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Miscellaneous - 1600 OSGOOD STREET 4/30/2018 (26)
f i a IS- Date...... � 4, TOWN OF NORTH ANDOVER 4L PERMIT FOR WIRING CHU NL This certifies that ............................... ..... ... ................................. has permission to perform )r�"rvp ........ ..................................... 44"-,/ � 1#.P of AlpeOaPT?��. ..... .. ..... wiring in the building at... .1.... . .I-. ,,NgrthAndovei-,Mass, Fee...J..Z 5..—. Lic.No...IU,34............... ELEcrRICAL INsPEc-r0R Check # Q / 8124 Commonwealth of Massachusetts Official Use Only ' rt No. Department of Fire Services Pemi12- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (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 W INK OR TYPE ALL INFORMATION) Date: y l aci og City or Town of: NORTH ANDOVER To the Inspector of Wires:. By this application the undersigned gives notice of his or her in ntion perform the electrical work described below. L tion(S t&Number) `�� S dQ G� )perform �����/ L►berry �-qs ` Owner' Tenant Q 44f� �• Y A1�^ 'o4ety+ I I r Telephone No. X04 rl° �` Owners Address aC S�• ti e N 3® �Lperl L L �C� by 9 Is this permit in conjunction with a building permit? Yes No (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und ❑ No.of Meters New Service Amps / Volts Overhead❑ Unda d ❑ No.of Meters Number of Feeders and Ampacity --aacs 4 Location and Nature of Proposed Electrical Work: J 6� (�� SF. x•11 icy 20, ZAA P[� k Completion of the followin table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In o.o mergency ig g d. d. Batte Units No.of Receptacle Outlets No. of Oil Burners FrRV ALARMc INo. of Zones No.of SwitchesNo. of Gas Burners No.of Detection and Initiating 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: - - Detection/Alertint,Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ � No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent t Heaters KW Signs Ballasts Data Wiring; No.of Devices or E aivalent No.Hydromassage Bathtubs g No. of MotorsTotal HP Telecommunicatins oirin ; OTHER: No.of Devices or Equivalent l 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 Stark y 2� Inspections to be requested in accordance with MEC Rule 10,and upon completion.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 cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE f BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME LIC.NO.: ' Licensee:�ay�( �.. SAires Signature � LTC.NO.: b503/7 (If applicable, enter"exem t"inKn sgn mber line ^� Address: (` Bus.Tel.No.103- S- Zac2 *Per M.G.Lc. 147 s. 57- 1 swork ree uues D fit•Tel.No.: q el?"ent of Public Safety"S"License: Lic.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 Owner/ ❑ ❑ wner s a ent. Agent g Signature Telephone No. r rERMIT FEE:�' zt � -jam A 7 f5- A47 lb v i The Commonwealth of Manachuseiv r ! Department of IndustrialAccidents Office of Investigations . 600 Washington Street JA Boston, MA 02111 e www mass govMtia . Workers' Compensation Insitrance Affidavit: Builders/Contractors/Electricians/Plumbers Aoolicant Information Please Print Legibly NanTe(Business/OrganizationJlndividual): ,l LL 'J i t`l CU Address: 3 Kra AA V t'_. . City/S'tawzip:_ �k }. ��� ( Phone#:_'0 3� 76,S - 97a.2 Are n an employer?Check appropriate hoz: —71 Type of project(required): 1.[ I am a employer er with 4. i am a general contractor and i .6 ❑New construction employees(full and/or parttime).* have hiredthesub-corrtrat�ors . 2.❑ I am:a.sole proprietor or partner= listed on the attached sheet 1 1. ❑Remodeling ship and have no employees These sub-contractors have 8. Q Demolition. working for me in any capacity, workers' comp.insurance. g, ❑Building addition v [No workers'comp.insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.0.Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No-workers'comp. c, 152,§1(4),*and we have no 12.[]Roof repairs insurance required.]t employees.[No woricera' comp.insurance required j 13.❑Other •My appliew tier checks boi#t must also fill out the section below showing their workers'co*msetion policy information. t Homeowneef who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suds iContraetots that check this box mustansdwd an additional sheet showing the frame of the sub-eontr=bms and their workers'comp.policy inamnation. lam-an employer Ulm'is pravidorworkras'compensaldon insurance for myemployee,» Below is the policy mid job site infonnadon. _ Insurance Comparry Nam • •U . e(Y t'_ ALIS•4`(j, -TN (`ct nl CP 1 � Policy#or Self-ins.Lie.#:_W C ]g- IL - 63 Expiration Date:• 3 413 0-1--00 YL,- 1Wt�u� t-tA Job Site Address c •t v,ldr� '20 2�A sl: ri l C' !boo bsr�, 5 1 uty/StateJZip: oi8`�S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). + Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby fcnertt under the pains and penalties of perjury that'the Worn"on provided above is nice and conrt� i Si :`/V 1 . �iU, Date: � �a o$ Phone#: AOR- 76 5- Official ase only. Do not write in this area,to he caanpleted by city or town offuiad City or Town: PermWL'ecense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector S.PluEns 6.Other Contact Person: Phone#: NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i a i S ••• SSACNUSE� This certifies that- j . . . . . . . .. . . .