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HomeMy WebLinkAboutMiscellaneous - 20 JOHNSON STREET 4/30/2018ho Date...2 �?�....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1.1 This certifies that (,Aro�- U, ,,C_. ll ...... has permission to perform.�.....c.. ,,1,22,,,,,l,,,,l; wiring in the building of r- l� g f i t T at .......2c�....: --J c���.,rJ..................+ orth Andover, ass. .............................................. 00, Fee... 9.7 ....... Lic. No... ........ . ....... . ............................ .................. LECTRICAL INSPECTO Check # 1. Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Only. Permit No. Occupancy and Fee Checked tev. 1/071 (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: 61-9 / -13 City or Town of-. V.vDoc/C'P, — 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) ©A Owner or Tenant 6,zW7 F& 1Z E% Z-7- Y 7-� 1/4; `l Telephone No. Owner's Address�, 0, & ox- FAl, W01,)7—/'f 441PO (/jgn 1'614 0/ F4r— Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building ,/ P j, Owl- Utility Authorization No. Existing Service lee Amps Vo Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters 0 /Yl= No. of Meters Location and Nature of Proposed Electrical Work: /Y G o r N E' T�/s'T�'G: � ✓r-'/�tI�I�C' Etc® .��T.�"c. Tot Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans r o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- rnd. grnd. Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches � No. of Gas Burners o. o etv Initiatinng Devices 'No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: um er on s o. o e - o0ine Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unic'paI ❑ Other Connection No. of Dryers Heating Appliances KW Security ystems: No. of Devices or E uivalent No. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or Equivalent OTHER: r 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a BOND ❑ OTHER ❑ (Specify:) j I certify, under the pains andpena/ties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.;A119 8 3 Licensee:LOUTS rQNTTNn Signature LIC. NO.. , x'28788 (/f applicable, enter "exempt" in the license number line.) Bus. Tel. No. cL7 g _ 3 6 3- d 0 Address: 1 nn�;nvnnT r) 1 GTFem RT T: GTR U V—MA —A-1 o pg Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, 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 agent. •.Owner/Agent Signatu a Telephone No. PERMIT FEE. $ .`��a0 . 1-1 r I 101 This certifies that. =�?H' '�.. �''d? �-!r-t S.141 ............... has permission to perform .. `J . �3 0 X U .A ................ plumbing in the buildings of ....0 1--r-tT C'� R CO. L-. Ly ..... at 54Q. A `-! C7 H rt . 5� , North A over, Mass. Fe- .°a.. Lie. No. lo3�f /Zee ...... ... ... PLUMBING INSIDEDt- Check # 763S. This certifies that ...,`% c{ ... 6M.t,.-1-t i.. S-14/ . has permission for gas installation .. �4 . k3U t!/L 10- in the buildings of ... .� (7 . at ... AT , North And er, Mass. Fe ,3C�OQ .. Lie. No ... j.cN3L(9- GASINSPECTOR Check # 8829 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYt1�L�F . • -I MA DATE PERMIT # JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS L TEL_ TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL°�tJI PRINT CLEARLY NEW: [ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES n NO0 APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER -- r^i (:-1 COOK STOVE !:.-1 n,. - .i - .1 _: I _ J r _.�If.. -� ---rl im I .. j _,� ,- DIRECT VENT HEATER DRYER _ J -.. FIREPLACE-- FRYOLATOR FURNACE I �_.-=J �_ J M (I �- _-. I _ I I__ --� IJ ._ -I . � GENERATOR C' 1 i I - .. .r . GRILLE ---j=- -{ r--_ I _..,-._ _-.-_(- _ -_ -.._ INFRARED HEATER - - _ I =- �T -_ �.-[�^ n� _I J ,.. - _j LABORATORY COCKS (� ((-- (` a _- I .r1.. _ i (- (� �- ,_ _ MAKEUP AIR UNIT OVEN ,-I r POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT - TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER --_I 1-- J I -1 - __.I .-,._.._J _ _ OTHER - INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES�E 11 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] 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: OWNER [ AGENT�jl SIGNATURE OF OWNER OR AGENT 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 com liance with a P rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �,.. ,f�1 LICENSE # ._ . _( SIGN RE MP T MGF C JP JGF [] LPGI E] CORPORATION []# =PARTNERSHIP __ PARTNERSHIP 0#���; ..� LLC [_11#= COMPANY NAME: ADDRESS CITY STATE G�� ZIP _.. J TEL ,. i FAX CELLL..EMAIL o El z �El W a ui w LL "Y' The Commonwealth of Massachusetts Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeaiblY Name (Business/Organizationandividual): Address: City/State/Zip:. Phone Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with -6. 