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HomeMy WebLinkAboutMiscellaneous - 1013 OSGOOD STREET 4/30/2018TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .........i> 4W .... .. .............................. has permission to perform wiring/ in the building of .... �o........... �. .............................. at ... ...... $iWi ,.... sr. .......................... . North Andover, Mass. - Fee.. �. fir' � .... Lic. No�! 9A ,/ ..... %'fir//� ............... J ELECTRICALINSPECjOR Check # 9254 -A (f1m4nonwaa& o/ ///addackwoUd Official Use Only �U`` cc://�� cc77 g�7 aParfmari� o�,.tira �arvica� Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07) 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: 2— /:a Z 1 U City or Town of: lVoeTAj4A40o:,a+2 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) 1,013 1544nJ Owner or Tenant So Telephone No. Owner's Address .SST 1i 17— Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building /*7:1414— Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: iWlo 7--= I ,1 47 T= ✓,4 Cmmnlptinn nflhp fnllnwi— in Alp .., ., A. e./ A., ,1,- i.,..,,,,,..,.- „fun--. No. of Recessed Luminaires No. of Cell.-Susp. (Paddle) Fans N No. -OU � _ ~ota V Transformers KVA No. of Luminaire Outlets /. No. of Hot Tubs Generators KVA No, of Luminaires Above ❑ n- ❑ Swimming Pool rnd. grnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No, of Cas Burners o, o etect on an Initiating! Devices No. of Ranges No.. of Air Cond, Total Tons No. of Alerting Devices No. of Waste Disposers eat um Totals um. er,. """" Tons. ""' """""""""....— o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ un c pa ❑ Other Connection No. of Dryers Heating Appliances KW Security stems: cfa„x+�•r� a No. of Devices or Equivalent �• No. o Water Heaters KW o. o o. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunicationsin No. of Devices or Equi v al: ent OTHER: Attach additional detail if desired, oras 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ .OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the Information on this applic tion is true and complete. FIRMNAME: i>Adr9 ELfC-TRtcAL Ca:;TRAe.,roWG i -L LIC.NO.: IN9634 Licensee: D 4d► D NA66Ak Signature �� LIC. NO.: (If applicable, enter "exempt" in the license number Line.1) Bus, Tel. No.. • 4, 2 • t;2 2 Address: 8 7 6ELM NT' Sr N ORTH gjiD0y6 R ► 01 {N Alt. Tel. No.: 7 • 3 S 'Per M.G.L. c, 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 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 Signature Telephone No. PERMIT FEE: $ CERTIFICATE OF USE & OCCUPANCY Building Permit Number NA Date: 5/7/2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1013 -1015 Osgood Street MAY BE OCCUPIED AS White Street Paint IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ira Gold North Andover MA 01845 Building Inspector Location No. Date t TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ wcMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20815 Building Inspector . CERTIFICATE OF USE & OCCUPANCY .» p. TOWN OF NORTH ANDOVER Building Permit Number 295 (10/17/07_ Date: November 20. 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1013 Osgood Street MAY BE OCCUPIED AS: Interior RM (Detox Intemational) IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Great pond crossing. LLC 865 Turnpike Street North Andover. Massachusetts 01845 Buitding Inspector W !d r� E c o �c16- •o v a-o � a � om ` c H • lam` m a� m ML yr 0a �c • � m C N R • i ` p • � N • r„ ��3pp mg *16,IJ y 'O m E .c 4$w : H C m vii: .... O O � V CD N Z �CD . :moo CL Q O m G H a* m ' 03 : •o . H 4D W B CD c ... F- .co .a C LU E Zf ow coo a mca S tv a 2�y $ �o r— s � m O EW A i C,7 A m F�1 0 CD C C N CD t 0 Z 0 9 z 0 u m T m cm I Q � H m m 0 CD co M d CL. a C a� CD C.3 COD cc c C cc .y 13 of � W a c �¢ x zl P -4o �- A w C 6 w° cn ° `; `s U w �a'✓ wo' u. mo cn cn E c o �c16- •o v a-o � a � om ` c H • lam` m a� m ML yr 0a �c • � m C N R • i ` p • � N • r„ ��3pp mg *16,IJ y 'O m E .c 4$w : H C m vii: .... O O � V CD N Z �CD . :moo CL Q O m G H a* m ' 03 : •o . H 4D W B CD c ... F- .co .a C LU E Zf ow coo a mca S tv a 2�y $ �o r— s � m O EW A i C,7 A m F�1 0 CD C C N CD t 0 Z 0 9 z 0 u m T m cm I Q � H m m 0 CD co M d CL. a C a� CD C.3 COD cc c C cc .y 13 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # e� L ADDRESSILOCATION OF PROPERTY: j l3 dSC Map Parcel Lot Number 'SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE r DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: 2 I� �' PD n1.p t' 01,Z i IU Address g �� �itj �11r✓ /UD_f�n�n� J %� R'!t U ROUTING CONS1. ERVATION 7 20cr- PLANNING DPW - WATER METER^ llllolo� SEWERIWATER CONNECTION � (1 // 6% �. NOTE DPW MUST INDICATE THAT THE WATER METER HAS. BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST Signature File: Application for OC form revised Jan 2007 APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit # ey qr- ADDRESSILOCATION OF PROPERTY: r Ci L3 OSq YrDC _ Map Parcel Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: (s R E AT' PD A)Z G Poems /U 47 X A G Address 6 S moi) ?,rj C, a ROUTING CONSERVATION 70 hcv 20C -f- PLANNING O DPW - WATER METER SEWERIWATER CONNECTION ®&Ibq NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYANSPECTION REQUEST DPW - " '&�mo Signature File: Application for OC form revised Jan 2007 DATE INVOICE AMOUNT 5-7515/0110 .GRASSO CONSTRUCTION CO., INC. 33595 865 TURNPIKE STREET IRT 114) NO. ANDOVER, MA. 01845 f7\�l�l.�iL��iLI�7I�JVJ�s�/I,��Q7I�rl��:�: �— ■ • - TO THE ORDER OF Sovereign ) O a THIS DOCUMENT CONTAINS HEAT SENSITIVE INK. TOUCH OR PRESS HERE RED I 11'03359511' 1:0 L L075 L50l: 5950001030711' Location /c� t ✓Sl" No.Date ORTIS TOWN OF NORTH ANDOVER 0 4 M,,-.: 1+0 } s Certificate of Occupancy $� ssNus <�'' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 206• , Building Inspector '."cai'fK?.�:sow,.r.'wkaS�R--s..s.q*�+:.-.r+•;;.+4 tiw.Y ir�t �/F .�� R'� .. .v�.�::�z�•-+�'J�.stews^•.�^!xmTa±C+e'.rt9tca@o`r+c.���A'1F�7�:pF- )7 Location �'� j. ` No. �7 Date l -7 NpRTq TOWN OF NORTH ANDOVER L Certificate of Occupancy $-------- Building/Frame Permit Fee $ 1ss�cNus•� Foundation Permit Fee $ Other Permit Fee $ ---- TOTAL $--- 'r)6 Check # r 2084 Building Inspector NP Location No.Date MORTq TOWN OF NORTH ANDOVER 3�•. '• O 9 s .•� Certificate of Occupancy $ Building/Frame Permit Fee $ J^CHUS Foundation Permit Fee $ / Other Permit Fee,,I,>, ,i $ TOTAL Check #�� 20f, s 4 J' r " I' Building Inspector O° 0 N M o o � � F j �1 � r0 a a 0 Ila. 0 m v a 00 :.a 9 I A C 0 4 LL z O Q U J a CL H R. w IL z U a 0- c a�im32 � c Oa N C N (B N � � mm5 N L mz c mri L a 3 t� N_E"� 0 �� O L O v E J C O m e � L coco� 53) 'tn O D U U O •N � '3 p zj 8 N U U \.J p O O w p o Lu aC.S �� = o aaCDC N o w >+'� c E ca cn 'c� c w- mu c a o co+,t O E mn E c �- €OpoOM Mo'ot� o�rns�E'LcunuZ a) 0- snr( c f° a� co C: c t� .0) C (4 - cu c E 'p O N " E 7 +p' : — O O CL C = >, a. 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P:\MISC\DTOX 1013 Osgood Street North Andover.plt 1/25/2008 8:17:48 AM Scale: 1:71.79 Height: 719.741 Length: 478.623 in .E11t o m mom m D 1 OX 1 1013 Osgood St., North Andover, Ma HAVERHU-MA 978 -art -3721 Sales Associate Deb Cary no s■ AC' date 1-28-08 designed by C6WR DESIGNER'S NAME := a file name DTOX 1013 Osgood Street North Andover.pit details 30" hx144"wx.122 Seamless white alum. tenant pan sign with digitally printed graphics to match client provided logo art file PAS -17533 andPowder Blue Detox N Andover l.jpg P:\SURVEYS\MISC Det -Ox N Andover j pg_..; 9 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRiNG, This certifies that ........... .......... ............................. has permission to perform .......... ... ....................... . ......................... wiring in the building of 6�4"- -AXI) ....... . . ......................... at ...... ....... ...... 57.. ....................... . North Andover, Mass. Fee. Lic. No ............ 4... 11... ...... ........ I�CAL INSPEcrOR ... Check # 7745 Commonwealth of Massachusetts Department of Fire Services UV BOARD OF FIRE PREVENTION REGULATIONS Official Use Only C Permit No. �5 n Occupancy and Fee Checked, [Rev. 1107] 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 W INK OR TYPE ALL INFORMATION) Date: 10-17—o-7 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) () ®lj g QQ Owner or Tenant G -np 011T Fp 11 aLf-0 ss 1 !SJ L L C, Telephone No. Owner's Address 2 7 v>'n �, ieG S •J Is this permit in conjunction with a buildin permit?, Yes , No ❑ (Check Appropriate Boa) Purpose of Building D �C by f ` t `1—��l�Kll 1 B�yp-LUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service -�5-0' Amps ` 120ldM Volts Overhead Undgrd ❑ No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tJl t'� •VIl r` r,,.... lam,; L- r_ - - — Ilk 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 cove e ge is in force, and has ffi exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE QBOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties o erjury, that the information on this application is true and complete. FIRM NAME: go ber- ' tov— LIC. NO.: Licensee: �j � G fi%L Signature fiffLIC. NO.: Z (If applicable, enter "exempt " in the license number line.) Bus. Tel. No.: Address: S /�- Q V P" ! l iPl�vl -'r,0 7 9 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability incur:,nce coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Owner/Agent Signature Telephone No. ...c uuumn a01e MaY oe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. Of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimmin Above In- g Pool ❑ ❑ o. o Emergency ig g nd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o etection an Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposerseat ump _umber ons _ -- ........ �........._. Totals: o. o e -Contained Detection/Alertin Devices No, of Dishwashers Space/Area Heating KW Local ❑unicipal El OtherConnection No. of Dryers Heating Appliances KW Security Systems:* No. o atero. Heaters KW of o . of Ballasts No. of Devices or Equivalent Dt Data N evices s . of or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunicationsWiring: No. of Devices or Equivalent OTHER: Ilk 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 cove e ge is in force, and has ffi exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE QBOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties o erjury, that the information on this application is true and complete. FIRM NAME: go ber- ' tov— LIC. NO.: Licensee: �j � G fi%L Signature fiffLIC. NO.: Z (If applicable, enter "exempt " in the license number line.) Bus. Tel. No.: Address: S /�- Q V P" ! l iPl�vl -'r,0 7 9 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability incur:,nce coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Owner/Agent Signature Telephone No. t S h t Ak fla f lir• ° The Commonwealth of Massachuseft Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 r i www mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Namie (Business/Organization/Individual): Address:_ City/State/Zip._ �G,t t� l �. D ?I Phone #:. Q?g ^ y% 1 ///6 Are you an employer? Check the appropriate -box: I . 0 1- am a employer with 4. ❑ 1 am a general contractor and 1 secti Type of project (required); ployees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. I am.a.sole proprietor or partner- listed on the attached sheet. _ . 1. ❑ Remodeling ship and have no employees These sub -contractors have 8. Q Demolition working for me in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9, F1 Building addition required.] officers have exercised their 10•❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself. [Nonworkers' comp. c. 152, § I (4),'and we have no 12.[:] Roof repairs insurance required.] t employees. [No workers' 13•0 Other comp. insurance required.] "Any applicant that checks bo)( # I must also fill out the bel h 1 k "I M ow s owrng then wo era eompensatton policy information. t Homeowners who submit this affiddvit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lCont actors that check this box must attached an additional shmrshowing• the name of the sub -contractors and their workers' comp, policy information. I ant an employer that is providing:workers' compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/%te/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date Failure to secure coverage as required tinder 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 cerci under the pains and penalties of perjury that the information provided above is true and correct Signature: �� Z— Date.' 7 f - 11-7? ' ll / QK,cial 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 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6.Other Contact Person: Phone #• N 