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Miscellaneous - 117 LYMAN ROAD 4/30/2018
i 117 LYMAN ROAD 210/031.0-0050-0000.0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING �+ SACMUS� \� This certifies that ............. ............................................................... has permission to perform ................................................................................ wiring in the buildling of... . ........................................................ at../�r� 9 ...1.. .V�...�.....................,North Andover,Mass. Fee -' ....I......... Lic.Nof.�Zl ........... ..... ..�:, ........................ / / (/ vtLECTRICAL INSPECTOR Check # 116") 4946 T1&C0A1MONWFALTHOFMASSAC SETlS Office fiUse only DEPARTMEMOFPUBIICS9FETY Permit No. BOARD OFFIREPREVENT70N ONS527CMR12.00 " Occupancy&Fees Checked APPLICAHONFOR PERMIT TOPE ORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE ASSACIgUSSTS ELECTRICAL,CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date-__II Town of North Andover To the Inspector of Wires: The undersigned applies fora permit to perform the electrical workdescribed below. Location(Street&Number) 117 Owner or Tenant Owner's Address �$' Is this permit in conjunction with a building permit: Yes 1:3 No 12r .(Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps� Volts Overhead M Underground No.of Meters New Service Amps / Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above ED Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices ado.of Dryers Heating Devices KW Local Municipal Othe_ Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER h>SutarloeCov$age.Ptusuanttodlete�r�ofMassad>u�tsGari-alLaws IhawaomaHLiabkyh ePo yw,x&gComp]ebm Covw,gorilsakstata givabt YES NO Ibavea nritwdvandpuofc(sametotbeOffioe YES13cubarsdiedl YES,plemmdowdrgpeofooNaWby drbox E INSURANCEW �1G� BOND OBER FloxeSpedy) FxpuatiolrDate F VahtedEbc lWolk$ wodctostatt /D hVeclionDateRegtlested Rough FmaI S*nedurxler`& ofpetjuu .. FIRMNAME C PFfl�!' 's /=.G�Gi/Z�.G �f�l LioawNo. /./ :�lCiZJ Lioa.�� .��/95 �, �Ib�/�U3/ Si _ n_ •�. 2/� --- LMWNo Bwh%TeL No. a L;7bf7 ,,ZaweLG- s'/moi-eei % 14Pfu �SS al�y� ' A1tTei No. -OWNER'SINSURANCEWAIVFR;Iamawaieiiatthelioeri6edoesnothavedru6 ma oovwageoritswbutalegwvalalasrogtutedbyMamdntttsCtnaWLaws and that my sigtiahue on this penrd application waives this mw*ffmlfft (Please check one) Owner Agent 0 j,i Telephone No. PERMIT FEE$ signature ol uwn—er-577g-e-TT" o IT The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations Boston, Mass. 02919 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: city Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address Ci Phone#. Insurance.Co. Policv# Compgnv name: Address Ci : Phone#: Insurance Co Policy# Failure to secure coverage as required-under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,=.00 and/or one years'imprisonment_as yell_as_civiI.penaltiesjn-thelam-f aSTQP.V ORK_ORDER.and_afine_ -($ljDO oo)-ajdm againstme` 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing. El Building Dept pCheck if immediate response is required .D Licensing Board E] Selectman's Office Contact person: Phone#: E] Health Department - -© Other - - Date. .): .Z.�. .`. �. N2 4737 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� / This certifies that . . .�` �.?.`. . . . ... . . . . . . . . . . . . . . . . . . has permission to perform . . . /. .�. . . .T• . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . >/�/��.U. . . . . . . . . . . . . . . . . . . . . . . . at ./1.7. . . . . . . . . . . . ._,North Andover, Mass. Fee. ? ` . . .Lic. No.. ? I . . . . . . . . ... . . :-! .''-C . . . . . . . PLUMBING INSPECTOR Check # �� 7 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM[ APPLICATION FO PERMIT TO DO PLUMBING-=a (Type or print) -- NORTH ANDOVER,MASSACHUSETTS - _ . Date Building Location 111 L4yn r h pw Owners Name Pn5e.t t Lt-1c-o, '5Pi vn0 Permit# Amount Type of of Occupancy New ❑ Renovation Replacement d Plans Submitted Yes No — FIXTURES w Cn >4 --I� Cn A a w w a accH x w - [aw-+ Fa d x A. W ona a a E-4 rA SOB-BM M MOQt zrn FT�OCR 3M RO(R 4IH H-aR 511H[ROCR 61H HJ00R 7IH F7 OCR M HJOOR - (Print or type) Check ne: Certificate _ Installing Company Name-An n y pr P 1 h p $u � ;g�.�„j n 6, LCorp. 1 Address 20 Aeg Pan Dr. Unit-10 Partner. Methuen MA 01844 Business Telephone -978 68b-8383 Firm/Co. Name of Licensed Plumber. George LaRos . Insurance Coverage: Indicate the pipe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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.State P mbing Cod apter 142 of the General Laws. By: rgna ol Licenseay=uer Type of Plumbing License Title 9 983 ^/ City/Town rcense i um er Master ' Journeyman APPROVED(OFFICE USE ONLY eee +++