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HomeMy WebLinkAboutMiscellaneous - 17 GLENWOOD STREET 4/30/2018 / 17 GLENWOOD STREET 210/006.0-0062-0000.0 IIS r Date......... �. ... + NORTH °•t""�'1"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SS^cMUS� This certifies that riT .�' 2 K............. has permission to performs �aiL . ........... .. ....... ...................................... wiring in the building of................moi .. . . ........................................ ...... Sr ,North Andover,Mass. Fee..r..�.....^....... Lic.No.............. . ......... ........ ELECTRICAL INSPECTOR r f Check If 1� 7 7P 86� � �_ Commonrvealth of Massachusetts Official Use Only mo pt�w — Permit No. t�}� Department of Fire-Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 9/05] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(7),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: �'�. /�il�y�� To the In pect r of Wires: By this application the undersigned ives notice of his or her intention to erfo the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. /�g'����a/9 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 f New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity aLocation and Nature of Proposed Electrical Work: Completion Of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o•of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool A ove ❑ In- ❑ o.of EmUgency rg ng rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners No.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste`Dispcsers Heat Pump Number Tons. KW No.of elf-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal E] other Connection No.of Dryers Heating Appliances KW Security Systems:* s. No.of Devices or Equivalent No,of KW No.of- Nn,of Data Wiring- Signs Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommumcahons Wirrng: 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: 3 11•Dy (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 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 pev�a ties of perjury,that the information on this applicatlion is tru�and complete. FIRM NAME: ��/��7D n 1�e--7 LIC.NO.: Licensee: 0) el Signature (If applicable, a ter exempt"in lig�nse nymb�r lyt Bus.Tel. Address: �� i�oo o S �! '"Qj/)�,;;, Alt.Tel.No.: *Security System Contractor License required for this work;-ff 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 agent. 0)-mer/Agent Signature Telephone No. FPERMIT FEE. $A '0 The Commonwealth of Massauhusea5 Deporment of lndmrial A rcidr&F Office of IfivestiYations 600 Washington Street Boston,IVA 0?XXI V-'in-kers, Compensatioi. iii crPm.,c Btjiid*r,/'-oittractorsi'Electi-icians/P)umbers ,tk—Q Information Please Print Legibly 1-7 AP Address: 2 z ciry-islate/zip: Phone F-Arc you an eniploytir?Check the appropriate box: Type of project(required): I 3m a general I 1 1 -am a;�mplo,y--i-with 4. \, ew co.iizm-c6on e loyees(full andior pLd-tim. e*l.* have bir=J ibe sub-ccrtrac.ors .1 - 'lcd sheet. 7. Rem3debug listed on�is atiac; -Lkl am a sol,!proprietor cr pa.tner- tovees slap d-li h,1vc no ealpi 1.liesz sub-cont.,*act..).-s lzvc 8. ❑ Demalidon emriovees an-3 have workers' wad-Ing for me in any capacity. 9 Btniding additicri No comp. insuraice.- L.No workers' comp. insurance I i5/ii Flo.-ctric al Mpa:ts 0- 0 additicn_ recluired.� 5. We are-cor,)urat"on and i-s 3.L_J I arra homeowner doing all work officers have exercised ffiair 11.0 Phunbi;,g lepaA or additions mysclf.PNC workers,comp right of exemption per MGL insurran.-e required.]t c. 52. §1(4),and we Neve no 112.C]Roof reprirs o workers 13.0 Other corip.insumic:e required., Ally applicant that chec'%,a bar#1 must also fitil out the s.-ction t)elow showing their wormers'comPais4tion policy inturrmirin. .4onavywnen who submit thio ofrv6vit ind;.-atitig they are daing A Werk and then hire outside csntract�.-swust submit a it-aw affidavi: ndiectiris such. ;Ccat.-ac-zin,that check this box must attached an additional sheet Abowing the n2nZ Cf the;ub-contmcmis and state w1ittlitror no-Aics:critiies ha:•e -mp1*vCcs. if the iub-contractors cavo employees,they must prv�,ide their wol%ers'comp.policy number. I am air emplaj-e'r that is providing workers'compen-sallon insurance for my conployem Below Is the policy and job site inforinatiopt. Insurance Company Name: Policy#or Self,.ias.Lic,9: Expiritior. Dare: Job Site Address: cizvistateMp:. Attucb n copy of the workers,compensation policy declaration page(showing the policy number and expiration date). Failure to accvak:coverage as requiredinder Section 25A of MGL c. 152 can lead to fle imposition of criminal penalties of a fine up to$1.500.0 andior one-year imprisonment,i;., -wcll ag civil perla:ties in the fonn,of a STOP WORK 0XDER Lnd a fire ,)t up to 5250.00 a day against the violator. 