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Home My WebLink AboutMiscellaneous - 217 HIGH STREET 4/30/2018r- Date :j- .. '/ . & .... 5;� ....... N2 2,� c. 9 .. .. ... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... e.. 62 -. e, � 1 i -? � � ............................................ ...... .... :� has permission to perform ....................... .............................................. wiring in the building of ..................................... .................. I at., . .. ........... ....................... , NorthMdover, Mms. Lic. N ...... Fee 0� ....... r'i ........ ....... ....... ELEcTRicAL MpEcmR 03/22/99 15:55 25- M PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �✓ THECOMMONWEEILTHOFMA S4CHII5= Office use only DEPARTMFIVTOFPUBLICSAFM + Permit No. BOARD 0FMEPREYEVT0NREGULATI0AN-V7G1R 12.00 Occupancy & Fees Checked UV4PPLICATION FOR PERAff TO PfRFORMEL =. CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSPS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -/G Town of North Andover• The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Purpose of Building Existing Service ,_•(2QAmps /20 / 2Y0volts New Service /0 Amps120/ ZRVolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes= No M Overhead Overhead I0a.4 1Q&e)ll (Check Appropriate Box) , Utility Authorization o. Underground No. of Meters Underground No. of Meters -m No. of Lighting Outlets No. ofHpt Tubs LitpsseNb Nb AI<TelNa 4��q 52'"`% /i/I.2 No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA � and Uound No. of Receptacle Outlets 15 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices _ No. of Dishwashers Space Area Heating KW 1 No. of Self Contained Detection/Sounding Devices Local Municipal Connections Other No. of Dryers _ Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Fleffie-*Cify) 3 -IIS -00 ET ratmDate Estirrmld Vah&d13ec6d W°� $ Raigh ' $ov Final`- /d 0 o L=-,seNa 0,-�q 5z1 OWNER'SINSURANaWAIVER; IamawarethattheLi=ecines=how the istra>ceammWoritssrhWiialepmala>taste#t!dbyNbsmdxmzCetralLaws aodthatmysigntaecnthisp=ntTpkMmw&i� sthistt4=ment (Please check one) Owner = Agent Telephone No. PERMIT FEE $ j1 R sitessTel. Q� 9� 1 vl C}Z12 S LitpsseNb Nb AI<TelNa 4��q 52'"`% /i/I.2 /OZ �j� OWNER'SINSURANaWAIVER; IamawarethattheLi=ecines=how the istra>ceammWoritssrhWiialepmala>taste#t!dbyNbsmdxmzCetralLaws aodthatmysigntaecnthisp=ntTpkMmw&i� sthistt4=ment (Please check one) Owner = Agent Telephone No. PERMIT FEE $ ACORD,. CERTIFICATE OF LIABILITY INSURANCE 3/] DATE PRODUCER RICHARD A KOWALSKY INS AGCY 544 LINCOLN AVENUE P.O. BOX 999 SAUGUS MA 01906 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED RICHARD PERAULT JR 102 BUTTONWOOD STREET DORCHESTER MA 02125 INSURERA: THE MARYLAND INS COMPANY INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE LTR OF INSURANCE POLICY NUMBER POLICY EFFECTI/YYVE DATE MM/DD POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $5 O O, 0 0 0 A X COMMERCIAL GENERAL LIABILITY TO BE ISSUED 3/15/99 3/15/00 FIRE DAMAGE (Any one tire) $ CLAIMS MADE II OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ t GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 17 POLICY ECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ r ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC LIMITS OTH- ATU TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ELECTRICAL WIRING CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION WIRING INSPECTOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NORTH ANDOVER TOWN HALL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NORTH ANDOVER MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AL,vrsv zo-o lnyi) "CORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25-S 17/971 - Date. TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING '�SACHUS This certifies that J r�/ ................ has permission to perform %.' Pq �/ ... / I .�. . ........... ... plumbing in the buildings of . 5.t�. F. .................... at. . '). /. �z . . // 1 0 ..................... North Andover, Mass. Fee. . 4e�'� Lic. No.. .. ........ PLUMBING INSPECTOR Check # Lt 5271 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING fPrfnt or Type) A A . ANd -, ✓i=11 . Mass. Date / /3 -C 4 *= Permit Building Location I/'� fl/471y .S7, Owner's Name l IX Z- z Type of Occupancy_ New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes (] No ❑ B . P . SEWER# FIXTURES SEPTIC# Installing. Company Name 19, 47 %'.6/ rf- //T Ca Check one: Certificate ,r Address_ /? 3 Cell& L' x,* Af ' ❑ Corporation /yam T1YW,t; A- q ❑ Partnership Business Telephone_ ` - `% r S - 5�9 S S-Ffrm/Co. Name of Licensed Plumber ,% ,Nifl l�. /7�t= 7-lu rl70- Aj I 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 coverage by checking the appropriate box. A liability Insurance policy ❑' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Ucensed Plumbe�� Title r j y/T Type of License: Master JourneymanCitown ❑ LAPPROVED OFF! US ONLY) Ucense Number ''d 2- S� Z Y Q v N W Y N J to N } O U Z 6 V7 C7 > ¢ 4J 7 W JJ J U N N W y = N H U d W N = z 4 a. a C7 ¢ < a W Z 2 O F' O f = W d W W x O d W J _ V) a a C < v} Z Y e ac a C LL. y r- 1 > x �- 3 o x O z x T yr ry 0 Y Z a O o O i. N d = _ x x d W W E' LL O U 0 'b a� 9 — Q < J J d = tt 2 d O < y in L' in p sue—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR I 7TH FLOOR STH FLOOR Installing. Company Name 19, 47 %'.6/ rf- //T Ca Check one: Certificate ,r Address_ /? 3 Cell& L' x,* Af ' ❑ Corporation /yam T1YW,t; A- q ❑ Partnership Business Telephone_ ` - `% r S - 5�9 S S-Ffrm/Co. Name of Licensed Plumber ,% ,Nifl l�. /7�t= 7-lu rl70- Aj I 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 coverage by checking the appropriate box. A liability Insurance policy ❑' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Ucensed Plumbe�� Title r j y/T Type of License: Master JourneymanCitown ❑ LAPPROVED OFF! US ONLY) Ucense Number ''d 2- S� Dat Z. . ( . ? ......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........................ has permission for gas installation ...... ................... in the buildings of .... 41.'. r I, - .................................... at .-� .......... North Andover, Mass. Fee. r. . Lic. No.. ... ..... GASINSPECTOR Check#- C'J � 1. A. 0 ;S i. MASSACHUSETTS UNIFORM APPLICATION FOR PE1: MIT TO OO OASrIT'ING3 (Print or Type) No ANDO yEn , Mass. Date -Z~ 3 - d 2 p Permit Building Location a / 7 R14 S% Owner's Name /CER Z- C4. Type of Occupancy PWgE LL /Xy4. New ❑ Renovation per` Replacement ❑ Plans Submitted: Yeso No ❑ Installing Company Name _, X -A Check One: Certificate # Address C111,Pf jpwe7 O Corporation �Tif/UE.U' /9�9 ❑ Partnership Business Telephone %dg,- Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current I!;bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes L' No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy l�� Other type of indemnity ❑ Bond O 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 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 of the Massachusetts State Gas Code and Chapter 142 of the General Laws. FTitle T e of License:�r �ii�/tt Plumber nature o cense t31um er or Gas rllerGasfilter n Master Ucense Number h7D.Z M('tic7Vt'p l0 !C Journeyman O. N N tt W � Vf C (n [C v O y T e x F W J N W 0 U m Q O M N Z W F F �' '� tC O O Z O O F- Q W F 9 ur < W N W 1-- d O C G W W ± J y Z G W C7 O o .�! S- W t✓ a 1 E W Y¢ W 7 Z. C Q d O' O W C O �y t— Z S O tti r. U. O O O J U C Y SU8-8SMT. BASEMENT ISTFLOOR 2ND FLOOR 3RD FLOOR _ 6 i 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name _, X -A Check One: Certificate # Address C111,Pf jpwe7 O Corporation �Tif/UE.U' /9�9 ❑ Partnership Business Telephone %dg,- Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current I!;bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes L' No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy l�� Other type of indemnity ❑ Bond O 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 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 of the Massachusetts State Gas Code and Chapter 142 of the General Laws. FTitle T e of License:�r �ii�/tt Plumber nature o cense t31um er or Gas rllerGasfilter n Master Ucense Number h7D.Z M('tic7Vt'p l0 !C Journeyman O. lu, .. ...... .. Date.... AO TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... Q.� ...... ...... ....... S.r.p?..j ............ has permission to perform ....... ............................................... wiring in the building of ...... .... ................................................ -Ut ....... ................ North do er, Njass Lic. N� ......... .............. ........ /. 'Fee .... 6 4). r 1 4; > ELE RI AL INSkCTOe Check # Depanment of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. !� IOccupancy & Fee Checked 3/90 I APPLICATION FOR PERMIT TO PERFORM E (leaveblankl All work to be performed in accordance with the Massachusetts Electrical Code, 5 L 27 ECTRII CA L" MR 12:00 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of --16-/2 file _ Date i�i�1Z7 - The undersigned applies for a permit to penorm the electrical wor✓�, w Location (Street &Number) k described belo. To the Inspector of Wires: f�j� Owner or Tenant Owner's Address (Check A Is his permit in conjunction with (� > cl�r� g permit: Yes No ❑ / Purpose of Building _gjjjh a buildin/{f� /t) N y ppropriate Box) � Utility Authorization No. ExisIting service Amps / Volts Overhead ❑ Nevy Service Undgrd ❑ No. of Meters Amps / 11Undgrd ❑ No. of Meters Numrber of Feeders and Ampacity Volts Overhead Location and Nature of Proposed Electrical Work 9 'Pod e No. of Li htin Outlets No. of Hot Tubs No. of TransformTOTAL No. of Lighting Fixtures A ove In_ KVA SwimmingPool rnd. ❑ rnd. ❑ ers No. of Receptacle Outlets Generators KVA No. of Oil Burners No. of Emergency Lighting No. of Switch Outlets Units No. of Gas Burners Batte No. of Ranges Tota FIRE ALARMS No. of Zones No. of Air Conditioners Tons No. of Detection and No. of Dis osals Heat Tota Tota Initiating Devices _ No. of Pumps Tons KW No. of Sounding Devices. No. of Dishwashers No. of Self Contained 5 ace/Area Heatin KW Detection/Sounding Devices. No. of Dryers Municipal Heatin Devices KW Local❑. Connection ❑Other No. of Water HeatersNo. o No. o KW Si ns Ballasts Low Voltage No. I71 dro Massae Tubs Wirin No. of Motors Total HP OTHER: 3, INSURANCE COVERAGE: Pursuant to the requirements of Massachuses General Laws of samea to this office. YES C�NO ❑ I have current Liability Insurance Policy including Completed Operatitt ons Coverage or its substantial equivalent. YES Q NO 0 ! have submitted valid proof If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE Ltf BOND ❑ OTHER[] (Please Specify) Estimated Value of Electrical Work $ (Expiration Date) Work to Start Signed under the penalties ofer u Inspection Date Requested: Rough ^---� p I ry� Final _ /— Z -- FIRM NAME LC� �� ' ,/ c Licensee `�; ', _1 LIC. NO. c Address Signature f /V LIC. NO. y l� / Bus. Tel. No.D' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required b Massachu General Laws, and that my signature on this permit application waives this requirement, Owner Alt. Tel. No. y Agent (Please check one) ss (Signature of Owner or Agent) Telephone No. �� PERMIT FEE $