4. ❑ I am a general contractor and I ❑New construction ` employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. x �• E] Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working forme in any capacity. workers' comp. insurance. g, E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11,❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13.❑Ocher comp. insurancerequired.] *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 tie doing all work and then hire outside contractors must submit anew 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. 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 4 or S elf -ins. Lic. #: Expiration Date: Yob Site Address: 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 requi redunder 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 under the pains andpenalties ofperjury that the information provided above is true anti correct. Signature: Date: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/Ucense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - 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 ofhire,• express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the 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 ofits political subdivisions shall enter into any contract for the performance ofpublic 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), addresses) and phone number(s) along with their certificates) 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 maybe submitted to the Department of Industrial Accidents for confnmation 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 if you are required to obtain a workers' compensation policy, please call the Department at the number listed 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 -andprinted legibly:Dppofthboom,eff 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/license applications in any given year, need only submit one affidavit indicating current Policy information (ifnecessary) 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. Anew affidavit must be filled out each year. Where a homeowner 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: Tho CQjnmonweatth ofMossachv..sPtts DDpaztment of Xrtdustdat Accidents of rj MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ,_,i MA DATE PERMIT # JOBSITE ADDRESS o _ OWNER'S NAMEl �-— POWNER ADDRESS _ TEL FAX j TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL QI RESIDENTIAL PRINT CLEARLY NEW: �I RENOVATION: REPLACEMENT: Ce PLANS SUBMITTED: YES ® NOM —1 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SANDSYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I DISHWASHER _ ._(J _( DRINKING FOUNTAIN ___( FOOD DISPOSER _ (._..__ FLOOR /AREA DRAIN __ __1 INTERCEPTOR (INTERIOR) _i KI i HEN SINK __. _.-__ _.__...__ _( -..._.__._i ..___.__( ._._ ..-.1 LAVATORY -- .- ._-( .-.-_-_,_--► l _..._.._._( I 1 _.__....I ..._._J-1 f ( _. __._ ROOF DRAIN SHOWER STALL SERVICE / MOP SINK _( ----_ l _..__._—( ----_..`t .______1 __.___! ____.._I . -_-___.I .___—I __.._.__( ..___ _I _____f _..__.► . _..__ I TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _ J= _ _-_I -__—(- . _ _. OTHER - _I _1 ..._._.__.F _._._ j== ' INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESF- .11 NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY D BOND Q 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: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 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 complia lice with all P rt' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME c.�.��i^LICENSE # .,[ CI,Y'; SIGNATURE N4P Y JP n] CORPORATION D# PARTNERSHIP -_.f # LLC U COMPANY NAME ADDRESS Q s CITY ;STATE ;ZIP �� � _�r� TEL ,�� FAX _ CELL �� EMAIL I W. M ❑ W a ui LU LL The Commonwealth of Massachusetts Department of IndustriglAccidents office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia bers Workers' Compensation insurance Affidavit: Builders/Contractors/Elepe'paePapr�t T egbl, Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 4. ❑ I am a general contractor and I 1. ❑ I am a employer with employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. # 2. ❑ I am a sole proprietor or partner- These sub -contractors have ship and' have no employees working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL c. 152, §1(4), and we have no myself. [No workers comp. insurance required.] t employees. o workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. [J Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section their workers' compensation policy information. below showing i Homeowners who submit this affidavit indicating they ke doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis 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 N Policy # or Self -ins. Lic. Expiration Date: Job Site Address: 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 requiredunder 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 cert under the pains and penalties of perjury that the information provided above is true and correct. Date: Signature: official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License U. Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Pers 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, association, corporation or other legal entity, or any two or more of the 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 if you are required to obtain a workers' compensation policy, please call the Department at the number listed 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/license 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 bum 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 Con onwealthofMassa.,clrusetts Department of Industrial Accidents Office ofIuve'stigaations 600 Washington Street Boston, MA, 02111 TeX, # 61.7-727-4900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax # 617-727-7749 w-Mass,gov/dia w. Date...�...`.Z"�7 TOWN OF NORTH ANDOVER F A PERMIT FOR WIRING This certifies that ......1.'.. (� `� G . �1... . ................................... ........................ ........... has permission to perform wiring in the building of ............:.....�T(.�l / �.P....................................... at .......!. .. 2. ©.......Ok/y c�!v.....57—..' North Andover, Mass. 06 . lr Fee ....�,?�..�.�..--_Lic. No�.....R1... .....- ........ ......................... .... ELECTRICAL INSPECTOR Check 7935 1fl Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. - M, t - BOARD OF FIRE PREVENTION REGULATIONS OccupancyandFee Checked [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 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 City or Town of: NORTH ANDOVER To the Inspecltor 4 Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 12 - a d S O h yl 5091 Owner or Tenant LeS / ! e S / f�n s'' 4x,41 EEA.A[�L Telephone No. ,r Owner's Address <3!hy mL: Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Rts i d4" +l at Utility Authorization No. Existing Service Amps / Volts New Service -00 Amps /Z6 /o1'10 Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd [g No. of Meters_ Location and Nature of Proposed Electrical Work: Ale� vin k 5 �L', C e n &c! c � �vr- �kr 1.Ce C'mm�letion nfthe fn77n in f.,h10 .,,.,,,� A- --_,41-.7__ T-_-__ No. of Recessed Luminaires -- - No. of Ceil: Susp. (Paddle) Fans erre jrrjewur U rrue*. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. grnd. o. of Emergency Lighting 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 Devices No. of Ranges TotInitiatin No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number Tous KW_, o. o elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of Signs Ballasts Security Systems:* Data Wiring: No. of Devices or E uivalent No. of Dvices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: c 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE jg.. BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Nk(kr&Gni EI.e! JS-Y'i'Cc A (+fitA LIC. NO.: AN) G, q.l Licensee: 5 0 Pd� • 1l (O Cl. . (If applicable, ente • "exempt" in the license number line.) Bus. Tel. No.; Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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: $ �� 1 'T,9-2- & l D,. 9- 7--69 � P-" 0)-9 Date. . 49f ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SS CH 5 This certifies thade has permission for gas installation-7-:�- in the buildings of`'`'...`'"'. ........... at .� ....................... ....... I North Andover, Mass. Fee. ... Lic No. .......... ......... ;� GAS INSCOR Check # 5893 MASSACHUSETTS UNIFORM APPLICATON FOR PERNIIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Z1 F%f 7 Building Locations '` U%%- Permit # 7=J Amount $ Owner's Name New D Renovation D Replacement 0 Plans Submitted (Print or type) •e'�- /7/ - Address cS U /36 k r0 4 -1 e,- i— usinessee one q 7 c Name of Licensed Plumber or Gas Fitter Che k one: Certificate Installing Company Corp. Partner. 13Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes �'� No � If you have checked Yes, please indica .the type coverage by checking the appropriate box. Liability insurance policy13 Other type of indemnity 13 Bond 13 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 herebv certifv that All nfthP rat.;l� —A :.,a - - �•� ,,,,,,..,LL�U kUl -1«lw) m aoove application are true and accurate to the best of my knowledge and that all plumbing work and instals per under rmit Issue or this application will be in compliance with all pertinent provisions of the Massachus tts ate G Cod and Ater 142 the Geral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S' ure of L Plumber Gas Fitter Da 13 Journeyman sed`Plumber Or Gas Fitter r7c—e'ns-eTurnoa � a C7 a v: W O U F x h z p w Q F• a z o z p E■ z w a z w x �, z a o a> W F xj C7 z w z > F w z a H -• F W C7 v, O m > z tr. O H W F W C x O x � � d 3 A C�,7 � 0 z > A O a u, F O SU B-BASEM ENT .da BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 1 1 8TH. FLOOR H4# (Print or type) •e'�- /7/ - Address cS U /36 k r0 4 -1 e,- i— usinessee one q 7 c Name of Licensed Plumber or Gas Fitter Che k one: Certificate Installing Company Corp. Partner. 13Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes �'� No � If you have checked Yes, please indica .the type coverage by checking the appropriate box. Liability insurance policy13 Other type of indemnity 13 Bond 13 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 herebv certifv that All nfthP rat.;l� —A :.,a - - �•� ,,,,,,..,LL�U kUl -1«lw) m aoove application are true and accurate to the best of my knowledge and that all plumbing work and instals per under rmit Issue or this application will be in compliance with all pertinent provisions of the Massachus tts ate G Cod and Ater 142 the Geral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S' ure of L Plumber Gas Fitter Da 13 Journeyman sed`Plumber Or Gas Fitter r7c—e'ns-eTurnoa jzj (Print or Type) UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING NORTH ANDOVER , Mass. Date o� 19 z Buliding Location j �11 Permit # a 3.36 : Owner's Name New ❑ Renovation p Replacement Plana Submitted: . Yea ❑ No [] Business Telephone Name of Licensed Plumber or Das Fitter C h H a a0e i ee " � a � w w y O e > s ,s N aG C x O at tl x J c 'Yr a w ►' O ►- < v 3- d s h M y = v r= Is' No y 0 O A41 a M M F N i z o o IL a O, o 2U18—eaMT. f1AtEMEHT 1!T FLOOR 2NO,FLOOR l aRO FLOOR 4TH FLOOR 6TH FLOOR OTH FLOOR 7TH FLOOR OTH FLOOR Installing Company am Address S S� Business Telephone Name of Licensed Plumber or Das Fitter C h H a a0e i ee � y O e > s ,s N w J a o Check one: Corp. u Partnership Firm/Co. Certificate INSURANCE COVERAGE: 1 have a current ilabllfty Insurance policy or Its substantial equivalent. hec�ne If you have checked Via, please irldteate the No ❑ type coverage by checking the apprapdale box. A liability Insurance policy ja' Other type of Indemnity ❑ Bond O OWNERS INSURANCE WAIVER: I am aware that the licensee d Chapter 112 of the Mass. General Laws, and that oes not have the Insurance coverage required b MY signature on this permit application waives this requirement.%y Check one:: nature o Owner or Owner's Agent Owner ❑ Agent ❑ that &I the ails and kr�wle�dge and that ellopil Plumbing work and( Installationsappve submitted eerformed u dt«sheer rm) issued for hla ail Ior# to will pertinent provisions of the Massachusetts Slate Gas Gbd pe plication are true and occur o lh best of my =and Chapter 142 of v 1 aiya I mpllan with all BY T I License., Title Plumber t3aslilter no We ° n or as or City/Town Q Joumeyman license Num krTTIOWD (OFFICE USE ONLY) 4. t Date •t!! l....... . 2336 :� 0 ,40 pT c,tio TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation ..... � of. .............. in the buildin s of .. enr j-. Y"< l .... Re,'�v < { r at .U....�.� fi . s �2.. 1 ..... . , N th Andover, Mass. Fee .,.O .,' .. Lic. No.1(> I ./)j.... .. 10/24/% 11:44 25.00 PAID GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File -\ MA5SACNUSETTS�U 4 FORM APPLICATION FOR PERMIT TO DO QASFITTINQ (Print or Type) / NORTH ANDOVER , Mass. Date G tg ,BundIng J Permit # Location Gni Location Owner's,-, Name�� US New ❑ Renovation ❑ Replacement p Plans Submitted: Yes ❑ No [p a s< N K N 0 K d J W H p x M X IS N F� K 19 O a C Y W N K at d u r X ht a o K < Y IT i o so: 3, u° s°e s d o flus-90MT. • OAIRMENT ' 111T FLOOR 2EOFLOOR 1 • SOOR 4TH FLOOR 8TH FLOOR 4TH FLOOR 7TH FLOOR STH FLOOR Instafiing Company Name {C ,��� �,�� ��A Check one: Certulcate ��i fl] Corp. Address S—b i v� lL'en1, 7 _. U Partnership e C-F1rm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter _ 1-711,17 INSURANCE COVERAGE: Check one I have a current liability Insurance policy or Its substantial equivalent. Yes b � No E) If you have checked ye, please/Indicate the type coverage by checking the appropriate box. A (lability Insurance policy p' Other type of (ndemntty ❑ 1 Bow p 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 permn application waives this requirement. Check one: %nature 61 Owner or Owners Agent Owner ❑ Agent ❑ I hereby certify that as 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 an plumbing work and Installations performed under the perm ssu ^for th a application will be M compliance with all pertinent provisions of the Massachusetts State Oas (bode and Chapter 142 of the `Lewy T of License: THIS umber Qasfitler gna " e o nae um er or as er qt,/Tow,n Master L�.loumeyman License Numbery 3 So . HT110NED (OFFICE USE ONLY) 2 _O F- t,) W CL N Z N N W • a u O a r '4 1, 1w i Z b o z F- f. U. N � J z ' O O w a N O f' U W O O z w W IL ' cc O . c i LLU. Z O • W F- m Ci J a d t w W W r '4 1, 1w i Z b