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Miscellaneous - 161 COACHMANS LANE 4/30/2018 (2)
CYy 161 COACHMAN'S LANE 21 0/064.0-Co68-0000.o Date :��?..1.0?�" .... . NORTH pF 6 6 TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION UCHUS This certifies that :T T. 144. ��+. . .t�J7N_G'. . . . . . . . .'1, has permission for gas installation . . Z� in the buildings47,,�y . .. . . . . . . . at/,O/• • '.� r. f�. �' l:, orth ov , Mas Fee./ d . . . Lic. No.. ., /� . `. l� G GASINSPECTO Check# 8095 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: _; off . MA. DATEA" PERMIT# JOBSITE ADDRESS: ��! �D%C / ! 'S L/ E OWNER'S NAME: PM ��� OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOOR— Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER AQAigo i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Pj-`N0 ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 e in�mplancewith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� PLUMBER/GASFITTER NAME: /�/-rIVA lJ L. ��/-�AFII�� LICENSE# Q SIG URE COMPANY NAME: —J ' / 7 �� �-1-ir -- ADDRESS: l � DEk4lYC✓ CITY: W& l l�Y 9TQI y STATE: ZIP: ® FAX: TEL:116-667-'/7/0 CELL!�'�/��EMAIL: �Qi�I11/�l/n�0��E MASTER©JOURNEYMAN ❑ LP INSTALLER❑ CORPORATION®# PARTNERSHIP❑# LLC❑# ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 9> Town Of Groveland Plumbing&Gas Inspector _ 13 Ashcroft Terrace Groveland,MA 01834-1341 a,*eo>nn Tel.978-372-1575 EFFECTIVE OCTOBER 1,2002 — PLUMBING&GAS PERMIT SCHEDULE RESIDENTIAL — Plumbing&Gas New—Remodeling $50.00 Plus$7.00 Per fixtures Replacement water heaters&boilers$25.00 each COMMERCL& — Plumbing&Gas New—Remadding $100.00 plus$7.00 per fixture Replacement water hewers&boilers 540.00 each Re-inspection Cee of$50.00 will be charged Work stMed wiften s parjdt for phtmbirtg a Z.fee will be doubled _ Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . /'°-J' f . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . .. . . . . . . . . . . . . . wiring in the building of . . . . . . . . . . . . . . . . . . . at . . ./47/ .l.:'o o e/,,- -" . .L .. . . . . . . ,North Andover, Mass. Fee 7. . Lic. No.t2 AW " ELECTRICAL Ll INSPECT Check 4 11307 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 11 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL) FORMATIOA9 Date: 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) 'J ectAckff ems 'L/V Owner or Tenant /0-e t/n�,vAL,c) Telephone No. Owner's Address � L/ eel'-;C11 . AJX Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service -"IW Amps /W IQY4G 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: �yCo /- G e4fe,2 A 7,-it Id 14 134r 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.of Emergency.Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 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 g Tons No.of Waste Dis osers Heat Pump Number Tons J.KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal El Other p g Connection No.of Dryers Dr Heating Appliances KW Security Systems:* y 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 No.of Devices or Equivalent OTHER: ' ,4 .A Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: �peAO — (When required by municipal policy.) Work to Start: /`Z-('d -11- 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: (--Yo- LIC.NO.: Licensee: CA,c L a j Signatur LIC.NO.: (If applicable a ter "ex t"in the li ns e 1 ber�u�,l_ Bus.Tel.No. : Address: G jj-C�p1�.1' CitCl S 1 /� '/Ze � /"1 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. 7 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 PERMIT FEE: $ Signature _Telephone No. o ' ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: a� Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed ❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: Date: FINAL INSPECTION: Pass ? Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com t!� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 SV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): N4 04/�J Y Address: )eS Cf� CJ S City/State/Zip: � 01ig COC E:_ Phone#: �1�� 3 57 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ T am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. $ F1 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 10.❑Electrical repairs or additions required.] officers have exercised their 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.F]Roof repairs insurance required.]i employees.[No workers' 13.0 Other comp.insurance required.] Any applicant that checks box#1 must also fill out the 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. contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site zformation. isurance Company Name: olicy#or Self-ins.Lie.#: Expiration Date: :)b Site Address: City/State/Zip: .ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereb cer ' under re ins an penalties of perjury that the information provided above istrite and correct. i nature: Date: t C ^` None#• 7 �� 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#: . Q Q 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-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 evised 5-26-05 Fax#617-727-7749 www.mass.gov/dia X6331 ................... k Y T" NOR'r" oft"`° '•,"p TOWN OF NORTH ANDOVER PERMIT FOR WIRING ` ,SSACMUSE� This certifies that .... .. ... :..