Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 195 OLYMPIC LANE 4/30/2018 (2)
i / 195 OLYMPIC LANE 210/106.8-0130-0000.0 -- - --- li Date./, .z .. .. . . NORTH o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �' �9�°°•�o.rr�SSy F SSACNUSE � This certifies that . . /..,(-7. . j has permission for gas installation . . . . . . .ev .. . . . . . . . . in the buildings of . . . .;.,. S. :.k . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . ? . . . ..��.�.,<::.s. . . , North Andover, Mass. FeeLic. No..,. . . . . . . . .'+ . .{.[.... ../:.. . . . . . . . CASINSPECTOR Check# i 4178 �b , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or T JI-01A—Mass. Date A,316� Permit # Building Location i\0-- Owners Name Type of Occupancy�5l�. New ❑ Renovation ❑ Replacement ❑ Pians Submitted: Yes[] No p N N W Y W W N N V Z CC cc N CC W CC O Cr W = H W W cc O V Ca N T W J W W FIc - _ O W 4 S a o o ~ ►W- <CC m W F- W W O a C ri 4 W W Y X �. WCC O O > W r aW cc O H s X J P X W yaj O p > Y. F� W J W X .4 W 4 C >- W W 2 0z = O X a uw a Z. < X < < 0 0 W O r- CC .x O C9 x W 7 in t9 J V CC > G 4 O SUB—BSMT. BASEMENT I Ix 1ST FLOOR 2ND FLOOR 3RD FLOOR �► 4TH FLOOR I STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR . Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET ® Corporation 1 0 3 C MIDDLETON, MA 01949 ❑ Partnership Business Telephone 978-774-2760 [] Firm/Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes X3 No ❑ !f you have checked It!. please indicate the type coverage by checking the appropriate box. A liability Insurance policy 91K 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: _ Owner❑ Agent ❑ Signature of Owner or Owner's Agent hereby certify that all of the details and information I have submitted(or entered)in above apprication 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 provisions of the Massachusetts State Gas Code and Chapter 142 of the Goner I s— eY T of Ucense: Plumber 'Signature of Licensed PI=6er or AGas Fitter Title Gastitter 3785 aster License Number City/Town Journeyman March 20, 2015 Inspector Of Buildings Town Of North Andover 1600 Osgood Street North Andover MA 1845 Claim Number: 033550154 Policy Number: 25523400005 Company Name: Arbella Mutual Insurance Company Date of Loss: 2/22/2015 Insured: Michael Crepeau Property Location: 195 Olympic Ln. North Andover,MA01845 To Whom It May Concern: Clain has been made involving loss, damage, or destruction of the above captioned property, which may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Rob Cleberg Crawford& Company 204 Second Ave Waltham,MA 02451 CC: North Andover Fire Department North Andover Heath Department Arbella Mutual Insurance Company 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of.ongoing construction activity,and may be.deemed.by-the,inspector-of_Wires abandoned-and.invalid_ifhe_. .- or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request f either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extendingthrough August 15,2012. 91339le 8—Permit/Date Closed• "Note:Reapply for new permit}] er it Extension Act—Permit/Date Closed: j?: Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACWU This certifies that .- .............................................. has permission to perform .....4�. ..... ...... ................ wiring in the building of......A................. ... at..'./J�'`�........ -. ... ...... North Andover,Mass. rw &e Fee.'— ................... Lic.No. ........................................ :d ELECTRICAL INSPECMR Check # 11).34 72 8073 Commonwealth of Massachusetts Official Use Only l I 9v 23 Departmentof Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked > IF [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 INK OR TYPE ALL INFORMATION) Date: /O� 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) / L h Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a buildingermit? Yes No ❑ (Check Appropriate Box) Purpose of Building 71CIE'yl'�i4 f Utility Authorization No. Existing Service Amps / Volts . Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: L) I Completion of thefollowing table may be waived bv the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total A Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o mergency Lighting nd• d. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones J No.of Switches No. of Gas Burners No.of Detection an ,t Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained t Totals: _ _..._._ ..__.__. .._........__. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of No.of No.of Devices or Equivalent Heaters KW Signs Ballasts. Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of E:Becprical Work: (When required by municipal policy.) Work to Start a 1 05� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no pernut 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 S I certify,under the pains and penalties of perjury,that the information on this application is true and complet& FIRM NAME: t" LIC.NO.: 1`7 b2)- Licensee: rr,6p Signature yL LIC.NO.: �73 q� (If applicable, enter"exempt"in the license number line.) Address: Bus.TeL No.: i Jr Q *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt L lc.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. PERMIT FEE:$�O <r ' The Common wealth o /Ylassach f usetts ! Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 www.mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Acwlicant Infor>acatiion Please Print Legibly Name(Business/Organizafion/Individual); Address: T'(D 1D Gr City/State/Zip: al-/11 �' ,:. �, pP� ^� Phone q� Are you an employer?Check the appropriate box: " 1.0 1 am a employer with 4• ❑ 1 am a general contractor and I Type of project(required): AmFloyees(full and/or part-time),*. have Hired the sub-contractors 6. ❑New construction 2.,,, I am asole proprietor or partner. listed ori the attached sheet._ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition' working for mein any capacity workers' tromp.insurance. g F1 Building addition [No workers'comp,insurance 5. ❑ We are a corporatism and its required.] 10. Electrical�l ] officers have exercised ❑ cal airs or additions i their rep 3.❑ I am a homeowner doing all work right of exemption per MGL I I-❑ Plumbing repairs or additions myself[No•workerscomp. c..152, §1(4),and we have no insurance required.)t 12.❑Roof repairs eq ] .employees. (No workers' comp. insurance required.] !3:❑.Other `'Any applicant that checks boi#1 must also fill out the section below showing their workers'com pensation iotL t Homeowners who submit this affidavit indicating they are doing an work and then hire outside c ntractors must submitlicy in. a new affidavit indicating such. lcontnwtors that check this box mustattached an additional sheetshow.ing the name of the sub-contr.actas and their workers'comp,policy information. I ant an employer thw7 is.providing workers'compensation insurance for nry.employees; Below is the information. policy and job site Insurance Company Name:_ /� (yvt� / ��47 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State2ip: 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 c under the pal and p erjury.that the information provided above is true and correct Si ature: p, Date.- Phone ate:Phone 4: 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 S. Plumbing Inspector Other - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,assodiation,corporation or other legal entity,or any two or more ofthe'foregoing engaged in a;joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the owner.of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance'coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign.and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or ifyou.are required to obtain a workers' compensation policy,please call the Department at the numberlisted below. Self.-insured companies should enter their self insurance'license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided,a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/iicerse applications in any given year,need only submit one affidavit indicating•current policy information(.if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address,telephone and fax number.- The umber:The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7744 Revised 5-26-t15 www.mass.gov/dia . .... ........ ...... 40RTH '6 TOWN OF NORTH ANDOVER A* 0 PERMIT FOR WIRING SACHUS EA This certifies that. .,'-..................? .. .............. .............................. ........... has permission to perform--:��::�.::�..::�14- .................... wiring in the building of.....Z.111.,.-'-.�.. .. .......................................... at ........ North Andover,Mass. ...............P............ Fee ........ Lic. ......f.... ....... ELECTRICAL INSPECTOR Check # 6682- C®rnrtio!:--vealth ®f ll aSSOMhusetts — --- --- :.`!cial Use Only DeparttI ei;t n,f Fire Setvicos Permit No. v_ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ (Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO P ERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A L INFORMATION) Date: City or'Town of; UV` r e'2 - To the Inspector of Wires: By this application the understgtied gives notice of his or her intention to pelf rm the electrical wor�scribed below. Location (Street& Number) 11�Z5— Owner or Tenant -� Telephone No. `t, Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. ,y fee P Existing Service Amps / Volts - Overhead❑ Undgrd❑ No.of Meters New Service Amps _/ Volts Overhead❑ Undgrd ❑ No.of Meters Number.of Feeders and Ampacity Location and Nature of Proposed Electrical Work: u 0, Completion of the ollowin table may be waived b the Ins ector of Wires. No. of Recessed Fixtures No,of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool bove 1:1In- ❑ o. o mergency lig mg rnd: rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners , No.of Detection and i' Initiatin Devices No.of Ranges No.of Air Cond. TotTons No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons........• KW No.of Self-Contained r g Detection/AlertingDevices Totals: �'"""�"""'- No.of Dishwashers Space/Area Heating KW ❑ Mumc►pal ❑ Other Connection No. of Dryers Heating Appliances KW Security—&y—stems- No. curity ystems:No.of Water o No. No.of Devices or E uivalent Heaters KW No.of Data Wiring: signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs lNo.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 suchcove ge 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: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested p eq ested m 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: LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, enter" mpt"in the license numbe line.) r ? r Address: Bus.Tel. No.: Y'2 , o� S.� 5,k � Alt.Tel.No. OWNER S I SURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norma y 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: $/Pt-) r i t r NORTI{ o?°,•,;�``°-:°1"°°� TOWN OF NORTH ANDOVER A PERMIT FOR WIRING SSACMUS� This certifies that .....�..... ........................ ....:r✓.. r. has permission to peiform�` 1al... ��t' .. .. .Y. wiring.in the building of....4?�..4.. !i:.:%... ................................................... ... .....SGC... ✓ � ,North Andover,Mass. ..... Lic.No�� ELECTRICAL INSPECTOR 1! Check N1� CJ�J 5670 J Commonwealth.of Massachuset s Official s o Permit NO. Department of Fire Service Occupancy and Fee CheckedJ�6 / BOARD OF FIRE PREVENTION REGU ATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO ERFORM ELECTRICAL WORK All work to be performed in accordance with the M ssachusetts Electrical Code(ME ),527 CMR 12.00 (PLEASE PRINT IN INK OR T E AL INF TI Date: �� City or Town of: To the Inspector of Wires' By this application the undersigne gives notice of li h r in ention to perf the electrical work described below. Location(Street& u ber) r Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a buldmg permit?. _ Yes ❑ No. (Check Appropriate Box) Purpose of Building Utility A thonzation No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the followin table maybe waived by the Inspector of Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above rnd. ❑ In-rnd. ❑ Bo.o Emergency Lighting attery Units 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. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers... Space/Area Heafing KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kit Security Systems: No.of Devices or Eq uivalent No.of Water No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of evices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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) � (Expiration Date) 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. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: Services LIC.NO.: 1 533C Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line) Bus.Tel.No.: 603 '594 5928 Address: q Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licl9hsee 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. PERMIT FEE: $ Date.. .�?'/..'�:�� .. ... . NORTH Of ,ti0 TOWN OF NORTH ANDOVER - PERMIT FOR PASZINSTALLATION SACHUSEtt This certifies that ' .?. .. . .: . .... .. . ... . . . . has permission for gas installation . . . in the buildings of . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.,:A-, . . . Lic. No.. . . . . �. . �AS INS Check# 6387 Date. r: i.: N`O1 RT: TOWN OF NORTH ANDOVER t�t A PERMIT FOR PLUMBING ,SSACNUSE� . This certifies that . .. . . .... . . . .. . . ?. . . ��'. . . . . . . . . . . . . . . . . . has permission to perform . ,. plumbing in the buildings o . .. . . . .�-� -. . . . . . . . . . . . . . . . . . . . . . / '�.. . . . . . . . . �- at . . . . . . . . :�' . ., North'Andover, Mass. Lu. No. �,� . . . . . . . . . . . . . . . . . PCMBING INSPECTOR Check # 7698 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 61 lU �, MA. Date: Permit# Building Location: 5 \C OwnersTame7—� t)� Type of Occupancy: Commercial DI Educational[I Industria! E] Institutional E] Residential New: Alteration: D Renovation: F] Replacement: Plans Submitted: Yes No Q FIXTURES Z Uj Y = Z O Lu � UJ -l 16- 0a j U) 0WIZ z W IX Cc OO z 1- N Lu W W W' m Q Q< H 0' 0 W X. W ca v W w zrul _ w O IQ F e OWLu Z>- W to —��, ~ Q' m W O z O Izu z W W X q L0 Lu F > z a SUB BSMT. BASEMENT 1 FLOOR -2'FLOOR 3Hu FLOOR —4TFFLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certilfiee# � ❑Corporation Address:�� �Q� ��nl % city/Town: Q r-p State: , ❑Partnership Business Tel: Fax: t?� ❑Firm/Company Name of Licensed PlumbedGas Fitter. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Ye No 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 0 Bond ❑'. OWNER'S INSURANCE WAIVER:t am aware that the licensee does not have the insurance coverage required by Chapter 1'42 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Q Signature of Owner or Owner's Agent By checking,this box EJ;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 worst and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts.State Plumbing Cale and Chapter 142 of the General Laws. Type of License: By El Plumber Gas Fitter Title Gas of Licensed PlumberlGas Fitter Master �Journeyman License Number: APPROVED OFFICE USE ONLY Q LP installer I I, � 4097 Date.................................. TOWN OF NORTH ANDOVER 0 0 , p PERMIT FOR WIRING SACHUS This certifies that :...1 ......................... ...................................... has permission to perform.- -.4 IS-_/ .... ....... ' 1 '4............................................................... wiring in the building of....... . ...... �A ...... North ,doves,Mass. at...).................. .... Fee ..,...... ............ Lic.No.:�� ...l- ... .............. -ELEM CAL Check # 2// 2,.-- / Ohice use Only ©�A The Commonwealth of Massachuset ti4b2o: mit No. A ON Department of Public Safety pancya Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3190 (leave blank) U. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DATE 2 Cityor Town of A-) c /� ✓��� To the Inspector of Wires: The undersigned applies for a permit to perforin the electrical work described below. Location(Street&Ntunber) [ ILK Owner or Tenant L- _Y-q 40' Owner's Address Is this pennit in conjunction with a building perntit: Yes ❑ No (Check Appropriate Box) Purpose of Building— Utility Authorization No. t2 3 2 Existing Service 24 1V Amps f�� Volts Overhead 171 Undgrd No.of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ . No.of Meters Number of Feeders and Ampacity_ j Location and Nature of Proposed Electrical Work I No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above I- Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones Total No.of Detection and No.of Ranges No.of Air Cond. Tons Initiating Devices Heat Total Total No.of Sounding Devices No.of Disposals No.of Pumps Tons KW No.of Self Contained No of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local [] Municipal Other No.of Dryers Heating Devices KW Connection 0of Water Heaters KW No.of No,of Low Voltage Wiring Signs Ballasts No.Hydro Massage Tubs No.of Motors Total HP OTHER: TrL INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws,I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES 13NO ❑ 1 have submitted valid proof of same to this office. YES E3NO C3 If you have checked.YS&please indicate the type of coverage by checking the appropriate box. / INSURANCE BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ /�/� Work to Start — 1-10 — `JZG /� �spection Date Requested: Rough Final ( Z,4?-P- (A- Signed under the penalties of perjury _ �l FIRM NAME LIC. NO. Licensee e 0 Signature LIC. NO. Addresso� �� Bus.Tel. No. 7 r2 5 Ft.Tel. No. n sr Ste- �'�e I���c. 9� OWNER'S INSURANCE WAIVER:I am aware that the Licensee 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$ (Signature of Owner or Agent) N° 2352 Date... NORTH °���``° :•1"° TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING ,SSACHUS I i Thiscertifies that ..................:.................. ................................................... has permission to perform .. .... . .......................................... wiringin the building of.........:............ .. ..... ......................................... at..�.� '. ...� .. ... .... ...........North Andover,Mass. Fee..'�........... Lic.No...—....�� .�.,;...r.........�..... �R1�LINSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Zhe Commonwealth of Massachusetts Dcparrmcnf of Public &fety �•••`� `° 0�3� t� BOARD OF FIRE PREVENTION REGULATIONS S27 CMR IZ-00 3/90 °"y~'" r.• o"`�'a Oz7 Uaa.• ai..a> APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All•ork to b•p•riormed M accordance with the Ma"Achusens Eleculcal Code. S27 CMR I2.00 x�PI:$EAISE PRI21T °Y2i I23K OR TYPE�}1LI, p��V(�,T.'.TT ,,rr }� 'A�i S m ihdr .Y '� Thi Y #7 a ,�, Qalloll�F S*a{§ q. "SrS '' Lath. V. 1� •i, r,.�.;1,... ..., .•. /�.:�/V+U��r�Y r}<<:. �''�+'�t.1�'��N�'An r` } i.n i _.. :, :Io che'Inspec.tar of Wire`s: i The undersigned applies for a permit to perform the electrical work described below. Location (Street b Number) ��,5 � iyl dJ�n � /UC Owner or Tenant .-J19Y.19V/•)-AI774 A/.f)t/ Owner's Address S�iylE Is this permit is conjunction with a building permit, yes ❑ No Q— (Check Appropriate Bos) Purpose of Bulldins ` ` ` Utility Authorixacion NO. Ex sting Service Amps / Volta Overhead ❑ Undgrd [] No. of Meters New Service '�'pa / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feedarz and Ampacity Locatioa and Nature of Proposed Electrical Work &-PL/1 LG4P)Q07 No. of Lighting Outlets No. of Hot IubsToC4. 1 No. of Transformers xy No, of Lighting Fixtures Above❑ In- ❑ Swimming Pool red. grnd. Generators 1CYA No, of Receptacle Outlets HO.-Of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Cas Burners FIRE ALY-2iS No. of Zones No. of Ranges No. of Air Gond. Iotal Np, of Detection and tons Initiating Devices No. of Disposals No. of Heat Total Total Pumps TonsAH No. of Sounding Devices No. of DishwashersSpace/Area Heating 1W No. of Sel Contained Datection Contained Devices No. of Dryers Heating Devices JU Local❑ Municipal N Connection❑Other No. Of Water Heaters KLA Si, of No. 01 Ballasts w Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVELiZEt Pursuant to the requirements of Massachusetts General Laws I have a current Completed equivalent. ZES�Lia (� I haus submitted validty Insurance Policy including Coop Operations Coverage or its substantialIf you have checked YES proof of same to this office. YES❑ NO ❑ please indicate the type of coverage by checking the ippropriate. box. INSURAHCE ❑ BOND ❑ OTF>�i❑ (Please Specify) - fy Estimated Value of Electrical Work SS•d(S piration at Work to Start Inspection Date Requested: Rough Final Signed a..Aer the penalties of perjur;: FIRM NAME o +(�� c , tC L LIE. NOZ-a ! Licensee Signature NO. Address —" r--v TLC Bus.. el. No. OWNER'S LNSURANCY wAIAlt. Tal. No. s I Am aware that the Licensee does not have the insurance coverage or its AU67 atantial equivalent as required by Massachusetts Caneral ws�that: my signature on this permit application valves this requirement. Owner Agent (Please check one) Tale hone N T FEE S ` P o. PERtlI Signature of Owner—a—r Agent Date. r ° 4428 NOR7: a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .to* SAcmUS 7 r IThis certifies that . . . ? has permission to perform �..:......,.�... . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . .� . . . . . . . . . . . . . . . . �� orth Andover, Mass. Feel .Lic. N %f�,' -4.C' � . _ t::-. .. . ��.� . . . . . . . . . -- -PLUMBiN NSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer �7 �/ ' • � "ICJ' • MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) — =� =1 �l�dii/C Mass. Date_ �.5 OO LPermit# ,=�. Building Location Owner's Name _ /Z Type of Occupancy New ❑ Renovation ❑ Replacement L� Plans Submitted Yes ❑ No ©- FEATURES z z z v7 07 07 O z t¢ j WH } U ¢ z u•� W Y U) ¢ Ir ¢ z F-- Z U Q Q �� Z F W CC O Z_ 4 in `-" m to = CE ` Q W cn Y U_ ¢ 0 ¢ X U Z O W Q w Q v7 Z p ¢ cn O o W W O ti Q w F- p J (� W Q _j Z O CELu T F- O LU LL ly F- C? cr j H O = O � F>- Z G p U Z_ Z_ W f- O (� Z ¢ H �¢ = v7 cn ¢ O ¢ ¢ m tz a ¢ O ¢ H SUB-BSMT. BASEMENT 1 ST FLOOR. J 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name67DCI Vc-;:z � LU/y/� �Q.�l/, Check one: Certificate Addretsa 1 SV ✓C�-� %�c S/ ❑ Corporation G 5� 0 Partnership Business Telephone 7 �U / —/81 60 / �mlCo. Name of Licensed Plumber /L INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes G—' No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy �— Other type of indemnity FI Bond ❑ OWNERS 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: Si nature of Owner or Owner's A ent Owner EI Agent ❑ 1 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 the permit Issued for this application will be in compliance with all pertinent provisions he Massachusett tate Plumbing Code and Chapter 142 of the General Laws. --� t By igna urs o icense um er Title Type of License: Master fes^ Journeyman ❑ Clty/Town License Number •�/O APPROVED OFFICE USE ONLY) 4239 N°R7M IV TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SSACMUS� This certifies that 'v � C � v` � has permission to perform .......... G.. ........................................................ wirffg in the building of..........6 at(..: ..5 /.......................................... . .,North And verFfNtass. Fee C�.... Lic.No./,. .......... _ . ...... ...... ELEr:= INi SPEcrOR Check Commonwealth of Massachusetts Official Use nl Department of Fire Services Permit No. �( Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MECk 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date: 1114 ?//)L�, City or Town of: Q vet To the Inspe for of Wires: By this application the undersign d ives notice-,07 his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. — Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the ollowin table may be waived by the Inspector of Wires. ` No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above [IIn- No.o Emergency iging rnd. grnd. ❑ Battery Units- No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 7NoofEnes o Detection and No.of Switches No.of Gas Burners o. Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other { Connection Heating Appliances Security Systems: No.of Dryers g pp Kms' No.of Devices or E uivalent No.of Water KW No.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: :1 Attach additional detail if desired,or as required by the Inspector of Wires. ' 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:) (Expiration Date) Estimated Value of El ctrical Work: 460- (When required by municipal policy.) Work to Start: ll (� Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains dndpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: ces LIC.NO.: 1 Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable,enter"exempt"in the license number line.) Bus.Tel.No., 603 594 5928 Address UAlt.Tel.No.- OWNER'S INSURANCE WAIVER: I am aware that the Licl9hsee 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. PERMIT FEE: $ i c �yllrvv�e- i V%l i I k Date/. . . . . . . . . . . TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING SACHUS This certifies that . . . . . . . . . . . . . . . ... . . . has permission to perform . . . . . . . . . . . . . . . plumbing in the buildings of • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. atJ�� . . . Fee!�� . Lic. N o.. . J:�/ N*G*INSPECTOR P L tL��'di Check # 8468 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: U© f,dw o _er , MA. Date: � /r- l ij`� Permit# Building Location: // _ Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional ❑ Residential❑ New:❑ Alteration: ❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED SYSTEMS LU Z W U � N N Q f/1 >' V W �' Z Z a W Z a: 0z N Z Q Q Z Q LU W J VI W f. Q i'n h W Q M , o Q Z °mac 0 G W Z vWi vJ z u a ,+, a 3 Y = y Z ~ W J Q vx� W W LU � OSI O W W Q cxn L p O > > 0 D Q Z e[ Q Q = d I ,tena � C2 � 3 SUB BSMT. BASEMENT 1 FLOOR 2ND FLOOR 3R FLOOR C FLOOR 5 XOOR 6P FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: J O n e C9Y1�-�' r ❑Corporation Address: 6 ( �;►'ti C-Cca C 1L10ty/Town: er State: N` , _ C�3C�3I El Partnership BusinessTel:C200 �O �� Fax: ff ❑Firm/Company Name of Licensed Plumber: J—C) C3 L4 C" INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes ❑ No❑ 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:1 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 ❑ 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. By Type of License: Title ture o I sed Plumber,--- City/Town aster urneyman LlCen umber: 7(/ APPROVED OFFICE USE ONLY) /3� y fll IN RS4 ri a# kl 'tb�} #J., I � Y }yam ,.,{y{,. ,rp{p{. �{ All,t a,� ACORD CERTIFICATE F LIABILITY INSURANCE OP ID z0' OlTEitIPJQaY YYE L LEONJO2 �_. III1S CEId31FiCA fE 3S ISSUEV A9 A:MATTER OF INFORMATION ONLY AND CONFERS±40 RIGHT 1 UPOt4`fHE CERTIFICATE 14hittemar" Insurance 11OL,DER.THIS CE RT:IFICAT'E DOES PLOT AMEN[?,EXTEND QR 501 Mammoth P,aad .1LT1 R THE COVERAGE AFFORDED BY THE POLICIES BELOW. __...._..._r..� 1,ondondorry UlI 03053 Phone: 603-432-2577 Fatx:603-432-•4700 VUSURERSAFFORDING COVERAGE :NAIC fA 't$UTf61! 1-744I.n=wr 14r.S Tnaurance company yaFsu��rl John Leonard 6 Tamarack Lana Amherst VM 03031 COVERAGES .FI$6�f11CiE:$'(3f�N,` Fii1i?'Jt. 1,.`:7TC}@4`I.'C1'N 100wIs4.F}UN FFMM TO THE ud SUri€l1 tJA?,it0,,iCr,Ep,. :•U.{i.HE PtSOCY i'F.R*D INDRUMELj.PFOIWi9F:. 1J'iNL71@1•r,:; .. A.ffY h*O.l'HEME--141•I'ER;U OR CC?tll tr11vN'TF.R€tY CQNTI AC T L.)413 114 F{r u:u At Ni YOM RESF'Lt;i fri s}l1 Cfi F'ilu URF11 K;MF MAY UE 15SUED t;f2 MAY PEE TA01•Tt?f 9,451 C{A,Hf_,r.ArFOr+rrs3 a T t IC r Ot iC4 S DESCF?:mf1 t E F3E:i+�15 S4t8J"F.CT TE1 AL(Ml C r0.gi,E wC LUSrOPIS AND C:*Jt:F IF.3PJS W 511F'H POUC�PS,M)Ci i OMF LINTS 13OU""Wif S>AY11.