3c advised that a:oFy of this statement-nay be forwarded to the Office of of:he i)[A for insurance coveme y-giftotion. J do herc-4 ceri,95,under the pai.nn�s and penalties ofperjun,that the information provided abo 0 is tr e and correct. Official tisc Only, Do not write irt thii area,to he completed by city or towpi ayleiaL it City it Town.- Permit/License lssu'ing Authority(zircle one): 1.Board of Heultb Z.Building Department 3.Ci"Jown Clerk -4.Electrical 5.Plurif-ing Inspector 11 ti.vtiicl' Contact Person: Phoric,tit Date. . .Y. U C7... .. . . Of o� TOWN.OF NORTH ANDOVER F • PERMIT FOR GAS INSTALLATION Y • v SSACNUSEt • 1 This certifies that has permission for gas installation . . �/?�f.!� .�. . . . : . . . . . . . . . in the buildings of . . . < . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . at . . .f 7. . ." . . . . . . . . . . . ., North Andover, Mass. Fee. 3�, ` . Lic. No..l �,l F . . � . 1-1. . . . . . . . . AS INSPECTOR Check# f 676 Date. .. .. .. NORTH 3 TOWN OF NORTH ANDOVER ° n ' PERMIT FOR GAS INSTALLATION h SACHU5E�S This certifies that . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . has permission for gas installation . .... . . . . . .. . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . at . �. .-�f . . .: . . . . . . .. . . ... . .. North Andover, Mass. Fee. :�. . . . . Lic. No.. . ' . . . . . . . . . : . . . . . . . . . . . . . . . GAS INSPECTOR Check# 7097 MASSACHUSETTS UNIFORM 4PPLICATION FOR PERMIT TO DO GAS FITTING r - '+�'� ate: i' -- City/Town oR► e1 >D� Y' MA. DPerr pit# Building Location:» `�"`Q.r'1 Wmda � Owners Name:�h�Wste� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional❑ Residential QJ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ® Plans Submitted: Yes❑ N FIXTURES (n Z W U = W Q 0 N = N N m 2 0 W J U (n H to 0 2 W ix ZO l— z 0 a Lu WQ H z0 0 V5 > W Z m 0 W a.O Q W W 2 u- W t" Q J W Z to J WLU Ue LL N 2 W FW- W W UJ Z J Q o a w W 0CL °� > > > 0 SUB BSMT. BASEMENT __T19T FLOOR 2 NuFLOOR :3 FLOOR 4 ' FLOOR 5niFLOOR 6 FLOOR T FLOOR 8 FLOOR _ Check One Only Certificate# Installing Company Name�J' "? [A Corporation Address%' 4_n� ,�'r �`i6� City/Town..-- 0 n State ❑Partnership Business Tel: fl Cz%tl\ $�''�0 Fax: �n \� ❑Firm/Company Name of Licensed Plumber/Gas Fitter:NF T%9.�9.'c INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ 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 ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ® Plumber _— ❑Gas Fitter Signature of Lic used Plumber/Gas Fitter Title Master cityrrown []journeyman License Number: 29S ❑ LP Installer APPROVED OFFICE USE ONLY) FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING i- R LOCATION OF BUILDING SKETCH I PLUMBER-GASFITTER.LP INSTALLER LICENSE NUMBER:` PERMIT GRANTED DATE: Y 1 GAS FITTING INSPECTIOR R Date. . �. . . . . NpRTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 has permission to perform . . t' -.`.. . ". . .`: . . ''.� !I.`, . . . . . . plumbing in the buildings of . . . .. . .` . .. .".`.. . . . . . . . . . . . . . . . . . . at. . . `-: , North Andover, Mass. Fee:r Lic. No.. . . �. . . . . . . . . . . . . . . . . . . A PLUMBING INSPECTOR Check # 8462 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Cit /Town. AA 1 Y o`o� r4�l'1 C o V 'o•N" , MA. Date: \\% k a Permit# Building Location: �ll Owners Name: QQqAnIfti. S1C4�I 1< Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement:® Plans Submitted: Yes❑ No 11Z>N-7 FIXTURES z z W Z U) } J = Fes- W U) Q. ? h- z N Q Q v)LU Z O m u=i W a. w U) } 0 Z U) C9 o a X �I� J � z Q Y = 0 0 P- � ,= z Q u. � a Y a z w w w V > > O 0 O z z Q Q � Q O F' O z ZlQ 2 Q 6 Q F- a m m o o tL c� = 4 w cn F- n 0 SUB BSMT. BASEMENT -isT FLOOR 2Nu FLOOR 3Ku FLOOR 4 ifL00R 5 FLOOR E, FLOOR 7 FLOOR 8 -FLOOR Installing Company Name:Qrz Check One Only Certificate# �� c� � >7� i ®Corporation ec;� _ Address City/Town<: �Q,T�-3h State: 1 N ❑ Partnership Business Tel:�o\ q111r-N 41Li t Fax: tt ❑ Firm/Company Name of Licensed Plumber: �2r�Ck �v`d Y1q 1Y1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes® No❑ If you have checked YJ 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 Signature of Owner or Owner's Agent Owner El 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ® Plumber Signature%ofLjc�en�sedPlumber Cityf'rown © Master APPROVED OFFICE USE ONLY ❑Journeyman License Number: FINAL INSPECTION BEL6W FOR OFFICE USE ONLY PROGRESS INSPECTIONS) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKE"fC1i PLUMBER I LICENSE NUMBER: PERMIT GRANTED 0 DATE: PLUMBING INSPECTIOR e r li i �' ;S� _ a t r !t ���h� ♦f I�II l 7 .r f� s rNY I II I u it I' c � � • II L,,,,�M 'I�tli��, i i �1' ✓1 .i I. "�:: t j• l � L2�u+t (I J����t�I�hI � • � I. Z �I y - � �l • • • , ` 1� A i it �.. .. h7 I` 111 _ r .. , - • • • >r ♦ • i �� �1 f � -n - u t� , � ► II - • f �• � _� � y � is is �r�r�r�r rr��i � , ���I , -i �Yr M MMW �I ;1 �r�wn�rr�� �w� on ��wrOman