-- - .................................. has permission to perform ....... � . '.,.. . ...... ....... .�^-�..... wiring in the building of....... ................ . ........... ...... . . .................................... at.A-./ .... I— -�..11..;n..:::..Y............ .North Andover,Mass. Fee. ............... Lic. .....!....... ........... ELECTRICAL INSPfCTO Z Check # -210 GS aqU A Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. --1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC). 527 CM 12.00 (PLE,4SE PRINT hVINK ORT ALL IIVF RI MTION) Date: 1--� —Q�p City or Town of: (Jp V��- To the Inspector of Wires: By this application the undersi�ne gives notice of r her intention to perform the/electrical work described below. Location (Street& Nu her) Owner or Tenant (' Telephone N Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility 4uthorization 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: Com letion of the following table may be waived by the Inspector of TVires. 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 ting rnd. arnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS 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 b No. of Waste Disposers Heat Pum Number Tons KW No. of Self-Contained Total : Detection/AlertinR Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection El Other No. of Dryers Heating Appliances KW Security Systems:* No. of Water No. of No. of No.of Devices or Equivalent Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent 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 6Vires. Estimated Value of Electrical W rk: (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 I 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. j CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) /certify, under the pains and penalties of perjury, that the information on this application is true anti complete. FIRM NAME: ADT Security Services, Inc. LIC. NO.: 1533 C Licensee: r — Signatur LIC. NO.:1pZ � 2 (I a licable enter -exem t-in the license number line. 601-594-5900 I PP ) Bus. Tel. No.: Address: 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-5930 *Security System Contractor License required for this work; if applicable, enter the license number here �� 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 anent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ,� V • Commonwealth of Massachusetts Official Use Only _ Permit No. �� Department of Fire Services - ' Occupancy and Fee Checked is BOARD OF FIRE PREVENTION REGULATIONS ,[Rev. 9/OJ] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All svork to be performed in accordance with the Massachusetts Electrical Code(SIE 527,C`'l 12.0 (PLEASE PRLVT LV LVK OR T ILL LVF R:�14TION) Date: /` Cit-N, or Town of: (JQ � fZ To the Inspector of Wires: By this application the unders!,ne `lives notice of I ' or her intention to pertorm the lectrical�work described below. Location (Street & Nu her) ? Telephone N Owner or Tenant Owner's Address • Is this permit in conjunction with a building permit' Yes ❑ No Fxp ) Purpose of Building Utilitv : thorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of deters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of deters I Number of Feeders and Ampacity LL Location and Nature of Proposed Electrical Work: 7P Completion of if? jollowina table may be waived by the Inspector of 66`ires. No. of Total No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA Above =Int o. o megency tg hag No. of LuminairesSwimming Pool arnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Air Cond. Total No. of Alerting Devices No. of Ranges Tons Heat Pum Number Tons KW 1 No. of Self-Contained No. of Waste Disposers Totals .... Detection/Alerting Devices { MunicipaI Other No. of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Heating Appliances K`� Security Systems:* No. of Drvers No.of Devices or Equivalent No. of Water No. of No. of Data Wiring: Heaters KW Ballasts No. of Devices or Equivalent Signs Telecommunications W'irtng: No. Hydromassage Bathtubs No. of Motors Total HP No of Devices or Equivalent I l OTHER: attach additional detail if desired, oras required by the lnspecror o� GbAes. Estimated Value of Electrical W rk: 55 (W' hen required by municipal policy.) Work to Start: Inspections to be requested in accordance with AEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless III proof of liability insurance including operation" coverage or its substantial equivalent. The the licensee provides p undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specifv:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NA!NIE: ADT Security Services, Inc. L(C. NO.: 133 C Licensee: Signatur�—^ ��—= LIC. VO.:/� � I /j applicab(e, enter exem t"in the license munber line.) bus. Tel. No.: 150;-i9a-5000 Alt. Tel. No.: <03-i9d-f9 Address: 18 Clinton Drive Hollis N.H. 03049 30 Security System Contractor License required for this work; if applicable, enter the license number here`s<Z� nc OWNER'S INSURANCE WAIVER: I am aware that the Licensee docs nor hove the liability insurance coverage normal v owner owners agent. required by law. By my signature below. I hereby waive this requirement. 1 am the(check one) ❑ ❑ /,�—` Owner/Agent Telephone No. PERMIT FEE: S Z Signature Date. . �� - .. HORTM TOWN OF NORTH ANDOVER t . PERMIT FOR GAS INSTALLATION S;CC uSE�S n � � This certifies that . :...... has permission for gas installation in the buildings of . . . . . .. . . . . . . . . + at . .� � . . . . .t' "'^' '�-�^-�. �`"'wNorth Andover, Mass. Fee.:.�O . . Lic. No. �... . . . . . . . GAS INSPECTOR" Check# 3730 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �:� Permit # P 16 L Mass. Date LL Building Location �,(� ( p Wwner's Name Type of Occupancy New ❑ Renovation C' Replacement F-4� Plans Submitted: Yes ❑ No ❑ FIXTURES rnCieW N JL z N cc x 0 V Cc D i,— O V mex Z z O W °C = < O a O z 1— Q W WJ (i W = Z O O > a ar -{ W W to !n Z Q iA = �. (,� �' W Q czol- v J Ce r Z O U = 3 o U OV oOc`S tW- O } SUB-BSMT. BASEMENT 1 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Check one: Certificate Address CLIMATE DES( corporation 19�C 7 Stewart Street 1i Fhill, MA-CAR _ Partnership Business Telephone (978)372.9999 Wo Firm/Co. Ic. um er: c H. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a curre�nt/ bility insurance policy or its substantial equivalent whicl ^/ ^ � Yes ; No C I / /y ('{ 9 I If you have checked yes, please indicate the type coverage by checking thi GSC' " " A liability insurance policy ^ G Other type of indemnity Bo c D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not t / Al /► ass. General Laws, and that my signature on this permit application waives this 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 app) ^ work and installations performed under the permit issued for this application will be in compliance with all peril Type of License: By -Plumber Title �i G rimsterer _journeyman — City/Town _ _ —-- ---• APPROVED(OFFICE USE ONLY( •--- ----- - - -- BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO OASFITTINO NAME 6 TYPE OF BUILDING 1 LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 OAS INSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) to A , f�tass. Date Uf �� Permit # ._ /�� Cly ffI/;kfik�'o � s Building Location /� wner's Name x \ - Type of Occupancy New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES toW N i Y Z vi V Ce ce LA C4 0 !� W 6&J N CieQ V m Z C V Cd F y Z Q f' W r Z O W ,< g w o a O W H t• U W W = Z O Q ' LU T H V = N W Q .1 W W H H Z Q cc U �' ce W W V J J = O U S u� 3 O U OV W`S FW- O SUB-BSMT. i BASEMENT i 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Check one: Certificate Address CLIMATE DESIGN "Corporation9 y3C 7 Stewart Street eFhill, MA-01Partnership Business Telephone (978)372.9999 Firm/Co. IC. um er: Ic Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current bility insurance policy or its substantial equivalent which meets the requirements of MCL Ch. 142. Yes No C If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity G 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 Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted for entered)in the above application are true and accurate to the best ot my knowledge and that all plumbing work and installations performed under the permit issued for this application will be to compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Type of License: t'1 By Plumber G si itter Signature ui icensed Plumber r Gas F A Tide aster lourneyman 2'� 3 License No City/Town APPROVED(OFFICE USE ONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO OASFITTING NAME& TYPE OF BUILDING 1 LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 GASINSPECTOR 1. 1 v Date. . 'j U N° 40/ 37 O!No TOWN OF NORTH ANDOVER 3? ��'r _.....'• OL p PERMIT FOR PLUMBING ,SSACMUS� This certifies that .f . . . . . . .. .. . `.'.-'��"y ` . . �• • '`' ':� d has permission to perform .F . .��-'' 44 plumbing in the buildings of .'.. z�� f . . . . . . . . . . . . at . , ,!. . . L- -�`'' .%`.'?'""�"'�. . . . , North Andover, Mass. (r ' Fee . . '. .Lie. No.. 1!:. . . . ../: . . . . . . .. .. . . . . . . . . . Q PLUMBI G J,SPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING \ (Print or Type) (� Mass. Date Ala0 lJ �6 19[-,,, Permit # "-' m = y �-- PI _ s = Building Location- l C dQ��l� � � Owner .a.m'� �` / ll� �' C 11 Type of Occupancy eW i New Renovation ❑ Replacement Plans Submitted: Yes No L FIXTURES Zz oin z W �L A to U _ (� N CC OL Z Q '^ if) `� = y H << W Y o<C '^ O Z a_ < a X V W O ? W Q N < W Z Q a Q t' W oc ~Q = 3 3 o Z = x t3. o F' < x W Y W < ~ < = n nD Q Q cc < oc of o� < p < 3 �e3mt �cc53x ,- � 66 o < 3ocm0 SUB-BSMT. BASEMENT tst FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR I# r Installing Company Name Check one: Certificate Address Corporation Partnership Business Telephone Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C No If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy C Other type of indemnity C Bond C 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: Owner Agent C Signature of Owner or Owner's Agent I hereby certify that all or the details and information I have submitted(or entered)in thfl;olvlel applicatio a true and c'urate to the best or my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c mpliall perti en pr vi'I.,ons i he nnassachusens State Plumbing Code and Chapter 142 of the General Laws. 8 Signature of Licen umber Tide Type or License:Masters _ ✓� Journeyman El Citvrrown License Number APPROVED(OFFICE USE ONLY) FINAL INSPECTION SKETCtIES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED Date 19 U.G. Insp. Rough Insp. Final Insp. • Plumbing Inspector x' 971 fri rP Date.. . ... A NORTH , TOWN OF NORTH ANDOVER a • ��ao ,a ti0 3` y PERMIT FOR GAS INSTALLATI01 � F s i, • SSACHUSEt lP] This certifies that . :.