The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 163 FARNUM STREET 4/30/2018 (2) 163 FARNUM STREET 2101107-A-00 0000-0 -9876 Date.................................. TOWN OF NORTH ANDOVER 0 v maim PERMIT FOR WIRING ,tsACMUSEt This certifies that ................... ............. L.. has permission to perform ...................... 4JO wiring in the building of........................... ........................................................ at...... e4luv.0.411........... North Andover ass. .. .. .............. ... ..... "1 47 Fees................ Lic.No............. ............ .................. ................. Et ECMCAL INSPECrOR theck # Commonwealth of MassachusettsOfficial Use Qnly Department of Fire Services Permit No. / ?) An BOARD OF FIRE PREVENTION UV 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 Electrica4Intor ,527 C R 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: f City or Town of: NORTH ANDOVER To the o Wires: By this application the undersigned gives notice of his or er intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant /LCA Tel hone No. Owner's Address U Is this permit in conjunction with a building permit? Yes ❑ No. ❑ (Check Appropriate Box) Purpose of Building l� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d �' ❑ No.of Meters New Service Amps ! Volts Overhead❑ Und rd g ❑ No..of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: IAO t Completion of the ollowin table may be vidived by the Inspector of Wires. No.of Recessed Luminaires Y No.of Ceil:Susp.(Paddle)Fans No.of r Transformers KVA No.of Luminaire Outlets No.-of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o,of EinergeucyL—igEE-g— d. d. Bette 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 Initiatin Devices No.of Ranges No.of Air Cond. TTons No.of Alerting Devices No.of Waste Disposers Heat pP Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers 0 Heating Appliances KW Security Systems: No.of WaterNo.of Devices or Equivalent Heaters ' No.of No.of Data Wiring: Si s Ballasts . No.of Devices or E uivaIent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: _ No.of Devices or E uivalent OTHER: Zeqo Al c�a �evl ' Attach additional detail tf 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 such cov ge is in force,and has exhibited proof of s e to the ermit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) � Q I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: �cJOle OniCA LIC.NO.: 3 � Licensee: 9AephP A ODU Signature LIC.NO.: (If applicable,janter"exempt"in the license nu line.) Address: Is Sous.Tel.No.: *Per M.G.L c. 147,s. 57-61,security rk requires Department of Public Safety"S"License: Alt.Lic.No. J 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:$ f r i 5 n r j i I i I I • P I i Date/:7. 8826 � � TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING � ,SSACMUS� . This certifies that ."j . . . L't'p, 4 . v , has permission to perform . . . P. u I+. t. 9. y . . . . . . . . . . . plumbing in the buildings of .O.4 /?. . . . . . . . . at . . -- . . . . . . . . . . . . . . , Norte Andover, Mass. Fee.��F. . .Lic. No. v t.�. .�. . . . . . . . ... . .. . . .. . . . . . . . PLUMBING INSPECTOR Check # U ! , MASSACHUH! UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:/ W- Date: Dormitf- Ak t I Building Location:& Owner: Name:Am/ g1w e5 -77 Type o* 1-cupancv� E.Iducptionail inciustriai ,: Institutionial Res iden L I)T U F-1 E DEDICATED SYSTEMS K, 1!7?4 LLJ z 0 Z Cc, LLJ < < Lr' f < V1 V, < "Z5 CD < D z = 1 Ci in V-1 Ln < < W § 0 C- W., L61 Ln iLl C) CD <1 ;cz < 0 < C) C'I b < < < 0 SUB BSIVIT. BASEMENT 1ST FLOOR 2"FLOOR 3"FLOOF, 4TI FLOOR ST"FLOOD, 6T'FLOOR T11 7 'FLOOR FT11 FLOOR Check One Only Certificate r Installing Company Name: 7 Corporation Address: a cw/x City/Town:ankAi!)4 State: Partnership Business Tel: Fa,: E?'/Firm/Company Name of Licensed Plumber: Q .5 'NE COVERAGE: INSURANCE liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No 71 If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner 17 Agent F-1 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to tne best or my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al! Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑ Plumber Signature of Licensed Plumber City/Town ❑ Master I 1 License Number-: CT 1 ge—ourneyman APPROVED(OFFICE USE ONLY) I ,31 /'/nib q7 FINAL INSPECTION 13ELOXV FOR OFFICE USE ONIA PROGR.kSS iP,!5Pl_c_1[OI_J S FEE: S PERM!F APPLICATION! FOR PEnM r TO 00 PLMIMNG NAME&TYPE Of BUILDING LOCA ETON OF BUILDING SKETCI-1 PLUMBER LICENSE NuNiBER: PERMIT GRANTED pAIE: PIAMIRRK INSPECI QR r, OP ID AC DATE(MM/DD/YYYY) AC ORD, CERTIFICATE OF LIABILITY INSURANCE WALSH-2 01/05/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chase & Lunt LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 Box 590 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 47 State Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Newburyport MA 01950 Phone: 978-462-4434 Fax:978-465-6204 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: The Hartford INSURER B: Walsh & Son Plumbing & Heating INSURER C: Thomas Walsh 12 Chase Street INSURER D: West Newbury MA 01985 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY FF TIV POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 08SBAII4008 09/16/10 09/16/11 PREMISES(Ea occurence) $ 300000 CLAIMS MADE r—] OCCUR MED EXP(Any one person) $ 10000 X Business Owners PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE s2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTOEA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I I ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 120 Main Street REPRESENTATIVES. North Andover MA 01845 AUT IZED REPRESE VE ACORD 25(2001/08) ©AACCORRDD CORPORATION 1988 Date....... za TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING * 1 1P C14US Et This certifies that ... ....... ... ................................. has permission to perform ...51-v —74 wiring in the building of......../4 ........................................... at... .........5.