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Home My WebLink AboutMiscellaneous - 29 Main1 1, i'T rig Date.... .. ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING -J-01,4 T�iqwa-cc),�-L This certifies that ............................................. r ......... .............. Ze,- 7"—co( has permission to perform .............. ................... ..................... wiring in the building of ... /— C4, � C4,4 "? , //0 ................................................................................ ............. ....... i at ........ X.7 /Vj/?� 'o-9 I �, .. S (. , North Andover _Mm� -dz� ............... I ....................... Fee .... 41-d ........ Lic. No,��.gtlkC) .......... .... .... ... Ic sl ELEcrRICAL =NSPECTUR Check # 15"115 Official Use Only /1*1 Permit No. - V -A -4--e Occupancy& Fee Checke/?6 BOARD OF FIRE PREVENTI N REGU IONS 527 CIVIR 12:00 U T APPLICATION FOR PERMIT TO ERFORM ELECTRICAL WORK 0 s All work to be performed in accordance,,.� h th/eassachusetts Electrical Code 527 CMR 12:00 0 (Please Print in ink or type all information) Date . I - Hhe inspector of, Wi in -as: Town of North The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number D,9 1\ror�t-� �-Aaj/i 5t, OwnerorTenant ku,�5 �C, Carr-,'Ilo /.�)-7 97Z -.;z-73-/996 Owner's Address Is this p ermit in conjunction with a building permit Yes a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps_________________�Voits Overhead a Undgmd 0 No. of Meters New Service —Amps_Voits Overhead 0 Undgmd 9 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work VG) Z-A� OlrHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - if you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start lwi Inspectiion Date Resquested Rough Final It' ry: Signed under the P!na !ps of%-1jUV— FIRM NAME LIC. NO. Licensee V��- -7,k- Signature f4e'1-404�— —LIC. NO. Bus. Tel No. 17 17,f a-67 J/F.:-�,)i Address A/ A*z,,—Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses 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 Agent (Please Check one) Telephone No._ PERMIT FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In a No. of Lighting Fxtures Swimming Pool gmd 0 gmd 9 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Bumers Battery Units No. of Switch Outlets No of Gas Burners FIREALARMIS No.ofZone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers SpacetArea Heating KW Detection/Sounding Devices 0 Municipal 9 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage I[No. of Water Heaters KVV Signs Bailases Wiring 114o. Hydro Massage Tuds No. of Motors Total HP OlrHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - if you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start lwi Inspectiion Date Resquested Rough Final It' ry: Signed under the P!na !ps of%-1jUV— FIRM NAME LIC. NO. Licensee V��- -7,k- Signature f4e'1-404�— —LIC. NO. Bus. Tel No. 17 17,f a-67 J/F.:-�,)i Address A/ A*z,,—Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses 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 Agent (Please Check one) Telephone No._ PERMIT FEE $ (Signature of Owner or Agent) .Name: Location: F-1 am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing. workers' compensation for my employees working on this job. COMDanv name: Address City: Phone#: Insurance Co. Policv # CompanV name: Address City- Phone#: Insurance Co. Policy # =o secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification. I do herby certify under the pains arid penalties of peijury that the inthrynation provided above is true and correct Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' E] Building Dept FICheck if immediat . a response is required Building Dept 0 Licensing Board F-1 Selectman's Office Contact person, Phone Health Department Other FORM WORKMAN'S COMPENSATION MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date NORTH ANDOVER iguilding Location aq' �ftMg., 517 Permit # 45LZ3 Owners Name W,44, New -Z,-�Renovation Replacement Plans Submitteld FIXTURES (Print or Type) Check one: Certificate Installing Company Name Corp. Address 133 zo Partner. M'4- Firm/Co. Business Telephone: 3?3043/ Name of Licensed Plumber or Gas Fitter Insuranc(- Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy r --j Other type of indemnity F --j Bond [D Insurance Waiver: 1, the undersigned, have been made aware that the licensee of is a4pplication does not have any one of the above three insurance coverages. I aturec"off o—w-fte'r'TJ'g66-t tur 4 of property Owner Agent 6 I Mal mom MuMMEMESSIME WMA"'141411 MEMO 0 0 ; MEESE no MENEM ONE MRSIMEMEMEMEM (Print or Type) Check one: Certificate Installing Company Name Corp. Address 133 zo Partner. M'4- Firm/Co. Business Telephone: 3?3043/ Name of Licensed Plumber or Gas Fitter Insuranc(- Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy r --j Other type of indemnity F --j Bond [D Insurance Waiver: 1, the undersigned, have been made aware that the licensee of is a4pplication does not have any one of the above three insurance coverages. I aturec"off o—w-fte'r'TJ'g66-t tur 4 of property Owner Agent I hereby certify " all of the details and information I haye submitted (or entered) in above application are true and accurate to the best of my knowledge and t1tat all plumbing work and installations performed under'Permit jzsLed fez this application wiU-be In compliance with &a pcttincnt provisions of the Idassachusetts State Cas Cude snd Chxvter 142 of the General LAws. By Title City/Town: APPROVED (OFFiCE USE ONLYJ �TYPE LICENSE: I a J11 Y7 /1' Plumber 1---p -- - - - - - 5-- P -.— Gasfitter /Sig'nAure of Li4!4nsed Master Plumber or Gasfitter Journeyman - icense umber ,,ORTM 0 us I SS CHUS Date. .�/ - .1 - - ......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...... ............................ has permission for gas installation ............................. in the buildings of . / ......................................... at ...................... I North Andover, Mass. Fee........... Lic. No ............ .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Bay Stat e Gas Company GAS INSTALLATION AUTMORIZATION F Date 6IA71741 Issuedto F ;N), cc,; / /U 4r n Address M4"lv S-1 Zj ,2/-A AAlAver L4 For Installation of: 2- 1�earers BTU Input 7 5, &,,ao ea 6A. 15o,oao Restrictions &OW -c - BSG Representative &,�' PERMIT ISSUED BY PECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: 0 Heating System (BTU input 0 Range El Water Heater 0 Clothes Dryer 0 Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR 'k BUSINESS REPLY CARD FIRST CLASS PERMIT NO. 721 LAWRENCE, MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES