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 Detectinn and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
I
Tons
I
KW
No. of Self-contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ F-1OtherI Municipal Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. or—'—Data
Signs Ballasts
Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
'TelecommunicationsWiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
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.
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 C?Ver3ge" is in force, and has exhibited proof of same to thep rmit issuing office.
CHECK ONE: INSURANCE OND [—]OTHER ❑ (Specify:) , -, 4 s•
I certify, under the pal and pennq 'es o perjury, thatAqnformation on this application is true and complet
FIRM NAME: Zi it t C ( LIC. NO:3
Licensee: Signature LIC. NO.:
(If applicable, enter "exem>n the icense n ab r line Bus. Tel. No.:�'7J
Address: t4, / ! Alt. Tel. No.:
'Security System Contractor License required for this work; if applicable, enter the license number here:
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, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent '
Signature Telephone No. PERMIT FEE: $
Date'�% �� ! .......
/'
A TOWN OF NORTH ANDOVER
• - PERMIT FOR GAS INSTALLATION
'•AGMUSE
This certifies that ... e., t�l.f �:.� .`.... J ?fix ` �!? �'. .
has permission for gas installation .. 1!.. i' N ..................
in the buildings of .. P/.7fi::.:............................. .
at .......... , North Andover, Mass.
Fee. . Lic. No.. '7. ?.... ..... n ... �....:: , .... .
GASINSPECTOR '
Check # / � ` I'
.'r)J;
c.1 !J .
G
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER Mass. Date 10/24
Building Location 101 DUNKIN DR
2006 Permit # �- Y f
Owner's Name GARY PARKER
Owner Tel# 978 794 3456 Type of Occupancy RESIDENTIAL
New 7 Renovation❑ Replacement Plan Submitted: Yet NQ
FIXTURES
Installing Company Name Eastern Propane & Oil, Inc
Address 131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628 C—)
Name of Licensed Plumber or Gas Fitter rV/ k -0—t A
Check one: Certificate
Corporation
Partnership
Firm/Co.
INSURANCE COVERAGE:
I have a cu liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No 11If you have ecked y&s, please indicate the type coverage by checking the 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 insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby
entered) in above application are true
knowledge and that all plumbing work and installations performed under the permit issued fo ti—is-pplicatio will be in compliance with all
ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene
By Type of License: /
Plumber Signat r of Licensed Plumber or Gas Fitter
Title i/(;as fitter .� r/
• -Master License Number J ij
Cityrrown • -Journeyman
APPROVED (OFFICE USE ONLY)
Date.
TOWN OF NORTH ANDOVER
PERMIT F2R PLUMBING
This certifies that ............ ......•
has permission to perform ....
plumbing in the buildings of . -Ail?. ...................
at rt (.-............ North Andover, Mass.
Fee. t 1. . Lic. No... c t.... ......... Pj,, - - .....
PLUMBING INSPECTOR
Check # - 7 1! -
.MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date J njd Z-31 d6
Building Location iOI PNw2ners Name ?—ncz1�tsZ Permit #
Amount
Type of Occupancy 1JW� LL t
A
A
New fj Renovation Replacement ® Plans Submitted Yes E] No {�(
)(c 'nTRES
i
(Print or type)-� Check one: Certificate
llin
Instag Company Name 1 )Cly l�/��I �-� '� PTC El CSP.
Address �t'u `� Partner.
��L F�mlCo.
Business Teienhanc. r A- 7 — % 1 n
Name ofLicensed Plumber. K. Lt.Po�-
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boac
Liability insurance policy tD Other type of indemnity Bond
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does noi have any one of the above
three insurance
rgnanrre Owner Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application ale true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massa&etts Stat ffl i& co e and Chapn1142 of the General Laws.
own
ROVED (OFFICE USE ONLY
Type offlumbing License
Llc=c Numoer Master El
Journeyman 11
N
e- - -, :�' e�� '-,
Date......... ............
AORTH
TOWN OF NORTH ANDOVER
0
PERMIT FOR GAS INSTALLATION
This certifies that .........................................
has permission for gas installation
.. ...................
in the buildings of . ... .............................
at .............. North Andover, Mass.
..... Lic. No... . . ... ........... ..........
GAS INSPECTOR
Check # 0/
CW
u
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
N ANDOVER ,Mass. Date 6/23
Building Location 101 DUNKIN DR
2006 Permit #
Owner's Name GARY PARKER
Owner Tel# 97 -794-3456Type of Occupancy RESIDENTIAL
New Renovation Replacement F1 Plan Submitted: Ye[] No[]
FIXTURES
Installing Company Name Eastern Propane & Oil, Inc
Address
131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628
Name of Licensed Plumber or Gas Fitter
Check one: Certificate
Corporation
Partnership
Firm/Co.
INSURANCE COVERAGE:
I have acur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No ❑
If you have c ecked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy R✓ 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I herebv certifv that all of the details and information I have submitted (or entered) in above annlication are tn,e and ar.mirnta to tha hast of n,
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
City/Town
APPROVED (OFFICE USE ONLY)
tts State Gas Code and Chapter 142 of the General Law
Type of License: /9
• plumber Signature Vidbnsed PlUraffer QL Gas Eifter
•Gas fitter
•
-Master License Number
•
-Journeyman
/ I- r,:z
Date. ; .............
"ORTPI
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
'Nqcmus
This certifies that
has permission to perform ....................................
plumbing in the buildings of ...... ...... ................
at. . .......... : ....... ..... North Andover, Mass.
.....
Fee. . ..... Lic. No................ .
.............. ....
PLUMBING INSPECTOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Lpf.0 Mass. Date _ Permit # �O 03
Building Location % I i'1 fan _�/�i YejOwner's Namer
Type of Occupancy `Residential
New f.1 Renovation LJ Replacement Plans Submitted: Yes ❑ No O
FIXTURES
Installing Company Name Heritage Htg 4 &Plg . Co. Inc. Check one: Certificate
Address_ 35 Pleasant Street [X Corporation 714
Stoneham, Ma 02180 n Partnership
Business Telephone __781 X38 — 73 7-6— rl Firm/Co. _
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes F-1 No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby cartify that a!! cf the details and infortnalion I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing vrork and installations performed under the permit issued tor this application wiii be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Si ature ofW icense rl lber
Title __---..__--
—�--�-- Type of License: Master IX Journeyman ❑
City own 3 2 2 -�
APPROVED 0 FICE-3l SE ONLY) License Number__-.______.__ _ �;�
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
L
STH FLOOR
Installing Company Name Heritage Htg 4 &Plg . Co. Inc. Check one: Certificate
Address_ 35 Pleasant Street [X Corporation 714
Stoneham, Ma 02180 n Partnership
Business Telephone __781 X38 — 73 7-6— rl Firm/Co. _
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes F-1 No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby cartify that a!! cf the details and infortnalion I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing vrork and installations performed under the permit issued tor this application wiii be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Si ature ofW icense rl lber
Title __---..__--
—�--�-- Type of License: Master IX Journeyman ❑
City own 3 2 2 -�
APPROVED 0 FICE-3l SE ONLY) License Number__-.______.__ _ �;�
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