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HomeMy WebLinkAboutMiscellaneous - 179 MAIN STREET 4/30/2018Date ....... .. ......<...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 7'- This certifies that..,.-/, :�C.! :."f.'.! Wi l''`).! .. • . • • • • has permission for gas installation • . • . • • • • • • • in the buildings of ... . <....0 . ............................... at ...f ....�:. ! : 1. ! :.... .. , North Andover, Mass. Fee./ J . Lic. No. ..... . / , .. ! ...,......"..... . /GAS INSPECTOR / WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N V MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations FITTING Permit 9 Amount S (Print ore) Check one: Certificate Installing Company Name �t.oa Q v,nn11_11 C.O M[:�W+ti ❑ Corp. Address �g `�'"�� �►� D A,,-� ❑ Partner. Business Telephone q5'1-"« Firm/Co. Name of Licensed Plumber or Gas Fitter t A-; �_ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ Ifvou have checked Nes• please indicate the type coverage by cfiecking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: ED of Owner or Owner's Agent Owner F-1Agent 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 pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ofthe General Laws. Signature of Licensed Plumber Or Gas Fitter ® Plumber ❑ Gas Fitter Liictnse iv um er 10 6 '� � • Master i� Journeyman Owner's Name New ❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print ore) Check one: Certificate Installing Company Name �t.oa Q v,nn11_11 C.O M[:�W+ti ❑ Corp. Address �g `�'"�� �►� D A,,-� ❑ Partner. Business Telephone q5'1-"« Firm/Co. Name of Licensed Plumber or Gas Fitter t A-; �_ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ Ifvou have checked Nes• please indicate the type coverage by cfiecking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: ED of Owner or Owner's Agent Owner F-1Agent 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 pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ofthe General Laws. Signature of Licensed Plumber Or Gas Fitter ® Plumber ❑ Gas Fitter Liictnse iv um er 10 6 '� � • Master i� Journeyman Location �/ q No. Date 7 —Z el J1. NORTH TOWN OF NORTH ANDOVER •OOH O?•' p Certificate of Occupancy $ } ; Building/Frame Permit Fee $ <�' s.KNusE Foundation Permit Fee $ MU Ammer Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ c TOTAL $ G &Build ing Inspector 04/ 4 1 '45 25.00 PAID • . -' Div. 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W :a � o s c..2 o a N O w :cam o 0 C3 c CD co CL i N N w C9 co m � A 'D C N N c C O =Em v v CD :nvL-: rn m rn c o Q 'n N : m p m u'Z `o c C) c ` m c c CD 0 =4- C3 N m m _ � L � � c a t c Z v� V N O o CO C 'O Q O! = = o H OL- t O r arm 16 O w f 4i4 L/ J 14--W A H W w w x w � w O - O O O O O y � C CD QM C C y � _ 1O co LA �E m m CD O.0 O > O D O m O Q 0— C* C* .0 CD C O O O C Z co V y C O �C C c _02 is Y _ .2c„�<_'..`.�.5, 5 _ oc - ot=>rlcEs OF: _ _`=-Town Of -= -z- - -- - ---�;12o M3iti�5tzees- - 7- APPEALS - ` : ` North Andover. � .y. -- NORTH ANDOVER MAS50Chii5Cft5 Q 1845 BUILDING f, �..'`�!%a� CONSERVATION DM ISION OF HE.-kLTH - - PIS.\\ING PLANNING & COMMUNITY DEVELOPSIENT L.... .- ... �._ S In acrd.,ncc with the ,rev -sit: .a ^,i �tG� -0. S cor,diticn of Number - is that tre resulting :rem this_ work shall bei disposed of in a prcne: a:,; sclid -aste � t ... by. titGL-a_ iZ'. S_ The debris will be dispose:! cf in: ��.