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HomeMy WebLinkAboutMiscellaneous - 23 APPLEDORE LANE 4/30/2018 (2) / 23 APPLEDORE LANE 210/097.0-0078-0000.0 J Date..... ................. .... NORTh TOWN OF NORTH ANDOVER 1 PERMIT FOR WIRING 4 ,ss�►CMUs�t This certifies that ................. /?'l./f'1... ............. ............. .................. has permission to perform ................... .... .. ,... ............................... wiring in the building of.......................... n'1..r�..,}. ,..1.:............................. ....... at ...Z.3... /�/ .L .. ..... ........... ......North Andove ,Mass. ,,,cc__-- A Fee.`:57..�.�"'�,ic. No. ..��1./.. .......hpw��zi;��CTO .7............ ........... Check# �S ✓ ,I Conu-wturm¢tttz of Va aetur3e `3 Official Use Only PerrmitNo.— _ �eftvrfinetx:a�.,f-`ira Jeruit:e3 „ BOARD OF FIRE PREVENT ION REGULA 1 IONS occupancy and Pee Checked [Rev.11071 (leave blank All,work to be performed in accordance with the Massachusetts Elechieal Code(MEC).527 OMR 12.00 (nr14SE P-UVTD.T1eu17s ORTTT' .Jt�T�oau—TIO1A9 , so / S Cay or'Fawn cm. Of?'H �l,(vt/e� 1 o Me lr%sPeClOr of j er: By this application the undersigned gives notice ofhis or her intention to 3erfbrm the electrical work descn'bed below. London(Street&Number)—2 a_ tvp I ©✓^e- 12 O�s1ot r od T ez /L t MsC7 0 Q x giepboaeNo. Owner's A ddress O? 1, 10OR6- R i;s this pe,-n?-,t in conjun n ar:� bu ice-pe Mtz fes� T o ❑ (the k Approgrinte So.-y) Purpose o:Buiidi✓8 s/ ��ce +�- '.iii`.t�F1� 6F'`%3iiL`II l ao. Etist€ag Service Amps t Vo.N Overbee d❑ Jndg;d❑ PIo.os I:seters New Service ps / Volts Overhead Q U:zdn d❑ No.of i; e_ers Number oy:eeders ane Arn-pdekty Location and Nature of Proposed ZIecf-rzcai yvorlc: �� /( vtJ//r�J� �� O✓� �3 � ry oyi -f7 Complexion of ritetable may be x awed b,tire Inspector of 1Pires I"?3S Of S:eCPSSed l.u: incisesNo.a_C iL-SEsp.(-'addle):arts NG.Oa 2®rai Tram formers -SIA Ple.Q f-'LLI aluaire Outlets �NE 0.U1 am ot TUbS fEr'-8�eac$Gss b VA I*o`Lumiinrudres �S,-r-timing Paai F ave Q Q Wo,W mergeney g r;g �� �'3t�. �2t$Si'V Units TYle.of Receptacle Outlets 9 wo.or al Burnes U AL ���� i;lo.of Zones lata.oa s�'t?�it�i2e& pZ Ira.o:was Burners lz1o.of:ye#action an l �4^, Y .n1datbaDevices I No.a .Ranges / Ne.of Air Coad. :ro s �%Io.of�se_�ng i'aeviees Tito,of:•',taste Dimose_rs � '`eat,u€2 g MUM-, Tons =��� aizio.of Self-�' E ant ne "cp=s: aiyetec�ex�lAle:$az C Deu=ces Pro,of Dishwashers f Spac lA:ea Heating 1.0%, ��,om,Q i'laa:ciD 1 Crs�eefoa ❑ '32her Rio.of 3ry ers He-Ang Appi?aaew W-1 et a r� :ysstems:` Ida.os Devices or Egttivalert No.o_' ter , }i�lo.o= iso.of eat:Wiri:tg: este;s i Signs BaHasts Wo.of Bavices or jouivg1ent No. ydE ou assn No.o_a Bathtubs =Y � � t elecoFa-�tt3:Ca ' 'e� _ g � T_Gto_s _o_aat. OT MR: "In.3_De-ices o.E u_i vaiept Attach additional detailif desirc=a;or as required br tJre l rspector of Ii Tres EstimY ted Value of Electrical Work %-5-00- O(D (When required by municipal policy.) Work to Start-5 /S�Inspections to be requested in accordance with ti1EC Rule 10,and upon completion. Sr-1RAINCE O 'EBF : 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 cerdfles that such coverage is in forrx,and has txMited proof of same to the permit issuing once. CHECK ONE: INSURANCE [3 BOND ❑ OTHE.R ❑ (Specify. Icer ify,trader Jte paints mrd penattles ofper,fury_fits ilte i.tfarrutlion or,this appyea ot=is ?rte and corVieta HLA'%aNAilvE: EihMc TTS'/4 e JCfJL S= vicesgC.1CY.: lS7/ �J Licensee:�[ Cy i•✓ ,-U?�;pa lure r O 415- 919 (fnppficable,ewer"sxe rpt"fntJt lic2nsenuurberline.} 3 .g .jdo., , 9,790 Address. f�O O �7 9�/ /?'l J od le 7ili�► �'Y1'� U/9 y y Alt Tet.No.: P ''Per M.G.L.e.147,s.:57-61,security work requires Department of Public Safety"S"License: Lie.into. 's3:JNE 'S jSEJI AIttCE vrs'�+ ?Ij : !am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby umive this requirement. I am the(checic o Owner/Agent ne}❑owner [j owner's agent. �.e _ 5ia��ra e Teiephoae No. M+ r='��`: S I b 4� � ��_�� �� ,,. The Commonwealth of Massach usetts Print Form. Department of Industrial Accidents Office of Invesdgations I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADnlicant Information Please Print Legibly Name(Business/Organization/Individual): 1--- 1,4,14 6-77 V/C cF-S .1 jQ C Address: �y. �✓`0 Y Y City/State/Zip: i 100/6 T aN A/I -01�YYhone#: q 7r &F �1- Are you an employer?Check the appropriate box: Type of project(required): 1.04 am a employer with- 3 — 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance; required.] 5. [1 We are a corporation and its 1 OZA Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions 1 myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑Other employees.[Ido workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Polic #or Self-ins.Lie.#: ?L'✓G CC f �7�1 Y —_Q f � Expiration Date: Job Site Address: a? e-ook 6- _ City/State/Zip: 9/0//7� M UIfYj .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 bf 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 eert6 under t p nd penalties of perjury that the information provided above is true and correct Signature; Date: S/ao /is Phone#: 9 7 6- 7 5' 0 Oficial 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 6.Other Contact Person: Phone#. r►OR'r#f TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 88,�c►,uss (( (( �� This certifies that...... v.�.��t w 5 JCS W 14 has permission to perform.... �. � +w...... ���lr> o.. ............................... plumbingin the buildings of............................................................................................. - .... � r� t^�;... ...........��.:: rr............�North Andover, Mass. Fee.T/ pe Lic. No. .. • -'' ...... >.I.. ?' ....................................... UrPLUMBING;INSPECTOR Check# �� 103q1 V MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAME P OWNER ADDRESS TELI FAX 0 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER NIL_ _j 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 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR 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. PLUMBER'S NAME Nicholas Savvas LICENSE# 15234 SIGNATURE MPQ JP CORPORATION El#PARTNERSHIP©#OLLC❑# COMPANY NAME I Titus/NSAV ADDRESS 111A Mary Jo Lane CITY Derry I STATE NH ZIP 103038 TEL 9788043303 FAX CELL EMAIL Iclearwaternsav@gmaii.com �1t ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTIONAOF9 Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES t. \ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):Titus/NSAV Address:11A Mary Jo Lane City/State/Zip:Derry, NH 03038 Phone#:978-804-3303 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑I am a employer with 3 employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 9. ❑Remodeling 9. El Demolition 3.