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HomeMy WebLinkAboutMiscellaneous - 25 ROYAL CREST DRIVE 4/30/2018co C) N O O a) C O cu milil 0 00 LO LO0 N U) W cn O L 0 V o EQ Z _0 o O a Z w O o Q "O c O O 0 = L d L 0 _0 € 0 LL Z H cu a U. U Z Wa. ac C6 O cu O m p CDCU <n O O O i Cu Cu Z > c cu o — O O� = O U L E Q Q 0 7r F o o � L `t ( o cu O m 0) z 0 CO ,^^ 3 o a) rn Ln N 4 U OC O Q Q L Z ^' to N C V ~ • L (Q J va��-e Ms Commonwealth of Massachusetts i IFDepartment of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only'—' Permit No, __ _A_•� � 7 Occupancy and Pee Checked ---- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL heave blank) All work to be performed in accordance with the Messaehusctts Electrical Code (Mjwo K (PLEASE PRINT IN INK OR TYPE AL,� INT City or Town of: l��`t 1 �. O �{�I TION) Date: By this application the undersi ned ANRc�Q�'�Y To the I Y gives notice o is or er intention to perform then electrical si w k described below, Oi r, Location (Street & Number) Owner or Tenant ��� Cr ' ►SCO Nam Noes d 1 � � Owner's Address r, _ V � LL ' Tpio,.► _ _ ., n Is this permit in conjunction with a building permit? Purpose of Building C1 % , , o t : , Existing Service — Amps / _____Volts IYe lAg --- -- Amps / Number of Feeders and Ampacit —volts Overhead n v • �• Overhead ❑ Location and Nature of Proposed Electrical Work; �( '" -- - ----.. :'�=C=`�,, _._.`J_/,.,.._.,,_•, t`_,,.,.,,.,�..,_ ..ter-��]� r.,.i �,-IA :�1, Date....a 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatQ.i>.�Ii.�� has permission to perform,.tvy.)..c .r tfv►.sa......1 wiring in the building of..............t`?......................................................................... at 2.5..Rbl !1 . ...... .,North Andover, Mass. Fee'.- ..r....�........ Lic. No.Z �G.3 ....ma ....../ . '..... LLECTRICAL INSPECTOR Check # 12679 Undgrd [] No. of Meters Undgrd ❑ No, of Meters M' be waived b the Ins e for of Wire o - ..,.,, uanr n KVA Generators KVA .0 merencyrig ------ Bette Units VIRE ALARMS No. of Zones o, o etec on, an Inttiatin Devices No, of Alerting Devices Dat ctioNAlertin nDevices Local ❑ untc pa onnection d Other ecur ty yystems; No, of Devices or E alvalont Data Wiring,:,, No. f ces or E uivalent e ecommun cat ons r ng; No, of Devices or Equivalent iJ'dertred, or as required by the Inspector oJ'Wires, lance of electrical work may issue unless )rage or its substantial equivalent. The the permit issuing office. F,stimated Value of)alectrical Wor vrvv •� .L Work to Start; 4/D -Y' ,),, (When required by municipal policy,) (hxptration Date) '� _ Inspections to be requested in accordance with MEC Rule 70, and upon completion. I certify, under thepalns artd penalties of perjury, !liar the Information on this application is true FIRM NAME: Ne,� p ton. '� � and complete, Licensee: LIC (ljapplicnble enter 'exempt'''in the licet'se nuntUer line,) Sl�i,atur Address; 0 y, LIC, NO,t (, n OWN>ER',S [NSU E WAIVI; Par ou a `i `l Hus. Tel, No. required b law, B Io I h aware that the I !ceases does not ave the liability Alt, Tel, No,- - 3 Owner/ gent y my stgnatut e below, I.hereby waive this requirement, I am the (check one ty insurance coverage normally Signature owner owner's a ant, Telephone No. PERMIT FEE. Date ...... * .. P.�A TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies ".0, has permission to perform wiring in the building of ......... ............................................................. ........... at . ......—...U,North Andover, Mass. Fee, ....Lic. No 2©G .... M4 ....... .......................... .9 LECTRICALINSPECTOR Check# If, t Commonwealth of Massachusetts Department of Fire services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No, `� Z Occupancy and Fee Checked rev. 11/99] leave blank 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 IN INK OR TYPEA4 IN , Oxy TION City or Town of: NOY Date: A 13y this application the undersi netor of ires: A (J ovey— To the Ins e ' i3 d gives notice o is or er mtenUon to perform the electrical work described below, Location (Street & Number) � Owner or Tenant MS_ i crAco T hrb\rQ,, y NC'` . _ �� 0' Owner's Address r•, V— , - -- _ V LLC Telenihnnn w., 0-7r- Is this permit in conjunction with a building N tiv O) FSS Purpose of Building_ �i1JJ �L; permit? Yes ❑ N° (Check Appropriate Box) Existing ServiceAmps Utility Authorization No. .