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Home My WebLink AboutMiscellaneous - 19 CIDERPRESS WAY 4/30/2018 b S f i Date.................................. i Ot NORTp 4,, 3: �.t;�``.-.•�.ao� TOWN OF NORTH ANDOVER PERMIT FOR WIRING • This certifies that �— has permission to perform ...... ... v ...................................... wiring in the building of....� -�!P/ '7f��s�^ at..�.1.... �� .. /tom 5..... ! �..... . ..... ,North Andover,Mass. Fee..................... Lic.No.��/d.......... ..... .............. ELECTRIC L INOECTOOe Check #6 1 73 v t Commonwealth of Afassachusetts Official Use Only �• _ Depar�tmentofF'ir`e Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] ---- leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts EIectrical Code 0C},527 CMR 12.00 (PLE14SEPRINTM-TNKORTYPEALL INFO TI011� Date: City or Town of: I By this application the undersi ed gives no ' e of his or her intentio to perform the electrical Inspector o Wires: \� Location(Street&Number) Q C l� rk described below. SSS w Owner or Tenant �L D.. Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of BuiIdin No El BLDG PERMIT# Building l6 t?,1' Utility Authorization No. Existing Service Amps _ / _volts Overhead ❑ Undgrd No.of Meters New Service 4-q-0 Amps JL0 / 2A DVolts Overhead Number of Feeders and Ampacity ❑ Undgrd No.of Meters Location and Nature of Proposed Electrical Work: Completion o !following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus . No.of p (Paddle)Fans Total, No.of Luminaire Outlets Transformers KVA Z, No.of Hot Tubs Generators KVA No.of LuminairesZ_ Swimming Pool Ab°ve Swirnd. grnd. Elo.o mergency ig tmg No. of Receptacle Outlets �� No.of Oil Burners Batte Units FIRE ALARMS No.of Zones No, of Switches 0 No.of Gas Burners No.of Detection and No. of RangesInitiatin Devices No.of Air Cond. Total Tons 3 No.of Alerting Devices No. of Waste Disposers Heat Pum Number Tons KW No.ofSelf-Contained Totals ......................... .................................. No. of Dishwashers Detection/Alertin Devices 7 Space/Area Heating KW Local❑ Municipal No. of Dryers lConnection El other Heating Appliances KW Security Systems: No.of Water N°.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts .No.of Devices or E uivt alen No.Hydromassage Bathtubs No.of Motors Telecommunications Wiring: ' O'P�R; Total HP No.of Devices or E uivalent Estimated Value of Electrical Work: oo flttach additional detail ifde'S 1 or as required by the Inspector of Wires. 0 (When required by municipal policy.) Work to Start:S Inspections to be requested in accordance with AMC Rule 10,and upon completion. INSURANCE CO GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance includin undersigned certifies that such coveg"completed operatiocoverage or its substantial equivalent. The CHECK ONE: INSURANCE [ e is in"n force,and has exhibited proof of same to the permit issuing office. OND ❑ OTHER d cert, ander th pains and penalties o er'u that the information on this application is true and corn lete FIRM NAME: wt i✓I,a fp > rJ', ota�:f� �Lim. rL .P Licensee: Lt-e LIC.NO.: Z Signature (Ifapplicable ent "exemp "in the license number line.) LIC.NO.: Address: 5u •a S �a �� Bus. el.No.: nA *Per M.G.L.c.147,s.57-61,se itywork requires Department of Public Safety"S"Licen `fit'Tel'No.: O'WNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabili LIC'NO.: required by law. $y my signature below,I hereby waive this requirement. I am the(check one)❑ rance nerco e ownnrm gent Owner/Agent Signature Telephone No. PE RMIT FEE: $ ELECTRICAL PERMIT NO. INSPECTION REPORT: u. ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSPECTION: Passed- Failed-[ ] Re-inspection required($50.00)-[ j Inspectors'comments: 5 (Inspectors'Sig Lure-(ho initials) Date 2.FINAL INSPECTION: Passed-[ ] Failed-[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date -2r/ 3. UNDER GROUND INSPECTION: , *E -[ ] Failed-[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 4.INSPECTION-SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed-[ ] Failed-[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: 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. • V 1 The Commonwealth ofMassachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 UW www.mas..gov1dia Workers' CompensationInswranm Affidavit: Buildelrs/Contractors)Electxicians)Plumabers Applicant Information Please Print Legibly Name(B.usiness/Ozganization/Individual): Address: LK f� Kra City/State/Zip: I��-taS, �/y 3 Phone it� Fa an employer?Check appropriate box: Type of project(required): .a employer with �S 4. ❑ 1 am a general contractor and I 6_ E]New construction.loyees(full and/or part time).