HomeMy WebLinkAboutMiscellaneous - 22 FIELDSTONE COURT 4/30/2018k
Date. . 6. � . ! .......
0
x TOWN OF NORTH ANDOVER
0
PERMIT FOR GAS INSTALLATION
This certifies that .... i�. ./�/ ..............
has permission for gas installation . T) nn ................
in the buildings of ./ ..........................
at ..... North Andover, Mass.
Fee.) Lic. No..�):-?�.? ... ... .. ........
'GAS INSPECTOR
Check# � I( )
4 1 S,' 0
MASSACHUSHITS UNIFORMAPPUCATON FOR PERMPr TO DO GAS FITTING
(Type or print) Date 1111Dd;'--
NORTH ANDOVER, MASSACHUSETTS
Building Locations 22 Gi eads-t.ov,e— Cour-+, Permit #
Amount $ 2 i
Owner's Name Layr'c%, mP_4:k2yn�4
New ❑ Renovation Replacement 10 Plans Submitted
(Print or
Name
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
QCorp. 2 12
ElPartner.
ElFirm/Co.
INSURANCE COVERAGE Check o e:
I have a current liability Insurance policy or it's substantial equivalent. Yes ,I No 13
If you have checked yes,please 'ndicate the type coverage by checking the appropriate box.
Liability insurance policy bi Other type of indemnity 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 1:3 Agent 13
i nereoy cenny mat an or the oetans ana mtormauon 1 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 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Pignature of Licensed Plumber Or Gas Fitter
lumber
ElGas Fitter License Number
0 Master
r7 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
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
QCorp. 2 12
ElPartner.
ElFirm/Co.
INSURANCE COVERAGE Check o e:
I have a current liability Insurance policy or it's substantial equivalent. Yes ,I No 13
If you have checked yes,please 'ndicate the type coverage by checking the appropriate box.
Liability insurance policy bi Other type of indemnity 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 1:3 Agent 13
i nereoy cenny mat an or the oetans ana mtormauon 1 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 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Pignature of Licensed Plumber Or Gas Fitter
lumber
ElGas Fitter License Number
0 Master
r7 Journeyman
Date .... ...........
40RTH TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
Z
This certifies that ... 14 h4l ... Z�1. '. 'I, ;?� ...............
.... .... ... ...
has permission for gas installation ............................
in the buildings of ......... : ............... ;�'.( ....................
at
............................... North Andover, Mass.
; , . . - , n
Fee. �,� ..... Lic. No.. ........... ............
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
ti >
MASSACHUSETTS UNIFORM APPLICATON
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T
�Tl ype or print)
NORTH ANPOVE MASSACHUSETTS
L�_-W,�))JfG
Building Locations Permit 9
C /� IountD
Owner's Name
New ❑ Renovation ❑ Replacement Plans Submitted ❑
0 31011
(Print 01=
e
Name /
Address 4` -e
Business TelepFione / ' - ` I- k- fb_ 77 '7 S
Narrp- of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
❑ Corp.
❑ Panner.
Firm/C
INSURANCE COVERAGE Check n .
I have a current liability Insuranc policy or it's substantial equivalpnt. Yes No ❑
If you have checked ves, pi a 'ndicate the type coverage by checking the appropriate box
Liability insurance policy rVI Other type of indemnity ❑ and ❑
Owner's Insurance Waiver.I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
vlass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner
) hereby certify that all of the details and information I have submitted (or n e�ed�
best of my knowledge and that all plumbing work and installations pe u
compliance with all pertinent provisions of the ylassachusetts State e
By:
Title
City/Town
APPROVED (UFi:u:: USE ONLY)
Signature of Li
Plumber
Gas Fitter
Master
Journeyman
❑ Agent ❑
bov on are true and accu�be'oin
he
:rmit issued for is application wi
pter 142 ofthe GeneS.S.
(ed Plumber Or F* er
)ce, se )NUM07e�r
Z 8 �" 6 Date ......
RTH
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
4L
Thiscertifies that .................................. ..........................................................
has permission to perform ...............................................................................