[:]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:Hartford Policy#or Self-ins.Lic. #:76 WEG VK0289 Expiration Date:2/16 1. Job Site Address: H}D�LI�.G�,l'-e [ °!� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expire 'on date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi I n. I do hereby c rd and the pains and penalties of perjury that the information provided above is true and correct Signature: Date: WV 115 Phone#:978-804-3303 ` Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ---- — w.rraw..arva-.a �aT" r:2_i7F? iVMMVIYrY Vnwar.i`1: :• €::;< t o 0 0 • _ - e o PLUMMBER l G'ASF('IT�Ei$ pLUf�{BERS$#�fi Gi4SFtTTIc( S ISSUfS THE FOLLt)W1tpLiJrENSE t SSUES Tti€ FOJ_L OWI( GIt 1VSf € ` L::I2C [10 AS A MASTIR PLUMBER L_t.t>JiNS tY A JQURNEY SAH PLl1MBfl rf N I !*AS R_SAVVA - E a J4J d110J:AS P SAVVAS : <: w. £ Vis, x 71A MANY.:J© RANI: .„ y 11A MARS J2 LAiJ1 { U --0-.3o38 4623 ErY t N 43038 462 <. 05d1/) i�z 206 6 : ._ . 9 3 - • . 2o6.g64 _ . MMONINE:ACTH-OE MOS". HU80. Commonwealth of Massachusetts • • • • • Department of Public Saf -BOA�IE3 C?F v ePa ety SHEEN -f�t-Y_A�._'VOR--lt License: PM-297297 -. Pipefitter Specialty Master "ISSUES THE'- FOLLdW1 L I CENSEk THE- . .A MASTED ) NJ ESTRrI-GTED r, NICHOLAS PSAVVAS = ` a 11A MARYJO LN �'j'- = i s -- - Derry NH 0303 �r ff1 CF1t1LAS P SAVVAS 8 f t y 11A MARY JO- LANE; Expiration: IIt�J2Y H 03038 4623 Commissioner 07/08/2016 7.2(1r(tif iii/a:R:/..t#>r;<:'=> a x� ,'f^i The person named below has completed the ThacFit _e training prograand is hereby awarded the.* m x CERTIFICATE OF TRAINING. : R �y/LL$l td�Of11p�nj InC � ,_ tC��^33�,�,,/',/ �4 _ �:. Piprrrg Distribvtfon firodficts + �= 4. a3 5 { Il �•Y �j 1i 3 r ',.. 2665 Research�r�ve. I Molina-iaJWW4928m? - Installer's Name-. •mp8ny : Phone{900370-500 Fax(9r79)27D--1600 <- }` N°" 21.89 `shuetor - zs, x, 3 ertlflcate 1Vo. '., :G - Y23t F�m141 Service Center 301 WOODS PARS DRIVE CLINTON NY 13323 MON-FRI 8AM to 6PM Eastern Time (866)467-8730 SCIC.NewHartfordCa hehartford.com FOR ASSISTANCE WITH A CLAIM CALL (800)327-3636 76 WEG'VRO289 ------------- r� Date. �IGL/Z . . TOWN OF NORTH ANDOVER 3r �a,r ...,.'• OWL PERMIT FOR PLUMBING SSACMUS� ,Q �� / This certifies that . .!. !1?7G''��?�. has permission to perform4*44. plumbing in the buildin sof rlov., . . . . . . . . . . . . . . . . . . . at . . . . �' '� !e. . �. . . . . qq 83 c �orth Andover, Mass. Fee. G �.Lic. No.. g . .. . . . , a,,, A . . . . . . . PLUMBING INSPECTOR Check # ��7G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: N�' �i�/e—,MA. Date: 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 2 w (A O O W N h Q N V H W C Z VI C Z F Y Q Vf Q W C7 Cr Q C W a H Z F N H Z y) _ {A Q yrj,� Z W'A W _ y to O d ~ Q . ~ 0 QCO LUJ n Q 'n o Q W or ac Z en {/� Z a o: ti ol3 O W Y x x a Q U Z Q O 3 a Y Z H tW- H u' I a s in o o > > o = o Q a a a � u a oc o a a m m o 'c SUB BSMT. BASEMENT 15T FLOOR 2ND FLOOR 3RD FLOOR e FLOOR 1 ST"FLOOR e FLOOR 7'"FLOOR 87 FLOOR Company Check One Only Certificate# InstallingCom an Name• cY Corporation Addresw?OA �/d City/Town: � /� State:..AW. [I Partnership Business Tel: Fax: r// cS, Jr ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ZeNo❑ If you have checked Yes,please indi a the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner E] Agent ❑ Signature of Owner or Owners Agent I hereby certify that all of the details and information 1 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 th67Massachusetts State Plumbing Code and Chapter 142oft General Laws. i By Type License: Title ember Signature nPricensed Plumber Cityrrown L!f master Q� APPROVED OFFICE USE ONLY) [:]journeyman Number: GLJ The Commonwealth of Massachiisetts Department of Industrial Accidents Office of Investigations 9' 600 Washington Street Boston,MA 02111 nwip.mass goildia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (business/Organization/Individual):�/�Q!/,�,/Q 1�s /�BjAI fe/1/ rjt/ SL Address: ,:A40 �iOMW /J�t/iT jD City/State/Zip: /� Phone#: Are you an employer?Check the appropriate boy: Type of project(required): �. I am a general contractor and I 1. I am a employer with ❑ g ❑ employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition and have workers' to working forme in any capacity. employees Y � [No workers $comp. insurance comp. insurance. 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10. lectrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their I 112rPlumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§I(4),and we have no 13.❑ Other employees.[No workers' comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that.check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I aur an employer that is providing workers'coarpensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: / p �,Ifz Policy#or Self-ins.Lie.#: 7Q i3alO Expiration Date: Job Site Address:/ J'�� �`L City/State/Zip:M!On i�t/�ie._/1___ D/� 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. 1 do hereby certify tut the pains and penalties of erjrr that the information provided above is trite and correct. Si natur Date: Phone M 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 5.Plumbing Inspector 6. Other Contact Person: Phone#: Date......../.:.is: ..... 1 NORTH °�� °:•1"° TOWN OF NORTH ANDOVER A PERMIT FOR WIRING sACHusE� This certifies that ..........T.......L-e. J ......... ......................................... has permission to perform ........ � c...e-...... ................................ wiring inthebuilding of......... .fv.��f. ..�� '.................................... at......�:. .. ��C......Gti ............. ........................n. ,North Andover,Mass. .... Fee.... ...."""_" Lic.No. .......... ...............1'44;0�=n�.J4........ .� ELECTRICAL INSPECTOR t Check # 86 (, ! C.OmrfwnweaUh o�cc/I/a�3aciusse Official Only Aparb.d ol.}ire Service9 Permit No. �% / Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev.1/07] eaveblank 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 PRINTW INK OR TYP4 ALL INFQWTIOA9 Date: q-31-0 9 City or Town of: VorA 7 h o t,l Ai To the Inspector of Wires: By this application the undersignedgives notice of his or her intention to perform the electrical work described below. Location(Street&Number)_ 3 5 4,pple &0 re- Owner or Tenant ©P GTelephone No. Owner's Address s R 1- • ` 17, 68s S--9F2- Is S-9F2Is this permit in conjunc 'on wi a building permit? Yes ❑ No ❑ (Check Appropriate Boz) Purpose f Building "S UtilityAuthorization Purp o g � 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: D ( - red t0g ►-aA Air , n r,? oi c � q Completion of the follow- table may be waived by the Ins ctor of)lues. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fan No.of TotalTransformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool S�nd.Above Eln-d. ElBatte units o.o cy g No.of Receptacle Outlets <N of Oil Burne FIRE ALARMS No.of Zones and No.of Switches No.of Gas Burners o.o ete Initiatintion Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Self-Contained No.of Waste Disposers �To �P um er ons — Detection/Alerting Devices c�p No.of Dishwashers Space/Area Heating KW Local❑ umConnection other No.of Dryers Heating Appliances Kyy Security Systems:* r7' No.of Devices or Equivalent No.of Water KWo.'of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunications firing: No.of Devices or Equivalent f OTHER: /�, Attach additional detail if desired,or as required by the Inspector of Wires. �l Estimated Value of Electra Work: �y U (When required by municipal policy.) Work to Start M 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE CV BOND ❑ OTHER ❑ (Specify:) <'�,7 t(r l C hyls 1(rq K C e I cetYify,under the pains and penalties of perju ,that the info n on this application u true and complet p C FIRM NAME: PA a LIC.NO.: p / Licensee: Signature IV LIC.NO.: (Ifapplicable,enter"exempt"in the license number linef ��T 7 � Bus.Tel.No.' Address: Px-� 44ceif� =� Alt.Tel.No.: ,7S'3 Y *Per M.G.L.c. f47-,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 PERMIT FEE: S I Signature Telephone No. 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.01 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 ofongoing construction activity,and may be-deemed-by-the.Inspector-ofWires abandoned.and.invalid_if_he--. .— 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 of 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 fi puipose 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 extending-through August 15,2012. c ule 8—Permit/Date Closed: ***Note:Reapply for new permit Permit Extension Act—Permit/Date Closed: L 99 Date..�--.�j.- 0.!......... f NpRTM 4 3?��_'�,r��-�1•_'s�ppL TOWN OF NORTH ANDOVER wrwww« � - PERMIT FOR WIRING �,SSACHU`��� This certifies that .............. ............ Eg ................................ has permission to perform ........... � �<'�?'/J�7& .T ..................... Ndring in the building of...... Z.. a/P .......................................... . ..........G ��L E............................ .North Andover,Mass. Fee....r9..S�.�r� Lic.No..,f,61,97..4 (/26~ r,<`... .. ELECTRICAL INSPEC7Y�t� Check # 15-1 894v G BOARD OF FIRE PREVE-N'[10N RESU AT10NS and Fey Cbecioed APPLICA' M FOR PENT TO PERFORM ELECTR"L WORK (PL"WPR v MJWORl7FXAU Da — ? .� —© 9 o ov sydrtssW&*--o�et� Am;-Wbpa�rmBteateosriaet�odcaesorBadbaMra►. tar ttw� .et�xaist� -�2 3 #gpg)e �7 OmsrarTmmt Ga i) Fn_S rvl r�r-1C ._ 7iipiaaai�M. Ommw%AdkM -- 5o�r.m.it� W 1110. ❑ x. ❑ OOM& ft* liaeMaadBs�is�-��. e� 1 C1(f 1/1l' a U A lta. eft Aso_.. 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HORT/y TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS '^ 7/ 1 This certifies that ,�-J �,, c c l /l has permission to perform . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . .. . . . . . . . . . . . . . . . . at. Z. 3 /?A/r. .c. . ..1, , . ./ . . . . . . . . ., North Andover, Mass. f �- Fee. .a?.)." . .Lic. No.. . ?.� . ? . . . . . . . . . .t— ! ! .`.''j--N . . . . . . r PLUMBING INSPECTOR Check # Z 1 -7 5069 �1--\ (Printor Type) NORTH ANDOVER, , Mass. Oats ,l9/ Building ,L3 Permit c Location . Owner's �� Name tflo A F_nsdor- New ❑ Renovation ❑ Repllacement (d�Plsns Submitted: Yes C3No.C]F XTUAES'....... — M s dc • ~ J M O s x M r A el 4t M s e s s M s ea e s s a= s o s e a < F M s : � 4 t t If tFt s r O p t t ! 4 ~ A O 4 J11 !at O O 6 ` d IL s O IL W M IL sua—esnT. •ASKUNNT ISTFLOOR IMO FLOOR 3110 FL0011 STN FLOOR •TN 'LOOR 4 4TH FLOOR. ITH FLOOR i •TH FL0011 - o : Certificate Installing Company Name Andover P.1 bg. & HtgCo. , Inc. jheck o ne2122 Address 20 Aegean Dr. Unit # 10 ❑Partnership Llpthuen, Ma 01844 ❑Firm/Co. Business Telephone (978) 685-8383 Name of Licensed Plumber George LaRose INSURANCE COVERAGE: ec e I have a current fiabllty Insurance policy or Its eubstantlat equWenL Yea No ❑ If you have checked jM. please Indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the Itcensee does not have the Insurance coverage required by Chapter 112 of the Mass. General laws. and that my signature on this permit application waives this requirement. Check one: Slon ❑ store of Owner or owner's Acent Owner ❑ Agent I hereby certlty that all of the delaile and Information I have submitted for entered)In above applicallon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under thepermM Issued for turcepa tion will be in compliance with all pertinent provisions of the Massachusetts Slate Plumbing Cada and Chapter 142 of tM Cleemal By Signature This Ctty/Town ticense Number 9983 Type of Plumbing License:Master Mr'Ti('JVED(OFFICE USE ONLY) Journeyman ❑ Date... . .. . .... .. .. ,AORT1y 3r �' TOWN OF NORTH ANDOVER �. =. PERMIT FOR GAS INSTALLATION o, h �,SSACHUSEt� This certifies that . ,, .Y .� . ?. . . . . .' has permission for gas installation . . . .. . .. . . . ... . . . . . . . . . . . . . . . . . in the buildings of . . . .�'°:.�.: : !: . : . . . . . . . . . . . . . . . . . . . . . . . . at .� � �. !:. . '. . . . .�. .`. . . . . . . . . . ., North Andover, Mass. Fee. ./.,). ; . . . Lic. No.. .!.'.! . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . GASINSPECTOR Check L � i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC 1 (Print or Type) NORTH ANDOVER Mass. y Date building Location _23 AooI26ore- I. av e. Permit # R Owners Name &g:A EnSACA ? New '1 Renovation D Replacement Plans Submitted n FIXT(_rccc N W N Q N tt .O .NUS Y f. CW O LO Iw t 2 N < a >' `= m 0 W W W O IL= O W H Q N t3 W 2 H N 2 > W cc U W W 0 Z Q C' 2 a Q W p W E• 2 t7 S O 1.. 2 1-` Z 1. WW O ? k 2 4 W CC •� f y N m 0 2 O N = W > W < G 4 a is o W o W 1- t= x v v = u. o v .s v > cz a 1— O Su$-8Sh1T. a SASEMEXT IST FLOOR ' 2ND FLOOR ` 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name_Apkx>--c Ph.. . Corp. 2122 Address 20 AeAeon Mr. LHt+ Partner. mi hu el /yk- Firm/Co. Business Telephone: C979s) Name of Licensed Plumber or Gas Fitter��K,� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [f Other type of indemnity Q Bond 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 coverages. Signature of owner/agent of property Owner 17 Agent Q 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 worts and lrtitalLations performed under Permit issued to:this application will-be in compliance with all perttn=t provisions of this Massachusetts State Cas Code and Qapta 142 of the Gencral Laws, By PE LICENSE: Plumber Title sfitter- Sign are of Licensed Master Plumber or Gasfitter City/Town: Journeyman 9953 APPROVED (OFFICE USE ONLY) License Number