* have hired the sub-contractors a sole proprietor or partner- listed on the attached sheet.x 7. ❑Remodeling . and have no employees These sub-contractors have 8, []Demolition ing for me in any capacity, workers'comp.insurance. 9. ❑Building addition.workers'comp.insurance 5. ❑ We are a corporation and its ired.] officers have exercised their10.❑EIectrical repairs or additions a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions elf.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofxepaixs ance required.]i employees.[No workers' 13.El Other comp.insurance required.] !Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. tarn an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: l�-� �,✓pv Policy#or Self-ins,Lic.#: Expiration Date: lob Site Address: City/State/Zip.- Attach ity/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 Ruda fine of up to$250.00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby eerti under•the pains andpenalties ofperjury that the information provided above is true and correct. SiRMatuxe: Date: _. 5-13 [J. Phone#: 3 -) C_0 Y,6 Li se onry. Do not write in this area,to be completed by city or'town official. own: Permit/License# uthority(circle one): I. fHealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector erson: Phone#: Date. . �1.�� . . "°R'M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,� This certifies that . .!'l. . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . ' plumbing in the buildings of at . . . 5 . . . . . . . . . . . . . North Andover,,Mass. Feec)LL? .°".Lie. No./S/S .7 . . . . . . . ,,E �4�� , . . . . . PLUMBING INSPECTOR Check MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:�p�yt MA. Date:—Z/3 / If Permit# Building Location:_ C C I ili� S f Owners Name: e L (/Afhojq ��L Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional ❑ Residential New: Alteration:❑ Renovation:E] Replacement:[❑ Plans Submitted: Ye s❑ No❑ FIXTURES DEDICATED e Z Z SYSTEMS z 0 Ln > Y z H O H d (i' z �"' Y V) UaUj I... L7 W O O Ui Cc of W ~ y o: h Y t7 ° Q N H LU �- S a Om 2 z O w `Z a z o C z olf o �,, 3 3 a Q H o o � o o a Z z y � � = D i Q N a m m o o LL x Y g g y �a 3 3 3 0 W a •SUB BSMT. Q 3 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR ST"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name: fICQ�6l!'/1 Check One Only Certificate# f Address: ) City/Town: ✓L State:_ El Corporation I. ❑Partnership Business Tel:-..(00? iS� —f 3� / Fax: El Firm/Company Name of Licensed Plumber: �`� 1 � INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes]the 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 1 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 ❑ Agent F1I 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 C/ /J Type of License: / Title ,❑ lumber Signat a of Licensed Plumber City/Town U Master APPROVED OFFICE USE ONLY ❑Journeyman License Number: �� u Date.. .5/�f /l.... .... 1„°RTH 11 6 TOWN OF NORTH ANDOVER P • PERMIT FOR GAS INSTALLATION SACMUSE� This certifies that . . . . /.i has permission for gas installation . . . . .,,��t:c., . . . ,i�, . . . . . . . . in the buildings of at . . . . . . . . . .. North Andover, Mass. Fee./C.w ,&c. Lic. No. /.)'q4 .? . . . . . . . GASINSPECTOR Check# J.�, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Ci /Town: h/ 'A ,�/f� �i-"' , MA. Date: Permit# J` Building Location: a C4,o/?-f Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [� New: Er-"'Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES W vi W cn z V = Cd m = o UJ w v U) Imo— o = W w _Z z 9 Z O W � W O Q O > z m O Q W w a W W W z y i W HO w � o ix LLI LL ' z W } z U) J F— F- O z J 0 LL � = W � W W V < W W = m > O Lu 0z O w z > z < _ O a ag > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR sTHFLOOR 6 THFLOOR 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# � ��'"� Address: 0 [:1Corporation City/Town: �/{�✓� State: pc� i El Partnership Business Tel: 4��r c1 3 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes Ey--Rb❑ 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 Signature of Owner or Owner's Agent Owner ❑ Agent El 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 Title Master Signature of Licensed Plumber/Gas Fitter City/Town 9-journeyman License Number: /5-/!5 APPROVED OFFICE USE ONLY ❑LP Installer