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Home My WebLink AboutMiscellaneous - 28 HOLBROOK ROAD 4/30/2018N) Q r", 0 C. 111) m 00 0 CD C3 X 0 0 6 ;K C:l C) 09 , 60 1 Date..................... ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION / P--�j "11 �Cn4AJCCD. This certifies that-j.&".P�. ......................................................... has, pemiission'for gas installation. inthe buildings of ............................................................................ at ........... ZI ... . ......... . North Andover, Mass. ................................................ Fee.... ........ HA . ... .............................. .......... Lic. No. GASINSPECTOR Check #CI L0151Y 9320 G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i A CITY I North Andover MA DATE E5/22/2014 __— PERMIT # t1v JOBSITE ADDRESS 28 Holbrook St OWNER'S NAMEE OWNER ADDRESS Same TE FAX OCCUPANCYTYPE COMMERCIAL[j EDUCATIONAL RESIDENTIALE] NEW:E] RENOVATION: El REPLACEMENT: [j APPLIANCES -1 FLOORS - BOILER BOOSTER ... CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER FOOM / SPACE HEATER ROOF TOP UNIT MIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHERT— BSM 1 1 1 2 1 3 1 4 1 5 PLANS SUBMITTED: YESF_] NOE] 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES E] NO [j I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY [j BONDE] 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: OWNERE] AGENT El 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 pliance with all Pertinent provision of the D Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Marino LICENSE # 8736 -MUTURE Pr MPEI MGFEI JPQ JGF[:] LPGI[:] CORPORATION PARTN RSHIPEI# LLC []# COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE=ZIP ]TEL 1_(2J8 832-3295 FAX CELL 4614 EMAILI JMarino@�HWhite.com CA co) 0 rA rA CL u LU LU > 9L LU z z 0 CL 0 - LLiLi LU CA CA) Em " It LL>- WLU LLI m ACURD DATE mmmoly 'Yyl oi (2 9 1 =20�1 3 CERTIFICATE OF LIABILITY INSURANCEP... 1 0 8 __J= ,711-11S CATIFICATE IS IS$ UED AS A MATTER 0 F INFORMATION ONLY AND CON FERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATF DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVE RAGE AFFORDED BY THE POLIC IES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is zn ADDITIONAL INSURED, the poliey(jes)must be endorsed. If SU13ROGATION is WAIVED, subject to the terms and conditions of the policy, certain Policies may require an endorsement. A statement on this Certificate does notconferrig hts to the Certift2te holder in lieu of such andorsement(s), willilp *9 Hasaftabusotte, 1:nc. C/o 26 century Blvd. P. 0. BOX 305191 Xftghville, TN 37230-MID1 R- X- Whit;e COnstruction CompanY, Inc. 41 Cmneral Streer. P. 0. Box 257 Auburn, MA 01301 I PONTACT NAMF- PHONE PAX _mNQ�Qff,L 8 77 - $!4 5 - 7 3 7 8 -467-2 Ag 'tif - No). 8813 378 Uri 111 INSURERPS)AFFORDINGCOVERAGE NAlOrt 0 INSURERA.- The Charter Oak riro 3:ngurayla,9 Company 25615-001 _V, 0 2 P C Ual ty Co��.7 I _ y '. y f� 2 56 74-06� INSURERS: TrILVOIAro Properhy AsualtY COX�pany of Am 25674-06� Un INSURERC: NAftiOAAl Union Firs) Insuranca CQmpLLuy OE 3,9445-001 56 58 001 INSURERD; Travelers indaynnity CoMpany 25658-001 INSURE I E; INSURER F; tr-K I U-IUA I 1� NUM13ER: 20287680 REVISION NUmBER; THIS IS TO CQRTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW H _i�' K AVE BEEN [$SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD Inji.11CA7ED. NOIWITHISTANDING ANY REQUIREMENT. TERM OR COND17ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PaRTAIN. THE IN$URANCr= AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, —EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. 1'r17 TYPRONNSURANCE POLicy Numsrm POLICYEFF POLICY EXP S.Uef .