`.: ? . . .. ..' . . . . . . has permission to perform—,,--, '�'. . .._.F- . . . . plumbing in the buildings at. . . . . . :. . . . . , North Andover, Mass. Feed... . . . . .Lic. No. Uci .3 ::. .. . . . . . . . . . . . ~ `PLt1MOING,4NSPECTOR -Check # fir'�� 7741 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) / NORTH ANDOVER,MASSACHUSETTS �� t W 1 LVl, G t, � _ S � l � Building Location �� 0 0 �� U -1 � V Owners Name �' � b� � � C Oy< y �--� Date � � Permit# :z � Type of Occupancy D r��� Amount New ri Renovation Replacement ' Plans Submitted Yes ❑ No FIXTURES 0 U o to A A w � I 0 ajmsw �>�loat ar aom 3m>zoaz 41H a0CIR 5MFLOCR 6M FLOCIR 7MK-OCIR (Print or type) �t _ Check one: Certificate Installing Company Name 6 �� � �t,�zi �'" `e-c z.� C ❑ Corp. Address �� V� ✓ °���'�� Partner. usmess elephone 7 0 - 3riFirm/Co. > Name of Licensed Plumber: ✓ a 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 ente in abov p Iication are true and accurate to the best of my knowledge and that all plumbing work and installation P7qprrned der ermit s ed for this application will be in compliance with all pertinent provisions of the Massachust St e hirribing Code d CA pt 142 of the General Laws. By: igna ure o rcense um er Title T pe of Plumbing License City/Town 71—cense NumurrMaster Journeyman APPROVED comm usE oNLY J /) ) /�. c---v,,1.1.c�-ti-.�-�'"✓ �/cam.� �7""""�-` �-t r a Date...... .......�...`-...'. .. HORTI� 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Io SACMU This certifies that .y... CAC! 9�/ �ry�% ................... ....... . ......................................G /f has permission to perform .........../ �l/�'l/C.�` ., /�/111T ................ . ..... ...... wiring in the building of Y../�L......................................... .......Z.z. , .... at...�bOd �S'Q��.1,�.....�?:-........................... ....North Andover. Mass. Fee.. �? .-"'" Lic.No. F?. T> '......f..2, ..-..... ..... 2 ELECTRICAL INSPECI�OR Check # 7966 Department of Fire Services Permit No.—T- BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned [Rev. 11/991 t � (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to th municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institutiol pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. f (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1- 11-69 City or Town of: 4,10rz77q A1Vh61V 2 To the 117speclor of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution OS 6C/o�N LA-"-JN,; Address C)S G Oa $�' Location and Nature of Proposed Electrical Work: el-C67707C`a 4- M�b�r►iT/�GwS7 ` NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- t� ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will rile this form on each such occasion(check one):. YES ❑ NO ❑ r We will maintain one or more contemporaneous log(s) (check one): YES NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew this application annually and upon significant changes in employment.. The following individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage,and location where it will be maintained Responsibleperson You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce• ' dure, indicate below how the Inspector of Wires should access the log: 11?C6'V155% ,v,Gc) flleiM Grhle Y Yj4-atldtaC0 l CidCur•rjt/i•✓ ,f How many electricians and/or-system technicians (as licensed by the Board of State Examiners of Electricians)do you employ at your Facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: `�j` Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see C. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans(see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- her of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: i Total electrical employment: Full-time equivalent electrical employment: "Institutions ure defined,for these purposes as any person,,/irm, or coy poration opej-ating under c. 14l ¢8, (Please see reverse side for certifications and required signature.) 4 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num-. bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less o ntractor on the standard form for such work. Do not include such em- than one year, application must be made by the c ployees in this application. _ Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition provide a statement that substantiates your authority to hire electricians pursuant to c. 141 }8 for electrical work on the prem ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant u authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules (J) said Board,or in contravention of the Massachusetts Electrical Code. My title is: %�/Z�S fJ G'�/� -- My authority to act for the aforementioned institution is: A2�S-,b t „v /certify,under the pains and penalties of perjuty,that the information on this application is true and complete. _ 4;e--;tt7 (Signature) (Dated) (Print name) ( Z y A a I (work telephone number) (extension) (facsimile number) 9'7�.- `�9 /F - 7 33 1, /7 ��k I i :4 i �a .FormatLlY { . t �J + f `� ' -- � ,.��..' . _ Y Y .� ��iff.x _t.s.�.�d,�Y � �, ;, r;LSs ,K ,�.' ... 7 Date. 9557 NORT:'�o TOWN OF NORTH ANDOVER r PERMIT FOR PLUMBING SSACNU���' ^( This certifies that . . . . . ++. has permission to perform . ✓� 1wtfk plumbing in the build' gs of . . .!).$�'� . �4-C. . . . . . . . . . . . . . . at ��vd4. . �.: . . . . /�. 6l/� . ., North Andover, Mass. Fee 3,V!Z(Lic. No.104/,S r. f!/L r' ,.sr . . . . . PLUMBING INSPECTOR Check f h MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - CITY /� ✓� _ ( MA DATE _ 'L ( tC PERMIT# ,p JOBSITE ADDRESS Gil �� eo -� OWNER'S NAME Xoaf ►' —_ — rx P OWNER ADDRESS ( TEL gFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL M RESIDENTIAL Eq PRINT CLEARLY NEW: ! RENOVATION:0' REPLACEMENT: ® PLANS SUBMITTED: YES U NOO, FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 14 BATHTUB CROSS CONNECTION DEVICE ( _ _f ! -_ __.__..... _ ..i ; _... l __.__..•! __.._I ____.1 .._._._ k ! f ! DEDICATED SPECIAL WASTE SYSTEM __T.! ____-.___-1 ! ._____! .._.___...( _.._._.__1 ! .__-...__J _.__.__.! ..__...J ._____! ___..._...► ! _� f _ J DEDICATED GAS/OIUSANDSYSTEM -__� --__._.1 --_.l ..-._.,-I _..______ _ _ _-----_! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM { -----._-_! ......___. I J I I=--J DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR)- KITCHEN INTERIOR KITCHEN SINK _--! ---___.1 _..-_t _--� ____._._( ..--___.J ._____.! ____._.► __...._._._l __-.._ I ._..__._I ___J _f _____.1 LAVATORY -_._.-__._.� ROOF DRAIN _._.._.._! -__-_� ! 1 I ---_-_I ! E ! J 1 SHOWER STALL SERVICE/MOP SINK TOILET URINAL t _-_-j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER .p I t , Al------__E _-.._._.i __ I -._.! .._-.-_._! ...__ ._! INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO M IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY © BOND MI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Genjeral.Laws,and y signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT � SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli flcgwiNall Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �J PLUMBER'S NAME , ,✓ (l1sG (LICENSE# F��ll: -( SIGNATURE MP m- JP Q' CORPORATION . # ;=PARTNERSHIPQ# _ _ (LLC COMPANY NAME G _t`J°•d ,� G� ADDRESS _ 6e--,.f/l�-i — — --------------- - CITY E� Cy/rj STATE /4: - I ZIP TEL rr FAX I ` ( CELL .. EMAIL (,r✓Cl��I�ir�a 1.n.C. �g �z Ji ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes NG,_. THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES a F The Conitnonwealth of Massachusetts r Department of Industrial Accidents Office of Investigatlolls 600 Washington Street Y— -- Boston, MA 02111 ww)u nucss.g o v/d is Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers :Applicant Information Please Print Leuibk Name (I;u,incss/Or,anii.atiun/In ividual): Fred L Webster, Co. ,Inc address: 306 Walker St City/State/Lip: Lowell, MA 01851 Phone #: 978-453-2891 Or 978-815-2417 Are you an employer? Check the appropriate box: Type of project (required): 1.tJ I am a employer with 4. [:] I am a general contractor and I * have hired the sub-contractors 6. ❑ New construction crnployecs (full and/or part-lime). i listed on the attached sheet. 7. ❑ Remodeling 2.El 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have b. ❑ Demolition \vorking for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.*- required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] t c. 152, §I(4), and we have no employees. [No workers' 13 ❑ Other_ _ comp. insurance required.] ',any applicant that checks box N 1 must also till out the section below showing their workers'compensation policy information. T I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new allidavit indicaune such Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hace employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. /am nn employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Safety Insurance Co. Policy or ;elf ins. I,ic. ,i: BP000.14268 Expiration Date: 8-1-2011 Job Site Address: 1G•019 oxo ,( c�P Cit /State/Zi d'. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of;i line up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby c•ertif, nalties of perjury that the information provided above is true and correct. Si_,nature: :/ ✓ _M." c_ Date: Phone a: 978-453-2891 or 978-815-2517 Official use only. Do not write in this area, to be completed by cit),or town official Cih ot-ToNN n: _ Permit/License tl IssuinoAuthority (circle one): 1. l3oard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plunibin- Inspector 6. Other Contact Person: Phone 4: Date. 9459 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SAC04USE� 1 / This certifies that has permission to perform . .1-271 . .F.- ao. . . . . ./I. . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . .It at . Q 27. . . . . . . . .....,. . . . . . . . . . . . . . , Ngo Andover, Mass. .Fee.A?. P9.Lic. No..,4?!7Z?. PLUMBING INSPECTOR Check # �_ 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO D. PLUMBING (Print or Type) �,) v A w Lu ui , Mass. Date -1 L -W Zo, Sc- Permit # Building Location G d c Owner's Name ., Type of Occupancy .,. .,r New O Renovation (7� Replacement O Pians Submitted: Yes❑ No O FIXTURES r.. m o z r- m J Z L4 J (A NQ O H m n v Z b 5 (A w ¢ -t 1- w z CL o a a ¢ a a o x rr } h Us d tO a < W m J an Z a x ., U. W s d S 3 � o z x � J ¢ f < Q N N a a 2 0 0 N Y W O Lf YtU Ir cc WESUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STHFLOOR 6TH FLOOR 7TH FLOOR aTH FLOOR Installingpant Name. N b /t H d o �., I��c-c-,•. Check one:. Certificate Address ��cc,r ,S'� - 1 �:i•yGwc.t ItiL 1 b J fid 31Corporation _ . 0 0 Partnership Business Telephone_g 7 j/ 7 36 CP 3 ❑ Firm/Co Name of Ucensed Plumber _ ✓ J i�l� 1� INSURANCE COVERAGE: 1 have a curI liab8ity insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. YesNoOyou have ed„mss, please indicate the type coverage by checking the appropriate box A liability insurance policy k L 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 waives this requirement Check one: Signature of Owner or Owner's Agent Owner ❑ Agent❑ 1 hereby certify that all of the details and information i have sulKede, rect) lication are true and acrxirate to the best of my knowledge and that all plumbing work and installations rfope f this pertinent provisions of the Massachusetts State Plum ' 14 f application will be in rAmpliance with afl Title Sig ature of City/Town Type of LicenJourneyman p APPROVED(OFFIC US ONLY) License Num7 3 `' Date....1 — ...12— ' f NORTH� n 3r ` �• oma TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING s i s ,SSACMUSEt Ile- This certifies that ...... ....... .................... has permission to perform GEN��!./11 ............................ wiring in the building of. . ... ... . .... . at. &� O . .1a..,5r..... U."'..1......... North Andover,Mass. Fee.. ............. Lic.No.............. ...... ........... .. . .. .. . . :- ........ CTRICALINSPECTO�� Check # — � 06'} 0 - — Commonwealth of Massachusetts Official/Use Only ^y Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. l/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 01EQ,527 SMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: a LI 13L 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)100 ©SJOOd 'St Owne or Tenant o Z Z Pro P e r-a1 e S Telephone No. Owner's Address %00 OSGoJ t• 6 t• O 1S f—La-r v Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters a New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity j _ OC) 14 f a06112 0 vv1,1 Location and Nature of Proposed Electrical Work: bv;idfn/r LQ, 3 rd FLdotz Le- Ff a+f e le ue Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ....""""""... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local[I Municipal El Other ` Connection 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 Equivalent OTHER: 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:/—d,3—12 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: INSURANCErA BOND ❑ OTHER ❑ (Specify:) I certify,under t e ains and penalties of per ury,that the information on this application is true and cornplet`. FIRM NAME: %L L /=�C 6fn i( Co_ XkC LIC.NO.: &503 A Licensee: 1A)Ag07z/LV �,p/t'{ I Signature - LIC.NO.: 6sd (Ifapplicable,en�t license numler line.) Bus.Tel.Nod—hO3-7 Address: 1,73 �'z�'L`7 , iy. �� 630?? Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department 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'sa ent. Owner/Agent Signature Telephone No. PERMIT FEE:$ FLECTRICAL PERM T NO. _ ELECTRICAL INSPECTOR.... I.ROUG71.xN_SP CTION; Passed _ Failed--[ ] De-inspection require ($50.00)-•[ I Inspectors'comrueuts: (Inspectors Signa a no bitials) Date 2.FTNAL INSPD+CTZON; Passed ' [ ] .Failed—[ Reinspection required($50.00)-•[ � Inspectors'comments: (Inspectors'Signafu no' tia Date 3.UMER GROUND INSPECTION: Passed—[ ] Failed—[ ] e-ins 'on required($50.00) [ ] Inspectors'comments: (baspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE C ,T-j1) dATTONA.L G I ; NA1Yff'•. Passed—[ ] Failed—[ ] Re-inspection required($50.00)••[ ] bspecibrs'coramenfs: (Inspectors'Signature••Ito initials) Date S.INSPECTION-•OTHER:' Passed—[ ] I?+ailed—[ ]_ 'rte-inspection required($50.00)••[ ] Inspectors'coin nments: (Inspectors'Signature•-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ONSITE IF THE AREA TO DE INSPECTED IS NOT ACCESSIBLE AND A RE WSPECTTION OF$50.00 IS TO BE CHARGED. Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations k1V 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /Ulf' f co�_(C c . T J C ' Address: /73 6 ry 16ve, (Vn ' City/State/Zip 'C��/'�� A 0307 /of Phone#: 1-003 -76S - 97J2 Are on an employer?Check the appropriate box: Type of project(required): 1. 4. ❑ I am a general contractor and I i am a employer with g 6. R New construction employees(full and/or part-tune).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins../Lic.#: !/ / Expiration Date: Job Site Address:�(�d� -Sp `� �G?//'!0/X12/0W 3/"4fZf_P?City/State/Zip !9 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." r Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia i Date.. :..Z3..` ........ 0 RT°�"°� TOWN OF NORTH ANDOVER o - p PERMIT FOR WIRING SSACMUS� This certifies that M#/ZCo T�� ...................... ..........., has permission to perform .....................P wiring in the building of �� ' Prz�����` i ...:............... ................... ................................... 6a�© h'ln.l�....S T....................... .North Andover,Mass. Teems ......r..... Lic.No.Z /...0.................4 ....................... ......... .... ELECTRICAL INSPECT r Check # 81 '10 Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.-1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICA WORK All work to be performed in accordance with the Massachusetts Electrical Cod '( }E 5;7 C 00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: Qt O City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives n ' e of his or h tenti o perform the electrical workLdescrib below. Location(Street&Number) G Owner or Tenant Telephone No. 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 ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity r Location and Nature of Proposed Electrical Work: ) r!/g !` Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)FansNo.of Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig g nd. rnd. Battery Units No.of Receptacle OutletsN4,. of Oil Burners FIRE ALARM No. of Zones No.of Switches No.of a ers No. ction and Initiatin Devices No.of Ranges No.of Air Cond. To No.of Alerting Devices No.of Waste Disposers .Reat Pump Nu Tons KWTotals: No.of Self-Contamed ._.. ........._...__...__. ...__..._... ' Detection/AlertingDevices f No.of Dishwashers e/Area Heatin KW Municipal g cal❑ Connection [] Other No.of Dryers Heating Appliances KW Secure ystems:* No.of Water No.of No.o ces or Equivalent Heaters KW Signs Ballasts of Data Wiring: . No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: r' No.of Devices or Equivalent OTHER: 'I Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value�Eletrical (When required by municipal policy.) Work to Stark 00 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 cLyerage is in force,and has exhibited proof of same to the permit issuing office.. CHECK ONE: INSURANCE BOND E3 OTHER E] (Specify:) I certify,under the s and pen !ties Jury,that the information on this a lication is true and complete. FIRM NAME: J 4 b Mt7 U-171, LIC.NO )160 Licensee: YLO Sign t LIC.NO. (If applicable, e r " a t�&te,,Iicense n er line.) Address: Bus.Tel.NI G � •� *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.NLic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability uipmce 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. PE FEE:$ v- �1 �a l The Commonwealth of Massachusetts Department of Industrial Accidents j Office of Investigations Ell 600 Washington Street Boston MA 02111 ll www.»wss gav/ttia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers konlicant Information Please Print LeQibl Nazne(Business/fOrrganizatio dividual)' Address• C City/State/Zip: Phone#: Are yo an employer?Check the appropriate box: Type of project(required): 1. ❑ am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).*. have hired the sub-contractors 6• ❑New construction 2. I am.asole proprietor or partner. listed on the attached sheet i 7. Q Remodeling ship and have no employees These suis-contractors have 8. D Q olmorr working for me.in any capacity. workers' comp.insurance. [No workers'comp,insurance 5. ❑ We are a corporation and its . 9. ❑ uilding addition " required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No-workers'comp, c..152, §I(4),'and we have no 12. Roof repairs insurancet ' ❑ rs required.] .employees. [No workers comp. insurance required.] 13•Q.Other *Any applicant that checks boy'#i must also fill out the section below showing their workers'compensation policy in Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConftctors that check this box must attached an additional sheet showing the name of the sub-contractom and their workers'comp.policy infomistion. 1 am an employer that.is pnquidingworkers'compensation irssurance for nry.employees Below isthe policy acid job site informadion. Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: �•, Sob Site Address: City/state/zi p l/$ ,l Attach a copy of the.workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $4500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER anti a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er the pains d ]perjury that the information provided above is true and co ct Si lure. Date: Phone 4: jol Official use only. Do not write in.this area,to be completed by city or town official L)�J City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical inspector S. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. •However the owner.of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of or insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit.may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should, be returned to the city,or town that the application for the permit or license is being requested,not`the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'. compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance'license number on the appropriate dine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pennitAicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under."Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investipations would Iike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations " 600 Washington Street Baston, MA 42111 `fell. 9 617-727-4900 ext 446 or 1-8.77-MASSAFE Revised 5-26-05 Fax 4 617-727-7744 www.mass.gov/dia Date..... 2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that ........ ...... .......................... 05 has permission to perform .. .................................................................. wiring in the building of..... ............................. 5................................. North Andover,Mass. & Fee.IST......... Lic.No..Ik4w......... Alsf�.......... ELECTRICAL INSPF R Check # 85 /- eommonwea&o f Mai9ac4uielb Official Use Only 2,pad.d of,cc77im SeC�rviced Permit No. } Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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:12-1101013 City or Town of. N cath ANdoycr To theIn peC or of Wires: By this application the undersigned gives notice of his or her intention to perform thQ electrical worke cribed below. Location(Street&Number) 1600 OS106d Str49C1_ � �Tt I f t f eq Owner or Tenant Telephone No. Owner's Address t600 OS400A Wmll fou;IJUwq $0 , 2--A FLAer uhit —T-og 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 ❑ 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:Au ���d tha95 asst 4 W i 1606 Osf&4 Simi' — nerfg;ctj N4tKtaurtee ' Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiatin Devices No.of Ranges No.of Air Cond. Total g Tons No.of Alerting Devices Heat Pump Number Tons KW o.of Self-Contained No,of Waste Disposers 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 E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent 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. Estimated Value of Electrical Work: (When required by municipal policy.) ) Work to Start: 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 suchcov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MI LL F Le LW c Co.TNc • LIc.No.:)L50.3 A Licensee:W"Ac W. Sp%CeS SignatureU)"W•S L LIC.NO.:16503 A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.46 Z Address: 113 WAkay Ave. % t h1.R. Alt.Tel.No.: *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic. 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: g p $ Date... .. ... ............. ... . ..... kORT01 TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUS Thiscertifies that ............................................................................................. has permission to perform.-.-I ��....... ...................... wiring in the building of ...... at.41. ......... .............. North Andover,Mass. .. Fee/Q..:......... Lic.No..... . .............. ' LEMUCRNZECrO n Check # 8553 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked`�j 4 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 PMT INIAW 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(Stree &Number) 600 0S a d II Owner Tena Re GID OW/1eR -/600 Gtroa bL Owner's Address /�Rop�,�tJ L�Telephone No. S Pyr., ._ Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) / Purpose of Building�`Le Snm-,o L`� Existing Service Amps Utility Authorization No. _ P / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity L c do and Nature of Proposed Electrical Work: �(�/� Com letion of the followin table may be waived by the Ins ector of Wires. � No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Poole ❑ In- ❑ o.o mergency ig g Abov d. rnd. BatteEX Units No.of Receptacle Outlets No.of Oil Burners �F)rRlr ALARMS No ®f Tones No.of Switches No.of Gas Burners No..of Detecfion and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers JUCAL Pump Number Tons KW No.of Self-Contained Totals: .... ...._................._................_. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal A Connection Other No.of Dryers Heating Appliances K, Security Systems: No.of waterofo. No.of Devices or E No. uivalent Heaters ' Bal of Data Wiring: Si Ballasts asts . No.of Devices or', uivalent No.Hydromassage Bathtubs g No.of Motors Total Hp Telecommunications Wiring: + OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: / (When required by municipal policy.)to Start: 'S -0 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 cov __Xage is in force,and has exhibited proof of same to the permit issuing office. l CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: /u tG ! CG. NC . LIC.NO.:16,5034 Licensee:�VA S� Signature ,S LIC.NO.•16563l (If applicable, en er"exempt" 'n the license fnumbqr line.) Address: 3 A , Ny �d 77 Bus.Tel.No.:/-fs03-74S- Z2 *Per M.G.L c. 147,s.57-61,1 security work requires Department of Public Safety" c S"License: Alt.L l.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. Ow /Agent Signatu Telephone No. PERMIT FEE: $/ci�5�J q V v 47 ��6 Y k. Date.... f �aORTI{1 "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSS^CHUSE� r f This certifies that ............... ....... '�/.? Gl ( : ......................y has permission to perform ......F7Ul.1...�?. `+��"�L .`. � wcic 15-4; J ........ wiring in the building of Al;2 p P � � /�C)�yc�<o Si 3a-/ at....... ...............n North Andover Mass. . Fee. .. .-��'�:.. Lic.No.U 3e4..... K ELECTRICAL INSPE�h'OR J Check # � �// 9 + 30 Commonwealth of Massachusetts Official Use Only Department of Fire Services PernutNo.- 1/33 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07) (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 W INK OR TYPE ALL INFORMATION) Date: I (, City or Town of: NORTH ANDOVER 16 the T s or her intention to perform the el�electrical wk dector o i By this application the undersigned gives notice of hidescribed below. Location(Street&Number) 1(flOU (�Squ3� S+ ,1 Idl _Q 3G l s+ Ft��n _ Sovttj e,4 Owne or Tenant D�_Pr*P��-i c--r LL C . Owner's Address Mo OS "PA St. bvAcU4_. W(} �� Telephone No. W, d Nd� t �1V,&JI Is this permit in conjunction with a building permit? yes NO ❑ (Check Appropriate Bog) Purpose of Building Utility Authorization No. Existing Service Amps / _Volts Overhead ❑ Undgrd❑ No,of Meters New Service Amps / Volts Overhead ❑ Unilgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Oki)y 7 3 U, ISf 2 13e`10 C°cc' t,,ilze vkcw se"v%kan cpm VIS o f ea pcSS ec+�r«la2 ati.l iNS�t ec t �« r ( +c �P` cc ifS av\ ev�tiwf c�eN►essj.� `" S 9 °��� Com letion-I.the ollowin table may be waived by the Inspector o Wires. No,of Recessed Luminaires No,of CeiL-Susp.(Paddle)Fans No.of Total . No.of Luminaire OutletsTransformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ in_ o.o mergency ig-&g — d. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners F'��'ALARMS No.of Zones No.of Switches No.of Gas Burners No-of Detection and No.of Ranges No.of Air Cond. Total Initiafmg Devices Tons No.of Alerting Devices No.of Waste Disposers Beat Pump Number ons KW p Totals: -.._ _ _._._ o.of Self-Containe _. Detection/Alertin D,Devices No.of Dishwashers Space/Area Healing KW ��❑ Municipal Connection ❑ �� No.of Dryers Heating Appliances KW Security Systems:* o.of Water No.of No.of Devices or Equivalent Heaters KW Si s Ballasts. Data Wiring: No.Hydroma ssa a Bathtubs No.of Devices or E uivalent g No.of Motors Total gp Telecommunications firing; // No.of Devices or E uivalent OTHER: fNS�`�'1( to '/- Fla.( ro(lgqm _S e2 ( -S /`v 6es c a Attach la onal detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: f/G� - (When required by municipal policy 1 Work to Start: 101 ested 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 &' BOND ❑ OTHER ❑ (Specify.) 1 certify,under the pains and penalties of perjury, that the information on this application is true and complete- FIRM NAME: KiL-L CLcc Ai C Co. . LIC.NO.: 16 50314 Licensee: W col vx e VU, S P1 pc S Signature cGc, i.U. S , (If applicable, enter "exempt"in the lice a number line. LIC.NO.:!(05 ,3 nes � Address: �71 3 B rd Ave • S-Tc c K )J..Lf- 0 3G�(5 Bus.Tel.Nod-feo3- 6S �a,Z *Per M.G.L c, 147 c. -61 security work requires D Alt.Tel.No.: Department of Public Safety"S"License: Lic.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 `\� .. 1' ��,�� � ��� s �. ._ M r� TOWN OF NORTH NDOVER ° p PERMIT FOR LUMBING a ,SSAC04US� .� A This certifies that . . o<. A40 . .- . 'I. . . . . . . . . . has permission to perform . AW. . . . . . . . . . . . . . . . l-0 tt plumbing in the buildings of .QZ . . t��1�. � . . . . . !. . . . . . at� r.s� C . . �•��Uv• •© d�IVorth Andover, Mass. ^�- G6 PLUMBING INSPECTOR Check # 8242 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location O O 05 4 Owners Name OZ2-X /�e �� Permit# Amount Type of Occupancy OvZ tj 0 Z-ty New Renovation 0 Replacement 13 Plans Submitted Yes No ❑ FIXTURES W. Ce biREM HASEW9 ]S]C FIDQt Y ��TT��p 4M FIDCR mRDm ,;k i * 4M FI" 5II•I RL" 6M FI" 71t)EI HBM 8M FIDM (Print or type) A / Check one: Certificate Installing Company Name nn t c.� y�<< z l Corp. Address T� S o v% L Partner. Business Telep one 7 7 — 7 v Firm/CO. Name of Licensed Plumber. P— L ti-/� T Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0--�" Other type of indemnity 0 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 ab a application are true and accurate to the best of my knowledge and that all plumbing work an 'nstallatio s perfo ed nder/)je Issued for this application will be in compliance with all pertinent provisions of the Massu tts t e Plu bingo d Cha r 142 of the General Laws. By: Sl—gniture 01 Llcen... Type of Plumbing License Title 1 0073 City/Town icen a um Master ® Journeyman ❑ APPROVED(OFFICE USE ONLY 9 9 U 8 Date...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that .................. ............................................................ ....... has permission to perform ......... wiring in the building of....... ....... at... .............................................North Andover,Mass. FeeIZA........ Lic.No..Jk��;:� . ......... E.