=..........................North Andover,Mass. Fee... ... Lic. o....2- . .................QikAIC�AL INSPEC'TqR Check # 9341 Commonwealth ofMassachusetts � Official Use Only Department of Fire Services Per n No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07) Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(MEC), ZOO�OR� (PLEASE PRINT W INK OR TYPE ALLINFORMATIOA Date: 4,City or Town of: NORTH ANDOVER By this application the undersigned gives notice of his or her intention to perform the electrical wTo the ect oP idescribed below. Location (Street&.Number) Owner or Tenant P0 Owner's Address TeIephone No.�1 — C /d Is this permit in conjunction with a building permit? S � Yes ❑ No C❑� (Check Appropriate Bog) Purpose of Building le Utility Authorization No. Existing Service e&� Amps oltsn �. Overhead L� Undgrd❑ Ne..of Meters New Service Amps / _Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Com !.,tion of thefolio-win table maybe waived b the Ins ector of Wires. No.of Recessed Luminaires No,of Cell.-Su8 No,of p (Paddle}Fans Transformers Total No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming pool Above ❑ �- o.o mergency — , No.of Receptacle Outletsd' d. Batt=Units No.of Oil Burners FIR Aa.ARPdS No.of fines No.of Switches No.of Gas Burners No.of Detection and No,of RangesNInitiatin Devices o.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number Tons KW 0--0Tof elf-Contained tals: Detction/Ale Devices No.of Dishwashers Space/Area Heating KW call.❑ Municipal No.of Dryers g�� A Connection Other Heating Appliances KW Security Systems: No.of Water o.of No.of Devices or Equivalent Heaters KW No.of Data Wiring; Si s Ballasts . No.Hydromassage Bathtubs No.of Devices or E nivalent h 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: /�, Work to Start (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee.provides proof of liability i�e .surance' luding "completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverag ' orce,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER I certify, under the pains and penalties o ❑ (Specify:) lrperjury, that the information on this application is true and complete. FIRM N Licensee7e, C LIC.NO.: Signature LIC.NO.: 6 (If applicater "exempt"in the license number line.) Address: ,jO j�p s`� E ?10 ®� Bus.Tel.Ne.:9?,f 573 /SAY *Per M.G.L c 147,s 57-61,security work re cues D AIL Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Ices a doles not have'thelIiabiIity insurance cense: Lic. o required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner coverage❑owneor's normally Owner/Agent gent Signature Telephone No. s r, The Commonwealth of Massachusetts E � j� Department of.I.ndustriid Accidents ' t ace of Investigations =iayr' 600 ffrashing ton Street . .� Boston, MA 02111 Wr\` www.nsassgov/din . or kers Compensation p nsation Insitranee Affidavit. A Iicant Information 1t ailders/Co>ntractorrmectricians/Piombers Please Print Leoi%bj Narl a (Business/organirafi,rAndividua1): Address: City/State/Zip: Phone k . -------------- Are you an employer?Check the apPrup�t box: 1.❑ I am a employer with 4, Type of Protect(required): ❑ I am a general contractor and I 2.7 I amaemployees(full and/or part-time).* have hired the sub-con Tactors 6. New construction I am.a-sole proprietor or partner- Iisted on the attached sheet$ 7. ❑Remodeling ship and have no employees These Sub-contractors have working forme m any capacity. workers'.comp. insurance. 8' Q Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9. 7 Building addition 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 rept or additions insurance 2, §1(4j,and we have no Hired].t employees. [No workers' 12.7 Roof repairs r comp. iraurasicc.:required_] 13 ❑Other ;Any applicant titet cheeks bo�t�1 moat also fill out the section below showing their workers'coin t liomeownora who submit this affidavit indicating they are doing all pensetion policy information. �Co"aietots that check this box must g N°*aid then hrte outside comsactots must submit a new affidavit Wita*such. attached an additional shearshowing.the name o£the suh.contra . - f am an employer that ro 'is , _+� Bucy maamnation. {� ,vtdittg:workert compensation insuraneeformy.e information mPlOJ'e below is the polity and job site Insurance Company Name: ' Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: CitylStatelZip. Attach Failure to sea copy of the workers'compensation policy deciaration page(showing the policy number and ex Failure expiration date}. cure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal 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 fin • of up to$250.00 a day against the violator. Be advised that a c of this e Investigations of the DIA for insurance coverage verification,copy statementy be forwarded to the Office of I do hereby certify under the pairs and pens/ties ofperlury that the infnrmotion provided above is true and coned Sit>rtattnr: Date: Phone#: Official use o7Doite ut this area,to be completed by citj or town ocia[ City or Tow Permit/License# Issuing Authe}:1. Board of Hng Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector6.OtherContact Perso Phone#: