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Miscellaneous - 189 BARKER STREET 4/30/2018
i I � ,96J0 Date l0 .7.6.—. /.1-%....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...................... .'.....(� ?q 5 0................................. �. has permission to perform 6�f ........................................................................... wiring in the building of ......... i% ................................................ .^ 1.!r9 .....`T . ........... . N rth Andover, Mass. Fee..:;;�0...T�Lic. No.... ......... ELECTRCAL INSPECTOR (i Check # -� J.umrnuuravWaian vg, f 1 ®e artrnent ®f ��re Services Occupancy and Fee Checked y 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 PRINT IN NK OR TYPE ALL INFORMATION) Date: V r6 la 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) 137 rJ7t' Owner or Tenant Owner's Address ah+ f1NN J 5ame Telephone No. Is this permit in conjunction with a building permit? Yes M No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity 1Loc//ationrand Natureee% of Proposed Electrical Work: Q�44fa 3M s /cq a" 74r ,A / r.Gk Ll ,X,�. y4V rGfC C �IT` Jj - FJ Yx 1 't QaA tG . No. of Meters No. of Meters ;or- L Q� D1" C-rXla. Cmmnlotinn of the following, table may be waived by the Inspector of Wires. Attach additional detail J desired, or as required by me insueutur u� rr 1r rs. 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 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 a penalties of perjury, that the information on this application is true and complete. ,/ FIRM NAME: (, r t, qA Q SSB 6 -lee fin' �e�(/ i C G� LIC. NO.: 7 T6 Licensee: ('C t,, 9 S r.1 Signature LIC. NO.: o?6/ 3 Ye (If applicable, enter "exem t" inJhe license number 1' e) Bus. Tel. No. :0632317 Y�' 7 Address: SIO Alta..,074- C /�T 4�� -,p N. d< e 3-P.-yf Alt. Tel. No.: *Per M.G.L c. 147, s. 51-6 1, security work requires Department of Public Safety "S" License: 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. V Total No. of Recessed Luminaires No. of Ceil: Sus . addle Fans P (Paddle) _Transformers Tr s KVA No, of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above Ei In- Swimming Pool rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No, of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons No. of Self -Contained No. of Waste Dis osers p Totals: " " J.KW .......... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW g Municipal E-]Otherp Local ❑ Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW No. of -No. of Data Wiring: Heaters Sim Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: __ Attach additional detail J desired, or as required by me insueutur u� rr 1r rs. 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 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 a penalties of perjury, that the information on this application is true and complete. ,/ FIRM NAME: (, r t, qA Q SSB 6 -lee fin' �e�(/ i C G� LIC. NO.: 7 T6 Licensee: ('C t,, 9 S r.1 Signature LIC. NO.: o?6/ 3 Ye (If applicable, enter "exem t" inJhe license number 1' e) Bus. Tel. No. :0632317 Y�' 7 Address: SIO Alta..,074- C /�T 4�� -,p N. d< e 3-P.-yf Alt. Tel. No.: *Per M.G.L c. 147, s. 51-6 1, security work requires Department of Public Safety "S" License: 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 4 sY` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): / �''li�. (?r4 l:; -A Address: SZ> /'lCr6"l City/State/Zip: AV5 7d 63� z(/Phone #: CO 3 X31 7V ? 7 Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. V I am a sole proprietor or partner- listed on the attached sheet. t 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 I L ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 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. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify underhe/pains and penalties of perjury that the information provided above its truce and correct. Sip -nature: 6 ' 'a- Date: Iola //w 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 #: 87U6 TOWN C Date ..1--30110 OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that '5.... ............ ... has permission to perform ... plumbing in the buildings of ...... 154�0aj. . A ................ at 1E.5 ... 4&-, .. ............. , North Andover, Mass. 7'0 Fee. -S .....0 . Lic. No./3 .j 7Q . ..... :1 "72 PLUMBING INSPECTOR Check #.,42�- I WACU TTS U.IXORM .�PPLxCATION FOR PFR�7 T TO 10 0 PLUli�DI NG (Type or print) NORTH AND OWR, MASS,A.CRUSEM Building LocationI _X_�/ k,( L� New of Renovation Replacement Date #�) _ 'ternui # _ Amount Mans Submitted Yes No (Print- or type) Installing CompanyNam Check one: Certificate 11 El Corp. Bariuer. liirmlCo, Name o_f_ icensed Plumber: Insurance Coverage: Indicate th e of insurance coverage by checking the appropriate box:Bond I,iabilityinsurance policy Other typeo£indemnity ,Insurancee Waiver: I, thundersigned, have been made aware that the licensee o£this application does not hays any one o£the above three insurance Owner Agent ignatare ' in above ap_ Ihereby certifythat all Ofthe detailsand iaformationlha�ll ns rfttO oomroete d rBezmitIssuedforthisapplicationwr�llbeite n e best of my� owledge and that all plumbing work an m p C e and Chapter 7.42 of the General Laws. compliance with all pertinent provisions o£the Mas setts S to B r By: 1 a o ice um er Type ofPlumbingLicensa Title 3I DMaster Joiuneyman CitylTown icense um er EI . APPROVED (OFFiCs USE ONLY 1,- 4 The Com monverzith ofHTssachusetfs ' - �3eprzl'iinen� o f £radustriaZ.�ccidents - Ofjzce of ivesg'gwaons ' 600 Maslzington &I-eer: {• astara, t 4 02111 w►pfv_masagov dia Workers' Compengation insurance Aff cja v t: BuHders/Contractors/FZecf ie a s/e tubers �ot��icant Sn£orz�zation PYA.-aca 11)-4 -.•f• r Namac(Businesslorgan_ization&gividual): 7 , q ey S 4p.t, t,•l �' QQ �G ' Address: _ f7 City_ /state/Ziv:_ L on, Phone #: Q3 -- r 'Are you an employer? Check the appropriate box: I am a employer v✓ith_ 4. ❑ I am a geiaeral contactor and T Type of project (required): employees (full and/orpazt-time). hava hired thD sub -contractors 6. Q xev' con-suucfion I am. a sole proprietor orpartaer- 'listed on the attached sheet 7• ❑Remodeling ship and have no employees These sub--cotdractors have 8. [] Demolifion working for me in any capaci4 : workers' comp• insurance. [No workers' comp. ins ranco �. 9. Building addition p ❑ We are a corporation and its required.] officers have exercised their I0•❑ Elecirical' repairs or additions 3. ❑ .Z am a homeowner doing all worknight of exemption per MGL I1.0 Plumbing reliairs or additions myself. [leo workers' comp. c. 152, 6-1 (4), and we have no 17 Roofrepairs i, r uraam required.] t employees. [No tivorlm-m, � goins mp. urance, requ red-] I3.❑ Other �•`-1u �-ICr.;?�$.^.��1"rc iJpv_ 47 ems. a�°_yTSCt 12if C:F!:' L.0 Ee."L� C�:^.S'J c:.nv . Co TLlran uNnn policy :-. �.'r. Romeowners who suomit'rtris affidavit indicafiag thcy, �� do s alt a �;i�aad = r--= r ? . ry : �heu hirefluLsid$ 4ontr�r±o5 isR at'+ mit. a aettw Aii&vit indicating such. CoatrEctors f��i c?•eGL Gas^ L„r ='—'q a �.c;-,�,. -cam atidirionai sbeeE showing '11e name'ofthe sub -contractors and their workers' comp. policy informafion lam an empLayer that is providing yrJorkers' cornpensauotm insurance for rimy a mpldyees .Beloit, is me policy and job site. infgrnmatzon, . Insurance Compiuy Name: Policy # or Self --ins. Lie. #: Expiration. Date: Job Site Address: City/State/Zip: Attach a copy -of the workers, compensation_ policy declaration pate (show,ng fhepoiicy humber.and eapzratian date. Failure to secure coverage as required under Section 25A of MGL G. 152 can lead to the imposition of Criminal peIIalfies o£a nue up to x1,500.00 and/or one-year imprisQnmen as well as civil penalties in the form of a STOP WORK ORDIlZ and a ane of up to 5250:00 a day ajain t the violator. Be advised that a copy of this statement may be forwarded to the office of Iuvestigatiens of the DIA for insurance coverage verification. _ I do hereby cerlifjr under the pains and peizalties ofperjup3, th,7r the znformaizon. provided ahove'is tF'ue ang correct Simiature: Phone #: DfficiaZ use ormdy. Do not xrite in this area, to be completed b3� city or taran ofj�icrrrl City or Town: 1 ermitUcense # 13snin,- Authorlty (circle one): l.. Board of Health 2. Building Department 3. CifylTgwn Clerk 6. Other 4. Electrical Inspector S. Plumbing Inspector Contact Phone'#. A I airilLu6jS LU 12_. I Go Ul m Ln LLM Cl) w NW U) z C U) w C7L) LL 0 Z > Ln - <0 m < Q teaw LU LU foui W 20:3 C/3 ch 1--; w o Q z 0 MZLD. F -I z -JLUz CLU S o 0 Z I.T 0 A I q= Fire & 'r` " Security `- ADT ADT Security Services, Inc 78 Gin ron Drive Hollis. NH 03049 Tale: 603 594 5900 Fax: 603 881 7282 STANDARD FORM REQUEST FOR ELECRICAL INSPECTION This letter is to request a final electrical inspection for the location as follows Tvne o` ]nstall: Security I 1 X 1'1rc (7 Access (7 CCTV F I'cmmit Date: o24P-- d5 f Name: Address: C Customer Contact Name ' Phone Number: /l1wz� a John S. Bassett License n 15330 ..X"i ED Fire & Security >4D T AOT Security Services. Inc i 8 Clinton Drive Hollis, NH 03049 Tele: 603 594 5900 Fax. 603 881 7282 STANDARD FORM REQUEST FOR ELECRICAL INSPECTION This letter is to request a final electrical for the location as follows:. Tvnt- n` Instal I: Security 71 ZFrc F� Access (7 CCi'V F Permit f (tea Date: ��'=-�J v,5 t Name: City: Customer Contact Name: Phone Number: ef—.jj7, ���� John S. Bassett License r 1533C 5940 Date ..... �c� .'.e4�......... ��',r���r•�'e oo TOWN OF NORTH ANDOVER p PERMIT FOR WIRING P This certifies that ._.¢- ... . ................ has permission to perform ..... ---'........................................... e� wi wiring in the building of ..... ..................................................................... at.!'..9................................... ...........-................. ,North Andover, Mass. SCS /S ' Fee ..................... Lic. No.....33 c ......... - r.:..s. A ELECTRidAL IN CTOR 4 Check # I M i i Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATI APPLICATION FOR PERMIT TO P F All work to be perfortped in accordance with the Massachuse (PLEASE PRINT IN INK OR City or Town of: By this application the undersigi Location (Street & NumbA_ Owner or Tenant Owner's Address Is this permit in conjunction with a [building permit? v . Yes.- ❑ Purpose of Building Existing Service Arps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Official Use Only Permit No. �d cv Occupancy and Fee Checked' S )[Rev. 11/99] (leave blank) RM ELECTRICAL WORK Electrical Code (), 527 12.0-0 J Date: To the -Inspector of Wires: )erform,the electrical work described below Telephone N No (Check Appropriate Box Utility uthorization No. Overhead ❑ Undgrd❑ No. of Meters _ Overhead ❑ Undgrd ❑ No. of Meters "---- r . _ ��Y No. of Reesssed Fixtures �r .. c rutty reit No. of Ceil.-Susp. (Paddle) Fans tuure May Ue Wut Vea oy the inspector of wires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency ig .ing BatterUnits - 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. TotaTons) No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number I Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. of Water KW Heaters Heating Appliances KW No. of No. of Signs Ballasts Security Systems: No. of Devices or Equivalent 0Z Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motc;s Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: - a ttuun uuuutunut aerau y aestrea, or as regutrea by the inspector oI wars. 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:) Estimated Value of Electrical Work: lqq--" - (When required by municipal policy.) (Expiration Date) Work to Start: `-'� 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 NAME:ADT Sacllrity Serilices 1-8 LIC. NO.: I r,_ Licensee: John S. BdSSett Signature ' t LIC. NO. 15330 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic'ghsee sloes 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: $ 11(5 19 ro Date. r/. -. 1 ./.-. C .I ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... 9. ....................... has permission for gas installation ... .................... in the buildings of .... rf-. �. . �........................... . at ........ North Andover, Mass. Fee. Lic. No..) !.'..'..'.. .... Ilk ......... -Y.:\ ....... /GAS INSPECTOR Check # /U (/ 4215 4- k MASSACHUSETTS UNIFORM APPLICATON FOR PERAUr TO DO GAS FTrr]NG (Type or print) Date p NORTH ANDOVER, MASSACHUSETTS Building Locations X �(_�� r�r� Permit # Amount $ Owner's Name ,��� New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Address 1-50 C' - Name of Licensed Plumber or Gas Fitter one: Certificate Installing Company Corp. ❑ Partner. ❑ Fimm/CO. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D No ❑ If you have checked M .please indi the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13Bond ❑ 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 ❑ Agent ❑ 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas, CodQ4 d Chapter 1V- 9P& General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber ;2 ! t a 5 3 ❑ Gas Fitter License NumBer ❑ Master M,46G' eyman 0 I, (Print or type) Address 1-50 C' - Name of Licensed Plumber or Gas Fitter one: Certificate Installing Company Corp. ❑ Partner. ❑ Fimm/CO. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D No ❑ If you have checked M .please indi the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13Bond ❑ 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 ❑ Agent ❑ 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas, CodQ4 d Chapter 1V- 9P& General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber ;2 ! t a 5 3 ❑ Gas Fitter License NumBer ❑ Master M,46G' eyman 0 -8 ^ ~ *- ' _---------------------- -------------------- .--------------------- '----- � � D�2%"7 CertificateGastite \ THE —sTemporary Certificate | �Is P -E sUUnm�r ! Authorized topurchase and install Gastitebyhteflex. � ^ /VO0e: n ` ' xo""^"'''-----�]/ --- � Vn6�fnr�D�xv«f,nn�+6� dofp ,°"" .~. -- -_' . -_--_-------'-'-------__- ` F Joseph Couto 189 Barker Street North Andover, MA 01845 November 3, 2002 Town of North Andover Plumbing Inspector Dear Mr. Jim Dio4;d This letter is to inform you that I am replacing Mr. Plumber as the contractor of record for my gas log installation with Mr. Adam Holmes. I am making this change as I have not been able to get Mr. Plumber to perform the work necessary to meet the inspectional requirements. If you have any questions on this matter, Please do not hesitate to contact me at (978)- 683-8429 or on my cell phone at (978)-828-5806. Regards, Joseph Couto 1 IA Date..'/Z)- 2- UL ...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .' .'z.......! has permission permission for gas installation; .� Q ..�f .............. . in the buildings of .....•-. ....... .! ................ . at ..... 5� �, .... r �.. , North Andover, Mass. Fee?0-...... Lic. No./ �� 1, .. ' -- �� ti ......... . GAS INSPEGTOR Check # '2'S Z u V 4152 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS HrrING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations / i e -ml / D Owner's Name New LJ Renovation ❑ Replacement ❑ Plans Submitted ❑ /O - ?, -0 Z. Permit # 'I r'0- Amount $ 3 � 67 (Print or type)C one: Certificate Installing Company Named %'�G`J` .�.-�" yl `c �� .v C Corp. 7 GCS/¢ �/.v• �i�. Address ❑ Partner. Business Telephone 4 m 3 L 3S" 3G 3 A ❑ Firm>Co. Name of Licensed Plumber or Gas FitterUGv�� INSURANCE COVERAGE Chec on . I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked ye_s .please indicate the type coverage by checking 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: Signature of Owner or Owner's Agent Owner 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett tate Gas Cod tl Chapter 142 of the General Laws. (OFFICE USE ONLY) Sighn= of Licensed Plumber Or Gas Fitter Plumber z -g--1957 -is ❑ Gas Fitter License um er ❑ Master M Journeyman E, ball oral me, (Print or type)C one: Certificate Installing Company Named %'�G`J` .�.-�" yl `c �� .v C Corp. 7 GCS/¢ �/.v• �i�. Address ❑ Partner. Business Telephone 4 m 3 L 3S" 3G 3 A ❑ Firm>Co. Name of Licensed Plumber or Gas FitterUGv�� INSURANCE COVERAGE Chec on . I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked ye_s .please indicate the type coverage by checking 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: Signature of Owner or Owner's Agent Owner 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett tate Gas Cod tl Chapter 142 of the General Laws. (OFFICE USE ONLY) Sighn= of Licensed Plumber Or Gas Fitter Plumber z -g--1957 -is ❑ Gas Fitter License um er ❑ Master M Journeyman N2....... NORTH TOWN OF NORTH ANDOVER 0 'mmimmiijift PERMIT FOR WIRING This certifies that ......... iIJ e� has permission to perform, ..h-.1 evt ............................................ wiring in the building of ...... ......................................................... at. /Z . ..................... North Andover, Mass. Fee ... ......... Lic. Nole4 . .......... ......... .......... ELECTRICAL INSPECTOR............... �- 04/05/99 14:00 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer A Office Use On! Permit No. ll A the C�ozrimnnwEtt(tt� ofZiBBttc�118E#s flepartment of Public %fttg } Occupancy A Fee Checketl z BOARD OF FiRt PREVENTION REGULATIONS 527 CMR 12:00/ I 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 C R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of Q, Qaf ty►Pex— To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) SV Owner or Tenant Owner's Address Is this permit in conjunction with it building permit: Yes ❑ No (Check Appropriate Boz) Purpose of Building Existing Service Amps __/ Volts New Service Amps _/ Volts Number of Feeders and Ampaclty Location and Nature of Proposed Electrical Work Utility Authorization No. Overhead ❑ Undgrnd ❑ Overhead ❑ Undgmd ❑ No. of Meters No. of Meters No. of Lighting Outlets No. of Not Tubs No. of hansformen Tbtal KVA No. of Lighting Fixtures Swimming Pool Above Int• gmd. ❑ gmd. ❑ Generators • KVA No. of Receptacle Outlets No. of ON Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection snd Initiating Devices No. of Sounding Devices No. of Self Contained Deteo WVSounding Devices Cp ion C]Other onnec No. of Ranges No. of Air Cond. Total tons No. of Disposals No.ol Hest Tbtal Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Healing Devices KWLocal No. of Water Heaters KW No. of No. of Signs' Ballasts ICA VoltaQ Wiring No. Hydro Massage Tubs No. of Motors Tbtal HP 1 OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Polley including Completed Operations Coverage or Its substantial equivalent. YES G NO O 1 have submitted valid proof of same to the Ofece. YES O NO O It you have checked YES, please indicate the type of coverage by checking tite appropriate boot. INSURANCE O BOND. O OTHER O (Please Specify) Estimated Value of Electrical Work i n • b© (Expiration Date) Work to start Inspection Date Requested: Rough Final Signed under the Penalties of per(ury: , . FIRM NAME LIC. NO. 12310 Licensee nnna1 d A- Brnnka nature LIC. NO.. 123 IC Address 111 Morse Street. Norwood. MA sus. Tel. No. (203) 978'741-4008I'Al All. Tal. No. �.I.l�t�2I8-1131 OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the Insurance coverage or Its substantial equivalent as re- qulred by Massachusetts General Laws, and thnt my signature on this permit application waives this requirement. Owner Agent (Please chock one) ... T51e13110ne No. _ „_ PERMIT FEE S. -PS' (Signature of Owner or Agent)