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Home My WebLink AboutMiscellaneous - 14 Harkaway Road cc Mom Cl Moon Min �w 3578 Date..'�—. .2: . .r.4. .. NORTh TOWN OF NORTH ANDOVER pF ��to ,s1ti0 ar '� p� PERMIT FOR GAS INSTALLATION • i � a / SAC HUSESA This certifies that . . . ..<� . . 1 f`�. %�/". . . . . . . . . . . . . . . . has permission for gas installation . . �i. ! �. F. . C.�� .� �. in the buildings of . . . . `. ` ! . . . . . . . . . . . . . . . . . . . . . . . . . . . at ... . . . . . . ., North Andover, Mass. Fee... -:. .'. . Lic. No.. 5�- `,a. . . . . . .. . . . . . ... . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING . (Print or Type) hO&�� Mass. Date �� 2� a6;: Permit # 3J^7� Building Location—) Gt/1� Owner's NameL��S� Type of Occupancy- New�enovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No FIXTURES iW V � 4A oNf V1 OAC O W " °L 0V °° ztj > rn J ~tta2 � p � y{°�yC to vu � xz1— V1 >V) W � W Z x ; W Q l Oz W z ,5 > a I j z < ac 0° O O W °L 0 � W SUB-BSMT. Od BASEMENT 1st FLOOR 2nd FLOOR . 3rd FLOOR 4th FLOOR Sth FLOOR 6th FLOOR 7th FLOOR' 8th FLOOR Installing Company Name u'J �� r`�A/ C�orration Certificate Address 9 J6 f,f n �� 4N� '4j IL lM /Ve ro H0 � 0/,gs7 ❑ Partnership Business Telephone �7f-6S — 72/0 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter i INSURANCE COVERAGE: I have a current 1iimy insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No❑ If you have checked yes, pleaseindicate the type coverage by checking the appropriate box. A liability insurance policy U, Other type of indemnity❑ 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 walves this requirement. Check one: Owner O Agent❑ Signature of Owner or Owner's Agent . I hereby certify that all of the details and information I have submitted(or entered)in the above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the 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. Ty license: By M Plumber ' G�ciittcr - Title atter Signature of Lic sed%u or Gas Fitter O Journeyman Citv/Town license Number APPROVED(OFFICE USE ONLY) I FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS • i " FEE " NO. ., APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING — LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. — PERMIT GRANTED Date 19 Gas Merc. Final Insp. Gas Inspector Date....... ....... .......... ,koRTH TOWN OF NORTH ANDOVER 0 I. , PERMIT FOR WIRING V o' '23ACHUS This certifies that .....................ir ................... ................................ has permission to perform ......... wiring in the building of... North Andover,Mass. ............ ...................... Fee. .... ....... & e// `—E-LEGrP[CAL INSPECTOR Check # 5271 1 4 ThEC'Ol MOATWEALTHOFMA SS4CHUSE7TS Office Use only ..y DEPART 1E'NTOFPUBMCSAFETY Permit No. BOAROOFFIREPREVVEMONREGUTAHONS527CMRI2.VOp t / Occupancy&Fees Checked APPLICATIONFOR PERART TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 ff� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) /dbelow. { Date 6O" "t'U L-I Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work describ Location(Street&Number) Owner or Tenant l Owner's Address S� VA_f Is this permit in conjunction with abuilding permit: Yes® No r7 (Check Appropriate Box) Purpose of Building I�e S l JQ v► �L 0 l Utility Authorization No. Ffxisting Service Q Q 0 Amps 110 / 27 o Volts Overhead 1Underground No.of Meters New Service 0 Q Amps <10 / 7 "1-OVolts Overhead Underground No. of Meters = Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �, [ J ol k/L-x aZ- ?�4 ' Ch g ny e- 160 A w.y., (��4 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KV.A No.of Lighting Fixturesl Swimming Pool Above Below Generators KVA t round ground r No.of Receptacle Outlets 1 No.of Oil Burners No.of Emergency Lighting Battery Units rNo.of Switch Outlets ,4 No.of Gas Burners ido. f Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones _ Tons Nii,of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Nq.of Sounding Devices Na'of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.ofMotors ` Total HP OTHER-. ('L dty\S� e c c°� fret ",C, 1 l-r/y►1 t(/1 .-C-I t 1,Jye,,t k.L rl, b>,stuar&Cowrage Pnts=tothem mmnl MofMasswhZettsCemallaws [have at maitLiab>7ityh wanoePblicyinchx gComplek Coverageoritssubstandalequivalent YES 4 NO [haw OrbmiWdvalidproofofsametothe 0ffim YES ffyouhawcheckedYES,pleaseindicatedievAmofooverageby ,heclmrgthebox NSURANCEM BOND F1 OIHER (Please Spa*) '- / ftiralioll Dai / Esti r'a arl ValueofF�C�ical Wolk$ NorktoStart 1/11 VVI _ InTechonDaleRagxsted Rough «</// Fvlal ,igned uroerTleanaltiesofpT,L11y: T � i n 1WNAME J ��vt /( eat S IP-% Liemse-No. It�, Signature Licc=No Business Tel No. Q'I R--1 S- v7 K _Z �drltece i r d /�a wt vr► 0�1 `, / AIL Tel.No. -7 Co 1 3 Co q tP ti )WNER'S INSURANCE WAIVER;Iam aware that the License does nothavedr-insurance-cover ageofits&t&mtial egtuvalentasrequired byNiassachuselts Gffera]Laws xl that my signab aeon this petit it application waives this regtmernent ?lease check one) Owner ® Agent Telephone No. PERMIT FEE$ ignature oT r7ner or Agent 1 U W The Commonwealth of Massachusetts d Department of Industrial Accidents A Office of Investigations Boston; Mass. 02191 Workers'Compensation insurance Afil-davit 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 f I am an employer providing workers' compensation for my employees working on this job. Company name: 1 Address City: Phone#: I r Insurance.Co. Policy# ►. Company name: Address City: 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$1,500.00 and/or one years'imprisonment-as-well-as_civi[penatties in.1he form of-a..STOP WORK.ORDER..and_a fine_of_(.$1D0.00)_a day.against,me. I 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 r Print name Phone.# 1 Official use only do not write in this area to be completed by city or town official' + City or Town Permit/Licensing � Building Dept ❑Check if immediate response is required Licensing Board p Selectman's Once Contact persona Phone#: F-1 Health Department Ei Other 11W LUIVILV1UlyYV 'A.9"n Ur lr1ti."nt1Lly.ALL1AJ.1 -- �••., DElANNEVTOFPUBUCSAFEW LPemi52- `71 t No.BOARDOFFMPREVEMONREGULMONSR7C1 MIZ-M upancy&Fees Checked APPI ICA77ONFOR PERAWTO PERFORMELECTIZICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 1�(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ` Town of North Andover eq,--v T e�-.rm-v HOV C ly To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 7 4/y/ �,��p Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps 'Volts Overhead Underground No.of Meters New Service Amps Volts Overhead 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 Below Generators KVA round 0 ground ri 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 r , Tons { �io.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 No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Si Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• b%V[ QMW Aasratibthetec}mena�ofNla�ad><>9e�GenaalLaws Ihmaamaltlmbkylm==Poky l*gCmrk*! arksWbaiartialagtrivalm:t . YES NO Il�nearbmitbdvafidptoofc's wiDdrOffxr.YES YywhmyE,pkmmk*,herAxc)f by 1NWRbat.AI FCE BOND r7 OTHER ( Y) EViralimDae Estirr*dvakiedBxu cal wo[k$ WcikIDSlatt IVxfimD*Reqxs1Bd Flnel Sigle d urnlerTie Fumkn cf p ew FIRMNAME LNo. L;om>see Signature !%-� 137 BtshsTdNa -A 4fimv INER'SNSURANCEWAIVER;IxnmmdutheLiom>sedDISnothaNetheinal = crgs A1CTe1Na rdtha rnysgrMmcnthispmrrit4#cabmwai�estlfsm#arlmlt egirivilm�tasrer}rbedbyl�lassad>u t,aleralL3ws (Please check one) Owner M Agent Telephone No. PERMIT FEE$ Nignature ol Uwner Of Agent l9fC,1- - t�/' c c2 tipi wo�K�•�f D� r � ti �1