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Home My WebLink AboutMiscellaneous - 101 HERRICK ROAD 4/30/2018 (2)MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY q�, MA DATE I PERMIT # JOBSITE ADDRESS�� x_._..., .19 ►1� . ' . OWNER'S NAME 2M GOWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL\ PRINT CLEARLY NEW: RENOVATION: REPLA EMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 1 5 6 7 8' 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER FE INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of M. Ch. 14 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I.have submitted or entered regarding this application are true and accu e t of my knowledge and that all plumbing work and and installations performed under the permit issued for this application will be innc rt e l provision of the Massachusetts Stale Plumbing Code and Chapter 1 2 of the General Laws. PLUMBER-GASFITTER NAME VU' LICENSE It IVA&A SIG 7 E �1 oe :MP MGF JP JGF LPGI ORPORATION # PARTNERSHIP # LLC # COMPANY NAME.- lC31 , , tC A&DRESS 'T CITY STATJ� „ZIP TEL 479 FAX K7B `525A-55pJ CELLH 2f EMAIL 8801 MORTH Q r; r 1 SSACHUS� This certifies that Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ...V. .: `` . 6..... ................ . plumbing in the buildings of ... A �� ..r................... at .. �L?... North Andover, Mass. Fee. U:..Lic. No... ........ ................. PLUMBING INSPECTOR Check # . U S FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town•/Date: Permit# Building Location:l _ Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential DEDICATED 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 indicate 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 ❑ Signature of Owner or Owner's Aaent I hereby certify that all of the details and information I 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 of the General Laws. By Title Type of License: il-flumber 9-ga-ster ❑Journeyman Signature of Licensed Plumber License Number: �-7— DEDICATED z SYSTEMS Ln D LU w x Z U Ln Z LU OC Z H Y Q Z W V1 J Z H Uj U W L7 C O Z OC Z fa/1 W y. W 0: 'n OJ ca = N Q W a W C Q Z C' K D: Z V1 U d U. Z ij 3 Q Q LU LL F se 2 U 3 O = a 0: 3 W 0 2 Z a W LL 3 H a W Y C a. Z v2i FW- H W coLn LU a Q co . m H LA i] c o o >> W 2 x g g o= oe ,n o Q E Q a Q� M 3 3 3 0 u a a oac a SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4T" FLOOR 5T" FLOOR 6T" FLOOR 7T" FLOOR 8T" FLOOR P Check One Only Certificate # Installing Company Name: (-��1` f (�G�c.� % �/�°� 8tlr�/�n orporation Address: J 7^ 1 '4& 7,-f/`�tity/Town: State:,,/4..14 El Partnership Business Tel: t, 71 3 Ll 2 I Fax: % t� ❑Firm/Company Name of Licensed Plumber: Z3--26.," 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 indicate 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 ❑ Signature of Owner or Owner's Aaent I hereby certify that all of the details and information I 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 of the General Laws. By Title Type of License: il-flumber 9-ga-ster ❑Journeyman Signature of Licensed Plumber License Number: �-7— lk FS Lr-': C.1 COMMONWEALTH OF MASSACHUSETTS I- Im VII REGISTERED AS A PLUMBING CO P ISSUES THIS LICENSE TO F EDWARD A KELLEY ► :HOFFMAN K KELLEY ,INC 57 MARILYN RD :u Ica ,ANDOVER MA 0181.0-293` 2606 05/01/12 75905. ------------------ COMMO,NWEALTH OF. MASSACHUSETTS LICENSED AS A MASTER 'PLUMBER I ISSUES THIS LICENSE TO EDWARD A KELLEY' s. 57 MARILYN RD ANDOVER MA 01810-293, g. 9429 05/01/12 759052... 7 5'2 6 Date. A.! /!. � ...... TOWN OF NORTH ANDOVER,- ° I� ' PERMIT FOR GAS INSTALWION • o a ' q •, C14 ' ,SSANUSEI L This certifies that .... 9f. �: �.%�</�? .':�.. � . �.�.�. G. :!.... . has permission for gas installation ...�,. •%? . rl• � ............. in the buildings of ....U.0 t�.I t;. ........................ at ... //.C/�. A.(.(' !c6' . /Z. . . . ., North Andover, Mass, Fee. 3 07777. Lic. No. S.fi .S ... .. L. -E ............... . / GAS INSPECTOR Check # N 1-^1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING W W City/Town: Y eA71 IHIIIV�, MA. Date: x ` Permit# y Building Location: Z01j C- J' V�gwners Name: N P Cd Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential,, New: ❑ Alteration: ❑ Renovation: ❑ Replacement:,R' Plans Submitted: Yes ❑ No ❑ FIXTl1RFS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [I No ❑ If you have checked Yes, please indicate 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 EJ Agent E]Siqnature of Owner or Owner's Aaent By checking this box ❑; 1 hereby certify that all of the details and information I 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 of the General Lpws,� By Title USE ONL License: 'Plumber C—.('✓/ J- /,, Gas Fitter Signature of Licensed Plumber/Gas Fitt aster /1 ❑Journeyman L�7 El LP Installer License Number: LU W W N P Cd :3 w m 0 ut x cn y Mm 0 0-j} Z z oC _ ~ v) 0 2 w= w O C05 0 N W W w m 0 Q p Q a I— o x w P xLL x > � w W z �a 0 W Z O J H P O z = J () w o LLO F W W H I -- W z 0 Lu >- w co J Q Q m o w LL 0__ W O O a z 0 fj > 0 >>> x 1 01 SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3 Ku FLOOR 4 THFLOOR 5TH FLOOR 6 IHFLOOR VH FLOOR -F A71 8 FLOOR _ Check One Only Certificate # Installing Company Name: �"��"�'� f�� % 112 Corporation C Address: City/Town: State: 4&�±" ❑ Partnership Business Tel: gZKL!%5- 1�12i Fax: �/ 2012M 9 ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: Z�qa,9 2/9 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [I No ❑ If you have checked Yes, please indicate 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 EJ Agent E]Siqnature of Owner or Owner's Aaent By checking this box ❑; 1 hereby certify that all of the details and information I 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 of the General Lpws,� By Title USE ONL License: 'Plumber C—.('✓/ J- /,, Gas Fitter Signature of Licensed Plumber/Gas Fitt aster /1 ❑Journeyman L�7 El LP Installer License Number: 7412 PER Date.. f �f.� ! �.� ...... OF NORTH ANDOVER IT FOR GAS INSTALLATION This certifies that ..._ . . ! ........t ... . has permission for gas installation ....... ... in the buildings of .....f :�t i �:1�� ........................ at .... i C . ... . , North Andover, Mass/., Fee`! 5'..J Lic. No. "? ?J. f..: ��... '-� . !r•C, ;�'C GAS INSPECTOR r' Check # y MASSAa SErIS UNMEM APPUC ATON FOR PERTNIrr TO DO GAS FnT NG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations ,9 P� -e %,�4,,� r __Owner's Name Replacement New ❑ Renovation ❑ Date Plans Submitted ❑ Permit # Amount $ (Print or type)/�� Check one: Certificate Installing Company �� Name (/ ❑ Corp. ❑ Partner.. ❑-Iriim/Co: Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes t!r� No ❑ If you have checked yqq, please indicate the type coverage by checking the appropriate box. 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 1.12 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 ❑ Agent ❑ I hereby certify that all of the details and information t have Submitted (or entered) in above application are true and accurate to tne• best of m} knowledge and that all plumbing work and installations performed un(ler Permiiit.ils,•ucd For this application will be in compliance with all pertinent provisions of the �lassuchusetts State .nde clad Chap('` l i the General Laws. BY: Title CitylTotivn APPROVED (OFFICE USE ONLY) Signature of Licensed PlumPlumber Gas Fittcs, ber`' ❑ Gas Fitter License 1 um er ❑ Master MFourneyman U F a z z A* O w >4 CA O O �j U Off' P4A Cti SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4T 11. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type)/�� Check one: Certificate Installing Company �� Name (/ ❑ Corp. ❑ Partner.. ❑-Iriim/Co: Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes t!r� No ❑ If you have checked yqq, please indicate the type coverage by checking the appropriate box. 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 1.12 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 ❑ Agent ❑ I hereby certify that all of the details and information t have Submitted (or entered) in above application are true and accurate to tne• best of m} knowledge and that all plumbing work and installations performed un(ler Permiiit.ils,•ucd For this application will be in compliance with all pertinent provisions of the �lassuchusetts State .nde clad Chap('` l i the General Laws. BY: Title CitylTotivn APPROVED (OFFICE USE ONLY) Signature of Licensed PlumPlumber Gas Fittcs, ber`' ❑ Gas Fitter License 1 um er ❑ Master MFourneyman