CA
e Ti n
w4ring in th b 'Idi g of ............... 1.� ... ..... ..... ............
at ...................... ........... ............ . rth Andover, Mass/
e�7
............... ... .... ... 7�...
4e.. Lic. NOP::�7?X? ...............
E crRICAL INSPECTIM
Check # I (I -� I
=''� \ l.onunonwaa[� o� ///a��ac�ttt9slfl Officisl Use Onl
2eparinurni ol ,}ira Sarnicm Permit No.
BOARD OF FiRE PREVENTION REGULATIONS OFee Checked
Revv.- 11119cyand 1199] {icave blank)
APPLICIATION eFO�RPERMIT TO PERFORM ELECTRICAL, WORK
Axvurk to be P ine with the Massachusetts Electrical Code (ML -C), 527 CMR 12.00.
(PLEASE PRINT W INK OR TYI'E ALL 11WOR L ATION) Date:� d �
City or Town of. _�_ Q�� To the Inspector o Wires:
this application the uudersigncd gives notice of his or her intention to perform the electrical work described below.
Location (Street & Nunibcr)_4Q—,26S'tlJtrt,e C t
Owner or Tenant wee( R.cdo�s
- - - �� TelephoneNo.
Owner's Address /f L/7A�a(�t i��t TiQeA
Is this permit in conjunction with .-% building pernYes No ul? Y,l ❑ '(Check Appropriate Box)
I'urliose of Building k .etaj Utility Authorization No,
--06��%
Existing Service ice Amps 12,dVolts Overhead ❑ Uud rd
6 1AJ No. of ilIcicrs . -0a
Nati•,9crvicc SAINZ Amps / Volts Overhead ❑ Undobrd No. of lfeten.
❑ '
'
Number of Feeders and Ampacity
f
Location and Nature of Proposed Electrical Work:
r
Completion of the foll urine table MaV be haired be. tltc /pis' for of Wires.
No. of Recessed Fixtures No. of Ceill,Susp. (Waddle) Falls °• UA Total
rransfornicrs KVA
No, of Lighting Outlets No. of Ilot Tubs Generators KAVA
No. of Lighting Fiitures Swimming Pool Above ❑ In- ❑ i o. o mer entg n mg
rnd. rnd. :FIRE
tte Units
No, of Receptacle Outlets No. of Oil Burners ALARnIIS No. of Zones
No. of Switches No. of Gas Burners • o Detection and
Iuiliatino Devices k
No. of Ranges No. of Air Cond. Total Tons No. or Alerting Devices
No. of'Waste Disposers heat pump 144 ber Ions --' 1h1 No. of Sel - o.ntained
Totals: _ Detection/Alerting Devices
'r No. of Dishwashers Space/Area Heating KwLocal ❑ � untcipa
Connection Other
No, of Dryers Heating AppliancesKWSecurity Syslenu:
t t o. of VaterNo, of Devices or Equivalent
I�Ieaters h1V t`lo. of No. of Uata Wiring:
Sins Ballasts No, of Devices or E uivalent
No. Hydromassage Bathtubs No. oftMotors Total HP lelecommutucatnons 111 11 11
OTHER: No. orllevices or E uivalent
additional aelall y desired, or a -T required by the Ills . pecior of Ivires.
INSUItNNCE 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: 1NSUTLANCE 9/ BOND ❑ OTHE-R ❑ (Specify:)
Estimated Value of Electrical Work:' (When required by municipal policy.) (Exp' tion Date)
Work to Start: 2 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I Certify, ,under• the earns and penalties ojperjnq; that the iti formation ott this application is trite and complete:
FI1z,t NAD1Lr � ui t dZSignature
Lic.l\o.:Licensee:
(!jalrplicable, cuter"eccrupt" in the license n sabeLIC. ir0..
Address: �a� d O 3 Bus. Tel. No.-
O\Vt lER' INSUR..ANCE WAIVER: I am aware that the Licensee does not have the liability nsu ance o�rerage normally
required by law. 13% my signature below, l hereby waive this requirement. I am the (check one) ❑ owner
Oivner/Aent ��
❑ oner's aLrnt:
g
Signature 'Telephone No.PI:Rt1f T FLE: a