�. . . . ..�. . . . . . . . . . . . . . has permission for gas installation N in the buildings of ? �.�~�. .�...! ��Nti!? • - ! ,� at .� !. *� �-*. - •�, North Andover, Mass. Fee:;;'—: `'". . Lic. No..!�5.`?h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer og \ MA4ZPAt.irtUbti i5 UNIFUMM AI-PLICATION FOR PERMIT TO DO GASFITTING (Print or Type) A/ o�ll//_/lr�l� � Mass. `--A Building Location & / (1 UAOAI AD Owner's Name �w•� Type of Occupancy_LT F T 'SaLad/ New Qom. Renovation O Replacement O Plans Submitted: YesO No p N N Z W N N N QZ Z Vl Q W Q W W 0: H �C ►�,O N Z O V F' ~T. 'J! 11 Z O W 4 ¢ 19 0 ? % W < C1 N f y W O r C F fi N O W < _ _ �. N O W Q� W �V ZCC N Z W Z V = VI Wcc W< a H Q M Y V }� 2 J h Z �., W W O O > Y. H W J H W w Uj 4C . Z < W r < <+ r f Y N m Z O Z O �J T. 1� SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR 5TH FLOOR STH FLOOR 7TH FLOOR STH FLOOR Li Installing Company Name AWaAo%7' y Check one: Certificate Address L-12A l A MP5,"C-1 Y P-D Ca'-Corporation �a? -- 1-4 7 O Partnership Business Telephone,yZ 8 �Z.3�-- O Firm/Co. Name of Licensed Plumber or Gas Fitter _ )XCV INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Com` No O If tyou have checked yes, please Indicate the type coverage by checking the appropriate box A liability Insurance policy O Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVER: I am aware that the Iicensee'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 0wrW or Owner's Agent OwnerO Agent O 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 knowiedge'and that all plumbing work and installations 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 oral Laws.. BY, T of Ucense: Plumber turuakber or Gas Fitter— Title Gasfitter er Znsle Number Glity/Town Journeyman i APPPP. BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAMES TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE 19 GAS INSPECTOR NN2 z / - D f JS Date.................................. NORT/, "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that f-�...........:.:....................................................................... r has permission to perform ... "77 ti+ wiring in the building of................... :...' '' ............................. ... .......... ,North Andover,Mass. at..........................................................` ... . Fee ...................... Lic.No-41,1�f.. ............:�� . -r '�f rte................. ELECTRICAL INSPECTOR Check # `�" 17-2e'/r_j / . WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts otrcial Use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checkedkv (Rev. 11/991 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: 6-11-161 City or Town of: 0 • AmAo ver To the Inspector of Wires: By this application the undersign?d gives n ce of his or her intention to perform the electrical work described below. Location(Street&Number) 16 I C 6 AC-h Y1n a 11,$' I'a l e Owner or Tenant ka w r-eAC L 014 0i r.51w Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No [X (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps l Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Akrt + C kAZ Conr lesion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ n- ❑ o.o mergency Lighting j rnd. rnd. Battery 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 Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons IKWNo.o Self-Contained Totals: " -'" — Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal El 0 Other Connection No.of Dryers Heating Appliances KW SecuritySystems: No.of Devices or E uivalent No.o Water KW o.o o.o Data Wiring: Heaters Sins Ballasts No.of n Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:_ No.of Devices or Equivalent OTHER: 4 Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force and has exhibited roof f t g p o same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) 11 • Estimated Value of Electrical Work: - 6•Qd (When required by municipal policy.) (Expiration Date) Work to Start:�p'. 'O Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete- FIRM omP lete:FIRM NAME: ADT Security Services 111 Morse Street,Noinvoog,MA 02062 LIC.NO.: 1533C Licensee: John S.Bassett Signature LIC.NO.: 1533C (Ifapplicable, enter"exempt"in the license mrnrberline.) Bus.Tel.No.: 781-278-1169 Address: Alt.Tel.No.: 781-278-1131 OWNER'S INSURANCE WAIVER: I am aware that the Li nsee 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 PERIIIIT FEE.- S3.5-06 Signature Telephone No.