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HomeMy WebLinkAboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (88) 1600 Osgood Street Building#40 1 6213 AV Date......{..�......— �..?........ AORTI1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SgACHUSEt This certifies that ............t' n/ ,STIP• ........��r .............. has permission to perform wiring in the building of...&t A.C'5' ( ZZ at.......t.C.0....q8PD.......5. ..................... .North Andover,Mass. r Fee... .". Lic.No...IA.L.4.-77.4....... 1!l �� + 7— ELECTRICAL INSPECTOR Check # DENJUNW FpuBracsAFM PtrndtNo. _ BOARDOFF'REA�R GVLA g11 M70a12'0 occupocy&Fees Checked �•.�• APPUCATIONFOR PERMIT TO PERFORM FLEC UC,AL WORK ALL won To BE PERFORMED IN ACCORDANCE Wn THE MASSACMSSTS ELECTRICAL COtm,527 CMR 12:00 (PLEASE PRINT 1N INK OR TYPE ALL MRMATION) Da%460— Town of North Andover To the Inspec r Wires: The undersigned applies for a permit to perform the electrical works described bellow, p Location(Street&Number) & vy Owner or Tenant V '!-t- .)7777' S 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 I Volts Overhead Underground No.of Meters New Service Amp. VoIU Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work s C�� on— tee.. MA Na of Uandna on" Na of Hot Tube No.of Tra vbnem Total Na of Uahtiaa Fixtora Swbnmins Pod AboveBelow pq�� KVA KVA No.of ReceptacleOutWa W.dOUBurnra Me.of Emaaenq Ushtins Battery Unita Na of Switch Outlets No.of On 8wnra No.of Randa No,of Air Cold. Total FARE ALARMS No.of Zaw Ten No.of Diapaeda Na d Heel ToW TOW No.of Dwection and I'MUM Ton KW Iddging Dev No.of Dishwashers Space Ara Hea ft KW Na of Swoft Dedom Na of Self Ccntabwd No.of Dryers Heating Devices KWDetecdwAoW1q Devices Lacsl � Other No.of Wets Helie» KW Na of Na tions sloe Blibi No.Hydro Maugp Tube No.of Motors TM HP OTHER• 4 hstRSloe�Plhourntblhehapiert�otMaedasrrQehealL�ts IhwaawtUd itJ==veFbkiEkft QbabbM IhtneatbTrieedveid blieOmon ztr Ir)muhnedmdwY]3%pka*drnhefhe4pecftmtxgby M ANC3 Btu[3 am [3 �I�aseSpedl� WodcbS�t � Irk nD*R�pd i?ot* F dValteafHectidWadrs < Oc fWNAME ::/71 Cn2zav cicareNd LiomseNo 1&L/—2 7 1 BtsinmsTdNa oWPm SIIV5[JRANCEWAMRIam&MtmttheLmw tkiraaai W,6Vorka>tastinddegtiva�tasaY}iedLTel,N®dssrer97 773 11 it C3 (Please Ihihegt>i�t (Please check one) Owner Agent Telephone No, pgRhff FEE 3 .r Date `- . . . . . . .. . "ORT:�ti, TOWN OF NORTH ANDOVER 3? OL ....,.'� o Aigliift S PERMIT FOR PLUMBING • ,SSACNUSE� 1 � This certifies that//. :��4- � . . . . . . . . . . . . . . . . . . . . . . . . . has permission to(perform .,. ° plumbing in the buildings of . « �/Q , n at. . . . . . . . . . . ._. . . . . . . . . . . . . . North-'Andover, Mass. Qq Fee ..�'. . .Lic. No r � . . .: _. i . . . . . . . . . . . . . . `_ PLIJ�MB NG INSPECTOR Check # � ? 64U2 fASSACHUSETTS SETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDDate 3/,q JOS- - Building Location /(l' Owners Name V C i 2. Permit# Amount eTJ �C Type of Occupancy New Renovation Replacement 0 Plans Submitted Yes ❑ No ❑ FIXTURES SUMM BASOAHM' IS):FIO(R 3�II FIO(R �i�IDCR a SIH itiIOCR 6M RDM 71H FIDM SIH RDCR (Print or type) p i i I Check one: Certificate Installing Company Name 1 f� t v 1 �-�l y o Corp. Address 10 t D Partner. usmess Telep ons e (r,C;� -a3 0—Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type 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 Massachuset to Plu b' de and Chapter 142 of the General Laws. By ignature o cense of MDe Type of Plumbing License Title -0-7 3g131--k City/Town License NumDer Master Journeyman 01/ APPROVED(OFFICE USE ONLY Date.................................. AORTH 0;_tom`` "°0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SS^CMUSE� This certifies that .. .....�:`"..... Ir!c� t t.. , ........................................ has permission to perform .+ �F? �.,- �c-c-� .:�... ..................'� wiring in the building of.. ..... .........a................................. ......... ......... ........ ,North Andover,Mass. Feelis' U iN,�... ....... �-ii�iC�ICAL�-��-....................... . : ............ Lic.No.' / INSPECTOR Check # dk 5114 1� Official -UO —se• /nly Permit No. ed�l2nZd?ZZU�r fl'�f 0 jl .SS>�fZt.S�?7S / De�auroneat ?�u�fie S Occupancy&Fee Checked!� f BOARD OF FIRE PREVENTION REG TIONS 527 CMR 12:00 _ APPLICATION FOR PERMITT PERFORM ELECTRICAL WORK All work to be performed in accord ce withTe Massachusetts Electrical Code 527 CMR 12:00, (Please Print in ink or type all information) Date //^/-O `'7l 10 aIc uwNcLavl of• it ca. Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number /,4 oep cOs(5 1 Owner or Tenant fic °els I Owner's Address Is this permit in conjunction with a building permit Yes 0 P" No 0 (Check Appropriate Box) Purpos- Building C Drys M E rc i A j Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters s New Service Amps Voits Overhead 0 Undgmd 0 No.of Meters Number of Feeders andAmpacity 111C ? y�l/5 /�y �sv,l� �� °d Nd1 Location and Nature of Proposed Electrical Work ,v x�uz/ 2D Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units 'No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and cNo.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices Nol of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal U Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent �J= NO s have submitted valid proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) Estimated Value of.Electrical Work$ . o' (Expiration Date) Work to Start 3-11-69021 Inspection Date Resquested C Q,0 Rough Final Signed under the Penalties of per' ry: FIRM NAME /XXC d/ 'M Iz Ae,-T i LIC.NO. Licensee M 11(9 1 X/f/C N Signatur l LIC.NO. 3 00 S7 ��/ Q f� z Bus.Tel No. Address /N f%C.Gv c+'o o� Q�. %1��I ie �/l Aft Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) of Telephone No. PERMIT FEE $ � (Signature of Owner or Agent) The Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. 01 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 City: Phone#: 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 civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)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 herby 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' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION