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HomeMy WebLinkAboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (31) ►cam, 0 2 Sk Date. "• 07 h�"o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SS•�CMUS� This certifies that . . . .f. . . . . . . . . . . . . . . . . . . has permission to perform plumbing in the buildings of . . 0 at./. ..`: . . . . . . . ... . . . . . . . . . . North Andover, Mas . Feed. . . .Lic. No/-P . . .. . . . . . . . . . . . . PLUMBING INSPECTOR Check q �d 7th U U 8*103 �. � • �{ �, ', J" 1. ��v� l � � f � r �v / k i � � � � 1 l 1 ' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING F (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 1 U d C)S' d t5 S Owners Name Al A Ste" d L 19 Permit# _©3 Amount / �-C- Type of Occupancy G !LG New Renovation ® ReplacementPlans Submitted Yes ❑ No ❑ FIXTURES Cc F WO W 9 cc a U cc w w o a 3 A A w A w x xa a a a ° 3 a A a a H w c� A = as SLsBM RASE"M 3m MOM �l 41H FL" s1H HfM 6Hi HjOCR ' - 71H FLOOR �F s>H HDM ! (Print or type) Check Certificate Installing Company Name )C) orp. 2' S u 6 r1C Address Partner. a,... IMG O! usmess Te ephone p Firm/Co. 3 C 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 perform under P it Issued for this application will be in compliance with all pertinent provisions of the MassaLt St Plumbi Co nd hapter 142 of the General Laws. By: igna ure 51 Ocensecium r Type of Plumbing License Title l City/Town icense INUMDer Master ( Journeyman ❑ APPROVED(omCE USE ONLY dam+ CERTIFICATE OF LIABILITY INSURANCE DAIF`yMr�,pY.Yy}Y�, PRODUCER 6 11 2 V THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.P. ROBERTS INS AGCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 (978) 683-8073 INSURERS AFFORDING COVERAGE NAICO INSURED NORTH ANDOVER MECRMICAL INSURER A: INTERSTATE-SPRINKLER CONSTRUCTION, INC. I,NSURER e: HANOVER INSURANCE CO 82 SO. BROADWAY INSURER C: SCOTTSDALE INSURANCE LAWRENCE, MA 01843 INSURER D: ASSOCIATED EMPLOYERS INS CO 1978-687-3083 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSION$AND CONDITIONS SU SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. onA WLPOLICY EFFECTIVE POLICY EXPIRATION LIR IrmAD TYPE OF INSURANCE POLICY NUMBERI pATE'MttlpO, bATERAMiLTD LIMITS GENERAL LIA91Lry aFCH OCCURRENCE S 1,000.000 X COMMERCIAL OENERAt.LIABILITY �� PREMISES(ED 000urenct S 100 000 CLAIMSMADE �OCCUR MED EXP(Any a"perEon) $ 5'000 A FSC1000171 05/12/0905/12/10 PERSONAL 6 ADV INJURY E 1 000 000 GENERAL AGGREGATE 2,000 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOP AOC 1; 2,00P 000 POLICY l a JEC7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMITANYAUTO '(Ea DOcldenl) 1,000,000 ALL OWNED AUTOS -- BODILY INJURY SCMROULED AUTOS (Per person) $ B X HIRED AUTOS AWN4747635 01/05/09 01/05/10 !b BODILY INJURY X NON-OWNED AUtO$ I IPlr aDOitlenlj H ,PROPERTY DAMAGE Y (Per accident) GARAGE LIABILITY G AUTOONLY.EAACCIDLNT $ ANYAVTO OTHER THAN EAACC S —L—�--- AUTO ONLY. AOG S �EXCESSIUMBRELLALIABILITY EACH OCCURRENCE 5 2,000,000 (OCCUR �(CLAIMSMAOE AGGREGATE s 2 000 000 XBS002963 05/12/09 05/12/10 C I DEDUCYIOU5 RETENTION S WORKERS COMPENSATION tE,L. CSYATU• oTH- AND EMPLOYERS!LIABILRY YIN -yRY Uh11TS X ER AHy FPO?RIL'I. Annrca—nCZ11111i �I WCC5005043012009 04/24/09 04/24/10 H ACCIDENT S �• 000 000 (mandatory If% cxc;uroT 1 000 000 n (MAnamory N NH) El.SE-.EA2MPLOYEE 0SPItyECIALPROVISIO1,000,000 SPECIAL PROVISIONS 6etow EL DISEASE-POLICY LIMIT 5 ' OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIGNS t! FAX: 978-687-9861/978-6889542 I CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BUILDING DEPARTMENT DATE THEREOF.THE ISSUING INSURER WILL CNDEAVOR TO MAIL 20 DAYS WRITTEN 1600OSGOOD STREETNOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO$HALL i u •7 O NORTH .ANDOVER MA 01845 IMP03E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENT 8w RUTH i p EPREs ACORD25(200910i) ' 01988-2009 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD JUH-11-204 9 THU 02:1.