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Home My WebLink AboutMiscellaneous - 30 HOLLY RIDGE ROAD 4/30/2018Q w 0 9 0 0 m 0 0 P 0 00 Date............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ .............. ..... . ....... ... ...... ..... ........................ .... ... has permission to perform wiring in the buildi of ... . �� ...... at ............. =OW ..... ... ... ... North Andover,�ass. ................... .Fee.4'-> .... . ... Lic. No . ............. ............... . .... . .. . ...... ... .. ... LECTRICAL INS IN PE Check # 10717 Commonwealth of Massachusetts Official Use Only Permit No. Lo -7 117 0 �A Department of Fire Services Va Wumw A Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEQ,,�27 CT�R 12.00 (PLEASE PRINT ININK OR Date: ;11311 L - City or Town of- TO the Inspedo� Of1wires., By this application the undersigned. gives notice of his or her intention to perform the electrical work described below. I Z 1.- 0-2 — Location (Street & Number) jt�� 11e1jK eLC�/ff (!V� a Owner or Tenant - !A/ ;6 Tel-epho A e No. YJE, Owner's Address 7 - Is this permit -in conjiJinction with a building permit? Yes El - No Eff (Check -Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd n New Service - _ Amps Volts Overhead Undgrd F] Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Completion of the fiollowing table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cefl.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire.Outlets No. of Hot Tubs Generators NVA No. of Luminaires Above Swimming Pool grud. El El grnd. o. of Emergency_L—igIiTmg Batte!j Units No. of Receptacle I Outlets No. of Oil Burners FIRE ALARMSTNo. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat7_um_pTN_u.mber I Tons KW No. of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Locaio Municipal r] Other Connection N�.�4 Dr- yers' Heating Appliance's KW .. Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total lip Telecommunications Wiring No. of Devices or Equivaient OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electri(y Work: __ZrdP (When required by municipal policy.) Work to Start: IZ-. Inspections to be requested in accordance with MEC -Rule 10, and upon completion. INSURANCE C6VfWGjL-_UnJess waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE El BOND F1 OTHER F� (Specify:) Icertify,underthepa!r'livid enaft o rjury, at Ifte information on this application is trite and complete. FIRM NAME: /_17 LIC. NO.: A112- " rz. — ' 6 '/, i Licensee: Signature LIC. (Ifapplicoble, ep e t t/ b /* Bus. Tel. NO. 4,�jwp in 7e hcense lin e ine.) Address: Az-fe-z'�-OW 4W 4��Zo A I t. T e 1. N o.: ?7 ff AzW, 3c [17/0 *Security System Contractor License required for this work; if applicable, enter the license number lie OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hove the liability insurance coverage normally required by *law. By my signature below, I hereby waive this requirement. I am the (check one) Downer El owner's a-ent Owner/Agent Signature Telephone No. PERMIT FEE: $ PLEASE COMPLETE REVERSE SIDE ___0' ,pq--A( \yq P . The Commonwealth qjfMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name City/State/Zip: zW-//3FPhone#: Are you an employer? Check the appropriate box: I LEI I am a employer with 4. El I am a general contractor and I (full and/or part -time).* have hired the sub -contractors _!!pployees 2. [�M am a sole proprietor or partner- listed on the attached sheet. *+ ship and have no employees These sub_� contractors have working for me mi any capacity, wo,r,kers' c:omp. insurance. [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL myself [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. F1 New construction 7. EJ Remodeling 8. [:] Demolition 9. E] Boding addition 10 . [IKElectrical re'pairs or additions I LEI Plumbing repairs or additions. 12.[] Roof repairs 13.E:l Other ;Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lain an employer that isproviding workers'compensadon insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Policy # or Self -ins. Lic. M Expiration Date: Job Site Address: 5V Ally 61 Z 4 City/State/Zip: z Attach a copy of the workers' compensatro/n policy declara iion 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 S 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 misuranc . e coverage verification. I do hereby cer1i U Fd d b fy nder thepains��ndpenaldes ofperjury that the information provi e a ove true and correct. 71-,7 3 ;z., Phone #: OgIcUil use only. Do not write in this area, to he complete I d by city or town official City, orTown: �Permit/License # ------ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cit y/Town Cle.rk. 4. Electrical Inspector 5.,Plambifig Inspector 6. Other Contact Person: Phone #: Date. ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........................................... has permission for gas installation ............. in the buildings of .3 Au- ��Jo .... .......... at rth ve S. Fee. �7 . Lic. Noft, A;�tq. GASINSPECTO f Check # -7q/ I 1; ;,.� ..