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HomeMy WebLinkAboutMiscellaneous - 19 STACY DRIVE 4/30/2018 19 STACY DRIVE 210/091.0 0025-0000.0 J J J Date.../.�! .�. ........ T NORTH TOWN OF NORTH ANDOVER 32 '� PERMIT FOR GAS INSTALLATION F 9 � r ,SSACNUSES This certifies that . . . . • • • • • • • • • • • • • • • • • • • • has permission for gas installation . .. ! �.:'.'. :. • in the buildings of . . ,j . . . . . . . . . . . . . . . . . . . . . . . . . . .. . at . .Cf. . . . . ?. �: :y.�. . .�`t.`. . . . . . . . . ., North Andover, Mass. Fee. 1 . . .. . Lic. No.. .'. . . . . . . . . . . . . . . . . . . . . . Z. . .... . . . . . . , GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG (Print r Type) Mass. Permit f # Bufldinq Location //gLL^S� lJ.� Owner's Name � T e of O 1pancy��� New • e ❑ Renovation ❑ Replacement , Plans Submitted: Yes❑ • Na Q N cc VJ WN x = s Tin N N V U3 S N rC O IA = }. W W 4) W O U m ?- Z 71 _ 1� C1 CC Uj I- -< tCCr O Ca to F' W O .. d C r 41 4 G a) CC W S v W N W < CC f0-• G h S W W r% W — 4 W G Q Cr W W O H rC LL F- to J F' F' W C > W o f � W �, C F" ?� N m 2 O :. O v1 < W > CC W < O O W E O }1 !- oC S O q X W 7 O C7 J 0 C > a CL F` O SUB—BSINT. BASEMENT 1STFLOOR r 2ND FLOOR 3RD FLOOR I I + ATH FLOOR STH FtOOR aTHFLOOR 7TH FLOOR STH FLOOR Installing.Cr©mpany Name CALLAHAN AIR CONDITIONING & HEATING Check one: Certificate it Address_ 91 BELMONT STREET ❑ Corporation NQ ANnnyFR,MA QIAAS ❑ Partnership Business Telephone 978=689=9'233 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter JOSEPH K.CALLAHAN INSURANCE COVERAGE: I have a current Ilablifty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes CS No O ' If you have checked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy V 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: 5ignalure of Cwnet 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 a me to the best of my knowledge and that all plumbing work and installations performed under the permit Iss d for this application will b mpllance with pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the Ge rat Laws. BY Type of License: f'fumber S ature cense um er or niter Title Gasritter M=3440 Master cense Number_ APr Journeyman �1 r 119 O No. I u L} c Date............. ... NORTp °�<��`° '•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUS This certifies that .......0.4...(.q .-le ...F-.�.�..C-......... ..................... has permission to perform .........E".................. .......................... wiring in the building of..... . .... at......... ......l ......................... .North Andover,Mass. Fee. .... Lic.No. .� .JINSP ........... ............... .............................. ELECTRICAL ECTOR C ( �+ ;�#;r/98 08:59 25.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only Permit Na 1, Dt¢art«rcat o6 e�7a6[le Sail Occupancy&Fee Checked t BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK •` All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:40 (Please Print in ink or type all information) Date S/9/9041 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number /9,ray oplw Owner or Tenant 04,01YVi•/ euoelee- Owner's Address �i0/11E Is this permit in conjunction with a building permit Yes I/ No ❑ (Check Appropriate Box) Purpose of Building 6AAO A/ID/!I Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lightling Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimminq Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices No./of Seif Contained No.of Dishwashers S ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: Q✓gwCo� GW- S INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Com Operations Coverage or its substantial equivalen YES NO = have valid proof of same to the Office YES NO If you have checked YES please indicate tt�tyF� coverage by checking the appropriate box SURANCE BOND = OTHER = (Please Spec. ) /// (Expiration Date) Estimated Value of Electri I Work$ Work to Start A'S.-A hP Inspection Date Resquested Rough Final Signed underthe Penalties of perjury: r�(1/t _ FIRM NAME IPE /C LIC.NO. G� Licensee r / Signature fAAr2/LH LIC.N0.�y/S� Bus.Tel No. Address Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) �. Telephone No. PERMIT FEE S_= (Signature of Owner or Agent) z-/6 -v 3 Date... . ......................... 1 N°RTI, °f'"`° :•�"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUS This certifies that .................................................S T'a `f./o has permission to perform ..........; .`.`..PA..1.�....1.......�'`.�.. ..�...`..... ............ wiring in the building of.....��?. .r.�.�`�. .....�. u!`�. `a' ..................................... at..............1.5......5. .?.. ..... ..:..................... ,North Andover,Mass. 3 3 5 66`I r . o A �....�( .�-.-- + � Fee... �.......... Lic.No. ............. ....................................... ....................... ELECTRICAL INSPECTOR s Check # 4 ; '12 Off U c Permit No. Dy :r a�P Sa Occupancy e Ghec BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 I APPLICATION FOR i PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 1 (Please Print in ink or type all information) I Date U G To the Inspector of Tres: Town of North Andover The undersigned applies for a permit to perform the electrical /nwork described below. Location(Street&Number / rJ L Owner or Tenant P Owner's Address `f ro r Is this permit in conjunction with a building permit Yes 0 No ✓(Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps U Voits Overhead 0 Undgmd 0111, No.of Mete New Service Amps Voits Overhead 0 Undgmd 0 No.of Mete Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ._ j� 7 )_ Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimminci Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets ' No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone _ Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers Sp2cefArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection t No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP t OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaleYES NO . have submitted valid proof of same to the Offi NO If you have checked YES please indicate the o erage by checking the appropriate box. INSURANCE a BOND a OTHER - (Please"Specify) �y} (Expiration ate) Estimated Value of.Electri aI rk$ /JU- Work to Start I v Inspection Date Resquested RougD,1 Final Signed under the Penalti s of perjury: FIRM NAME LIC.NO. Licensee %m fmA LE 2 w lu r Signature / f LIC.NO._� _ B .T No. r p J 7 G Address ( r 6 , C/L, el.No. OWNER'S INSURANCE WAI�VE�R: am aware that the Licenses d es not have the insurance c vera a or its substantial equivalent as required by Mass; General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ 7� (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of lndustrial Accidents } Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: city Phone # Q1 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'compensationfor my employees working on•this jot Corngg ff name. Address tatty Phone#. Insurance:Co. Poliev# Comuarn name: 64gress. Insurance_Co. POkV# Falure to secure coverage as required urrftr Section 25A or MGL 152 cm lead tok"impos ion of criminal penalties or a lft arrdfor one years'irnprisonrr�t�s r�tel!asal pe ��S�o1heSarm�ofa7�F ;fi� �� understand that a copy of this statement may be forwarded to the Office-of Muastigabons of the DIA for coverage verifrcatioir_ /do hereby raerW under Me pains and penalties o/perjury bW fhe#farmabw provridled above is&w and correct Signature Date r Print name Pbonef ` Official use only do not write in this area to be completed by city or town dficiar City or.Town PomM icermn4.. []Check Yimmeckate respcanse is required Cl Set Contact person. Phone A F1 Hei F-1 Ott R 1