�mmrnp —1 (MMID11cc=1 I LIMITS GENERAL LIAAILITY VTC20co 977X9940-13 9/3./2023 1-9/l/2014 I FAcHoco rR5=5 Is 2-nnn-nnr B C a 50 /1/201.3 19/1/2014 A/2013 9/1/2014 /l/2013 19/1/2014 wA�! Mil ACM W1, Acfdltori(;l HernarkaSchedula, It more epaca Evidence of Inauxance PERSONAL &ADV INJURY 2, 000, 00a I BODILY INJURY(Per person) I$ 1130DILYINJURY(Peracolditnt) 1,; LE.L.r;ACHACOIDENT $ 1,000,00 0 E.L.DI8I7A5E-EAr!mPi.9yP.rz S 1,000,00 (1) E-1, DISEASE- POLICY LIMIT $ 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THERFOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZ0 Rel"REaUNTATrVE Coll.*4297604 TPI:1694012 Cert:20267680 Q 1988-2010 ACORD CORPORATION. All rights reserved -CORD 25 1 (2010105) The ACORD name and logo are registered marks of ACORD X COMMERCIAL GENERAL LIABILITY CLAIMS-MADET OCCUR [�EN'LAGGRF=GATE LIMITAPPLIES PER; POLICY aP;Rr?- T F� LOG AUTOMOBILE LIABILITY VTaCAP 977K95S.A-13 ANYAUTO ALI.OWNED GILIEDULED AUT08 AUTOS HIREDAUTOS X MON-OWNED X Col Ded X C911 Ded 0-90 ando X I -X I OCCUR PXCESS LIAS F-1 ELAIMS-MADE 13E8766140 NUMBIZELLALIAD X 1 DED I V IRETENTIONS 3,0,00 WORKERS COMPENSATION VTRFUB 820SAISS-13 9 AND EMPLOYERS! LIABILITY Y� N ANY PROPRIETORIPARTNF-RIEXECUTiVE MIA VTC2KUB E120A71A-13q9 OFFICERIMEMSI�R EXCLUDED? N f MandetoglnNH) frS.468i,lba UnElm U S K111 ON UF Ql`).RA'nON3 below /1/201.3 19/1/2014 A/2013 9/1/2014 /l/2013 19/1/2014 wA�! Mil ACM W1, Acfdltori(;l HernarkaSchedula, It more epaca Evidence of Inauxance PERSONAL &ADV INJURY 2, 000, 00a I BODILY INJURY(Per person) I$ 1130DILYINJURY(Peracolditnt) 1,; LE.L.r;ACHACOIDENT $ 1,000,00 0 E.L.DI8I7A5E-EAr!mPi.9yP.rz S 1,000,00 (1) E-1, DISEASE- POLICY LIMIT $ 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THERFOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZ0 Rel"REaUNTATrVE Coll.*4297604 TPI:1694012 Cert:20267680 Q 1988-2010 ACORD CORPORATION. All rights reserved -CORD 25 1 (2010105) The ACORD name and logo are registered marks of ACORD Date.. /Z ................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ......... ... has permission for gas installation �kr. in the buildi of . . . .......................... at ... North Andover, Mass. Fee.. Lic. 'No..* GASINSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING cityrrown:. POC AAAgje C- _, MA. Date: 0Z>)0;)A Permit# Building Location: Ac> 1 W04 OwnersName: MC40f-0-0—�J �L-'ecs Type of Occupancy: Commercial 0 Educational E] Industrial El Institutional 0 Residentia�k New)QL, Alteration: F] Renovation: El Replacement: E] Plans Submitted: Yes El No-b� W z W C) W 0 U-1 W 0 0 to U) 0 W I-- z 9 0 z O z -J>- la� Lu z n O2WlX w 0 co LU 0 W W > z 0 0 W --W<0 0 < W CO 9L 0 W I-- 91-0 a W 0 IX WI > W Z Z W WE -j F- 1- 0 U)2:LUF- Z -j 0 LL W 3: F- Z W W W W 0 0. 0. T. W 0 Z >0 ao 0 wo W Fo- D > nz Z >W I- X F- 0 SUB43&*T—. 4 ---- BASEMENT I FLOOR 17 2 2 FLOOR 3 FLOOR 31 4 FLOOR 6"' FLOOR 6"' FLOOR 7 "' FL6-0--R 8"' FLOOR—,—]—]— F Installing Company Name: "ja Lae� 14 Check One Only Certificate # te # 1 Addressj� J'41 014 it� [Nameof 4 n: 6WAI(� City/Tow State: El Corporation B us I ess Te usiness Tel: - 28 1 (q*7 J3 0 Fax: -7 Partnership El FirmlCompany m of Llcq L.Icensed Plumber/Gas Fitter: ell, [I INSURANCE COVERAGE: NSURANCE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YesX No 171 If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy iq Other type of indemnity El 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 Signature of Owner or Owner's Agent owner 0 Agent El By checking this box -0, 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and �� W My IlUINIVUEJU dJ1U L11dL dil piumoing worK ana instaiiations pertormea 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. Type of License: By &lumber Title Gas Fitter Signature of Liceiis—ed Plumber/Gas