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Home My WebLink AboutMiscellaneous - 18-20 Ashland Streetcc r Cl vim mmom r`� i 985-6, Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ D6 ......... 2le has permission to perform .... .................................................. wiring in the building of ...... 4e � �, � �, 1 � � � � ............. at ... ..... :v:.. ......... 4 .. .... . North Andov Mass. Fee.. . On�E Lic. No..�Iq ...... .. ...... .... .............. ELEcriucALIxspEcroxf Check # 3703 .1 i Commonwealth of - Massachusetts Official Use Only Department of Fire Services Permit No. 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 PRINTININK OR TYPEALL INFO TION) Date: (J City or Town of: To the Inspector of Wires: By this application the undersi d Ives not' e of his or her intentiMperform the electrical work described below. Location (Street �& Number) - �O A—�A A C4 - Owner or Tenant -ova lz Owner's Address No. 50f 553 -,?J i9 Is this permit in conjunction with a building permit? Yes No BLDG PERMIT #J Pur o f B '1d' p se o ui ng j4 '14" ngW Q. (,t�l.9-& -Ct,,, -C-6 Utility Authorization No. Existing Service (-100 Amps /L O / Z Ya Volts Overhead ❑ Undgrd'�' No. of Meters 9 No. of Meters New Service qD�2_ Amps 120 /2YO Volts Overhead ❑ Number of Feeders and Ampacity _3 -- ro pP zt- G r . & Location and Nature of Proposed Electrical Work: ,_ 1 Undgrd uuccauuiuc aerau J aesirea, or as required by the Inspector of Wires. Estimated Value of Electrical Work: L (When required by municipal policy.) Work to Start: 1-2- — % U Inspections to be requested in accordance with NEC 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 cert, under 4thhepalvadLenazifies of perjury, that the in ormation on this application is true and complete:FIRM NAME• i LIC. NO.:Licensee: � p g� Signature LIC. NO.: (If applicab e, enter "exempt" in the license numbe line.) 6� 1 T Address: - a 3o Bus. Tel. No.: J Alt. Tel. No.: *Per M.G. . c.147, s. 57-61, security work requires Department of Public Safety "S" Licen LIC. NO.: 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. FPERWT FEE. ,$ ELECTRICAL PERMIT NO. INSPECTION REPORT: a� ELECTRICAL INSPECTOR - DOUG SMALL 2. FINAL INSPECTION: Passed — ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date 3. UNDER GROUND INSPECTION: Passed — Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: L (Inspectors' Signature - no initials) Date U 4. ilvarEU LJL0.N — ar:Rv1C:E: DATE CALLED NATIONAL GRID: NAME: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date :5. J1V 6ri U,_t jL A - 011MR: - Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. 4 G, The Commonwealth of Massachusetts Department of Industrial.Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 UV www.massgov/d'ia Workers' Compensation Insurance Affidavit: builders/Contractors/Electrlicia-nsfplumbers Applicant Information e-OV41" Please Print Leg ibName (B.usiness/Organization/individual):,64y) jJrG l d CTl C C Address:,, -/19- A os o up-�-S k Pb City/State/Zip: �-fyuso �� 0 36 &� Phone #: &L Are you an employer? Check the appropriate box: 1. XI am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet.1 ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1111 PIumbing- repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. T 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. , , , n A Insurance Company N Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: It, , 2-0 — /- SLsAIaI7 %L City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Si ature• Z €'-n S �Ci � �� 41-1Date• 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): X. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone#: 11 0 '/? 05 Date...................... TOWN OF NORTH ANDOVER F 9 •X PERMIT FOR GAS INSTALLATION �9SSACHUSEt This certifies that ... 4"� ..... .. . has permission for gas installation in the build'ngs of Glr�� at aC 1 - ...... , 4orth Andover, Mass. Fee. Lic. No. C,! . ........... ........... GAS INSPECCTOTO R Check # 5001 P 44 IN MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUSETTS FOR PERM TODO GAS FfYMG Date Building Locations 41 r `� 5� Permit # Amount $ Owner's Name �(/ %�i�//�!/Gvov✓ick,, �y� New Renovation rl Replacement ET Plans SubmittedQ (Print or type) Name Address d7-/ Name of Licensed Plumber or Gas Fitter 4 1¢— U / Check one: Certificate,Installing Company LT -Corp- J '776 - Partner. 