=PH ID: PAGE:2 Date...... ........ NORT/{ °`<�``°:•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �9SSACMUS� This certifies that ........:.............................................. has permission to perform_....:..-.:.......................... ......................................... wiring in the building of.... ....t-r ^ �... ................................ /'0 °...... / --r��!,� ............. . ........ .North Andover,Mass. ? - Od 4 ` Fee.-::�..... '.... Lic.No.1,212�D ............ t.. f ELECTRICALINSPE OR Check # y GSA/ 890 '•� Urrl m 00141eitillt J� //J4'S Irl C:Ill r r jH(L1 2 P.v rif"I Sill tl�_.}trN \er!1!�Ci?5 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK : - ..,. ..!,C.� Ali _. i'i•I I'.. �,i,!, �!,.. \I,r �.•i.. ,.:i _, :",C.il'. .._ `:I- ...;j: _ lll �r .� (r;? % • �':. !..!'. I'.,' r ;;,� ,-. , ;rpt• I)atc':----� --���----- -...-------- C. if\ ut I uu'(t 111: -AA WWev'vgr ,-c_. lu lltc 1;?Vnc1C rrrr ul ff :i1'; .�` :!l' .Il;till:.ii a.li Iii•: 11?',ICI'.I"'�C'1 ,:� Il/l;(IC" •,! ills it Ilii 111tC11i;1111 <; iCrlli l'!11 '.I h: '.Il'Cll-iL.!1 .bury :Il'Sl i'i7C-d iC;l t'.� I Ii:limll i (rec( \ ----- t h� ner or (er1:1n1v l e(e )hune \ t. Mvllvr•s \llllress L!!r _ � - - -------- ---- -- - - k [Ills penult In Conjurlcti,nt With .1 Intilding permit'.' \es \'o (-Iterf: \Itprndtriatc Botj Purpose lid IiuilClin_ - --- — - - I tility \uthurminon \u.- ---..----- [:slstin'r i%�crvice \nips i Volts Oycrhra!I _-_-! Lnll;rt( ! \n. of\lcter� \ew service _ \colts ! \ ndts OyencCacl ! ncl'_rtl \n. of Vieters \anther of,Feeders and \ntpacitc Location alid \azure of Proposed l:leclric:rl \\nr(:: Colo N!ericn;of thr ln/lu:r•irlg rrr6L ,,till,•ir(•lvoi-.f,a/hr rhr h!51hv.Im :,r't l ;r(•.;. \u. fit'Recessed Iunlitiml-es \o.o(C eil.-Susp.(1);Iddlel Fans I I ( ransfornteI S � I \o. of,Luminaire Outlets I\o. of Hot Tuhs !G ell eratol.s \hove Ili o. ol Fineruencv !\o. of I.untinaires ISwintntin_ Pool 21-1111. rnCd. Battery 1. nits i,,\o. of Receptacle Outlets ------ I\o. nl Oil Burners - --- IFIRE ALAUIS No. of,Zones f No. of Detection and \o. of Sssitches No. of Gas Burners I Initiating Devices Ao. of Ranges --- — \o. of \ir Cond. total +\o, of Alertin Devices --- - ------ -- !heat Pump ' \umber [ons hi\ !\o. of Self-Contained --I !\o, of,\\aste Disposers Fotads: • I - �Detectnutl:Uerhng Devices ------ i I - Municipal \n. of Dishcv:uhers ISpace,'\rea lleatin'_ K\\ lLoc•al Connertiort ' Other --- ----- --- ---- ---- ----�e- l(eatinr_ \ ttliances (Security Svstents:` No. of Drters I f I h\\ I \o,of be%ices nr Fr uiyalellt \o. of 11 iter i\o. of, \o. of ! L\V Data i\icing: llell tcrs Ballasts Sr_ns \n.o(Ur\ices or FAuiyalcnt ' frlrrontntunicatinns All. IItllrnmassage B,ttltluhs \n. of nlors lural (II' No. of, Device.<. nr Ft nicakttt htr.. -:rrirritr� r:i:1,'-,ni y „•vr�.-a' n- .... •t; r;• i :�� %Ir• l�r,��.!, „ .r ti�;rr'• I fll;!'-c_;wrin H; hf: I,LI[I.s!C:d u: .t.: n;f,ur:, ",,ill AI! ( fi.uc I. ;trd ;ii'.nn _:,I.lhi,'..uu II WAV I: ( O\ [:R \(J. 4 r; ;> 'it •t . .)• '. n1 . .. 