HomeMy WebLinkAboutMiscellaneous - 21 WAVERLY ROAD 4/30/2018m
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Date....
°:<`" TOWN OF NORTH ANDOVER
e °c
PERMIT FOR WIRING
This certifies that ................... DnIII)......t14..................................
has permission to perform . ........................
wiring in the building of .............. o %! t A.................................................
at ............. .0 'W*4Y AP ......................... , North Andover, Mass.
av .
Lc. Noy` . 3. ? � ....
Fee ................... ;.,....... ,........
�{ ELECTRICAL INSPECTOR J
Check #
7019
4
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS,
.r r=
Official Use Only
Permit No. Zb (�
Occupancy and Fee Checked
[Rev. 11/99] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICALIWORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 27 CMJ 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: A) Zd 6L
City or Town of: %V. 11Ai,WLS7Z To Ili(, h!.-:nt'rtnr of Hlires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) Z 1 14-AU5" RD
Owner or Tenant 5tJ"a Yaj_ vy,4A4 Telephone No.
Owner's Address z "Atm -j 2/J
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:
z
Completion of the followiav table mar be tiraived by the Inspector of J,Vires.
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 ❑In- ❑
rnd. grnd.
o. of Emergency Lighting
Battery Units
No. of Receptacle Outlets LlNo.
of Qil 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
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local [IIYlunicipal ❑ Other
Connection
No. of Dryers
Heating Appliances K
Security Systems:KW
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Signs
Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail ijdesired, or as required by the Inspector of,Yires.
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 covera e 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 E ectric d Work: (When required by municipal policy.)
Work to Start: A23 6Z Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under th pains and penalties of perjury, that the information on t pplicati�n is true and complete. /,�3
FIRM NAME: t/�O �CCT�C/G4�. �'6vn2/� LIC. NO.: IW6 3'4
Licensee: 44010 Signature
(lj applicable, enter "exempt " in the license number line
Address: 5-&T$�-9�ub ST 4441AC—�AC.�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does
required by law. By my signature below, I hereby waive this requirement.
Owner/Agent
Signature Telephone No.
LIC. NO.:
Did. V Bus. TeL No.:q?? 6F32 -� Z
Alt. Tel. No.:97r 3-7 5- s7 3Y
not have the liability insurance coverage normally
I am the (check one) E] owner ❑ owner's agent.
PERMIT FEE: S
Date. /Y..;. 0../..... .
3? ' TOWN OF NORTH ANDOVE
PERMIT FOR GAS IN#AL_ TION
This certifies that .. C 'O.P9 ,01 h i-.'. 'X .................. • ... .
has permission for gas installation ....R.P. 1 ..............
in the buildings of ...4 .CC:K .4 t!' ..............................
at • • • • • • • . , North Andover, Mass.
Fee. .. Lic. No./1 l.,i; .� .. ...Y��S-
ECOINSPTOA
Check # ) S" r
5767
MASSACHUSETIS UNIFORM APPUCATON FOR PERM TO DO GAS MING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
DateOG% r�iP> -a 6
Building Locations o7/4&e&Q4 &A-4:1Permit # .S 16 7
Ir
Amount $
Owner's Name `�o
New Renovation Er Replacement ❑ Plans Submitted
(Print or
Name _6
Name of Licensed Plumber or Gas Fitter
Check ne: Certificate Installing Company
I orp.
L
Partner.
Firm/Co.
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked y please ind- ate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ® Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent 13
nereoy ceruty mar au or me oetaus ana inrormation i nave submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 14'' of the Genwil Laws.
By:
Title
City/Town
APPROVED (OFFICT USE ONLY)
Signature of Licensed Plumber Or GaSrFitter
Plumber
0 Gas Fitter Mcense Number
Master
Journeyman
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SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7 T H. F L O O R
8TH. FLOOR
(Print or
Name _6
Name of Licensed Plumber or Gas Fitter
Check ne: Certificate Installing Company
I orp.
L
Partner.
Firm/Co.
INSURANCE COVERAGE Check on
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked y please ind- ate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ® Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent 13
nereoy ceruty mar au or me oetaus ana inrormation i nave submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 14'' of the Genwil Laws.
By:
Title
City/Town
APPROVED (OFFICT USE ONLY)
Signature of Licensed Plumber Or GaSrFitter
Plumber
0 Gas Fitter Mcense Number
Master
Journeyman
1 14
Date./
iF
TOWN OF NORTH AXNDER'
PERMIT FOR-PLU BING
- 0."
S CHUS
This certifies that ....................................
has permission to perfOrml 1 ^.
plumbing in the buildings of ........................
at. . ................... North Andover, Mass.
Fee .�/)— . . . Lic. No.11f. �-5 . .......
k...... .........
PLUMBING INSPECTOR
Check # )' 5 Ir I
7158
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date '2eo!;�
Building Location a1jAb Owners NameW,4 Permit #��r`
� Amount �Jr
Type of Occupancy .51A lm -
New Renovation Replacement Plans Submitted Yes No
FIXTURES
(Print or type) Q/ Check e:
Installing Company Name G LAG P,�s [J orp•
i
/ P �. /,i irk/d- / ' M.4.016'
TelephoneBusiness — ■
Name of Licensed Plumber: Al &Idmg 7^
Insurance Coverage: Indicate the type of insurance coveragg by checking the appropriate box:
Liability insurance policy /� Other type of indemnity Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ® Agent 11
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachuset tate Plumbing Code ani Chapte9y 142 of the General Laws.
BY fri�lGleri . /�. %Nl"
Signature o
Type of Plumbing License
Title
City/Town 1cense Nu'mmB r Master
APPROVED (OFFICE USE ONLY
Journeyman
Location Uj nyt12� i, IL
No.y 4'- Date 14 c. n. J t L
M°RT"
TOWN OF NORTH ANDOVER
.p
Certificate of Occupancy
"'Suilding/Frame
$
Permit Fee
$
's�cMusEt
Foundation Permit Fee
$
_ .... a,
Other Permit Fee k
$
yECE�VE®ewer Connection Fee
$
WIJA Wection
Fee
$
44R-T?r L
N0' Andover
C°dE
lec#.i
5U1�
Building Inspector
Div. Public Works
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