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Home My WebLink AboutMiscellaneous - 124 Pleasant Street f/�� /FGSG�/7f 5�2£�T� . _ \1 ___ C- Date. . . . ... ... . . a... .. 10� p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION '1 ��SSACMUSEtt l f� - f This certifies that P. . . . !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. has permission for gas installation . . . ..... . in the buildings of . . . . . . . . . . .. . at . . . . . . . . . . North dover, Mass. Fee. 2U."�. Lic. No. ?. . �� / • GASINSPECTOR I Check# # 1 f O 6371 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS F rnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 12- 61dF. �-f � , Building Locations a-L� OL, Permit# & 3 Amount$ , Owner's Name New Renovation Replacement ®/ Plans Submitted a W C ' O F ¢ > W w o4 O O p z F w x v v w z �" a p x > w V F Z Q x w z w m Z Q W Q C F". F, rn m Z O W > W Z Q C Q Q O O w x o x > o a o SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR r 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR 1 17 (Print or type) Name .� Check one: Certificate Installing Company � °`� � � 1�f`PiGtiGGu.. G" `�' Corp. Address �� J'�� , "lir, n Partner. Business I a ep one o D d--y Firm/Co. r Name of Licensed Plumber'or Gas Fitter ��J 1✓ INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes No 13 If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— Other type of indemnity 13 Bond 1 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 1 I hereby certify that all of the details and information I have submitted(or entered)in above pplication are true and accurate to the best of my knowledge and that all plumbing work and inst ions rformed u er Permit ssued for this application will be in compliance with all pertinent provisions of the Mass us S Gas Code Chapte 42 of the eral Laws. By: _ Signature of Licensed Plumber Or Gas Fitter Title Q Plumber % City/Town, 0 Gas Fitter License Number Master _ APPROVED(OFFICE USE ONLY) 1:3 Journeyman Date. ....... AORTof TOWN OF NORTH ANDOVER 0 , * PERMIT FOR WIRING S CHUS This certifies that ....... ........ ............. ............ ............................................... has permission to perform............................. .. .. ................................... wiring in the building of......... ................................. .........01................................... ................ .North Andover,Mass. aoo� Fee`. ............... Lic.No.............. ...................... ......... ............. ELECMCAIL rliN�S�V'E R Check A 6542 _ Commonwealth of Massachusetts —Official Use Only , r5 ," Permit No. y Z Department of Fire Services -� Occupancy and Fee Checked "ays BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leaveblank) 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: �=- `wl 1 City or Town of-. W_-a O-Lr 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) l�a 9\X O Sbg� —� , Owner or Tenant cre.S(:i+`\"-Z, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ff No ❑ (Check Appropriate Box) Purpose of Building Utilit uthorization No. Existing Service , ,00 Amps 4-0 / oLq'OVolts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:' A",Q ,,4 _ 00n, Cont letion ofthefolloi,,4ng table may be waived by theInspector o Wires. No. of Recessed Fixtures No.of CeilSusp.(Paddle)Fans No.of Total : Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection and No. of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I.Num Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW �� Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No. of Water Kms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) 11,0 O Q, a� (Expiration Date) Estimated Value of Electrical Work: NWO (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the ains andpena\ltiessf"% perjury,that the information on this application is true and complete. FIRM NAME: S t,o \ CSX "�,J%CL") LIC.NO.: h xoi�r%?-- Licensee: Licensee: �k,.%.vx �5i,o4 Signature LIC.NO.: qES�AL& (If applicable,enter " xemRt"�'+the license nun7taane.) Bus.Tel.No..,�� S 01'3 S(Z3 Address:�0ol;�l�e �c. \ chS�d� D-\n Ol�'Zg Alt.Tel.No.: OWNER'S INSURANCE W IVESaware thdtt 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 PERMIT FEE: S �Oy Signature Telephone No. Commonwealth of Massachusetts Official Use Only Permit No. 2, Department of Fire Services Occupancy and Fee Checked $; BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leave blank) CDAPPLICATION PbR 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: Y<<,. City or Town of: �� 0,u- 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) la-� Owner or Tenant Telephone No. "A l (11� Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utilit uthorization No. Existing Service �10O Amps Q-A' / D-q-OVolts Overhead 7'Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the olloivin ..tablemay be waived by the Inspector o Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.:of Total Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA Above In- o. o Emergency Lighting No. of Lighting Fixtures Swimming Pool rnd. [I rnd. ❑ BatteKy Units No. of Receptacle Outlets l No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners o.of Detection and Initiatin Devices No. of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ' iDetection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [-] Municipal r-1OtherConnection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 OND is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Ltd d �:•� (Expiration Date) Estimated Value of Electrical Work 'N\,D (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under tht5w-tV ains and penalties o perjury,,that the information on this application is true and complete. FIRM NAME: \t ��C � s"VM1i C�7 LIC.NO.: N v_Oz L Licensee: +�v� [-5 i� , SignatureLIC.NO.: IES 0'i L& (If applicable,enter 'xem, I— the license numb�(ine•) Bus.Tel.No.a`Z>v Address: l� JC ut �t . r\0, + \r. Ol�d'� 1 Alt.Tel.No.: `il$ 64"i -Y)l5 OWNER'S INSURANCE WEER: I am awareth t�Licensee does not have the liability insurance coverage normally O required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ �Oy Signature Telephone No. _ _ S CD 0 DEAD BIRD REPORTING FORM FOR WEST NILE VIRUS CALLER (person reporting dead bird[s]) Caller's name: O ce5C I vh G no, Me/l n dl Date of report: , Caller's addre��ss: A&Z �leC7 Sio h � S7 city/town:A � An dno-C.L- zip:6/ Phone: BIRDS) Number of dead birds observed: Date dead bird(s) found or seen: Species of dead birds observed,if known: 12,U'Oti `/OU n Condition of dead birds observed(eyes visible?,maggots, etc.): 00e e V r- W5 b' Any evidence of trauma (e.g.wounds on the bird or damage to its body)?: B-YES7'O NO Odd behavior of sick birds, if observed: LOCATION OF DEAD BIRDS) Address or location of observed bird(s): t5O M ,e, City/Town of observed bird(s): zip: HANDLING OF BIRD(S)? Has the caller oo omeone known by the caller handled the dead bird(s)with bare hands? ❑YES If yes,how many persons handled the dead bird(s)?: SUBMISSION OF BIRD(S)? For a SINGLE dead bird: • Submission of the dead bird IS NOT recommended, except in unusual circumstances. • Advise the caller to safely dispose of the bird: DO NOT HANDLE THE BIRD WITH BARE HANDS. Use gloves or a shovel (or other appropriate tool) to either bury the bird or to double bag it in plastic and then dispose of it in the trash. For MULTIPLE dead birds (2 or more dead birds observed at the same time and place): •. Submission of the dead birds IS recommended. • Advise the caller NOT TO HANDLE THE BIRDS WITH BARE HANDS. • Arrange for submission with the local WNV Dead Bird Contact Person. Will the bird(s) be submitted for testing? ❑YES ❑NO Person Completing Form: Name: Phone: Agency: /U J�'16 Please fax completed forms to Michael W.McGuill,DVM at(617)983-6840,or mail to Michael W.McGuill, DVM, State Laboratory Institute,305 South St,Boston,MA 02130. April 2000