7(oPartner. ElFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes �� No If you have checked yes, please indic a the type coverage by checking the appropriate box. Liability insurance policy12 Other type of indemnity 13 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: Signature of Owner or Owner's Agent Owner 13 Agent 0 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 installation S"Prf��ormed un Permit Issued for this application will be in compliance with all pertinent provisions of the MassachuseWF"93: o e 9t9r_�44 of the General Laws. OVED (OFFICE USE ONLY) Signature of Licdnsed Plumber Or Gas Fitter [ dumber ea - Gas FittericL�ense um 131"Master Journeyman FLOOR (Print or type) Name Address d7-/ Name of Licensed Plumber or Gas Fitter 4 1¢— U / Check one: Certificate,Installing Company LT -Corp- J '776 - Partner. 7(oPartner. ElFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes �� No If you have checked yes, please indic a the type coverage by checking the appropriate box. Liability insurance policy12 Other type of indemnity 13 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: Signature of Owner or Owner's Agent Owner 13 Agent 0 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 installation S"Prf��ormed un Permit Issued for this application will be in compliance with all pertinent provisions of the MassachuseWF"93: o e 9t9r_�44 of the General Laws. OVED (OFFICE USE ONLY) Signature of Licdnsed Plumber Or Gas Fitter [ dumber ea - Gas FittericL�ense um 131"Master Journeyman Date..0- ..�/�-)�..... O' NO o� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION I✓ SAC MUSE s� This certifies that ... /� !? �r :. k.. , ......................... has permission for gas installation ... - ... :� .+-/............ in the buildings of .. !.4.< n .............................. at .. . �`?. t `:. ............ 'North Andover, Mass. Fee. ? ..... Lic. No. 1......... ....... ..... � .... GAS INSPECTOR Check A 1 � 5349 LIN G MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFITTING (Print or Type} N. Andover ,Mass. Date 11/30 Za Permit! sunana LOCadon 28 Ashland St Ovmers mate—Jim Wilen /' r Type of Oempalley Recap Renovation p Replacemetlt Plans 8ubndtted: Yes p o � i� �f - n 1 • • r n - • • m immmmmmmmmi®mmON� mmmmmmMMmmmWMmIEWmIWMNW qimmmmmmmmmmmmmmmmWMmmIWW InstaillmcornpanyRame Bowman Plumbing Services Chedcone cerllftCate Address 6 Home Street . p Corporation Bradford, MA 01835 susinas Tdepieone1978) 994-6207 o Pa'inersdip Ranee of Licensed Piueaber or Gas Ritter Richard T. Bowman D FirraiCo. w IRSNRAM COVERAG4: • 1 Tante a tUrrantilabMty 11maranee policy or its substantial *WAvl4e % 111ld0h M15% the reQuiretnents of NCL CR 14Z Yes Ido p If you hilae Checked M. pease bmftate the type of toverape by Cbwkh p the appropriate box. A tlabhlty lnsuf9l m poncy Other type of lndenvdty a Bond p owMn 0WRINIM WAMW 1 and aware that the licensee dace not hare the Imumme coverage required by Chapter 142 of the !utas: General Lags, and that my signature on l aldorl naives this requirement s0imm— Of truer or 0~9 Rent Check one: OWN Agent p I hereby ew6fr thatan of On details and lnlbrmation 1 have submitted for entm edl In 0M appilmden are a/nw�d��aacceumte to the bat or i. 80 Iwdnl t P and Cha Of plutnbiS Cort and ate Ca tions p and Cft ed under of pet�0 � �/ / Inc once wAth ap perMlealtproNshute Of thelWesadnaetls Static Cas Code and Chapter 14! of the G Type Of License: BY g Plunder came u e r Fibber t. Tnle fltiasAtter chyrr a Master eRtanber Journeyman #25201 APPROVED (OONLY) -Rjo` mewnan Master#13496 ;. r- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Date //�f�es /f / / ' '414mv S%- Owners Name �d �9l�li 4."'44 ." Permit # of New Renovation Replacement FIXTURES Amount Plans Submitted Yes ❑ No a (Print or type)Check one: Certificate Installing Company Name— /Date..� . D . . qTOWN OF NORTH ANDOVER • o PERMIT FOR PLUMBING This certifies that ............�. has permission to perform .. plumbing in tl buildiii fgs of at F ....... North Andover, Mass. ee.... tc. o.. ............................ PLUMBING INSPECTOR Check # 6305 Partner. Firm/Co. Bond ❑ on does not have any one of the above application are true and accurate to the Issued for this application will be in aptex.,142 of the General Laws. Journeyman ❑