Fitter D Master City/Town Ajourneyman APPROVED (OFFICE USE El LP Installer - License Number: -The Commonwealth of massachusetts Department ofl-ndustrialAccidents, QfPe of Investigations ..600 Washington Street Boston, M4 02111 www mass go vldz a Workers' Compensation Insurance Affidavit: IRnUders/Contractors/Electricians/Plumbers -Applicant Information Name (Business/organizafionandividual) Address: -r7 UP— City/State/Zip: V (�A4 Phone#:__�)661- WE -<;_A30 Are you an employer? Check the appropriate box., " — ' -1 LEJ I am a employer with 4. El I am a gelleral contractor and I 2.Pemployees (fall and/or part-time).*' J am a sole proprietor or have hired the sub -contractors listed the partner- on attached sheet t ship and have no employees These sub-zcontractors have working for me in any capacity. �No workers' comp. insurance workers' c'ornp. msurance. 5. El We are a corporation and its required.] 3. EIJ am a homeowner doing fficers have exercised their all work roight of exemption per MGL myself [No workers' comp. C. 152, § 1(4), and we have no insurance required.) t employees- [No *orkers' Comp. insurance required.] *Any aPPEcant ecks. ..j the gection below I 'thatche box:4 must also M OL.t Type of project (required): 6. M New construction 7. [] Remodeling 8. . []Demolition 9. El Building addition 10 -El Electrical repairs or additions 11 -E�Plumbing repairs or additions 12-n Roof repairs 13.n Other — w Homeowners who submit this affidavit indicating they are do all work d th COMPOU Won PollUmformation. i-9 an, en hire outside contractors must submit a new iffidavit indicating such. �C-trartors that check this box must attached an additional sh-eet showing the name of the sub -contractors and their workers' comp. policy information. am an eMP10Yer that isproviding workers'compensafion Insurancefor my employees. Below, is thepolicy andjob site informadon. Insurance Compiny Policy # Or Self -ins. Lie. Expiration.Date; Job Site Address: City/State/Zip: 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 ofi4GL 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 again9t the violator. Be advised that a copy of this 9tatement may be for'warded to the Office of Investigations of the DIA for insurance coverage verification. 1do hereby c eriz thepa 19di5clafties ofperjuij t at' e inforMadon provided above is true and correct Signatu 11 Date: Phone4: - ---------------- OffIcial use, only. Do not write in this area, to be completed by i or tow of c c ty W C y or Tow - t ity or Town: Permit(License 4 Issuing Authority (circle one): 11._ _r, FF, L Board of Health 2. Building . Department 3. CitY/T0" Clerk 4. Electrical Inspector 5. Plumbing, Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every pr-rson in the service of another under any caitract of hire, express 6r implied, oral or written." An employer is defined as "an individual, partnership, 'association, corporation' or other legal entity, or any two or 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, pariaership, association or other legal entity, employing employees. How' ever the owner of a dwelling house having not more than -three apartnents and who resides therein, or the. occupant of the dwelling house'.of another -who -employs persons to ido -maintenance, construction or -repair work- on -such dwelling -house or on the grounds 6r building appurtenant tilereto 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 to operate a business or to construct buildings in the commonwealth for any applicant who has inot produced acceptable evidence of coinpliance 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 fo.r the performance.of public work liritil acceptable evidence of compliance with the insurance requirements of this chapter hay.e been presented to the contrabting authority." Applicants Please fill out the workers' compensation aff ' i&vit completely, by checking the boxes that apply to your situation and, if necessary, supply subLcontractor(s) name(s), address(es) and phone number(s) along with their certificit�(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) wit�.no employees other than the members or partners, are not required to ca.rry workers' compensation insurance. If anLLC orLLP does have employees, a policy is required. Beadvised that this affidavit may be submittedto the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date -the affidavit. The affidavit should apPHioa-tion for the permait-Or"HI-ense is being reqaestod, not th-_ Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a work -us' 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 that the affidavit is complete and printed legibly. The. Department has provided a space at the bottom of , the affidavi ' t for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be -used as a reference -number. In addition� an applicant that must submit multiple permit/license. applications in an'y given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address"' the applicant should write "all locations in city or town)." A copy of the affidavit that has been offici�lly stamped or marked by the city or town iu�y be provided to the applicant as proof that a valid affidavit is on file for firture permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license orpermit not related to any business. or commercial venture (i.e. a dog license or permit to bum.lea.ves etc.) said person is NOT required to complete this affidavit. The Office of Investigations woulflike to thank you in advance f6r your cooperation and should you have any quokions, please do nbt-hesitate to give us a call. The DepartmenCs address, telephone and fax number. The Commonwealth Gf Massachusetts Departmont of Indusffial Accidents 0 ffice of Investi'g;ations 600 Washing -ton Street Boston, MA 0.2111 Tel. #-. 617-727-49-00 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass..gov/dia TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... P M .... has permission to perform ......... � Ll & LA—) C5—t—t-7Lkc-�� ................................................................... wiring in the building of ..... .............................................. at ........ 4F494S ........ .......... I North Andover, Mass. Fee..= ................. Lic. No�.P�ao./9 .......... ELE�C4MRICAL IiN�S�PECTO Check # 106.91 oat .q=qy=dftvCbvdWd Ptm- M ommm"mL APPUCATION FOR PERMIT TO PERFORM a :.CTMAL WORK Agwo*ftbr,pjsi' aPL9AWPMrXXK0JtrA city or Tqwl�efi. Todwhwpac6r & a 'desatindbdow. Syddsommadw-cm--m own -we Ofbb at rol, a ampapm VF%oaft Loaaft Gurea & Numb= 7 Y./ - KV A 31 AN I .OwmesAd&vw J)( Is ab Im in 4fw No (CM*AffnPtftftBg* cGv$mKdm *ft a g PWML"- -lb pft, UdWAL Rxkft AW- - vift overhad f3 umftvd[:] fb6 of mefto AMMS -veft ombmdo 024pd C pk.. of wsdm Nvimbw efFaftv sikd A=pft Imafto md NAUm,@fftvpWW =0CkW Wslft 7s KVA E3 0 =06 a area m"Im ALA=drb_ tt SfTARW of am".0 4lfAirCXo& of 96paca f 40dmpdmv daw KW orwatw- jcW BdIaM �4& stWOOKS TOWSP T41060f or Waft *A22) (WbW by Vcd W= k 11*0 L5 I ?" laqpectiam to br. iorm$W in ac C 0 - Lim - 1 1 vAlk 140C.Rok W md Wm =00dim nq5URA=NCX7&9"m udm "Y lby to wasm im pounit for do F!"l- �— afdact*d Wa* mxy bm mbn pi0aav*Wfmmm � 0 0 .- -4 - A-- - -4--A -e. I Mo the fir em I I ravyida --- , WJJVPIAD� 181: it iD an*; SVA tisj� pgoeorsammia dwpumk kaft Sam 0 onmR maw FWMNAbOL' Lwniv �� Y-4 LW- NO-- -63 7 f4rq lafrgwpbAgw dwo BmTeL Addrc= CA AIL T& No.-.-- - ,p" bLGJ.�C_ - 149L -*vn,=9sv*;uaANcsWAxvziti 1=----~--dmLhmWWdvWjWhamdW bybw. By =W SWAM= bdaw. I bumby waim dift tequicumaL t=mem(cbv*am)E3ewm t3owelft ownentArm FpA WPM-$ siguatnt f � �- 7� ��- �, r' 7 7 77 1 � Mow— �t;7 t7j �C, Name : NO~ Address: Shvet mme Am M*mpbW?Che&&eapproprbftbM z L VImm a employer wi& 4. [] I am a Senetal conuacMrmd I emplayees (W mdkr pwWime)�* bmhhed*e 2. E] i ant a soie proprietor or partaw- NsWonfinaftcheddieeL ship and have no emplaym vroddog for me in any capacity. Did WO&W camp. bamme reqdre&] 3.0 Imahomeommdoingallv/01k myselE [No vutbeW comp. immeance, requW&j t Inew Ram employ= wd have Madne camp. insunw-t S. 0 We we a corporadon. and its offWarsbanamcbedgm dgk of aunpdoo per MUL c. IA §1(4), sad we haw no empkIYOM [NO Ihn of Pf eject (reqdndor- (L [:] NOW. consftocfion 7. 0 Remodeling L Demolifian 9. Bailffing adMon 10.&T&M-Wrepabsoraddidm 11-0 Pkmdft Maim or ad"Mas 12.0Radnpairs. 13ZI O&w dMoboubboxft miodw Moutdomcdcabobwshowinadv* cowpowmdolft Parmy ba-nad— t anowiffil tCannocton do chock this bm mW sanchod an adEdond shoot dowimg do � offic, sub-cooftoctoco and soft wbdba or wtdww codfia bxve cropiqyem comp- pficy nodw- bdbrmm" -ht Insurance Company Naw. 1 0 PbHcy#crSeIfLimLic.#.- MKODWISGOM300 -- EivirationDaw: 7/*1-3 Job Site CiIY/SMMT4r-- Atta& a copy o(dw workers' compemadon polky dedwaden pqp (showing dke polity wamber md asphadn daft). Fam tD secure coverage as requited under Sectim 25A ofWA. c. 152 can kad tD &a imposition oferitnind penakies ofa fine up to Sj,5W.00 andfor one -yew haprisonment, as well as dvff penalties in te fam of a STOP WORK ORDER and a fine ofiup in SZO.00 a day againa ft violaw. Be advised dw a copy ofdds statenum may be famarded to dw Office of hwastigadons of Ow DIA for insut=ce coverage vedficadon. 47f- IrW— 4K 17 offxW aw eak Do am wr&- in A& are% a be c, V I No by cW ortom idi I I (Zy or Teww Pa MidUVMW# L Board OfHnft 2. BWWM9 DeFWbIMVWt 3. C14YAr4nm C19A 4- Ebc&icfA IMVVdW & PbMbiM9 bWMdW 6. Odwr c6sted Put Pboloolk The Commonwealth of Massachusetts Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 FOR OFFICE USE 0 Permit No. Occupancy & Fee Checked (leave blank) APPLICATION FOR PERMIT TOPERFORM ELECTRICAL All work will be performed in accordance with the Massachusetts General Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date oo-,,9 7 City or Town of Akt 4, V67 -K To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location (Street and Number) — 0� � AlL ex Map: - Owner or Tenant /��Vge-cx/ �14'&� Zone: Owner's Address Lot: Is this permit in conjunction with a building permit? Yes El No 11 (Check Appropriate Box) Purpose of Building Utility Authorization No. �7o -'7/ 0019 a Existing Service —Amps Volts Overhead El Underground D No. of Meters New Service —Amps Volts Overhead 0 Underground El No. of Meters Number of Feeders and Arnpacity Location and Nature of Proposed Electrical Work 5t�w to No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above gmd. El In-grnd. 13 Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emerg. Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection'and Initiating Devices No. of Sounding Devices No. of Self -Contained Detection/§ounding Devices No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Total Total Heat Pumps Tons KW No. of Dishwashers Space/Area Heating KW — No. of Dryers Heating Devices KW No. of Water Heaters KW No. of Signs No. of Ballasts Local El Muncipal Connection t] Other No. of Hydro Massage Tubs No. of Motors Total HP Low Voltage Wiring OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts Genjelral Laws I have a current Liability Insurance Policy including C pleted Operations Coverage or its substantial equivalent. YES Q9 NO 111 have submitted valid proof of same to this office. YES ON, 0 El If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 