HomeMy WebLinkAboutMiscellaneous - 29 MILLPOND 4/30/2018-IV
ic I
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
ACHUS 7�
This certifies that .. ................. .........
.................
has permission to pe�rform-,-,
plumbing in the buildings of ...... .. ....................
at.(9!7 .... ....... ... .... . ...... , North Andover, Mass.
Fee�0. . ��. �.Lic. No.-. . . ........ A.
PLUM� �ING �INSPTO
Check
6961
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMf3ING
(Type or print) I
NORTH ANDOVER, MASSACHUSETTS
Building Location
Owner
Date
Permit #
Amount
I
New Renovation Replacement 0 Plans Submitted Yes No 0
FIXTURES
(Prinfor type) Check one: Certificate
Installing(C) ompany Name Corp.
Address Partner.
0
T;usiness Telephone �Fj - C� 0-1, —a,/- Y
Name of Licensed Plumber: ./ Hill Roqe \' t1 -0\-A 1<1
Insurance Coverage: Indicate the typ5,of'rnsurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 0 " Bond
-Insurance,Waiver: Agnundersipned, havd been made aware that the licensee of this application does not have any one of the above
t e
hre
Sighature Owner Tj ----�Agent E]
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 installationsoepformed under Perm,,Issued for this application will be in
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an I C
compliance with all pertinent provisions of the Massachu St" (�Mter 142 of the General Laws.
By: Signanire OFT 1_rlcf,,nsea riumSer-3
Type of Plumbing License
Title 7Z I Z (4-7
City/Town MumDer Master EFZJo*urne;man
APPROVED (OFFICE USE ONLY
Date.....................
40\
TOWN OF NORTH ANDOVER
0
X PERMIT FOR GAS INSTALLATION
4-
1 (�2
. . . . . .. . . . . . . . . . . . . . . . .
This certifies that:60�-- L A*
has permission for gas installation . .
.......................
in the buildings of . 2- �-- - �
at .... .. North Andover, Mass.
Fee.Zq Lic. No.
I S�EC
Check -y4S
5566
,%v%ACHLSET1S UNITO&M APPLICATON FOR PER.Nfflr TO DO GAS FTITING
ff�pe or print) Date
NORTH ANDOVER, -�IASSACHUSETTS
A
Permit #,
Building Locations Amount S
Owner's Name
New C] Renovation Replacement Plans Sub4itted
(Print or type)
Name
Address
Name of Licensed Plumber or Gas Fitter
Cffone: Certificate- Installing Company
Corp.
[]Partner.
U"VC0.
INSURANCE COVERAGE- Check one: Noo
I have a current liability Insurance policy or it's substantial equivalent. Yes13
If you have checked y�Ls, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 1:1 Other type of indemnity 0 Bond 13
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
NIass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's A.-ent Owner 13 Agent 11
i �creby certify that all of the details and information I have submi
best of my knowledge and thatall plumbing .�ork and installptions
--c rnphance with all pertinent provisions ofthe Missachus "ts att
[%,iTcwn
,.\PPRO�'ED,4-.FFTCEr�SEI-,�,I-Y,
or entered) in above application are true andaccurate to the
ed under Permit lssu4
lor this application will be in
th K1 -3d lNavter 142-L&Lhr—General Laws.
. Signature of Licensed Plumber Or Gas Fitter
1:3 PlUmber I Z 12-
C G itter License 4umrer
a aster
ste
Jeumeynian
4
4ASSACHUSETTS UNIFORM APPLICATON FOR PE RMIT TO DO GAS FMING
or print) Date o // t & 19 0 0.
. OUM I ri 'k1'4UkJ V JIM, IVIIAZOA4-171 UOr- I L 3
Building Locations C;- Permit
Amount S
U
Owner's Name
New 011- Renovation F-1 Replacement Plans Submitted
(Print or type) Check one: Certificate Installing Company
Niame—
Corp.
Address -T-�70 "02 J Partner.
C/ .�
Business Telephone aowr Y 77 D-FTF-M/Co.
Name ofLicensed Plumber or Gas Fitter Ll I) t�, �- 4".4- 4�4zl 4, -C -f P
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If vou have checked ves, please indicate the ty
pe coverage by checking the appropriate box.
Liabilitv insurance policy Other type of indemnity Bond
13 .0
Owner�s Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
1\11ass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Sianature of Owner or Owner's Agent Owner Agent
Z� -
1 nereov certity that all ot the details and intormadon 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 pertbrmed under Permit issued for this application will be in
compliance with all pertinent provisions of the �.Ivlassa s St;W�Gas Code ai�qhapter 142;qthe Gener��s.
cxs9t Z / -
By:
Title
City/Town
PROVED foFi-icF USE ON1,Y)
Signature of Licenset"lumber Or Gas Fitter
F74--Plurnber , a -� �,
r7 Gas Fitter License Nurnmlr
r7 Joumeyman
'� 6 4 5-
14, t
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation ..............
in the buildings of .... ck y .........................
at c).,3 .... ...
. ........... , North Andover,,,Mass.
Feff-30.-PP. . Lic. No../..�"``/`�.
GASINSPECTOR
Check# 367n
Installing Company Name: Central Cooling & Heating, Inc.
Address; 9 North Maple Street
Business Tel:. 781-933-8288
City/Town: Woburn
Fax: 781-982-9017
Fitter:. Mike Bernasconi
Check One OnfY —Cerfift
v/ Corporation . 2806C;
State: MA
Partnership
F!rTn/Company
%, WVCKAWt:: — -------
I have 8 current 1kh-Ift Insurance policy or its substantial equivalent which meets the requirements of IAGL. Ch. 142 Yes V No
If you have checked jes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance poilcy ,/ Other type of Indemnl4t Bond
O%FNERIS INSURANCE WAIVER: I am aware that the licensee does
Q� .00thave the Insuirance, coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this PSM111 application yLalves this requirement.
Check One Only
Signature of Owner or Owner's Agent owner Agent
by checking tiiiii!;—b�x _ �,l he�reiy certify that all of the deill1l: on I ha su d r tered) regardl th
,111:111 1011111 1111 7na
accurate to the best of my Knowledge and that all plumbing ' orkand Inatt on d a the permit Ise PPIIc9t on are true and
ft t, o rmit Ise
compliance with all Pertinent provision of the Massachusetts State QAUmb c n� ad r this aPPIfeatlon will be in
w
a d hap r 1 of the General
By. Type of License:
Plumber
Title Gas Fitter Sig atur o Licensed P um as Fitter
Master
City/Town Journeyman
A,PPROVED (OFFICE USE ONLY) LP Installer License N mber: 15137M
fifiASSACHU-,t,',':'Jkv'FORkfiAPPLICA ION FOR PERMITTO-U0 GAS —FITTINe
Ck'/Totyn:
06 '4h
'4/tddVf'--
Date.
q) )Sh)
Permit#
Building Locatic,
27—ML'a
Ovenerslvlarne: MCI C/616> -
IYPc Of OccuPanCy.'
Commercial Educational
Industrial
institutional Residential
New:: Alteration:
Renovation;
Replacement:,,y
Plans Submitted: Yes No. Qi
FIXTURES
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Installing Company Name: Central Cooling & Heating, Inc.
Address; 9 North Maple Street
Business Tel:. 781-933-8288
City/Town: Woburn
Fax: 781-982-9017
Fitter:. Mike Bernasconi
Check One OnfY —Cerfift
v/ Corporation . 2806C;
State: MA
Partnership
F!rTn/Company
%, WVCKAWt:: — -------
I have 8 current 1kh-Ift Insurance policy or its substantial equivalent which meets the requirements of IAGL. Ch. 142 Yes V No
If you have checked jes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance poilcy ,/ Other type of Indemnl4t Bond
O%FNERIS INSURANCE WAIVER: I am aware that the licensee does
Q� .00thave the Insuirance, coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this PSM111 application yLalves this requirement.
Check One Only
Signature of Owner or Owner's Agent owner Agent
by checking tiiiii!;—b�x _ �,l he�reiy certify that all of the deill1l: on I ha su d r tered) regardl th
,111:111 1011111 1111 7na
accurate to the best of my Knowledge and that all plumbing ' orkand Inatt on d a the permit Ise PPIIc9t on are true and
ft t, o rmit Ise
compliance with all Pertinent provision of the Massachusetts State QAUmb c n� ad r this aPPIfeatlon will be in
w
a d hap r 1 of the General
By. Type of License:
Plumber
Title Gas Fitter Sig atur o Licensed P um as Fitter
Master
City/Town Journeyman
A,PPROVED (OFFICE USE ONLY) LP Installer License N mber: 15137M
CIO
GC
�4
Zi
Date.
. . . . . . TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
all
This certifies that
has permission to perform .....
, , I I /�;4
plumbing in the buildings of . J114.41. ....................
North Andover, Mass.
at ......
F-Ae,3, 6, 4X) L i c. N o. -T/� 3 .7 ....... /Az4J- * /A
PLUMBING INSPECTOR
Check
All
11
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Clity/Town; N6f-+h JqAJ(SVQ-r Date: Permit#
BulklingLocatio owners Name: _.P4ddd),,-
lypeof Occupancy: Commercial, , Educefional Industrial: Institutional Residential: 100,
Now:
SUB-BSMT.
BASEMENT
IST PLOOR
2ND FLOOR
3RD FLOOR
AITH FLOOR
STH FLOOR
6THFLOOR
7TH FLOOR
8TH FLOOR
Afteratlow, .. Renovatilow.. Replacement: PlansSubmitted: Yes No. 0
FD(TURES
Installing Company Name:;, Central Cooling & Heating, Inc.
Address,-; 9 North Maple Street CItYrrowm Woburn
Business Tel: '781-933432M
Fax:: 781-932-9017
Name of Ucenew PlumbedGas Fftr,. Mike. Bernesconi
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Check One Only Certificats 9
vf.� Corporation 2806C
State:.
Partnership
Finn/Company:
I have a current liability neurance policy or Its substantial equivalent which meele the requirements of UGL. Ch. 142 Yes -: No
ff you have chocked Yes. please Indicate the type of coverage by checking the appropftla box below.
A liability Insuirance policy: V( . Other type of Indeminky Bond: ;
OWNEWS INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Massachusetts General Lon, and that my signature on this permit application walm this requirement
Owner Ag�nt
Signature of Owner or Owners Agent
ft checking this boir[, I —Mnft cerft that all of the detalle and Into -- 8 Itted (or rding �" applicedon-are true and
accurate to the beat of my Knowledge and Vint all plumbing work an M U permit be this application will be In
compliance with all Pertinent provision of the 11 huseft Stam IN! 9 Chapter 42 of
,,nnatWi lave ,I,,n "*so
F-Riamnatrns F... ' "
f erp of�p'
.Type of License:
By.
Plumber
Gas Fitter 'Signature
Two Plumbs Fitter
'CenseW
Mania
Ckyfrown; Jou
LP"w'man Ucense N :15137M
AP0R0Vgbj6iFh6jjAk0- Installer 1-1 u In
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Installing Company Name:;, Central Cooling & Heating, Inc.
Address,-; 9 North Maple Street CItYrrowm Woburn
Business Tel: '781-933432M
Fax:: 781-932-9017
Name of Ucenew PlumbedGas Fftr,. Mike. Bernesconi
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2 12 LL
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Check One Only Certificats 9
vf.� Corporation 2806C
State:.
Partnership
Finn/Company:
I have a current liability neurance policy or Its substantial equivalent which meele the requirements of UGL. Ch. 142 Yes -: No
ff you have chocked Yes. please Indicate the type of coverage by checking the appropftla box below.
A liability Insuirance policy: V( . Other type of Indeminky Bond: ;
OWNEWS INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Massachusetts General Lon, and that my signature on this permit application walm this requirement
Owner Ag�nt
Signature of Owner or Owners Agent
ft checking this boir[, I —Mnft cerft that all of the detalle and Into -- 8 Itted (or rding �" applicedon-are true and
accurate to the beat of my Knowledge and Vint all plumbing work an M U permit be this application will be In
compliance with all Pertinent provision of the 11 huseft Stam IN! 9 Chapter 42 of
,,nnatWi lave ,I,,n "*so
F-Riamnatrns F... ' "
f erp of�p'
.Type of License:
By.
Plumber
Gas Fitter 'Signature
Two Plumbs Fitter
'CenseW
Mania
Ckyfrown; Jou
LP"w'man Ucense N :15137M
AP0R0Vgbj6iFh6jjAk0- Installer 1-1 u In
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The Commonwealth ofMassachusetts
Department ofIndustrial Accidents
Office of Investigations Map#—Lot#
600 Washington Street Address:
Boston, AL4 02111 Permit#
www.mass.gov1d1a
Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/orgmiizafion/individuai):
Address.:. 2 : mor- �- -maglia RLee,+
City/State/Zip:_
Phone#: —79J—c?33-9'c;thF
Are you an employer? Chick the appropriate box: Type of project (required):
1.0 1 am a employer with 4. E] la mi a general contractor and 1 6. El New construction
en4 3loyces (full and/or part-tirne).* have hired the sub -contractors
2. El I am a sole proprietor or partner- listed on the attached. sheet 7. Remodeling
ship and have no employees These sub -contractors have 8. Demolition
employees and have workers'
working for me in any capacity. 9. E] Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. We are a corporation and its 10.n Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their I Ln Plumbing repairs oradditions
myself. [No workers' comp. right. of exemption per MGL 12.E] Roof repairs
insurance required.] t :c. 152, § 1(4), and we have no
employees. [No workers' 13.[S Other
comp. insurance required.]
*Any applicant thatchecks box #1 must also fill out the section below showing their workers' compensation policyinfonnation.
t Homeowners who su6it this affidavit indicating 1hey am doing all work, and then hire outside contractop; must subrnit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet sbowi . ng the name of the sub -contractors and state whether or not those entities have
ermloym. If the sub -contractors have employ=, they must provide their workers' comp. policy number.
I am an employer that isproviding workers' compensation insurancefor . my employeeL Below Is the policy andjob site
information.
insurance company Name: GLOBAL XNSUAANCE N67116)?X, ZVC,
Policy # or Self -ins. Lic. M a a 9 (n3(,n Expiration Date: /.2 0 /1
Job Site Address:— City/State/Zip: IV J4/7/,/r1,/`,?,- jj�Tf
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 under th pains andpenafties ofperjuiy that the information provided above & true and correct.
use only. Do not write In this area,
or town ojykiaL
City or Town: PermittLicense #
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 #:
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 person in the service of another under any contract of hire,
express or 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, partnership, association or other legal entity, employing employees. However the
owner of a dwell ing house having not more than three apartments and who resides therein, or the occupant 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 to 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 requi red."
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 contiacting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, ff
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or ff 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 =Drot)riate line. . I I
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 affidavit 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 permittlicense number which will be used. as a reference number. In addition, an applicant
that must subinit multiple permittlicense applications in any given year, need only submit one affidavit indicating current
policy information (ff necessary) and under "Job Site Address" the applicant should write "all locations in, (city or
town)." A copy of the affidavit that has been officially damped or marked by the city or -town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fined 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 or permit to bum leaves etc.) said person is NOT required to complete this affidavi�
The Office of Investigations would like to than you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.'
The Department's address, telephone and fax number:
The CommonwWth of Mmuchusetts
Dqxrtment of Industrial Accidents
Office of invesftations
600 Wwhington Street
Boston, MA 02111
Tel.'# 617-7274900 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax # 617-727-7749
www.mass.gov/dia
4
COMMONWEALTH 6F MASSACHUSETTS
IN PLUMBERS AND GASFITTERS
LICENff&A&QR�N$VM,AN PLUMBER
MICHAEL C BERNASCONI
;V,
58 ALBATROSS RD
QUINCY MA 02169-2658
-Ml will
cbmmoNWitAL:fA-6f -MA§S-A'-dH-U,S--E-T--T-*S
'DIVISION OF PROFESSIONAL LICENSURF - �OARDOF
IN PLUMBERS AND GASFITTERS
LICE1JW7&SA&VMjg(fkUMBER
i e
MICHAEL C BERMASCONI
=0 AIUATonce on . cr
QUINCY NA 02169-2658
774A99
COMMONWE'- ALTH OF M ASSACHUSETTS:
BOARD OF SHEET METAL WORKERS
AS &u'I&SHTEE CREENSS ETTRO! C T E D
AFRUEN
MICHAEL C BERNASCONI
58 ALBATROSS RD
QUINCY MA 02169-2658
LICENSE NO. DATE SERIALNO-
-.D
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ :: ..... ...............................................
has permission to perform
..........
:Z
wiring in the building of ........ ....................................
1� 0
at. .......... ............ . North Andover, Mass.
.............. ......
Fee ..................... Lic.
............ ..........
Check # ELEerRicAL INSPECT!7
6 62- 5
Commonwealth of Massachusetts
, �LCI
9
OCCLIpanc� and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9 051 jej,"C blank)
Department of Fire Services
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All .,,ork to lie pedol-Illed ill �jcct)rdallCe \\i1ll tllC \,hS'.,!lCl1LISCttS l'lCCtI'iC,ll Code (%IF0 R 12.00
/._ fi7 (/10
WLEASE PRL\ T /A 1AW OR TYPEALL L�TQRHATWN) Date: -) I ID
Citv or Town of: 4-4-V Aakm- To the Inspeclor ol Wires:
13Y this application tile undersioned ives notice ot'his 01' her intention () pel-t orill tile clecti-ical work described below.
Location (Street & Number)
Owner or Tenant Ajpvlc�,. mAdda.)� Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes X N o (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead F] Undgrd No. of Meters
New Service Amps Volts Overhead 0 Undgird No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: V4"A rlemoA
C,,I) 4" 1 im I o I I hc '(*j1/1, I I il If, I( I h le nim be I va I I,d bv / /IV 1jISj1)C(1i)I' 0/ 1 Vir,
Mach i,khotma! � Ici, W il dc"Nivi'd, ol, (I'S I C,JIIII*L 1i hI I/It. oiq;t C WP ii
E.,,tinlated Value ofElectrical Work: (�k lien required by InUnicipal policy.)
% ork to Start: inspections to be requested in accordance xkith 'vIEC RLIle 10, and Upon C0111PICti011.
INSLRANCE COVERA(JE: L.,nIcss waived by the owner. no pcnnit for the pci-lormance of clectrical �vork 11lay issue 11111c,
111c licciisec provides proof of liabilitv illSILIRII)CC inClUding �'complvtcd operation"" covel-a.�!C of- ItS SLIbSiantial CL111i�aILAlt- i"hL:
l,lndcrsi-,,,ncd certi[Ics that ;tIch CoN cragc i�, ill 1,01 -cc, �llld has c"llibitcd proof ot:.;aric to tile pel-Illit
7,K I
-1 11:1Z spucilv:)
I I E C K ON E: I N S (; R, 0--, [] llom) D m . f__ LeC4�� I i 0 6 ? d"
I ceriq5!, wider 1he I idpenalties o0qjury, ihaf The hilormalion int Ih isippflelt 111) ivi.s trile alyd co� yiphle
FIRM NAME: I A! L I C. \i 0.: acl�5y)
E-_ t tf - A�
Licensee: DCAI-Peii) r1),'\A1 IAC. .1�O.:
t 11", �1_11* * W/C IL6 ''� _C'I 114 M Ili" 1,L1 me (9;�- I q -T Otis. Tel. Njo.: _�7sl
Add. 11— tBbx,-,-,>,5 -7 m,, , Jj .1 A7 A 4��_Alt. Tel. No.:—
*SM11-ity S�,,tcnl Contractor License reqUircd for this \�ork; if applicable, ciatcr the IiCLAISC IlUniber 110V
O�%vNER'S INSURANCE \NAIVER: I am aw;ire that the Licensee do(!,%.;7(,1 havc the liability ill.S1.11-anCe C1JV1:I_aLC 11CI-111ally
ICLJUircd by law. By mysi,piatlat-L below, I hcrL:by \\,ai,,e this rcquil-LI1101t. I ain the (check one) 0 owner 0 ownur�;
Owner/Agent P F R Vf I T FFF,-
:�igajture —4 L 1) 1-1 CY 4 1 0.
No. of I otal
No. of Recessed Luminaires
No. of C,il.-Susp. (Paddle) Fans
Transformers KVA
No. of Luminaire Outlets
No..of Hot Tubs
Generators KVA
No. of Luminaires
%bo,.e Ei In
Swimming Pool grnd. gi-nd.
No. of Emergency Lig ing
Battcry Unit.�
___�No.ofZones
No. of Receptacle Outlets
No. of Oil Burners 11FIREAL
11
ARMS
No. of Detection and
No. of Switches co
No. of Gas Burners
Initiating aevices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
"eat Pump
I Number
JTOIIS
KW Ji
No. of Self -Contained
No. of Waste Disposers
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 0 iNlounliniciptipoin E] Other
No. of Dryers
Heating Appliances KW
Security S steins:*
No. oi 6evices or Equivalent
No. of—Water KW
1 0. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
Felecommunications Wiring:
No. "ydromassage Bathtubs
No. of Motors Total HP
No. of D"ices or Equb�alent
OTHER:
Mach i,khotma! � Ici, W il dc"Nivi'd, ol, (I'S I C,JIIII*L 1i hI I/It. oiq;t C WP ii
E.,,tinlated Value ofElectrical Work: (�k lien required by InUnicipal policy.)
% ork to Start: inspections to be requested in accordance xkith 'vIEC RLIle 10, and Upon C0111PICti011.
INSLRANCE COVERA(JE: L.,nIcss waived by the owner. no pcnnit for the pci-lormance of clectrical �vork 11lay issue 11111c,
111c licciisec provides proof of liabilitv illSILIRII)CC inClUding �'complvtcd operation"" covel-a.�!C of- ItS SLIbSiantial CL111i�aILAlt- i"hL:
l,lndcrsi-,,,ncd certi[Ics that ;tIch CoN cragc i�, ill 1,01 -cc, �llld has c"llibitcd proof ot:.;aric to tile pel-Illit
7,K I
-1 11:1Z spucilv:)
I I E C K ON E: I N S (; R, 0--, [] llom) D m . f__ LeC4�� I i 0 6 ? d"
I ceriq5!, wider 1he I idpenalties o0qjury, ihaf The hilormalion int Ih isippflelt 111) ivi.s trile alyd co� yiphle
FIRM NAME: I A! L I C. \i 0.: acl�5y)
E-_ t tf - A�
Licensee: DCAI-Peii) r1),'\A1 IAC. .1�O.:
t 11", �1_11* * W/C IL6 ''� _C'I 114 M Ili" 1,L1 me (9;�- I q -T Otis. Tel. Njo.: _�7sl
Add. 11— tBbx,-,-,>,5 -7 m,, , Jj .1 A7 A 4��_Alt. Tel. No.:—
*SM11-ity S�,,tcnl Contractor License reqUircd for this \�ork; if applicable, ciatcr the IiCLAISC IlUniber 110V
O�%vNER'S INSURANCE \NAIVER: I am aw;ire that the Licensee do(!,%.;7(,1 havc the liability ill.S1.11-anCe C1JV1:I_aLC 11CI-111ally
ICLJUircd by law. By mysi,piatlat-L below, I hcrL:by \\,ai,,e this rcquil-LI1101t. I ain the (check one) 0 owner 0 ownur�;
Owner/Agent P F R Vf I T FFF,-
:�igajture —4 L 1) 1-1 CY 4 1 0.
io
7454
No
Date ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......... ......... T��f,..,xh& .........................
has permission to perform ...... �C. I Ll,rc, I ........................
wiring in the building of ........ ..........................................
I ................ North AndQyer. Mass?
at ........... r2l
Fee.4,02...t.(". .. Lic. NoA- ....
// ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
.-,A
TBE CVW0AWE4LTH0FA14MCHUSETJS Office Use only
DEPARTA1E7VT0FPUB1JCS4FM Perrait No.
BOAM 0FFMPREVEW0NRWMT10AN 527CM 12.0
Occupancy & Fees Checked
APPUCATION FOR PERAff TO PEUORM ELECMCAL WORK
A
ALL WORK TO BE PERFORMED IN ACACORDANCE WITH THE MASSACHUSSTS ELECMCAL CODE, 527 cmR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -142211o.1
Town of North Andover
The undersigned applies for a permit to perfbrm the electrical work described below.
To the Inspector of Wires:
Location (Street & Number) a9 A4 i i 04�
Owner or Tenant 6Q C�
Owner's Address
Is this permit in conjunction with a building permit: Yes [:] No (Check Appropriate Box)
Plurpose of Building Utility Authorization No.
Existing Service /00 AmpL.LW LoVolts Overhead Underground No. of Meters
New Service Amps Volts Overhead Underground No. of Meters
Naimber of Feeders and Ampacity
1.6cation and Nature of Proposed Electrical Work am
Mo. of Lighting Outlets
No. of Hot Tubs
No. ofTransformers
Total
KVA
No. ofLighting Fixtures
Swimming Pool Above
1:1
Below
M
Generators
KVA
ground
ground
No. of Receptacle Outlets
No. ofOil Burners
No. ofEmergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. ofZones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. ofDisposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
M
Other
No. of Dryers
Heating Devices KW
I Connections
No. ofWater Heaters KW
No. of No. of
Signs
Bailasis
— — —
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER -
Ifimeabnadvamprodofsamelotheoffim YES I V
+pcpi*bcPL
INSURANCE BOND 01HER
tionsCovaaWcrits%ks0rtdeqivdkrt YES L_!J NO L__J
NO 0 WWuhmedWWYESpkmffdc&dei)�cfwmaEpbydiedmgthe
70-1
WorkoSwit YbOJO 1_ InspeWcnD*RaWcsWd
Signedunder&Rrult�s ofp4ay.
FIRMNAME
la,
ft"Speffy) a- h 3 16 /
EMWdValuedUmftxalWuk
RaLo Final
Aq )r) U9 - wX c
Ak.TdNh
OWNER'S PqRRANCEWAIVER-,I.anmmtxttheLicemedxs not Laws
anddUnrf *utaronthis pan*WpfiadimVQr%4eSdii& r&T ri-emat
(Please check one) Owner Agent M Telephone No. PERMIT FEE $
3) 4 5 21 Date./
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that 1.)e' '�' - .-. . . . -55�� �'
.. ...... ...................
has permission for gas installation .... / ........................
in the buildings of . . .
d. ..............................
at ......
................. North Andover, Mass.
Fee. Lic. No. .
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
INSURANCE COVERAGE:
I have a currqr# liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes PN No 11
It you have checked yes, please Indicate the type coverage by checking Um apprapdate box -
A liability Insurance policy X Other type of Indemnity 0 Bond 0
OWNER'S INSURANCE WANER: I arn aware that the licensee does r& Wpm Ow kumlrance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this penAft aWkmVion Youlives Uft re quirement.
Check one:
CMTWO Agent 0
Signature of Owner or Owner's Agent
I hereby certify that all of the deWls; and information I have submitted (or entered) in a bove appitoation are true and aocuraleho the best o( my
knowiedge and that all plumbing �Yotk and Installations perfourted under the A for r17 �* 7!7-7
' S lance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142
BY Time of License: F/
1:4.1,lumbef Signature of It Plumber or Mas Fitter
Title KGasfitter
50
MASSACHUSETTS UNIFORM APPLICATION
FOR PER IT TO DO GASFITTING
(Print or Type)
1,S
Mass.
Oe
d -J
Permit#
Name
BuNding Location
s
Type of Occupancx.—�&�fL�--�
New
Renovation
Replacement o
Plans SubmItted: Yes 0 No 0
4n
U4
a
CC
0
0
U
EU
IC 1-
0 tu '<
i -
'4
'Ira
:-1
Z
0
Z
a
X
W
4K
0 W
4u
V)
tu
Uj
la
-A
x W
VA
114 S-
=
W
>
z
0
z
0
X
t
W
tu
0
0
W
0
P
0
SUB—SSMT.
I
I t
BASEMENT
I -ST FLOOR
2NDFLOOR
3RDFLOOR
4TKFLOOR
STH FLOOR
6TKFLOOR
7THFLOOR
OTH-FLOOR
Installing Company Name.
n
Check one: Certificate
Address 1q0 4�n NAd
In
X ommation 10,5c--"
Mi�ip4rin
MCA 01CILIg
0 Paftershlp
7n
Business Telephone M'17�1,9�1140
0 Firm/Co.
Name of Ucensed Plumber or Gas Fitter.
INSURANCE COVERAGE:
I have a currqr# liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes PN No 11
It you have checked yes, please Indicate the type coverage by checking Um apprapdate box -
A liability Insurance policy X Other type of Indemnity 0 Bond 0
OWNER'S INSURANCE WANER: I arn aware that the licensee does r& Wpm Ow kumlrance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this penAft aWkmVion Youlives Uft re quirement.
Check one:
CMTWO Agent 0
Signature of Owner or Owner's Agent
I hereby certify that all of the deWls; and information I have submitted (or entered) in a bove appitoation are true and aocuraleho the best o( my
knowiedge and that all plumbing �Yotk and Installations perfourted under the A for r17 �* 7!7-7
' S lance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142
BY Time of License: F/
1:4.1,lumbef Signature of It Plumber or Mas Fitter
Title KGasfitter
.0
N22229
Date. ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... 11)..'...D.—T ............... : .............................................
has permission to perform .... .....................................
wiring in the building of ......
............... .............................................................
at .... C.i ............................................. .......... . North Andover, Mass.
Fee;9.5 ................. Lic. No��,4j. ....... >
ELECTRICAL INspEcTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
.4
Cwnweahk ol Y4a4.iac1xuje1b
2eparinzad olJitz Sertjcaj
BOARD OF FIRE PREVENTION REGULATIONS
Official USC Only
Permit No. '2- -Z -Z "?
Occupancy and Fee Checked
Rev. 1 U99] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perrornicd ill acicord.mcc with the Nlassachuscits Elcctrical Code (MEC), 527 01.111 12.00
(PLEASE PIUNT1,V INK OR TYPEALL INFORM -1770H) Onte: P
City or Town of: _Q0 (-42v-�, A t3 80 �e(z_ — To file ljispecto;- of pij-es:
By this application die undersigned gives notice oriiis or hcr intenti t
perform the elccrrical work described below.
Location (Street & Number) all 9 OP"', A 6z -?j
Owner or Tenant 7 -an \6e,
Owner's Address
Is this perinit in conjutictiolf with 1 buildiii- perinit?
Purliose of Building
Existille Set -vice
Anips Volts
New Service Anips Volts
Number of Feeders and Anipacity
Location a nd Nature of Proposed Electrical Work:
Telephone No. 0
2 ffL �E
Yes N o f 7,A
VY (Clieck Appropriate Box)
Utility Authorization No.
OverlicadEl
Overhead 1:1
UjidgrLIE] No. of Meters.
Undgrd El No. of Nleters.
C n
coninteliall of r. IL
No. or Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
—Transformers
may e iva vc( v the hispcetor at I-Pires.
N 0. of Total
KVA
No. of Lighting Outlets
0
No. of I -lot Tubs
Generators KVA
No. of.Lightincy Fixtures
t� b
Above E] in-
Swimming Pool a El
riid. gr d.
'N 0 01 Emergency Ligtiting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAj;LjIS
No. of Zo . iie
No. of Switches
No. of Gas Burners
No. of�Detecuon a�d
Initiatina D S
I orRancres
Total
No. of Air Cond. Tons
No. or Alertina Devices
No. of Waste Disposers
Heat Pump
Totals-
iVu—niber Forts
P
KW
No. of Self-Contai—ned
Detection/Alerting Devices
F
No. of Dishwashers
Space/Area Heating KW
Municipal ID
L 'Other
oc egtion
No. of Dryers
Heating Appliances
ft jKW
ecurity Svsterns!
Data W
No. iriV-vices or Equiv
of e alent
No. of Water
Heaters KW
INO. of No. of
Si -lis Ballasts
No.HydroinassageBailitubs
No. of 11%liotors Total TIP
I clecommunicatioas Wiring:
No. or Devices or Equivalent -
OTHER:
Attach additional detail if desired. or as required by the lns��wires.
INSURANCE COVER -AGE: Unless waived by the o%mer, no -permit for the performance of electrical work may issue unless
tile licensee provides proof of liability insurafice 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 O'NE: INSURjkNCE 0 BOND El arHER C] (Specify:)
Estimated 'Value of Elcctri'cal..Work: . C;-) (0 9. (When required by municipal policy.) (Expiration - . Date)
Work to -Start: �5.)/,3kd Itispcctions to be requested in accordance with NMEC Rule 10, and upon completion. )-?D
I cerlify, tin tier the pains and penalties qfperjury, that the hifi�rtyzation on this application is trite and complete. P. S
171101 NAME: _:�' , ADT"SECURITY SERVICES, INC. LIC. NO.: ClS'33
Licensee: _J0 14-1-' -S - /3 A 5 5 .9 / _ISi-natur
LIC.No.:CI533
(If applicable, enter t . it the license number line.) B us. T.I.,No.(781) 278-1r69
Address: ill NORSE STREET,*NORWOOD, MA O�Oj Alt.Tel.No..(781) 278-1131
OWNER'S INSURANCE WAIVE R: I atil aw-arc 1h3t the I icensee doeT not have the liability insurance coverage normally
required by law. By my signature below, 1 hereby waive this requirenicilt. I all, tile (chcck olic) E) o%vl1cr El owner's agent.
ONYner/Anent M ]
Signature' Telepholle No. FPE-R,41IT r, E- E: S 155
el -
2" 9 8 9 .......
Date../�." �10
CL
"Ol'i TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
�"U
CU
This certifies that ...............
9
has permission for gas installation ... /-/ 13
.........................
in the buildings of �� ........................
at ........ Pkmlk Andover, Mass.
Fee. Lic. No. ......
QAS�I�N�PEIC�To
ept.
WHITE: Applicant CANARY: Buildin 4 PINK: Treasurer
JASSACHUSETTS UNWORM APPLICATON FOR PERMrr TO DO GAS FTITING
or print)
I'NqJKItIAI'41JVVLI'k,IVIAOOAq-EIU C113
Date Z/,Z -;z 19
Building Locations �2 9 11?—�.,ell Y_?g� Permit A A "
Amount S
Owner's Name
New N Renovation F� Replacement F-1 Plans Submitted
(Print or type) Check one: Certificate Installing Company
Name— �— yz rl�, M Corp.
Address
usiness Telephone -V 7 3— 6
Name of Licensed Plumber or Gas Fitter
11 Parmer.
ElFirm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Nom
If you have checked ves please indicate the ty
pe coverage by checking the appropriate box.
Liabiliry insurance policy Other ty
. M , pe of indemnity Bond 1:3
A
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.
.\ I Check one:
Signature of Owner or Owner's Agent Owner D A2ent
i hereby certify that all of the details and information I ha e b itted r �entered) in above application are true and accurate to tne
I s P I Pe It
best ofmy knowledge and that all plumbing work and insta latio; orZmed under Permit [ssuedZr this application will be'
compliance with all pertinent provisions of the iN/lassachusetts St 42�15�
,�e enws.
By:
Title
City/Town
A-PPPOVED (OFFICE WS� ON1, Y)
Signature of Licensed Plumber Or Gas Fitter
Plumber /-�/ :::� r— 91—
E] Gas Fitter T 777—enseiNumoer
Master
Joumeyrnan