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Home My WebLink AboutMiscellaneous - 23 GILMAN LANE 4/30/2018 (2) 23 GILMAN LANE 2101107.000'0 I` 1 I I 1 I I 1 i 1 f I I I i 1 Date. . .c . .. . .r!/. . . . . RTk °f ,44, - TOWN OF NORTH ANDOVER A ' PERMIT FOR GAS INSTALLATION 2 SSACHUSE4 This certifies that . has permission for gas installation, !�A - . . . .>>-. . . . . . . . . . . . in the buildings of . �?'' `c,. �`? R- ^-'f +. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ... . . . ... . !� :�+r-�.� . . . , North Andover, Mass. Fee,XI ."' Lic. ` GAS INSPECTOR Check# / r 5469 N !� CIO � I d NIASSACHi SETCS LNIFORNI APPUCATON FOR PERM TO DO GAS FTI'MG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations C � �/�� ` ez- Permit# Amount 16r)" Owner's Name New❑ Renovation Replacement ❑ Plans Submitted ❑ U z K E+ aR O Z w' F 'a 3 a ° a o kuB -BASEM ENT BASEM ENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type)�!��iJ � � �Z� �f C one: Certificate Installing Company Name /9/C yls/9 11/ _ �7 L Corp. Address r ❑ Partner. Business a ep on - a irm/Co. Name of Licensed Plumber or Gas Fitter JC yl INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes EY No❑. If you have checked yes,please in icate 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 ❑ 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 .&ork and installations performed under Permit Issued for this application will be in _cmpliance with all pertinent provisions of the Massachusetts S ate Gas Cod nd Cha er 14 the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber Cit)/Town Gas Fitter License Number Master �\PPRQ,rED OFFICE USE NLYj Journeyman i i Date... .ljj...� i ............................ OF NOwTN,� TOWN OF NORTH ANDOVER �O �O9 PERMIT FOR WIRING SACMUS� { This certifies tha( R A-,'.... .............. has permission to perform ................ .k..............................v u� . .............................. Tt viring in the building of....,.. � ..................................................................................... /'� • VY1✓�J At .............................................................................. '.............flCTR�IiC��AL North Andover,Ma Fee.. ..........Lic.No. INA +.....'......... .. ........................... . ........ EINSPECTOR Check# i J! Commonwealth of Massachusetts Official Use Only - . Department of Fire Services Permit No. Occupancy and Fee Checked ,M .. BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] peaveblank 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 INMK OR TYPE ALL INFORMATION) Date: (G- J g- I q City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersignd ives notice of his or her intention to perform the electrical work described below. Location(Street&Number) C I Log) LA Ae— Owner or Tenant D_ ,vt t S I g y 4 G AJ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes P-----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: R62/L.e_&4 rco"U rNib ou 1„(/S P(6-5 ddLP ui F2CPt M IFS 40 (bde -- Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA �- No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o,o mergency ig ting No.of Luminaires Swimming Pool rnd. rnd. El Batter Units r �- No.of Receptacle Outlets I No.of Oil Burners FIRE ALARMS I No. of Zones No.of SwitchesNo.of Gas Burners No.of Detection and [ ^ Initiating Devices tI ' No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons g No.of Waste Disposers Heat Pump Number Tons J.KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Device s or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: J� No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 11506 (When required by municipal policy.) Work to Start: (p-(5 `'f 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,tinder the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.:I C)90—8 Licensee: C(tq;c C(A-Ct I fa w.,0 Signature ___LW=-NO.: (If applicable,ent "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: 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. $1 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.G.L c. 166, §32,an p electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the i notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires 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 purpose 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. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: j PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors ents: V J r Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors mm ts: C4A of L� / . Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com i The Commonwealth of Massachusetts - - Department of 1ndustrigl Accidats Office of fnvestigations 600 Washington Street Boston,MA 02111 www.mass govIdia TWO ers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pliimbers A11lxcant Information Please Prim Le 'bl Name(Businessiorganizatioai&&vidual): Address: r - City/Sh( YOO rO ) Phone#: Are you an enaployer?Check the appropriate box: Type of project(required): l.❑ T am a employer with 4. ❑I am a general contractor and T 6. n New construction f employees(full and/or part-time).* have nod the sub-contractors 2. am a sole proprietor orpartner listed on the attached sheet. 7. [�Remodeling ship and`iave no.employees These sub-contractors have 8. ❑Demolition working 'for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. ❑We are a corporation.and its 10.[]Electrical repairs or additions 3.❑ required.]' officers have exercised.their . am a hoin.eowner doing all work right of exemption per MGL 11.)]Plumbing repairs or additions myself. oworkers' comp. c.152,§1(4),andwehaveno y [N p 12.x]Roofxepairs insurancerequired.1 i employees.[No workers' 13.[:]Other comp,insurance required.] �xAny applicant that checks box#f must also fill outthe section below showingtheir workers'compensattonpolicy information. i'Homeowners who submit this affidavit indicatingthey Aire 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. lam an employer that isproviding workers'compensation insurance for fny em ployees Below is the policy andlab site information. Insurance Company Name% Policy#or Self-ins.Tlic.#: ExpirationDate: Yo Address: City/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Faijure to secure coverage as re%*edunder Section 25A ofMGL o.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 maybe forwarded to the Office of- Investigations fInvestigations of the DTA.for insurance coverage verification. Ido hereby cert&under the�iwuandd Ve—s ofpe.-Pry tt'iat thein•formation provided above zs true a d correct. - Si ature: Date: Phone#: Official use oply. Do not write in Mis 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' Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an ernployee is defined as"...every person in the service of another under any contract ofhire,- express orimplied,oral orwrittem" An employei is def mad as"an individual,partnership,association,corporation or other legal entity,or any two ox 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 notmore than.three apartments and who resides therein,or the o ccupant 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 io 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)andphone number(s)along with their certiixcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other that the members orpartuers,are not required to canyworkers'compensationinsurance. If an LLC orLLP doeshave employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confi nation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town,that the applicatign 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 thatthe,affidavit is complete andprinted 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-me to fill in the permit/license number whichwill be used as a reference number. In.addition,m applicant that:must submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessmy)and under"Job Site Address"the applicant should write"all locations in (city or towh.)."A copy of the affidavit that has b ee a officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit-ii on file for future permits or licenses. Anew 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 orliermit to burn leaves eta.)said person is NOT required to complete this affidavit. The Office of Investigations would Ile to thank you in advance fox your cooperation and shquld you have any estioms\` please do not hesitate to give us a call. The Department's address,telephone and fax number: no CQ ollwcalth of f-asmchUw#,q DepaXIMent dTududdal,A,ccidants Of Roe oflimstigAftns Boston,MA 02111 P .#611.27,4900 ext 406 QJr X-877MA-SS•".'F _ Revised 5-26-05 FaY,#617"727'7749 ' W�4v.�aS�,ggv�dla . i COMMONWEALTH OF MAS ACHUSEf :..;: BOAR ff1:0 R'1 CiAN,S SSUESENS THE FOLLOWI'N.G>` LICE;;::::. RSG OURNEYMA,N ELECfiRIG°IAN CRAIG CATALFAMO 11 WOo1}LAND 'ST RSA .,I 10898 a 0 /31 39 1 v : 1 Date...� ....��...�.�....... O HORTl� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUs� This certifies that ...................../,,' ................................................. has permission to perform .........�lll.�rzW. /........................................ wiring in the building of....... ./ �'STAT.?................................................... at.... :,1....��....44^'.OW........ am................. .. .North Andover Mass. Fee..3 5 ��"'Lic.No.�Z�,1..D3B LEC MICAL INSP R Check 10540 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK aa All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 aK(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: f a 11(�W t City or Town of. NORTH ANDOVER To the Inspector of Wires: \\,k By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Q!) G;CMan Owner or Tenant �rrc�� (yu S So, J k y 4-e t1 Telephone No. a�(� Owner's Address Is this pIrmit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 0.JJ t'r1rA Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters f Number of Feeders and Ampacity rr 1 Location and Nature of Proposed Electrical Work: �p�rno 11 r T r t-a-C.I-<- 3 t c O JfI1 di J Completionlof the ollowing table may be waived by the Inspector o Wires. No.of Recessed Luminaires - No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ 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 Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KNo.of Self-Contained Totals: W Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW - No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent [OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Val4oflec ical Work: I ,pp, pU (When required by municipal policy.) Work to Start: 7 11 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCEE GE: 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 f Yce,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenaltiesy%fperjury,that the information on this application is true and complete. FIRM NAME: 36kx\ — Mbs-(Ktr a LIC.NO.:I 0Q9 0 b-B License r Signatur LIC.NO.: t;;kW3-R (If applicable, enter "exempt"in the license number line) Bus.Tel.No.: 97A 3CoO 9S9a Address: Lo v l 61A. 01830 Alt.Tel.No.: �7&91 Pl C19q *Per M.G.L c. 147,s. 57-61,security work rdquires 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 Owner/Agent Signature Telephone No. PERMIT FEE: $ ,4 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 b� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.T 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[:]Electrical repairs or additions. 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.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are ng doiall work and then hire outside contractors must submit a new aff davit indicating such. $Contractors 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: r Policy#or Self-ins.Lic.#: Expiration Date: i Job Site Address: City/State/Zip: 1 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date Phone#: 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.. 4 ....................... NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ,SSACMUS This certifies that .................1.o.!�........ has permission to perform ..... "P. ly wiring in the building of.................../11 .................................. at..... North Andover,Mass. Fee... Lic.No.5.13.0-.O.E........... .. EL ZCTRIC... AL INSPECTOR'* Check # 64-71. ZN ()I[it:i al I MIN Commonwealth of Massachusetts r Permit No. Za el 7 2- Department of Fire ServicesxI I Occupancyand Fee Checked 7, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9 051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All ,cork to be performed in accordance with the NliINSildlLISCUS Hcorical Co&j\IFC) 527(AIR 12.00 INK OR TYPE.I L L LVFO N Date: l,PLE,1SEPRLNTA WTIO 6 /nit To the h7Sj?eL'101'0jJfi1TS: City or Town of: /t/61A _. OV er By this dPPli0ti0ll the undersigned gives notice ot'his or her intention to pertorin the electrical work described below. Location(Street& N u lit her) e Owner or Tenant Telephone No. Owner's Addressorh Is this permit in conjunction with a building permit? Yes E— No El (check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 6200 Amps Volts Overhead 0 Undgr(IF] No. of Meters New Service Amps -1❑Volts Overhead F Undgrd -1 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A,,-Ay rA Complelion o/the,,iJllmt iq, able Inew be wail"I 11v Ilse his c'-tor of jV,,- No.of Recessed Luminaires ,2il No.of Ceil.-Susp.(Paddle)Fans No.of Tollall Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above Ei In- N—O.—Ory—mergency Lighting 6 grnd. grnd. El Battcry nits No. of Receptacle Outlets /,;? No.of Oil Burners FIRE ALARMS No. of Zones of No.of Switches No.of Gas Burners No. InDetection and itiating Devices No.of Ranges No.of Air Cond. Tops! No.of Alerting Devices No. of Waste Disposers 1 Heat Pump I.Numher Tons [K.W.77�,!No.of Self-Contained Totals: Detection/A lerting Devices No. of Dishwashers Space/Area Heating KW Local[] Municipal Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: "eaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs v No. of Motors Total Hp Felecommunications Wiring: 2_ No.of Devices or Equivalent P4 OTHER: I'dt,sircd, oras rcquircd lit filL.hisl't,01)j,"'i 11"l, Estimated Value ofElectri A Work: Ok lien required by municipal policy.) work to Start. Inspections to be requested in accordance with .NIEC Rule 10, and upon completion. INSURANCE COWERACE: Unless waived by the owner. no permit for the performance of electrical work may iSSLle 1.1111CS (lit: licensee provides proorof liilbilitti illStil-auCC including"conipletcd operati611"coverage or its SUI)SMIltial Cquivalcllt. 1,11C Certifies that such C( e in 1,01-ce,:111d has v.,.hibitUd proof of:.arae to, the Permit office. ( I I E C K 0 N E-1 1Ni S1 R,\N(T i3o\l) [:] (mll"R 1-1 (Specify:) f -eriilj,, wider the tins antipt i affies q1'1,)erprrj,,.1tal the infin-nialion on iltivapplicadon i,%brie e encomlilete. F11 R M NAME: '/0^ c 6_7 LIC. 1 0.: 41 /_1 180)d-f C 9.,i C. 0.: 36 T6,E Licensee: (/1", -!,lir ill thf'l,L.I,.- T I ble.) Rus. Tel. NO? Address: .-\It. Tel. No.: Security System Contractor License required for this work, if applicable,enter the license number licru:Lel OWNER'S INSURANCE WAIVER: I ;iiiiaware that the Liccllseed,)(�s not have the liability illSLirance,,ovcr,.we ncrliially required by law. By my signature below, I hereby waive this requirement. 1a the(check one)0 owner El oWlicr,"i .1gelit Owner/Agent :;ignatuve PFR,Vf f T FFF: S � �� .y o� ��- z�- � � �� 6� lZ -z .� � � Date.F . ox. NOR7: o TOWN OF NORTH ANDOVER aaaL PERMIT FOR PLUMBING ,SSACHUS This certifies that . . . . . . . . . . . . .. . ..`"J . . . . . . . . . . . . has permission to perform--4-.r^O� -`47'. . . . . . . . . . . . . . . . . . . plumbing int the buildings of . . . . . . . . . . . . . . at ... ^• . . . . . . . . ., North Andover, Mass. Fee��.yy 1. l�'. . . . .Lic. No..f 3 G art. -'`� �. . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # C� a � W/ /7 � 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS n Building Location c. Owners Name �)/( /`� permit + —��— /` > s7 SZ� `�' Amount Type of Occupancy /t f_'$i� y� Q` New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES Q Cr z z z z a U Fro / a ~ d 3 w Ftn ►-� A A a H d x x x w W d 0-4Q Q Q C a a A a s l��v>avr isr HIM 3MlL,oCIR 4M FLOOR 5M FLOOR sMHLOOR 7M HSM gm FIiOGRI I + (Print or,type) 1 Check one: Certificate Installing Company Name / e ❑ Corp. + l b Address' � Partner, l� Business Telephone _ WFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy W 11Other type of indemnity 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 Signature Owner Agent i 1:111 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 Massach tts St e Plumbin C e and C pter 14 f the General Laws. By: NignaLure ul i7censecium er Title Type of Plumbing License City/Town icense Numner Master Journeyman D APPROVED(OFFICE USE ONLY i