Loading...
HomeMy WebLinkAboutMiscellaneous - 104 GREENE STREET 4/30/20180 co A�4�, U � U ¢, N 0 .7A• O�� f7. cd ° O O C •CS ❑ ti idF."" N N .Nr ca cod' ami N °� y o i vi N ti y w C id '� paim., 0 3a,a o'o� � °'gv� N O N .fl b N O i o o 0 a c v ho ti 3 ts ;; pp N .rJ' rn N U N bA a+ .5 a O cOV •O -, N ted b •p 0=r3 cd .a •d U cC p ,� C. V bA o o o a> UC Nw" ti ni O y U �. -0 ¢� O DAN 0 O U b' O cd N N N g z OS J �^ '.. O O ow ° ;3 cs oN c ° a 4)10.2 tiAcod °vi b � � cps A .0 y O p p .w 2 q crn b O .'gyp'. N cdd GL T N w�. w� O U C.• id N .� W N R bA � w4) o o O O •^1 O. O Oj "pO •p M ,ted, H V cNW .�'' ��" t9 d w O O w ' O ren3^�a� ov 4-4 •N O � b cd p O C. p p ' .0 p V •O cOd U U y O w Oo d wpA o 0 0 a ° y O •� U N "" N W r n N Ow O O y v O N U :t4 N U Y U U N b N N rao z aA. 8 Cd 2 H -S o.= Date .l(!...... � 1....�...�1..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that j`� v P ....Aa `-5 ... ....................................... has permission to perform .... �t.�....... J ...... ............................ wirin&in the building of................................................................................... at ............................. T ... , North Andover, Mas . fee .... ,f ... .. Lic.No/ .............. ........ ..... . ELECTRICAufi4 �EcrOR Check # 7 G i- - Commonweaith of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked _ rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRIC ALAll work to beperformed in accordance with the Massachusetts Electrical Code (MEC), 527 CT 12.00 WORK (PLEASE PWT N NK OR TYPE ALL WORW TIO City or Town of: NORTH ANDOVER TO -the Date:_ ns v2 r By this application the undersigned gives notice of his or her intention to perfor�the el� trical wk described below. Location (Street & Number) (`� �r w. Owner or Tenant Owner's Address Is this permit in conjunction with a building Purpose of Building Existing Service _Amps (adVolts New Service 00 Amps a2 / of (SVolts Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: of Recessed Luminaires of Luminaire Outlets INo. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers Vo. of Dishwashers Jo. of Dryers Heaters KW Hydromassage Bathtubs OTHER: Telephone No. Yes ❑ No (Check Appropriate Box Utility Authorization No. ' oC Overhead © Undgrd ❑ No. of Meters Overhead Undgrd ❑ No. of Meters c omp[etion of the No. of Ceil: Susp. (Paddle) Fans No. of Hot Tubs Pool auove ❑ ,m_ grad. urnd ❑ Of Oil Burners o. of Gas Burners o. of Air Cond. Totals: :. �..-...�� ....u,_.....I, Space/Area Heating KW Heating Appliances, Ballasts. o. of Motors Total HP (064- �A :J Ors table may be waived by the No. of Generators —0-10T Yin Battery Units FIR_ A.1 ARCS o. Spector of Wires. Tota! KVA KVA o.' of Zones of Alerting Devices cal ❑w1unicipal Connection 0 Other :urity Systems:* No. of Devices or Equivalent to Wiring: No. of Devices or Equivalent ecommunicattons Wiring: No. of Devices or Eanivalen+ Estimated Value of Electpcal Work: / 00 6 -Attach additional detail if desired, or as required by the Inspector of Wires Work to Start: (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the lieenseeProvides proof of liability insurance including "completed operation, coverage or its substantial equivalent. The undersigned certifies that such co erage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE J BOND ❑ OTHER I certify, under the pains andpenalties o j ry, information P fper u that the information on th' appli anon is true and complete. FIRM NAME: Licensee: S ( LIC. NO.: 119 3, �!,� _Sigf nature LIC. NO.: (If applicable, enter "exempt `' in the li nse number 1in� ✓`�/ Address: ` s K� Bus. Tel. No.: I - $ ),Z - od a *Per M.G. c 147, s 57 61, security work requires D � �� Alt. Tel. No.: OWNER'S INSURANCE W q aPartznent of Public Safety "S" License: Lic. No. RIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive Owner/Agent this requirement. I am the (check one) ❑ owner E-1 owner's agent. Signature Telephone No. PERMIT FEE: $ ELECTRICAL PERMIT NO. INSPECTION REPORT: P ELECTRICAL INSPECTOR -DOUG SMALL ' I- ROUGH INSPECTION: Passed — [) Failed — [ ] Re -inspection required[ ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) ' Date 2- FINAL INSPECTION; Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) DflfP. 3. UNDER GROUND INSPECTION: Passed — [ ] Failed — [ I Inspectors' comments: (Inspectors' Signature - no ii 4. INSPECTION— SERVICE: DATE CALLED NATIONAL GRIia: Passed — [ ] Failed — [ j Inspectors' comments: NAME: inspection required (550.001 - Date (inspectors' Nignature -.no initials) Date 5. INSPECTION - OTHER: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: �y L lr M (Inspectors Signature - no initials) Date I y DOOR TAGS ARE TO BE FII.LED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 TS TO BE CHARGED. 4' �. The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations Uf 600 Washington Street Boston, M4 02111 www muss gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: ' ho M - , (a M _,J AV. City/State/Zip: CU 61% UiYaYPhone #: 'A - S 7d - CDU a? k Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. 111 am a general contractor and I mployees (full and/or part-time).* have hired the sub -contractors 2. E I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub_contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5• ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and Nve have no insurance required.] f employees. [No workers' comp. insurance required.] i Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9.❑ uilding addition 10.dlectrical repairs or additions 11. ❑ Plumbing repairs or additions 12.7 Roofrepairs 13.❑ Other W3' apptrc:.' - MEL cn�:s oox i n2'!$`l a:SU t711 L'St the SeCf3Dn bele shoR' ng their worxers' compensation policy :Formation. - t 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. lam 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. Lic. Job Site Address: Expiration Date: 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 again a violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA j6r ins ante coverage verification. I do hereby _ &0 and penalties of perjury that the information provided above is hwe and correct Official use only. Do not write in this area, to be completed by city or town officiaG City or Town: Permit/License # �10 Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #: 7 5 io'j Date. �z �,/<........ o? °` TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION This certifies that ..... ., has permission for gas installation .. /. � !? " <' in the buildings of 4, ........................... at North Andover, Mass. Fee.. -L.- No../. ...... GAS INSPECTOR Check # 7 7 7 199` M W"It NOR7/� Oft..•° .�h0 Oc F A SAcMUSE� Date... �. 2....9..../ d TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... K......V .��.�............ .f................................ has permission to perform ........... G/ �l � .......(1? . �.�.... .. ....... wiring in the building of .......441 . oll..!��.................................................... at ......�lL..La-%1,-ZP t :5..%.' .......................... } North Andover, Mass. Fee ... ,.� '�''` . Lic. No.: 32. U "4........ .,�/ EiecmicAL ImPSCm y, Check # ammonweaa o/ ///ae eu" 2eparkned o f -}ire Swvice6 BOARD OF FIRE PREVENTION REGULATIONS OfficialUse Only FOcc7 15 kedev. e APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYPE AF/L�INTION) Date: )' 527CMR 12.00 City or Town of:�Z —_� To the Insp ctor 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 &l A r ov 01-v Owner or Tenant Je a / ,�/,,,, a Telephone No. Owner's Address K6 vu,o Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building W4— Utility Authorization No. --, Existing Service Amps / Volts New Service Amps / Vohs Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Cmmni"I nrpl— No. of Recessed Luminaires - - No, of CeiL-Susp. (Paddle) Fans ...v.t ..w. — wurvea vyine inspector ol wires. NO. ° ote Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ INO. of Emergency Lighting d. gmd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. oDetection an Initiatin Devices No. of Ranges No. of Air Cond. Tons I ° SJ No. of Alerting Devices No. of Waste Disposers eat mp Totals• .._ umber ons `" "�' o. o f- ontam Detection/Ale!ft Devices No. of Dishwashers Space/Area Heating KW Local ❑ MunIcIpal❑ Other Connection No. of Dryers Heating Appliances KW Security ystems: No. Devices Equivalent No. o Heaters KW ater No. Si Ballasts of or Data Wiring: s No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcations wingg• No. of Devices or Equiv@ent OTHER: vv Attaen aaatttonat detatt y desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: L11/110 Inspections to be requested in accordance with NEC 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 application is true and complete, FIRM NAME: Licensee: AgoILI %' 6k -/'11j— Signature (If applicable, enter `exempt" in the licen number line) Address: LIC. NO.: _ LIC. NO.: 4�a 63 E - Bus. Tel. No.. G/7 y;D- 9, Alt. Tel. No.: jg1 ,17�00A_5 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. y m signature elow, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agen Signature Telephone No. 'V8 -X? -31 3% 7/ f PERMIT FEE: $ MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 12— Z—/0 Building Locations 10L-1 G -R EEn/E JT Permit # _ Amount $ Owner's Name New F1 Renovation ❑ Replacement 11 SCo7 - J4— "A Plans Submitted 11 (Print or type)/ Check one: Certificate Installing Company Name /\O L L7 J2AJCI5 Corp. Address 70 Af 7 H S- ` LQ -o,--11 A4 Partner x v n U OU zz c w �" ¢ a z z d W w a a w Q 12 C7 F z H z T. a W C7 0. Ow W O W U x CG Z w > w C F, z O z w G vHi x SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR fC 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)/ Check one: Certificate Installing Company Name /\O L L7 J2AJCI5 Corp. Address 70 Af 7 H S- ` LQ -o,--11 A4 Partner Business Telephone r2 dF— S7 Z--gZ- y Firm/Co. Name of Licensed Plumber or Gas Fitter ?o8ot:7- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes E] No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond WLnthat I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the my signature on this permit application waives this requirement. Check one: or Owner's Agent Owner ri( Aeent n I herebv certifv that all of the details and information 1 have suhmitted (or entered) in nhnve annlirntinn are true and ncenrnte 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 Massac]wZetts State Clas Co ,& an(,hChapter 142 of the General Laws. (OFFICE USE ONLY) 0 Plgnature of Lic d Plumber Or Gas Fitter number /Z6 cf E] Gas Fitter License Nurnoer Taster ❑ Journeyman n 1 u6iS 1 � '--L;�rT s; W m,• 00 UJ J � � N . a c Ln co � .� Q N W N N Z w 1. Q \ � O LL O j N • 111 O -3 m W o Q Z W w c O • Z: Z ON U. J N O oZO O .1• 1 NOR7p Ott...o `�1tiO 0 a qr Date :...... ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ../. r..... .....?-.......... ........ ..:....i.....'-.................lt... has permission to perform ........................... .. ........... .......:..... wiring in the building of ....-.-.::.......: �.:!................... , North Andover, Mass. Fee .. s ............... Lic. No i?. ^iw `.............� .......................... r / ELECTRICALINSPECCOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer • nlltea dee ewly 7The Commonwealth of Massachusetts L6 • , r.r.li �-. Department of Public Safety ' ocr.pacy s fee otcAra - DOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 lir,., )1 ORO APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORIC Asa "rh So lot perlorrned In accordance rAtla she f Lu.chusetu Elecuical Cede. S27 CNQ 12:00 (PLEASE PRIIFT IH IMC OR TTPE 1IIIFOPMAT1011) • Date. • I -j_ " City or Town of To the Inspector of Direst The undersigned applies for a permitto perform the electrical work described below. Loeation (Street 6 lumber)S7- 0.rer or Tenant Owner's Address. ��,e�c►/,q TIed�1�L Is this permit in conjunction with a building permit: Yes ❑ Ito (Check Appropriate Box) 1 No. of Lighting Outlets Ito, of ilot Iubs Ito. of Iransformers Total KVA ove In- Swlavting Pool grnd. ❑ g nd. ❑ Ptirpose of building 4S4Q /I U Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undard ❑ 110. of iieters_ Bev Se"Ice Amps / ,• Volts Overhead ❑ Undgrd ❑ ito. of iieters lh=t>er of Feeders and Ampacity lio. of Pets Total Total Tons KW 110. of Disposals Location and Nature of Proposed ` lectrical Work 1 No. of Lighting Outlets Ito, of ilot Iubs Ito. of Iransformers Total KVA ove In- Swlavting Pool grnd. ❑ g nd. ❑ No. of Lighting Fixtures Generators KVA No. of Receptacle Outlets ito. of 011 Burners ito. of Emergency Lighting nattery Units ito. of Switch Outlets No. of Cas Burners FIRE ALAMIS ito. of Zones No, of Ranges Ito. of Detection and No. of 'Air Cond. Total tons Initiating Devices lio. of Pets Total Total Tons KW 110. of Disposals ito. of Sounding Devices Space/Area heating KSI No. of Dishwashers ito. of Sel( Contained Detection Sounding Devices heating Devices KW of Dryers llunicipallo. Local ❑ ConnectI ❑ Other Connection Ito. of hater Heaters KV Signsf Ballasts Voltage Wiring r No. Ilydro Massage Tubs No. bf Motors Total lip OTHER: INSURANCE COVERAGEt rursuant to the requirements of Itasischusetts General LaJi I have ■ current Lia lit Insurance policy including Completed Operations equivalent. YES[110 [i I have submitted valid proof of sane to Coverage or I substantial this office. YES I1O 1( you have chec ed YES, please Indicate the type of coverage by checking Lite appropriate box. 111SURA110E 13'BDIM ❑ OMER ❑ (Please Specify) ' —j xp rat on me Estimated Value of Electrical Work S Work to Start Inspection Date Requestedt Rough Final d6 c• d d rt;ne un er Lite penalties of 1•e1J'.r71 FiRH ME CIT71 licensee U14Y-417` ii�. Lj /j���becsignature2 « �. ~LTC. 110. — I / �/ us. B.. Tel. ito. - 'y Addtets �1r71a �S aD S%. d'�2- ;Z dj%�7Q lE �/ / Alt. 7e1. Ito. - OIIHER'S INSURAiICE WAIVERt I art aware that the Licensee does not have the insurance coverage oris sub— atant1:1 equivalent as required by llatenchusetts Ceneral Laws, and that my signature on this permit appiletton valves this requirement. Owner Agent (Please check one) Telephone No. _ ° rERliit FEE S Signature of Owner or gent '