HomeMy WebLinkAboutMiscellaneous - 29 RUSSELL STREET 4/30/2018'IV
6
Date.. ......
%ORTH
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
This certifies that ..... ................................................................
has permission to perform
wiringin the bu ' ilding of � .............. ....... I .......... ....... ........................................
..................... . North Andover, Mass.
at ............... .........
Fee � ..... .... ............. .. Lic. Noi�'�L� . ...........
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(C�\ Official Use Only
Permit No.
Occupancy and Fee Checked il�
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perforined in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12-00
(PLEASE PRIATT IN INK OR TYPE ALL IATFORAL4 TION) Date: IDe
City or Town of: A),), -A '6� /0'/ g-- To the InspecIO7- Qf Wires:
By this application the undersigned gives notice Of his or her intention to perform the electrical work described below.
Location (Street & Number) d7 g'44_��-e ( / &�-
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building 3 EP Utility Authorization No.
Existing Service
New Service
Amps Volts
Amps Volts
Overhead 7 Undard 7
Overhead F-1 UndgrdF]
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
s4oa-SA I "
Coinpletion of thefiolloiving table n7ay be ),vaived by the Jnspector of 1411'7-eS.
No. of Recessed Luminaires z_
No. of Ccil.-Susp. (Paddle) Fails
No. of Total
Transformers KN7A
No. of Luminaire Outlets
No. of Hot Tubs
Generators KN7A
No. of Luminaires �_
Swimmin- Above 0 In-
11 Pool grad. grild.
'No. of Emergency Lighting
Battery Units,
No. of Receptacle Outlets 2, D
—
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 ir Cond Total
No of Alerting Devices
-A Tolls
No. of Waste Disposers
Heatpump
Totals:
N.ilm.be.r...Tons
I .. .... .. ..
..........
..
o. of Self -Contained
Detection/Alertina, Devices
No. of Dishwashers
Space/Area Heating K*A'
E] Municipal
Local Connection El
No. of Dryers
Heating Appliances KW
t,
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Mlirina:
No. of De'vices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
,4ttach additional detail if desired, or as required by the Inspector of Ill'ires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 1, 1-', (C'g Inspections to be requested in accordance with MEC Rule I O� 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 includin "completed operation" coverage or its Substantial equivalent. The
undersigned certifies that such coverage is in force. and nas exhimteo pl-001 01 Sallie to tritz: pz�rlllll issulll�' 6i3lC1--.
CHECK ONE: INSURANCE Z"' BONDEI OTHER F-1 (specify:)
I certify, under thepaz . as andpenalties ofpeiju�)), that the infiormation on this aliplication is true and complete.
FIRM NAME: C- A LIC. NO.: 4 t i�6 -7
Licensee: Sic'nature 1,11C. NO.: U126 9
(Ifopplicable, enter "exen2pt " in the license nianber line.) Bus. Tel,. Nc.-
Address: c� 66 )- L' 8 14 & Te�. No.�' "2
*Per M.G.L. c. 147, s. 57-61, security work requires Depard-rient of Public Safety "S" License: Lie. No.
OWNE R'S ENISURfiNCE WAEVER, I arn aware that the Licensee does not have the liability insurance coverag�c normally
required by law. By my signature below, I hereby waive this requirement. I arn the (check one) [] owner F-1 owner's agent.
Owner/Agent C) -, — V.
Si -nature [�E:' 7)? ff f T r, E E, : S
Telephone No.
�z' .'
11/20/2008 16:07 9788580662
CGELECTRIC
PAGE 01/01
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Boston, M4 02111
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WildrersIt Com'pensation 1wur2nce.A2Mday.itI lauDders/Contr*ctors/EimtridiAns/Plumbers
ARPlicant.Informatioi
Plena
N2LMC (BiLqine&Yorgani2ationtlndividual):_C— e r� r-% r . .
Ad&ess: . z
city/stale/zip: Phone
jkre y0H in employer? Cheek the 2ppr9priste blix.
an a employer w&
4. []'1 am. a ganeml contractor and I
O'npleyeat (full 2md/or part-zime).*
2. 1 &M A $;OIC�Propnetor or Partner-
have himd the sub�co�orl
listed cc tim aftchad she=
ship and have no employees
These 8��cMtr=ors have
working for me in amy capacity�
[No worken*. cornp. inamnce:
workers, -comp. i nsuratice.
5.0 We- are a corp=bon and its
requked�) I
3. 1 am a homeowner doilig all work
Officers hgrve exemise&tbtir
r'vht Of exiTnPtiOn PC MOL
myself. [No. workers' camp.
0. 152, § 1 (4), and we Jove no
insurance req.uire&],?
�'emPlOYeL's. [No workers'
AL� A—h— it.., �U . L__ A,,
TYPe of Project (required) -
6.. M New construction
7. ED Remodeling.
8, Darnolition
84ilding additiol)
Elec*Rl repairs or additions
ILEI Phrmbinc, rePairs'or additions
12, E] -Roof repairs
lI[] Other
.1&��L�l�VW*W-,nngthCkVjorJC6r,, ft nnation,
ZY'"10 d0hig 61-w*?k AL111Z i�cn hire OuMicke Conimclori; 8"M9 subihi(IL np� 3ffidavij indimft'l—'.
H4tmaQw=6 wh* SaInnh.this afIrsdavit ititijeafing WMPM=tiD p0hu infh
3COMN10tv thAt ch=k this box-mdqtiff-W an addhioral AM showing
0 thV !AMt Qf!h:t Old (imir workm - 6mp. pqj iry igf,"'tion
I am aft rMpkYer MW is jorvvi&pq Werkery co"Wemadon
iN S"Aurancefo-" nF eMP'VY=' Bd#w 4T the PvficY andjob site
. f0r"wdgn. -I d i _—)
lnsmnce Company
Policy 9 or Self -ins.
Job Site Address-
city/stabj-zip:
AUSch A Copy of the workers, compeamtion policy glec6ration.Fat,
, (showing the Policy number and expiration 4ste�
.5ailure to secure' Dovente.- as required under Section 25A Of MGL c. 152 can lead to thr imposition.of r
fift. up to $1,500.00 and/or onc-yaw i1riplisopmM as well as civil penaftics in th.- fom ritninal Penalties of a.
of up to MOM a day against the violator. Re advised that a cop), of of a STOP WORK OPDER and a fme
investigations of the DIA for insurance coverage verificati,611. this.sWMcni MAY b-- forwarded -to ttte office of
A
of peryag t*= the information provided. above is rme md ogrrM
off'CW Aue on(Y' - Do. 1W1 write in this area, iD he 4-111WIeld-by chy or town &ffWi&L
City or Town- Permit/License
Issuing Autbority
circle one):
1. Board of Health 2. Buildifte'DcPartment 3. City/Town aerk 4, Electrical Inspector
6. Other S. Plumbih*, Inspettor
Contact permn: Phone
-r
At
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
C6.
i;o
This certifies that B ...... tl;;�
..........
has permission to performp;�� ea L—
........................... ..... ....
wiring in the building of ....... ...... .............
at ...... A'?XK, ...... ��. <2�?44 . ... :: ...... North Andover, Mass.
Fee.1.1.57 . . .... Lic. No. 4�355J� ...............
Check # ELECTRICAL INSPECTOR
67 'e� 7
1P
Coil. -onwealth of Massachusen- y
H Depardlient of Fire Services Pc!rnill NO. -7
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/99] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfonned in accordance with the Massachusetts Electrical Code (MEC 5276N� 12.00
(TLEASE� PRINT IN INK OR TYPE, ALL INFORMA TION) Date: (, - I
Cityor'rowrion . k�ortjq A-4DOUE-(L. To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) I? L-' 6 5 r, L L 5 f
Owner or Tenant poi kC— Le, FoS te Telephone No.
Owner's Address c, -r
is this permit in conjunction with a building permit? Yes [W No El (Check Appropriate Box)
Purpose of Building Electv, � c-4 i e(-)-rJO 'j 0� ' Of' -r Utility Authorization No. 2A Ll coo
ExistingService t6O Amps feC,-1 Zelo_volts Overhead [!T Undgrd F-1 No. of Meters
New Service 2 6c�) Amps 12��r 04olts Overhead 9 Undgrd F] No. of meters
Number of Feeders and Ampacity
"cation and Nature of Proposed Electrical Work:
Comnletinn nfth.- fnllnwincy tnhip mav hp wnivod hv thp fnenprtnr nl'Wiroc
No. of Recessed Fixtures
-a
No. of Cei I.-Susp. (Padd-10 Fans
zz;z
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lightin? Fixtures
Swimming Pool E]
-nd.
No. of Emergency Lighting
BatteEl Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
rNo. of Zones
No. of Switches
- --3
No. of Gas Burners
No- of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I Number
I Toq,� . . ..... I.KW---.-
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
space/Area Heating KW
Local Ei Municip�l El Other
Connection
No. of Dryers
Heating Appliances KW
gecunty Systems:
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
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 pe . t rice.
to the r6 I
CHECK ONE: INSURANCE 11--,BoNDE) OTHER El (specify:) t; A 6 4 1 t
elv-, -C/O (Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Y� "21) Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certi P nons an4 penalties ofperjury, n on this application is true and complete
fy, under th F that the informatio
FIRM NAM 77 - -
CO, 0 v I C & -e-? TAJ (!2- LI . NO.:-Iq 67
Licensee:, Signature �171 LIC. NO.: -!�O J6
9
(if applicable, enter "exempt.,in the liqense n*m line.) Bus. Tel. No.*q-76'- 5' -YO
Address: — 7z, Lff '� % Tr 19 '6 Alf Tel No
r- k1'\6tt-11JE1
required by law
Owner/Agent
Signature —
JRA,NCE WAIVER: I am aware that the Licensee do& not have the liability insurance coverage normally
By my signature below, I hereby waive this requirement. I am the (check one)Elowner Downer's ager
Telephone No. [;TE��T FEE,: $
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Date.'�? .........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...... ....... ..........
has permission to perform ...............
fl
plumbing in the buildings of
at N h Andover, Mass.
Fee. ...... Lic. No.
.'— ......... . .. . ..............
P Ms� IING INSPECTOR
Check #
7 14' ' i D
MASSACHUSETTS UNIFORM APPLICATION FOR P . ERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
3C 1 (
of
New 1:1 Renovation tff Replacement * n
PTV7rTTY)�T7,c,
Date
Permit #
tt
Amount
Plans Submitted Yes . El No n
krnnz or type) Che
lnstallin� Compan arne I ck one: Certificate
Vqa�� Corp.
Address e
/VO � 49-11— Partner.
tusines Telephone S-7?
Firm/Co.
Name of Licensed Plupbelf 1eq
Insurance Coveram. Indicate e of insurarte coverage by checking the ap
Lab.ility insurance policy Other type of indemnity . propriate box:
Bond
Insurance Waiver I, the undersigned, have been made aware that the licensee of this applicatio'n does not have any one of the above
three insurance
Signature Own Ag
I hereby certify that all of the details d information I have sub tted tmered^Ah a e aP c are true and accurate to the
best of my knowledge and that aIl plumb rk and iristalla
the tYD
upder Pe e or this application will be in
Icompliance with all pertinent provisions of the Massac us ts State P1 bmi I an a r 342 of the General Laws.
By: LUM U"I LAL;Unst -
Title Type, of Plumb - License
City/Town 11717
APPROVED (omcE usE ONLY I-IL=St AUMDFI----� Master 'Pr Journeyman
I L -j F1
Date. �-. - .4!� m/
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ......... ......
has permission to perform
p I u m b i n g i n t h e- b u i I d i n g s of -&4 1 ... ............
7 -
at �/ ..... / �/i
� ........ No Andover, Mass.
Fee'��!'R. Lic. No.A&(?
... Lill ...........
P L U K�B/ZG�f4 S PECTO R
Check ff le, /'�5'
6 1./, Si 7
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTTI ANDOVER, MASSACHUSE-fTS
Building Location '-'_ 9 'ZI SS r- ( ( Owners
of
New 1:1 Renovation 10 Replacement 1:1
Date
Permit 4t
Amount
Plans Submitted Yes 0 No 0
(Print or type) Check one: Certificate
Installing Company xam`e`--// �,r N64 X
0 Address E] Corp.
im Ajo - El Partner.
nusiness Telephone (J -
Name of Licensed PlumMli�-�/ 11 Firni/Co.
r: -- (
Insurance Coverage: Indicate the type of insikance coverage by checking the appropriate box:
Liability insurance policy 12 Other type of indemnity El Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature -1
I hereby certify that all of the details and inforr/ation I have submitted (o enter
I
best of my knowledge and that all plumbing wprk and installations perfo ed di
0
compliance with all pertinent provisions of the"��se ts Sta I Cod
By:
Signature o7ri—censea m0e—r
Title Type of PlumbinFic, ense
City/Town 16--161 —
11 APPROVED (OFFICE USE ONLY License Number Master
Agent 1:1
in above a
,pK/atior� are true and accurate to the
�p ss d is application will be in
M the General Laws.
5 ner 'rof I
Journeyman
WF'--3-"7'Ur1MMMMMMMMMMM
MMMIMM
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(Print or type) Check one: Certificate
Installing Company xam`e`--// �,r N64 X
0 Address E] Corp.
im Ajo - El Partner.
nusiness Telephone (J -
Name of Licensed PlumMli�-�/ 11 Firni/Co.
r: -- (
Insurance Coverage: Indicate the type of insikance coverage by checking the appropriate box:
Liability insurance policy 12 Other type of indemnity El Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature -1
I hereby certify that all of the details and inforr/ation I have submitted (o enter
I
best of my knowledge and that all plumbing wprk and installations perfo ed di
0
compliance with all pertinent provisions of the"��se ts Sta I Cod
By:
Signature o7ri—censea m0e—r
Title Type of PlumbinFic, ense
City/Town 16--161 —
11 APPROVED (OFFICE USE ONLY License Number Master
Agent 1:1
in above a
,pK/atior� are true and accurate to the
�p ss d is application will be in
M the General Laws.
5 ner 'rof I
Journeyman
AV
�"' 2-ej - 06
Date . ..................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
x....
This certifies that
has permission for gas .............
in the buildings Of ...... ......... .....................
at (� ...... .......... ... North Andover, Mass.
Fee -y—, -I . Lic. No. (J./ .. . Q. �'� . '
Z'4
,EAS INSP66TOR
Check # /0 45,
5627
MASSACHUSMS UNUMMAPPLICATON FOR PERNU TO DO GAS FMING
(Type or print) Date 00
NORTH ANDOVER, MA58ACHUSETTS
Building Locations 09
-t ff S T -
Owner's Name
New Renovation Replacement 1:1
Permit # -,�&c9 7
,Amount$ -aj.
Mlie- lAin
Plans Submitted
(Print or
'14 Name of Licensed Plumber or Gas Fitter
51
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 11 No 13
If you have checked yes, pleasejq#icate the type coverage by checking the appropriate box.
Liability insurance policy 10 Other type of indemnity 13 Bond 13
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 ion waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner A
,u
I hereby certify that all of the details and info tion I hatve :tib tied (or enterwin abov ppl �fn are true and accurate to the
t" s 11
'n I have
tio
t
MX
best of my knowledge and that all plumbing wkrk and instal ati s performed/ �ss
drs 1, r this application will be in
compliance with all pertinent provisions of the ett o and AAP, V10"�t*-,�Jhh'e General Laws.
by:
Title
City/Town
OVED (OFFICE USE ONLY)
r7e."g1nature of icenseOl t6imber Or Gas Fitter
P Um le3n /;
Gas Fitter ri—cense Number
rMaster
Joumeyman
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3RD. F L 0 0 R
4 T H F L 0 0 R
5 T H F L 0 0 R
6 T H F L 0 0 R
7 T H F L 0 0 R
8 T H F L 0 0 R
(Print or
'14 Name of Licensed Plumber or Gas Fitter
51
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 11 No 13
If you have checked yes, pleasejq#icate the type coverage by checking the appropriate box.
Liability insurance policy 10 Other type of indemnity 13 Bond 13
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 ion waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner A
,u
I hereby certify that all of the details and info tion I hatve :tib tied (or enterwin abov ppl �fn are true and accurate to the
t" s 11
'n I have
tio
t
MX
best of my knowledge and that all plumbing wkrk and instal ati s performed/ �ss
drs 1, r this application will be in
compliance with all pertinent provisions of the ett o and AAP, V10"�t*-,�Jhh'e General Laws.
by:
Title
City/Town
OVED (OFFICE USE ONLY)
r7e."g1nature of icenseOl t6imber Or Gas Fitter
P Um le3n /;
Gas Fitter ri—cense Number
rMaster
Joumeyman