�,� - New ervlee Amps / Volts -- —Volts OyerheadEl Undgrd ❑ No, of Meters Number of Feeders and Ampacit / Volts —Overhead IF Undgrd ❑ No, of Meters Location and Nature of Proposed Electrical Work: _ ve ► ��ve , , ,ms s aN tt�te cs.,re.Ye5sfU C'5 'the C 1511. yr No. of Recessed Fixtures letlon a ollowin table ma be waived b the Ins ector o Wires. No. of Cell-Susp. (Paddle) Fans oo No. of Lighting Outlets No. of Hot 'Pubs Transformers K VA t No, of Lighting Fixtures Generators KVA No. of Receptacle Outlets Swimming Pool eve n- rnd. rnd. ❑ o. o mergency g ng Bette Unite No. of Oil Burners No. of Switches Na, of Gas Burners FIRE ALARMS 0.0 No, of Zones No. of Ranges No. of Air Cond, otal etec on, an InitlatinDevices No, of Waste Disposers ea um p ns um No, of Alerting Devices No, of Dishwashers er ons Totals' Space/Area Heating KW Detection/Alertln Devices No, of Dryers Heating Appliances ❑ antea Local onnecttion 11 Other 0.0 ater Heaters KW KW o. o ecur ty yyss No. of Devices No, Hydromassage Sl ns Ballasts or E ulvalent Data Wiring: Bathtubs No. of Motors' No. f Devices or E ulvalent `r 'i OTHER: 6 Total HP L=I��T,i C �,�e d a ecommun cat ons r ng; No• of Devices or E ulvalent INSURANCE COVERAGE; Unless waived by the owner, no permit for the performance of electrical work may issue u l ttach additional detail II'deslred, or as required by fie lntpector of Wires, the licensee provides proof of liability insurance including `t;ompleted operation" coverage or its substantial undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office, y unless nal equivalent. The CHECK ONE: INSURANCE [F' BOND ❑ OTHER ❑ (Specify: Estimated Value of Electrical Wor ' (When required by municipal policy.) (hxpirntion Date) Work to Start; d Inspections to be requested in accordance with MEC Bute 10, and upon completion, I certify, under, the pains and penalties o er ur that the Information on this application its true and complete FIRM NAME: N2yJ .%P ,i y, G P Licensee: LIC. NO.; 12 0 (If applicable enter "exempt "in the lice se number line,) Slgnatur Address: D LTC. NO,; d OWNER'S INSUPor mt✓� d`1 Bus. Tel. No. RAN WAIVER: I am aware that the Licensee does not have the liabili Alt. Tel, No., 3 required bylaw, 13y my signature below,l hereby waive this requirement. I am the (check one insurance coverage normally Owner/Agent Signature owner owner's a ant, Telephone No. PERMIT FEE; $ SU OC yI 5 f !tte 1,0111410npi)ealth gf'Massaehtfsetts De,0artltrent of IIIdrrstrial Aecidlents a Office of Investigations 1 Cortgt"ess Street, Srrite 100 BostonMA 02114-2017 WH)"I' ass gov/dia WoIrkeirs' Compensation Ju.sulirance Affidavit: Builders/Contractors/Electricians/Plumbers in icant rnfnrma+;. " Na1110 (.Business/Organization/Individual): Address: 2m City/State/Zip: OgIc " 11 �, 1 Phone #t: ..� Ar ou an; employer? Check the approprastte box: m a employer with 4. �] I a.m a. general contractor and I Type of project (required): employees (full and/or part-time),* 2,0 1 am a sole have faired the sub-cont�Ca.ctors listed the 6. � New construction proprietor or partner- Ship atyd have no employees on attached sheet, 'hese sub -contractors have 7. �] Remodeling working, for me in any capacity. employees and have workers' S' Demolition [No worket:s' comp, insurance comp. insurance.$ 9, uilding addition 1010 required.] 3. 3. ❑ 1 am a homeowner 5.] We are a. corporation and its 10 repairs or atiditionts doing all work mysClf [No workers' Comp, officers have exercised their right of exemption per MUL 11.El Plumbing repairs or additions insurance required.) t c, 152, §1(4), and we have no 12•[] Roof repairs employees, (lo workers' 13.® Other comp, insttranCe re aired ] Any applicam that chucks box X11 mus I' t also rill out the section below showing their workers' compensation policy information, Homeowners who submit this afr1dffvit indienting they are doing ail work and then hire outside cggtracton must submit a new affidavit indicating such, $Contractors tMt check this box mist attached an aelditionnl sheet showing the name of the sub•contmctars and store 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 rvoakers ° coraapensadon inR1ra)ace for nay eMployees• Below is flre policy anal job site information. Insurance Company Name: (/7 Policy # or Self -ins. Lic, #: Job Site Expiration Date: 0: lS tty tate .,tp, r7 VtR. 1 _01 49 ' Attach a copy of the wort�eas' coMpenstttion policy declaration page (shotivitag the policy number and a piratipn date). Failure to secure coverage as required. under Section SSA of MGL C, 152 Can lead to the imposition of criminl( penalties of a fine t to $1,500,00 atrd/or one-year irraprisollmen.t, as well as civil penalties in the form of a STOP WORD OR ER and a tine of up to $250.OU a day against the violator., Be advised that a copy of this statement may be :forwarded to the Office of lnvestigatiOns of. the IIIA for insurance Coverage verification, I do Under provided above is trate and COMM Official Kase 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, Oohed of Health Z. Building /scouttmetat 3. Cit, Clerk 4, Electrical inspector 5. Plumbing Ins ector 6. Other P Contact Person: Phone # ?IRATIUN UP W NEWP013 OP ID: �-- CERTIFICATE OF LIABILITY INSURANCE DATE(MIWDD/YYYY) THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAC3E AFFORDED BY 0110/R. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THE POLICIES I IMPORTANT: If the certificate holder is an ADD the terms and conditions of the policy, certain po icI0S may 8 require an endo e(ment A statement on this I must be en IT certlfRl ateAdoes not aonfersubJect to certificate holder in lieu of such endorsements . PRODUCER rights to the Dwyer A enoy 38 Bellevue venue _ D.F. D____ wyer Insuranc 38 P �••--_.e A ency Newport, RI 02840 .401.546-9629 AX Daniel F. Dwyer III a dfdC�dfd we Noh401.846.9829 _.- wyer com -- INSURE S AFFORDING COVERAGE y .-•~ NAIC p INSURED Newport Electric Construction -- " INsuRERA: Foremost Corp RS: Scottsdale Insurance Company- 200 High Point Ave, Suite B5 INSURERC:Beacon Mutual Insurance -' 41297 Portsmouth, RI 02871 INSURER0: ..-...__._....._.,........___..-__._ INSURER C : -'—' THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION NUMBER: 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. E OF INSURANCE _ _....._.____-•- _� LITY POL1C NUMBER LIMITS AVE IAL GENERA/ LIABILITY EACH OCCURRENCE SCPp06046448 12/30/2013 12/30/2014 �ERTEi = S MADE a OCCUR ISEB /Eau c inn n DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attaoh ACORD 107,AddlUonal Ramarka Schedule, It mon apace is required) THE SHOULD EXPIRA OF H DATE VTHECOFFIBENOTICE POLICIES WILL CANCELLEDBDEL DELIVERED RN Insured's Copy ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26 (20111 The ACORD name and logo are registered marks ACORD D CORPORATION.. All rights reserved. — GENL AGGREGATE LIMIT APPLIES PER: . Ia AUV INJURY $ _ GENERAL 1100 PRO- (�1 AGGREGATE g 2,00 POLICY T I I LOC PRODUCTS -C OMP/OP AGG $ 2,00 AUTOMOBILE LU1&LITY A 7 ANY AUTO S 0.8 ED SINGLE LI I ALL AUTOS NED X SCHEDULED AUTOS 5CP005046448 12/30/2013 12/30/2014 E accl e^!L BODILY INJURY (Per person) - 1,00 HIRED AUTOS X NON -OWNED AUTOS g BODILY INJURY (Per accidenl) g �- PR PERTY D GE ------ UMBRELLA LU113 X g •---' B OCCUR X EXCESS LIAR g CLAIMS MAGE BSOO1969$ EACH OCCURRENCE g D D N WORKI3RS 12/3012013 12/30/2014 AGGREGATE g 5,00( CpMPENEA110 SA N - -••---- C AND EMP LOYER$' LIABILITY 3 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? 68861 WC STATU• OTH• $ (Maa dean In NH) NIA If ea deacriDe under DE GSR PTI N OF 01/18/2014 01/18/2016 E.L. EACH ACCIDENT g 500 A ERATIONS Delow Empl Prac III E.L. DISEASE . EA EMPLOYEE 3 lio� SCr-WOU48448 12/30!2013 12/30/2014 E.L. DISEASE . POLICY LIMIT g _ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attaoh ACORD 107,AddlUonal Ramarka Schedule, It mon apace is required) THE SHOULD EXPIRA OF H DATE VTHECOFFIBENOTICE POLICIES WILL CANCELLEDBDEL DELIVERED RN Insured's Copy ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26 (20111 The ACORD name and logo are registered marks ACORD D CORPORATION.. All rights reserved. 9970 Date ......3.. ��... // f NOR7N , TOWN OF NORTH ANDOVER mom PERMIT FOR WIRING This certifies that .............................. .................... has permission to perform ....4 s c G..ate........... wiring in he building of ....................................................T at So�-l..'��. �/ 5. �R � N rth Andover, Mass Feel 5`�n.. Lic. No...� G %� ........ACTRICAL . ............. ... ... ....... INSPBCTOR Check # ` 1 C,ommonwea& o f /i'laseacLati6 Official U5� Only cc�� cc77 Permit No. a1Je�nartmenl o�,}ire �ervicee Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) 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 IN INK OR TYPE ALL INFORMATION) Date: March 14, 2011 City or Town of. North Andover To the Inspector of Wises: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. r Location (Street & Number) 50 Royal Crest Drove Buildings J Owner or Tenant Royal Crest Apartments Telephone No. J78-681-1$22 Owner's Address 50 Royal Crest Drive North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Commercial - Apartment BuildingSUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ]nstall 6 Gell Packs! No. of Meters No. of Meters Completion of the following table may be waived hv the In ector 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 No. of Luminaires Swimming Pool Above ❑ n- ❑ rnd. rnd. o. of Emergency Lighting 6 Batte 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 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eat Pump Totals: Number ........................................................... ons KW o. of Self -Contained 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. o aterKW Heaters o. o No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: 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: $ 600.00 (When required by municipal policy.) Work to Start: 03/14/2011 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:) 1 certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: The Electricians & Co. Inc. LIC. NO.: A10737 Licensee: Michael J. Parziale Signature C. NO.: E20269 (If applicable, enter "exempt" in the license number line) FBus. T. No.: 781-322-9344 ':j Address: 50 Branch Street Malden, MA 02148 Alt. Tel. No.: 781-322-3111110 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SS CO 001021 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 125.00 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date MW 9 1993 Permit # Building Location Owner's Nan Type of Occupancy New ❑ Renovation ❑ Replacement llgPlans Submitted: TesElEl _G Installing Company Name J ), PWG) a BT(—) I Zqeck one: Certificate # Address rporation ❑ Partnership _ Business Telephone - ) ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 7V INSURANCE CAGE: I have a current ' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ,yes, please I ate 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: Signature of Owner or Owner's Agent , Owner❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above apr knowledge and that all plumbing work and installations performed under the permit issued for 1 pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of General Law; BY Te of license: Plumber Sign ure of Lia Title_ nrn 7 . , Gasfitter Master License Number City/Town Journeyman APPROVED OFFICESF ONLY ition are true and accurate to the best of my application will be in compliance with all or 101801 ■� �ft�■1f���i0 KNEEN RON Installing Company Name J ), PWG) a BT(—) I Zqeck one: Certificate # Address rporation ❑ Partnership _ Business Telephone - ) ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 7V INSURANCE CAGE: I have a current ' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ,yes, please I ate 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: Signature of Owner or Owner's Agent , Owner❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above apr knowledge and that all plumbing work and installations performed under the permit issued for 1 pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of General Law; BY Te of license: Plumber Sign ure of Lia Title_ nrn 7 . , Gasfitter Master License Number City/Town Journeyman APPROVED OFFICESF ONLY ition are true and accurate to the best of my application will be in compliance with all or v r C m M m u z a r z N V m n 0 z N A m n 2 m co Date..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .....'1...! ........... j. .. ................. . has permission for gas installation ..411''l` .l.�l:....... ...:; ... . in the buildings of .............. .:....'........................... at .............. I.. I................. , North Andover, Mass. Fee.:..'':.. Lic. No.. f f t ! 1 WHITE: Applicant- - --CANARY: Building Dept. GAS INSA.IvCTOR r; PINK: Treasurer GOLD: File 496 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Li -LUa. l N oVeR ,Mass. DateA V . I _ 19 1—J Permit��-- Building Location Owner's Name V Typof OccupancyY L✓/e�/New O Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ B • P • # SEWER# FIXTURESCFPTT('A Installing Company Name tZ S �BG C ,leek one: Certificate # Address91 V\Corporation ❑ Partnership Business Telephon ❑ Firm/Co. Name of Licensed Plumber _ /✓ INSURANCE COVERAGE: I have at current Ija6ifty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ves. please i to the type coverage by checking the appropriate box. A liability insurance policy : Other type of Indemnity ❑ god ❑ 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 r)wnar',t Ana—M Owner ❑ Agent ❑ l nereoy Certny tnat 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 pe it issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi Code and a 142 a General Laws. gY Title Signature cense um er 1p�� '7 ir�o City/Town Type of License: Master-[ jar/ Journeyman C]. 0 FIC USE ONLY) License Number— _ � L a N • Z z N X z a }. 41 W M X j J W 0 } O V z a N X > W S1 0 J Z N N W y < ~ CC W y < F• _~_z V¢ CO ]C < 0 p W Z N a J-1 4j U 0 0 Vl ¢ x y ¢ W ¢ i~ W y Z o Q 0 0 ¢ d o ¢ O Gu W W X d W W o O P N < ? Fr >F- ; O x y N 0 4 'J Ul g O 2 a O J p J N < Z CC Z cc W et I- a p V Y vi o x 1, tel U. c7 a a 3 a m Q 0 SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR' 6TH FLOOR 7TH FLOOR -±±fE STH FLOOR Installing Company Name tZ S �BG C ,leek one: Certificate # Address91 V\Corporation ❑ Partnership Business Telephon ❑ Firm/Co. Name of Licensed Plumber _ /✓ INSURANCE COVERAGE: I have at current Ija6ifty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ves. please i to the type coverage by checking the appropriate box. A liability insurance policy : Other type of Indemnity ❑ god ❑ 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 r)wnar',t Ana—M Owner ❑ Agent ❑ l nereoy Certny tnat 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 pe it issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi Code and a 142 a General Laws. gY Title Signature cense um er 1p�� '7 ir�o City/Town Type of License: Master-[ jar/ Journeyman C]. 0 FIC USE ONLY) License Number— _ � L a i W A 'n �v m m m � D 0 � r c D z � Z' m Cf 2 3 N � � m m A O I r c 3 W A 'n � m .v m A 0 Z m O � z m p 3 r O D O r c 3 W Z A Date..'./ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Ss cmus This certifies that ........ has permission to perform "'!` _! ! `. f.. - . i ..: r '� ... a .. . . f �. G �r / plumbing in the buildings of ........... l .. , .. ........... at .... !�%'� ! �r . .t . t . rT...... ,North Andover, Mass. Fee Lic. No.. �'. :� ... o, - . 1.... /PLUMBING INSPECTOR I �P/29193 15:59 12.54 PAID WHITE: Applicant CANARY: Bbilding Dept. PINK: Treasurer GOLD: File "'IASSACHUSE"S UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print pr Type) A�j 444 I/f! , Mass. Date /� 19Permit # �S /.�� Building Location t Owner's Name Type of Occupancy IN New ❑ Renovation ❑ Replacement L9' Plans Submitted: Yes ❑ No ❑ B.P.# SEWER# FIXTURES SF.PTTC4 Installing Company Address A 4 Av Business Telephone ,S Name of Licensed Plumber V r/y / (9 —/- "-C N e'Corporation 8 `�L� ❑ Partnership cu- ❑ Firm/Co. z z of Y z Q N W Y J N N ) O 0 2 Q N }" z C7 > W N � N O Z N Q a:~ Cr x _ N- z O z N a .0 4J W f- N W N a N LL 2 a z YC rl . V Cr. Z W S O m O cc N Q W N >- ¢ Q F- Q N W Z O Q N C9 Z Q [! a Q O +3 GW W t- x6 V S W 3 0 z 2 Y N a O c J_ a d W G LL .j Y C) O i i N � f' > < 1- Q O=tL S N N a vi Q E o z Q O J Oj N Q ¢ _Z cc � F Q O - x -+ W H n a 3 x N LL a n a Q 3 a m �1 .0 O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR r` Installing Company Address A 4 Av Business Telephone ,S Name of Licensed Plumber V r/y / (9 —/- "-C CC eck one: e'Corporation 8 `�L� ❑ Partnership cu- ❑ Firm/Co. Certificate # INSURANCE COVERAGE: I have a currennViability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ET No ❑ 1 If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Cf 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 nereby certify that all of the details and information 1 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 Piumbin �andao eneral Laws. BY SignatureWlJcensed Plumber Title 11C City/Town r^ 11" " Type of License: Master Journeyman E]`/ ! f� APPROVED OFFICE SE ONLY) license Number � 7 �/ .y !i z O w N W U U. L6 O Ic 0 3 0 J W W N z 0 F U W a N z N N w S (7 O IL N z O F- U W M N z J Q Y n r w W N. O z m J a 0 a O I— o cc z a cc O W z O f - d U J� a IL oc 0 z c J m LL 0 z O_ i - U 0 JI r cc O N U W CL N z 0 Date ...:..:.:.... s ",0 RT :'�a TOWN OF NORTH ANDOVER F p PERMIT FOR PLUMBING ••,,r- 0; �SS�cmusE� This certifies that ...� ! ;'��. .� ...!.............. . has permission to perform plumbing in the buildings of ... ! 1',f .. . �:'! f.t ............. . at ....... ' 1 �.' �fC .. .:>. f .:......... ,North Andover, Mass. Fee...�+� ?. 'Lic. No... 1. �: �! ....Fa: �.(.t._ .. ` ...... /........ . PLUMBING INSPECTOR r" f• /r 11/17/93 01;36 .! r... WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION (Print o Type) rV l� Pr4ass. Date .. n A R PERMIT TO DO GASFITT 19 9-3 Permit Building Location J %1'� Owner's Name AType of Occupancy T`11r, New ❑ Renovation ❑ Replacement Plans Submitted: Yes[] No ❑ Installing Company Name %� 1fW 1 %�%�� Check one: Certificate # Address V a f 9- Corporation ❑ Partnership Business Telephone ;Oo ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter V a/ INSURANCE COVERAGE: I have a current Ii bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes U/ No ❑ If you have checked Les, 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: Signature of Owner or Owner's Agent, owner[] Agent ❑ 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 Ge raI taws. gY T e of License: Q�v�aQ a`L Plumber Signature of Licensed lumber or a atter ; Title slitter b CO OV 1 6 1o!�� aster License NumberAPPPOVEff City/Town Journeyman ' ■■■■■■■ �■�■■■■■ ■■■■■■■■■■, .. ■■■■■■■II■■■■■■■■■st■■■.■■■■ R■■ • • ■■■■■■■■■■■■■■■■■■ ■■■ ONE Installing Company Name %� 1fW 1 %�%�� Check one: Certificate # Address V a f 9- Corporation ❑ Partnership Business Telephone ;Oo ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter V a/ INSURANCE COVERAGE: I have a current Ii bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes U/ No ❑ If you have checked Les, 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: Signature of Owner or Owner's Agent, owner[] Agent ❑ 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 Ge raI taws. gY T e of License: Q�v�aQ a`L Plumber Signature of Licensed lumber or a atter ; Title slitter b CO OV 1 6 1o!�� aster License NumberAPPPOVEff City/Town Journeyman 4 m'. 09, r- p z s m '++ m m o v r 2 '" -4 m ' o w r z C) v r n v gym.. 0 O O M 2 O N N � A N • 9 . m A � � C O N m - 2 � " O O = A r p• -S N m -1 z p O G1 m N N N • 9 . m A � O - 2