� I � 'NI A%ACHUSETrS UNIFORMAPPUCATDN FORPERMrr TO DO GAS FrrIING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations Permit# Amount (Print or type) Name— Address -Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company E] Corp. 11 Partner. ri Finn/Co. IN , SURANCE COVERAGE Check one: Ihive a current liability Insurance policy or it's substantial equivalent. Yes [:] No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity, 0 Bond 0 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. CAnc�ral s signature on this permit application waives this requirement. Check one'd Signature 40wner or Owner's Agent Owner Agent j hi-.ri-hv ni-.rt;fv thnt nil nftht-, A-tnik nnd infhrmntinn I havp qiihmitted (nr entered) in �hnvesnnficntinn are tnie. and accurate to the best of my knowledge and that all plumbing work and installations performed under P ,;zfiit Issued tor&s . application will be in compliance with all pertinent provi�ons of the Massachusetts State Go/1CZ)e and V$pter_142j9,f th / eral Laws. City/Town VED (OFFICE USE ONLY) Z_ Signature of Licensed Plumber Or Gas Fitter Plumber a SZ-14?13 -j— Gas Fitter License Numoer Master Journeyman Owner's Name /��Yte New Renovation Replacement 1:1 Plans Submitted (Print or type) Name— Address -Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company E] Corp. 11 Partner. ri Finn/Co. IN , SURANCE COVERAGE Check one: Ihive a current liability Insurance policy or it's substantial equivalent. Yes [:] No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity, 0 Bond 0 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. CAnc�ral s signature on this permit application waives this requirement. Check one'd Signature 40wner or Owner's Agent Owner Agent j hi-.ri-hv ni-.rt;fv thnt nil nftht-, A-tnik nnd infhrmntinn I havp qiihmitted (nr entered) in �hnvesnnficntinn are tnie. and accurate to the best of my knowledge and that all plumbing work and installations performed under P ,;zfiit Issued tor&s . application will be in compliance with all pertinent provi�ons of the Massachusetts State Go/1CZ)e and V$pter_142j9,f th / eral Laws. City/Town VED (OFFICE USE ONLY) Z_ Signature of Licensed Plumber Or Gas Fitter Plumber a SZ-14?13 -j— Gas Fitter License Numoer Master Journeyman (40 &n &0 z co z > PQ 0 Gn ?� Z >0 0 > SU B'-BASEM ENT B A S E M E N T 1 S V. F L 0 0 R 2N!D. F L 0 0 R 3,R D. F L 0 0 R 4TH F L 0 0 R 5 T H F L 0 0 R 6 T H F L 0 0 R 7 T H F . L 0 0 R 8 T H F l[, Q 16'111 (Print or type) Name— Address -Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company E] Corp. 11 Partner. ri Finn/Co. IN , SURANCE COVERAGE Check one: Ihive a current liability Insurance policy or it's substantial equivalent. Yes [:] No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity, 0 Bond 0 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. CAnc�ral s signature on this permit application waives this requirement. Check one'd Signature 40wner or Owner's Agent Owner Agent j hi-.ri-hv ni-.rt;fv thnt nil nftht-, A-tnik nnd infhrmntinn I havp qiihmitted (nr entered) in �hnvesnnficntinn are tnie. and accurate to the best of my knowledge and that all plumbing work and installations performed under P ,;zfiit Issued tor&s . application will be in compliance with all pertinent provi�ons of the Massachusetts State Go/1CZ)e and V$pter_142j9,f th / eral Laws. City/Town VED (OFFICE USE ONLY) Z_ Signature of Licensed Plumber Or Gas Fitter Plumber a SZ-14?13 -j— Gas Fitter License Numoer Master Journeyman Date. ........ ,ORTH TOWN OF NORTH AN660VER 0 PERMIT FOR GAS INSTALLATION J., This certifies that 54 ....................... has permission for gas installation( .2) 4-7 f :-� .... . . . . . . in the buildings of . . V.,9.n JLL.,J. /-,. k I" I .(? ....................... ........... North Ando er, Mass. at -V Fee ... .... Lic. No.. �IS-INSPECTOR ly Check# 5.545 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING Date _��_20(5� Receipt# J 'Building Location HOOK r'Joliz 0 Van -rk, k, OwneesNam Map: Lot: 0 Zone: Type of Occupancy . Mgq I dap cf:� Now C3 Renovation U Replacement U Plans Submitted: Yes U No L] Installing Company Nam (L; M6,vt Chockqne': Certificate Address 'S9 Askm_vLnV94-- Mclro5;e Corporatio n Estimate Valueof Work: Partnership Business Telephone. 6 U Firm / Co. Name of Licensed Plumber orGas Fitter MzAevs INSURANCE COVERAGE: I have a Currqq; liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes '' No U I If you have cked ves please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity L1 Bond U OWNER'S INSURANCE11V ER: I am aware that the licensee does not havg the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Signature of Owner or Ownees Aaent Owner 13 AgentO 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By --Type of Lic6nsd: PGIasmber Signature oftjc6rised PFurfibimor Gas Fitter Title sfitter 0� -7 Mas r LicenseNumber City/Town Kjourtneeyman 1APPROVED (OFFICE USE ONLY) Rwsed 05/17/00 W4�IMMENOMMUMMMMMMMMMMMMMMMMMMMMMM W11; "@JW41111*1j1: MMMMMMMMMMMMMMMMMMMMMMMMMMMM Comm Installing Company Nam (L; M6,vt Chockqne': Certificate Address 'S9 Askm_vLnV94-- Mclro5;e Corporatio n Estimate Valueof Work: Partnership Business Telephone. 6 U Firm / Co. Name of Licensed Plumber orGas Fitter MzAevs INSURANCE COVERAGE: I have a Currqq; liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes '' No U I If you have cked ves please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity L1 Bond U OWNER'S INSURANCE11V ER: I am aware that the licensee does not havg the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Signature of Owner or Ownees Aaent Owner 13 AgentO 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By --Type of Lic6nsd: PGIasmber Signature oftjc6rised PFurfibimor Gas Fitter Title sfitter 0� -7 Mas r LicenseNumber City/Town Kjourtneeyman 1APPROVED (OFFICE USE ONLY) Rwsed 05/17/00 Date ... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ....... has permission for gas installation ... u. .................. in the buildings of 1�-IAI f -t-. A i/�. 6 ...................... at ......... North Andover, Mass. Fee. Lic. No... .......... qASINSPECTOR Check # 3748 .............................. .. ....... .. ... ... .... .. .. . ... .... . ... . . . .... 46 Au .... ........... .... . . . .. .... . .. 6a