&VE F'E£Nt EfJVCIELI UYNAJL)LLAIMS, "Pot,POLICY M LTR TY F1 cItlfi' Fl"i`��I1F+I�J4TY}p� _ .__ .___._ ,._ ON.§ >T.E RJf)N�f pa'E :E POLICYI3ft:EE)d DW'E 'btfi'tt�� +J�1T IPNfiflDUIY� ' umir8 I GENERAL UAWW-ry _ } i rAuHCK r_L1 eAs Nct I I000000 A .. t�1IP AMILGE:'9KALtiArlLlry *141P005796 05f1S✓l33I D'�/��i/313tr�,�nl��ss�'rtura p $ 50000 I I iLatS MADE L 1 ' F F.RSOMAI A r.(x�.Ua 1UFYY g S X000000 re 1 _ _ 3F1JF1? LAG"GRE@ATE E 2000000 E GEWL a GGPEOAIL L1141 AI Pt; r.vi.ji., 11ar� tnlwrprr;�slt7QQQ4 G _- � AUr6MC18AEL1A�l5F.1TY t r;,s! C! ° ANY b:Ino ' G f1Ft .P.Frf�_P,i.lttlr T 1000000 I ..._{ � H1C+45`l4fi I 09'1 ,2✓0� � t?$✓I2✓Ip I!°,tTrrd„r;,t MIN 1c❑A!ITh f ,X =2,%ti[C3UI 1:O".0 f CIS_X1 HiREDAUTOS ' - L..-........ 'HOOK NClld-('i'ti'psF,fD t!1t+,S .,ro n t a{ (3 i 1 GMIAOe L(AIN,1TY. - j — ....._....••,..... ..,.:..... ..._._...-- {Fi?741 F3:FK.';.lL .,y FL7f.i2T !��____._ ANY AL1 Try OU"y li(sti i S I {FXCt 34,9"FtELLA 41AGILTFY Occ.UFt r CLAIMS',IAM }. f i WFOR W'S CtlMMOSAVON AtnO X711;V,_MT-''-' t"tiTT- -- .' WPLOYEA (Lct316ITY I t rtP1 kaf�1T ' rr AUV Pt? F1 rT�F?R'A1tfiM1F f�4 tEL'3Jlf C t i.( f* 11 rtr C=f fD1T f.,t•h1t;F1^J6k?.;XhEft♦~9!GG!rFtED'? ....__ if r��in,lY ih11 ury eY” � �t s.Ui.,£,4.:t:•Lf' Ri"�43—L1 S FI'EGF EL i F?Cri SN):tg Tx F iJl ihA.`t•P Vol IL+'I lfdlll $ {I i y { 01MC.fdF'TGON OF OPERATION t(.00ATI I.15 r Y[61!CLGS i J;7t LV51L7':;4 C�pL?ELI°J'Y FIrULdytg�F;I.tEiET F`;NfirIA1.PF}�)V191pttS '•���"" '"" l((t[Ig3inj and heating 20036 Dodger Liam 1500 QUAD 3O7XS19F).S6G239293 CERTIFICATE HOLDER CANCELLATION SMQIIl.4)A,%v O1 TtC-ABOVE OVE LC&CR!UE'U POUC)E'S BE CA-K.E(.LED BEF,??£111E EWRAT4 f,+A'r�Th{FWF-'j F,;}t�.S$UNI�kHSfrf;F`41fdfC 1.E:Kt' fs,VfrR i;)Rt,�if, 1.V :7,AT44�S @l i`iFN -E 1'C?I'Mr i'rRIWIGAYE UOLDER NAMED TO THE LEFT,OI1T rAll-GRE TO M, SO SHALL fMP0fiiS NO 03UGAI"D 4 OR UAWL11 Y Of ANY KNO UPON rPIE 145URE A,iFS AGENTS UR Ari FtESEtiTAFF`%E3. J 11111OR:2L!t)"—FR C:TAsI`4'c_' 4ACORD 25(20011€15) � _ __ _ � �w '+:t. ✓%` �¢'Ls���. C�?RPORATION 1g88 Date.... ...... .....lr.... .. NORT/, °f'"`°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 3 C14u5Et This certifies that.. ... .!....... �..Or.�................. has permission to perform .. .. ................ ....... wiring in the building of.../_;. � ,D ................................................... at.................. ,-G� �, ;.!a �r-..Wa` -,/......... ,North Andover,Mass. 'fee. �� YN(4.......... . ELECTRICAL..IN...S.P..E ... .. ...:.. ;O�Check # t, � 6644 ` Commonwealth of Massachusetts Official Use Only `y Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] 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 INK OR TYPE ALL INFORMATION) Date: City or Town of: lVA,, , 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) 1` V Owner or Tenant 0,,6t;E1 ILz LS pAt Telephone No. Owner's Address /r, Lv„P Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units 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. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No. o Self-Contained Totals: ... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No. of Water KW No.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: i No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 covege 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 and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee:6 fly 1 Signatur&Q(_00 '� LIC. NO.:UIS'�;_/ (If applicable, enter " xempt"in the licgnse Ember line.) Bus.Tel. No.:92,C 7ES_ 2� Address: 7 tit? S 0 If 7L Alt.Tel. No.: � � � G *Security System Contractor License required for this work, if applicable,enter the license number here: 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. PERMIT FEE: $ It/ _ _-4 r'' i 1 r �� -� ��� !� (� � �-off � � � '.,� �,