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 timstee-of an individual, partnership, association or 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 who employs 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 acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill 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 affida.vit.may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Aiso *be sure to sign and Hate the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, 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 beee 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 you in 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Date �....n. `.......... ° TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. `. JJa ... ................. has permission for gas installation in the buildings of ......................... at /.4.! -cv. ......... Nort� Andover, Mass. Fee! . .... Lic. No % ' ... ...... • GASINSPECT�� Check # 4� 0// 6,185" MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations /o/ r9 -9G2 ®O 7 Permit # Amount $ C6 e r e i Owner's Name New 121 Renovation 1 Replacement 13 Plans Submitted (Print or type) �A j �U 2 A -O Name I 6--11YJ Address �� NJ6X P©O 6 t/i'Z� 7L c N //" A--6 GDS z -e q Name of Licensed Plumber or Gas Fitter h k one: Certificate Installing Company Corp. 0 Partner. IDFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes NoO If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnityD Bond 13 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 1 Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 13 Plumber / 11:0 q Gas Fitter License Number 0Master 0 Journeyman � x w v�' Z p F. z z w z z F �, a x > a Gw7 H z F C x w w w FO z d w d a �- > °m z' o z w o x x o x 3 c o a > a a F o SUB -BASEMENT .4 BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR LED STH. FLOOR '+ (Print or type) �A j �U 2 A -O Name I 6--11YJ Address �� NJ6X P©O 6 t/i'Z� 7L c N //" A--6 GDS z -e q Name of Licensed Plumber or Gas Fitter h k one: Certificate Installing Company Corp. 0 Partner. IDFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes NoO If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnityD Bond 13 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 1 Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 13 Plumber / 11:0 q Gas Fitter License Number 0Master 0 Journeyman Date. /. -eq. �%. V, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBfkG This certifies that has permission to perform C". ................................ plumbing in the buildings of .................. at . .. '�-/ ..... ........................ North Andover, Mass. IS-& �/ J'3 4!?Y 'a iel!� ........... F e ele.-2J Lic. No.. . . . PLL1,MBINd INSPECTOR Check # 7535' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS --" Date r 6- l— Building Location % O / 3 G S q oo C" 5, Owners Name JO �"� itJ C2 h}SS© permit # � 9 v Amount Type of Occupancy New ® Renovation Replacement Plans Submitted Yes 0 No <s (Print or type) Check one: Certificate f! Installing Company Name_ �� l C�wV�C> �l ci/yJ jj��/q ElCorp. V C 0 6v � acD6 6 Address � partner. B iness Telephone ?)7f 6f.5— ?/ 3 ' Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity El 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 signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are 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 Massachusetts St PI mbing bode and Chapter 142 of the General Laws. By: Sig' nd ure icens um er Title Type of Plumbing License l 3 6 ? y City/Town 71—cense um er Master Journeyman ❑ APPROVED (OFFICE USE ONLY r /" f 1.' -----------------------®-■ 1 �.' MMMMMM-------®--.---t----N (Print or type) Check one: Certificate f! Installing Company Name_ �� l C�wV�C> �l ci/yJ jj��/q ElCorp. V C 0 6v � acD6 6 Address � partner. B iness Telephone ?)7f 6f.5— ?/ 3 ' Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity El 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 signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are 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 Massachusetts St PI mbing bode and Chapter 142 of the General Laws. By: Sig' nd ure icens um er Title Type of Plumbing License l 3 6 ? y City/Town 71—cense um er Master Journeyman ❑ APPROVED (OFFICE USE ONLY .T