1e !l__1) , l',I It!C il'..?i ...1!: .il" !I ;I!I".,,;I ;,:II .IC,I, !I(:.'! .I1!iC, .I'_ .....il�, :il,ll ;1,., ..:1•_ .. !I'. !r.. .l!li; ItaS C\Itl!•.II_, l•L_/,Y ..11'.. �.. 1h; (;:"..:C ., U'tt_ .!I._ ( iHJ k t!\!.. !\�i. h \`( !. A- il!/\I% �-_ (i1 iil:R / tint rrrtJ r[hf p rirrc /Ili/pCrr,ririrr r;p(.1-pir;. rhw till,,irr/,nrrr-,titin, 'M dit, .r l,li,rrrr:,n is our :nal 10MIl"Ch. d IRv1 \ VAIF : AMI,RICAN ALARM & COMMUN'!.CATION'S N 12 l2 ___-_--- I.rc•en:ec: RICIiARD L. SAX PSON i_nanlrr I I( \O.: 5021) _ --- -- - -- -- ---- -----Itu:. I el. .-6! 1 -2000 \Iflhc.�: 297 BROADWAY , AIR LINC"I'ON, :"'A 02474 — r'. ! t, I ! II I. SS CO 000090 (1\1 \1.R I\�I R \\( I-: \1 \1\ 1-:R: 1 .Mil .1i,.:11 i!t:!! the I i,,, ,i:. r Iryl; r.,� h•. i r,;. ;!_ �;I;�In: � .� '�� I !?��. .ii... tL•I, � .jul�.:n�;., I .Ili 1!,, .,i;� :�, - m - ttc: I•_cn (htner \ col ! i'_nitnre d cicphonr \o. I'l.K 1117� �,�.. -AA f � /� V 'V � [� W f 1V [' 9720 /0_. Z '" aDate.................................. ' f NORTH'1 TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING 41 ��sSACHUSE� This certifies that ...........DejUD..... ..�T✓1....G ............ .............................. has permission to perform ...........�� �/T. ... .. ... .............<......................................... 8 S ��z it hi k.,4. A,Pr4/k�.IP /). T� Winn in the building of....... ............................:. . ..:... .. . .. .. ... .../�!� at...06 0 ......................................7, orth X"Y't- Andover,Mass. Fee..`1!4 ........... Lic.No..�.�.9.6 x.4......... .... ll /' .... ELECTAICAPECTORl Check # tfccommonweaR of MamacLetb Official Use Only ..UeparEmetif o1 jire Serviced Permit No. 7 2,2 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 IN INK OR TYPE ALL INFORMATION) Date: le) — 05-- %y City or Town of: N,04rb4 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) 1600 A,5;-�5eA>6 5r Owner or Tenant N�27N , 441A.Ji../4 A:�)Or 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 Location and Nature of Proposed Electrical Work: AL014 ri 07 V"Ka6ira 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 Luminafres Swimming Pool Above ❑ In- El 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. o etection an Total Initiating Devices No.of Ranges No.of Air Cond. Tons No,of Alerting Devices No.of Waste Disposers eat um umber Tons o.oSelf-Contained Totals: "'.""'."."""""""'""""""""""'."""""""".""""" Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ un c pal ' Other Connection No. of Dryers Heating Appliances KW ecurity ystems:* No.of Devices or E uivalent _ No. of WaterKW No. o No.of Data Wiring: Heaters Si ns Ballasts No. of Devices or Equivalent i No. Hydromassage Bathtubs No. of Motors Total HP elecommunications 1Viring: 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: X-Zf1O 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 rage 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 ofperjury, that the information on this application is true and complete. FIRM NAME: �/D ezgr, -4. r OX,7oo4c-0, 6 LIC. NO.:_ Licensee: A> fA44-t - Signature— LIC.NO.: (Ifopplicable, er "exempt"in the license number line.) Bus.Tel.No.:fyt-ZC2 6x6 Z nlg Address: 7 Dor- �' AA#e>1 Alt.Tel.No.: 9�,oY­3,7s-sway *Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic. No. OWNER'S INSURANCE WAIVER. 1 am aware that the Licensee does not have the liability insurance coverage normally I 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: $ � f��� `��. 1r� ����� .,� �� � h f r