1r`BOND D OTHER El (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME- LIC. NO. AS21-7— Licensee VllleeAl�_ 9 zll�Alh_�_5e5 Signature 14/1-�/'� LIC NO /Z�,9117- 1&&-r, ky, Address Bus. Tel. No. S--0 60 - ��,p 0�� Alt. Tel. No. OWNER'S INSURANCE WAIVER. I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner 0 Agent 11 (Please check one) (cicrnabirp nf ()wnpr nr Acpnf) Telephone No. PERMIT FEE $ Date.... .17 N2 --�' 12 2) 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... C -C, ................................... .... A .............................. has permission to perform Sfwc�,�. t .... C, hcut e .......... wiring in the bui Iding. of ..... at....XV .... ................................... NorthAmdover, Mass. Fee....... Lic. No'*J-70 ................. ...... .............................. CAL INSPECTOR PAID WHITE: Applicant CANARY: B PINK: AsNer 0, se Onl Office '01 41! 011allitunwralo of mauac4uo Permit No. Eirpartintut of Vuhiic j8,vfctg Occupancy Fee Checkeui$o� 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 j. PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A wo to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 ll, rk PLEASE PRIN ' T IN INK OR TYPE ALL INFORMATION) Date `iCity or 1mvp of 00 V To the In/spec-to/r of Wires: T., Pe u0ersldhe&f1pphe's for a permit to perform the electrical work described below. Number) h(o C 4 Rac I <- S,/, Wner�qr`T�ina, U R "A (,y o J. pWnet's Address 'I 'this It in conjunction with, a b�.iilding permit: Yes No R�-(C s, perml -heck Appropriate Box) Purpose of Building Df',AJ--1L I I A Utility Authorization No. �'E�istlng Service., Amps -Volts Overhead Undgrnd No. of Meters -AF New service Amps Volts OverheadEl Undgrn'J__E1 No. of Meters ml Number;of Feeders and Ampacity Loca't1166.:;dnd Nature of Proposed Electrical Wo rk C Total N o. of Lighting Outlets No. of Hot Ibbsi No. of Transformers KVA No of Lighting Fixtures Swimming Pool Above In- gmd.E1 grnd. D Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners rIRE ALARMS No. of Zones No. of, Ranges No. of Air Cond. Total No. of Detection and tons INtlating Devices No. of DI §posa s.;�., No.of Pumps Tons KW No. of riding Devices T �i NSO U Ti 'o 0. No. of Se \Contained N IV— 6washers Space/Area! Heating KW Detection/Scundirig Devices rs,,, I<W !,i: Nbi! 6111 Devices J Heatin6, Local F Muh�plpal M Other Conribption p Low Voltage NO KW Wiring 1:4 eaters 0 �V Ballasts a sage Tub No 0 No.`!, Hydro M t 'Total HP S "I'l 0 rs 4; Rh IN W AAN Co C dVt RAQ ft,",O 'iui� P., to the rpq� !qTpriis �i Masiachu6etts general Laws o it fl I �have 6 current LabillIV.., n6urance Policy including Complete C or Its substanti eq I alent. YES 0 NO 0 1 d Operations overage at uv hbi Vir:subehlit'6j vaild same1b the Office." YES 0: NQ1 Oal Ifyou have checked YES, please,indicate the type of.coverage by prObf.10f. che'eking the date 4ox �ONIJ OTHER 0 (Please Specify) INSURANG 0;'0', .10 7 (Expiration Date) 71 ti to* it�A�J,� Inspection Date Requested: Rough Final rJ aPenalil perl . .. ... eb bf ury. tra Q n tt. i LIC. NO. 1!20 1 A '�!,Zud dv.,'�:.'Ele.b E R Llcens? 1: -n T,;� n &e r s J rSignature LIC. NO. 23684 7 �.';i 14, Bus. Tel. No. 4`,,!�blg8,to r kl.Andoyer. Ma 0184 It. Tel. N J D 5 A 0 VO �;7 1 OWI` ER'S INSURANCE WAIVER: I am aware that the Licensee does hot have the Insurance coverage or Its substantial equIv I alent as re- qu, Iri Masdb6hu� letis-Oen6rai Laws, and that. my signature on this permit application waives this req6irement. Owner if," Agent I i0lease check 6n6i, 4 0r! Telephone No. PERMIt, FEE $ �(Slgqalufe'of Ov wPerQrAgenQ,,.1J I,'', 0 1� x -6565 N2 )1421 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 16 .................. ......... 4 .................................................... has permission to poerform .... .................................. .. ..... ........................ wiring in the building d-2-2. Z ........ .. ........................................................... at ........... .. ............ .................................... . North Andover, Mass. ...... Lic. Noldwl . ................. il�� 'C"A*L*I"N*S"P*E**C*T'*O**R***'***"**"**** 02/02/98 11-.52 25. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location No j Date TOWN OF NORTH ANDOVER =111111111111111M Certificate of Occupancy $ 'Building/Frame Permit Fee $ Iva ,4CM Foundation Permit Fee Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL (]aBuilding Inspector ()4/24/96 11:52 25 .00 PAID 9731 Div. 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Dat �uilding Location Y_ux.) J* " Permit # 7) -7 —Owners Name .t,once 71 New Renovation Replacement ID.,–Plans Submitted Fly. Lrocc (Print or Type) Installing Company Name.-, _.Z)_. z54..)�_r Address -1; -T-f )q, Check' on'e:_'t�rtifiC' Corp. Firm/Co. Business Telephone: Name of Licensed Plumber or Cas Fitter Insurance 'Coverag type 07 insurance coveragq-.-by cheCkin t appropriate.,Lbox: Liabi li ty---insurance-,pol icy, Ctln.er type o indemnity_=,,_..BOP4 Insurance Waiver: .1, the uncersicned, have been made aware - that,Jhe, lic4ns4f SIP I--- thi s application. does not have any one of' the above three insuran p c QygC41Qgkr;. 03 us 02 =.0 (a cc `V- MA C us 1414 MIT Cr , -, AC = I_ 116 0 UA 02 L", al a W j - = A !L = !! M -K UA Q LU 34 , -4' 2 'Zlr. 0 U_ U, Q > UJ ca 'C 0 0 = 1U 0 0 UA 0 U. CL. sua–as-wr. I T i Pt� V I&ASEmrzmT T 77 -tS. FLOOR IT -j -'I 2HO FLOOR 13RM FLOOR 7-1 AT K FLO 0 R 1117 STK FLOOR GTHFLOOR 7TK FLOOR R (Print or Type) Installing Company Name.-, _.Z)_. z54..)�_r Address -1; -T-f )q, Check' on'e:_'t�rtifiC' Corp. Firm/Co. Signature of owner/agent of property Owner I hcscby ecrtiry Uut &U of the dcWU and irtformadark L have zubmitted (or entered) in above soplicatiots see true and accunte to the beit rny kno-1cdCa and tUat Q plurnbing wait and inSLALUtiocts —crior=zd undcr'ftrmit i=ucd Ea: this aprucation will coaxpLiance wtut all VwMacat peovisiocu or .,%a wAssac.,tusects state. cat c3da and CL&,;tcr 14-" a Lh4 Ckmczal Lawa. By Title City/Town: APPROVED (OFFICE USE ONLY] TYPE' L1CZNSE-',$' c- uIrtmer Ga S f i t ter Master Journeyman 4 Signature of Li Plumber- or,,Gasf ense Number e Business Telephone: Name of Licensed Plumber or Cas Fitter Insurance 'Coverag type 07 insurance coveragq-.-by cheCkin t appropriate.,Lbox: Liabi li ty---insurance-,pol icy, Ctln.er type o indemnity_=,,_..BOP4 Insurance Waiver: .1, the uncersicned, have been made aware - that,Jhe, lic4ns4f thi s application. does not have any one of' the above three insuran p c QygC41Qgkr;. Signature of owner/agent of property Owner I hcscby ecrtiry Uut &U of the dcWU and irtformadark L have zubmitted (or entered) in above soplicatiots see true and accunte to the beit rny kno-1cdCa and tUat Q plurnbing wait and inSLALUtiocts —crior=zd undcr'ftrmit i=ucd Ea: this aprucation will coaxpLiance wtut all VwMacat peovisiocu or .,%a wAssac.,tusects state. cat c3da and CL&,;tcr 14-" a Lh4 Ckmczal Lawa. By Title City/Town: APPROVED (OFFICE USE ONLY] TYPE' L1CZNSE-',$' c- uIrtmer Ga S f i t ter Master Journeyman 4 Signature of Li Plumber- or,,Gasf ense Number e 2779 Date "�.7. ...... TOWN OF NORTH ANDOVER 6 PERMIT FOR GAS INSTALLATION Iss C" This certifies that ............. has permission for gas ............. in the buildings, of-. . ................... at . .��e . . �. .. ........... North Andover, Mass. Lic. No ........... .......................... GASINSPECTOR W�HITAppllcartt CANARY: Building Dept. PINK: Treasurer