- ZICAL INSPECMR Check # Commonwealth of Massachusetts Official Use Only Department ®f Fire Services Permit No._ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICALrpr All work to be performed in accordance with the Massachusetts Electrical Code WOR ®�� (PLEASE PRINT (MEC),527 CAM 12.00 WINK OR TYPEALL INFO TIO City or Town of: � Dater � -a() By this application the undersied gives no . e of his or her intenuio o Perform the electrical ctof Wires Location(Street&Number) �`Ip1J� [�S Oat S t-eGjscribed below. Owner Tenant ®22 r o , . H e vX cL - ''`1 �� d-- Scop t re 4, 1 Telephone No. wner's Address b 06 OS ctt3 S fi'C�- 3u,I d i o p �N� �}'luu>t Is this permit in conjunction with a building permit? Yes Purpose of Building No ❑ BLDG PERMIT# tL Utility Authorization No. Existing Service Amps _/ _volts Overhead ❑ Undgrd❑ No.of Meters New—_Service Amps _ / _Volts Overhead 10010-P ❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 10010 p Location and Nature of Proposed Electrical Work 1 i� a�'ice rel'f6 I Tlltouf- S 301 2N4 FLmtz „Fest - Approx ZIMO-Siff _ Completion of the following table m he waived ht he of Y he Inspector of wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Total. No.of Luminaire OutletsTransformers KVA, No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool A bovnd.e ❑ In ❑ 0.0 mergency ig Ing No.of Receptacle Outlets rnd. Batte Units No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection and No. of Ranges Total Initiatin Devices No.of Air Cond. No.of Alerting Devices Heat Pum Tons No. of Waste Disposers p Number Tons KW No.ofSelf-Contained Totals: ......__.. .... No. of DishwashersDetection/Alertin Devices Space/Area Heating KW Local❑ Municipal No. of Dryers Connection E] other Heating Appliances KW Systems:* No. of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wirin : Signs Ballasts g No.Hydromassage Bathtubs No.of Devices or E uivalent g No.of Motors Total HP ' Telecommunications Wiring: OTHER: No.of Devices or E uivalent Estimated Value of Electrical work:,' �Q�/ Attach additional detail ifdesired, or as required by the Inspector of wires. (When required b m -�• 0 ` q Y municipal policy.) Work to Start: d� Inspections to be requested in accordance with AMC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work in issue the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equay issuhe ss undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit is CHECK O s NE. INS p issuing office URANCE BOND g . I � ❑ OTHER ❑ (Specify:) eerti under p ') f1', r the alas a�r+zd penalties of perjury,that the information on this a lacatio FIRM NAME: ,LL l(.(C` `� Cc PP n is true and complete: Licensee: ell-If �e �, Isp 1 re S Signature LIC.NO.: (Ifapplicable,ent ex pt"tri the lice e num Ilye. �: LIC.NO.V 3Address: rid ,� /j w Q,5 0-� Bus.Tel.No.:/ 7 5--9712 *Per M.G.L.c.147,s.57-61, scarify work requires D partment of Public Safe S Licen Alt'Tel.No.. OWNEW S INSURANCE WAIVER; I am aware that the Licensee does not have the liabilityLIC.rance cove required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ogwner°smauent. Owner/Agent g Signature Telephone No. pE RM7T FEE:� ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSP CTION: Passed—[ Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: S 5 (Inspectors'Signature-no initials) Date Z_ /e 2.FINAL INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: F (Inspectors'Signature-no initials) Date y 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] - Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: x DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] r Inspectors' comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. � The Commonwealth of Massachusetts Department ofXndustrial.Accidents Office oflnvestigations 600 Washington Sheet Boston,MA 02II1 UV www.massgov/dia Worker' Compensation Insuran.ee Affidavit: Buiiders/Contractors/JElectriciansIPlu tubers Applicant Information. Please Print Legib Name(B.usiness/organization/!ndzvidual): RL L LeG N C Cc) Address: City/State/Zip: i �"�. !�I H ' 3b_ Phone# �7 b s"1_7C2`Z A xe you an employer?Check the appropriate box: Type of project(required): employer with4. ❑ I am a general contractor andl6. ❑N constructionyees(full and/orpart time).x have hired the sub-contractors soleproprietor orpartner listed on the attached sheet.i 7. emodelingd have no employees These sub-contractors have 8. [❑Demolitiong for me in any capacity. workers'comp.insurance. 9. ❑Building addition.orkers'comp.insurance 5. ❑ We are a corporation and its 10❑Electrical repairs or additions d.] officers have exercised their 3.❑.I am a homeowner doing all work right of exemption per MGL II.E]Plumbing repairs or additions myself[No workers'comp. c.152,§1(4),and we have no 12.0 Roof repairs insurance required.] employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also f9l outthe section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address:)00 ©SIO04 S'kce+ 30,2�A 1Co"lCity/State/Zip;Nos� �NdauGl I-.�4 d1[�4$ Attach a copy of the workerscompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties i a the form of a STOP WORK ORDBR and a flue ofup to$250.00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Z do hereby cer 'y under the ains andpenalties ofperjury that the information provideda7bove is true and correct. Si ature: Whil/LD C , ! �d n r- ate• Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): X.Board ofHealth 2.Building)Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ContactPerson: Phone#: