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HomeMy WebLinkAboutMiscellaneous - 109 FOREST STREET 4/30/2018 (2) 1 109 FUKtS I J I Ktt i f 210/106_A-0172-0000.0 --------------- ,. I I i I I I A Date......./. n/.77.0,5.. f pORTh 1 3?°•,;�`"-.•�."�O� TOWN OF NORTH ANDOVER r ; PERMIT FOR WIRING 1 SACHUSE� This certifies that .............. ..... .��....... 4 = ........... has permission to perform ...................... ......................... wiring in the building of T � .......................................... j Q' �T S?..................... .North Andover,Mass. O� Fee.. .......... Lic.Noe4.pp,{ ..................../-c .E, . ,:, ,.�<<' ..c.... ELRICALLNSPECTOR j Check # 7963 r� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 71 e3 cy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev.Occupancy 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 0�� 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) 7''— Owner or Tenant T A'„ iii,'r v / Telephone No. Owner's Address I'/O Is this permit in conju9--'No [Inction with a building permit? Yes © (Check Appropriate Box) Purpose of Building 1� .111 1r A Utility Authorization No. Existing Service Oo Ams /2 Volts Overhead e-----Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No,of Meters 9 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Y —Completion Lf the ollowin table ma be waived by the!ns ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool ove ❑ n- ® o.o Emergency ig mg rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switchesl No.of Gas Burners o.of etectton an Initiating Devices No,of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers eat PumpIum Numberons o.o e - ontaine Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municip?l ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent o.of Water , t o.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or Equivalent OTHERi 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: /— /,7 v r--' 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 OND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this applicadon is trite and completes FIRM NAME: A;7 LIC.NO.: 115L`J'r'3 3 Licensee: fr / Signature LIC..NO.: / ►¢ 3 (lf applicable,en r "exempt in the license number line.) ilIlpef No.:4,C 7--Z t+� Address: Alt.Tel. No.: `Per M.G.L c.-147,s. 51-61,security work requires Departm 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. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. S Date. NORTH pf TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION �,SSACMUSEt This certifies that . . .g j„ . sIn . . . . . . . . . . . . . . . . . has permission for gas installation . . . .13 fQ�-?. .Y . . . . . . . . . . . . in the buildings of . . . .T A.1. slc.c . ,C. . . . . . . . . . . . . . . . . . . . . . . . at ?A . . . . . . . . . . . . . . .. North Andover, Mass. GiS INSPECTOR Check# 141 , - 6317 MASSACHUSETTS UNIFORM APPUcATON FOR PERMIIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS � , // � �� Building Locations z�( Permit# Owner's Name Amount$��f`�'Co Gr New Renovation Replacement Plans Submitted � a w � o a cK C7 U w x z F v, n. a > d w w � � � x 'x a w � w z Q w Q z F F w t7 p > w F w ] F w x z a d C° z o a x >o > SU B-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR rA 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR Yr 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR I (Print or type) /� Name �� �l f ���� "e / L Check one: Certificate Installing Company �l E] Corp. Address 1 1"4� k r d Partner. Business I a ep one -77 z U Firm/Co. Name of Licensed Plumber or Gas Fitter �Lo lett ., INSURANCE COVERAGE Check one: I have a current liability Insurance'policy or it's substantial equivalent. YesNo� If you have'checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy 13-- Other type of indemnity D 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 Agent Owner 13 Agent 13 I hereby certify that all of the details and information 1 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 e Gal�,Code and 6,hapter 1 of the G eral Laws. By; Signature of Licensed Plumber Or Gas Fitter / Title [3--plumber �� /s L City/Town, Gas Fitter ricense Number- 13—Master um e13—Master _ APPROVED(OFFICE USE ONLY) D Journeyman