--a cn c aC:lIi; 94-2 lop j�ezatcre of Pcrmit Appiicant Date NOTE: Demolition permit fro= the Towns of :forth Andover must be obtained for this project through the Office of the Building Inspector. 0 OEPARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR IICENSE Nuaber: Expires: CS 064680 01/09/1998 Birthdate: Restricted To:00,87/09/1969 . � )rho Y DAVID N GLOVER 14 IESTGATE OR 206 _ — Y08URM, NA. O1B01 I D O _ Z F � d D —Di D CO � m O z 3 G~) S M. b n r— O C> r- r*� cZn 0 o m = n � o N Z Ol Date .... x ....... .. v TOWN OF NORTH ANDOVER 6-1110 PERMIT FOR WIRING This certifies that ... S /f� ; X4 .......................................................................... ... has permission to perform ..........1.4.. / "' 1 5 ...... wiring in the building of ...... _ ... /. J J at.�[[..................... LZ........�� �.....�. �'�..�?/. /North Annddoover/a/s �'l Fee..../. . : ......... Lic. No. ..... -/n. ......................... # _VLECTRICAL INSPECTOR Id Check # �- 44 4 i ThECOA MOATH ALTHOFMASSACHUSENS Once Use only DEPARTA1EW0FPUBUCS4FE7Y Permit No. BOAROOFFNEPREVE VHONREGULAHONSR7CAIR12-M Occupancy &Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 j (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) / 7 -ct _I&I e22/"n) SI Owner or Tenant � j 0 77-,0 / ��- i J ilk Owner's Address- C1669�Lf.4Sspiv rV- /14 /QAA-P 14/2- L, Is this permit in conjunction with a building permit: Yes M No r�71 (Check Appropriate Box) Purpose of Building /zJ(J /- b'1 &L J E: n/S rtes✓,- IFUtility Authorization No. Existing Servicei 01) Amps /Volts Overhead r 77 Underground � No. of Meters 4( New Service Amps / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -�rn/J Y� /'_ / S1W 0.-f- tA) -7,4 1 L,,,VIVVJ No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures %Ah Swimming Pool Above round Below M ground Generators KVA .No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units *to. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pum s Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of 4 Si ns Bailasis No. hydro Massage Tubs No. of Motors Total HP OTHER 7 S /Y! d 7J f % (,•rp,zs /� L�, I=WXeC0WMge. R=anttotbeteqtlitanaYsofMasmdxmasCe aalI-aws Ibaw,%b iwdvafidpioofofsmwtotheOffioe YESEnale j INS NICE box BOND F1 MIER aLt n •gym #.01 i � 0 O. FIRMNAME lJ�/�'l�// , lica>sae J !J -77 alai YES © NO F3uu have drdod YES, please indicate the type of oovw,W by • 1Q- -"�� EvRafiml)& Estrnl kd VahleofFkcbcal Wbik $ Rough C.J/ eL e l L Final G"7t.l e,i A -i) I-kmseNo. J2X J L LimwNo Z- 1 �'cJ0 C �T / Busu�essTel No. 1 ry� / -/ 7 (F6 Achiness %Z .�C� /�(/a-AsyLA, /s�/?o Alt Tel No. OWNER'SWSURANCEWAIVFR,Iamaware#AthcLmwdoesnothawd)eirmumoeoovaageoritsaibstaiMegrmlemasmqurodbyMasmdugomC,erg Laws and thatrrysign kmonthispennitappficMenwaivesorismgturanait (Please check one) Owner Agent �J v Telephone No. PERMIT FEE Igna ure oi Uwner or Agent The Commonwealth of Massachusetts i Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for rry employees working on this job. Company name: Address City Phone # A• Insurance. Co. Policv # / Company name: Address City: Phone # Insurance Co. Policv # Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.: fine up to 31,500.00 and/or one years' irrpm risonent.as_well_as_civil.penattiesmlbeim-n A-STQPVATM ORDER,and_afire-f_($1-00M)-aAW against I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. } Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensigg D Building Dept OCheck if immediate response is required .[] Licensing Board p Selectman's Office Contact person: Phone # E] Health Department F, Other