HomeMy WebLinkAboutMiscellaneous - 326 FOREST STREET 4/30/2018 (2)E
Date..�
TOWN OF NORTH ANDOVER
...........
This certifies thaty........
PERMIT FOR WIRING
.... �Co.kx . I )
..... . ..... ... . ........
.....
has permission to perform ......... ;;�ev-P�e_ ....... ..... ............................
wiring in the buil�d�inof ........ *le),.� ... D. �j cv,
. . ... .........
*at
.... ... ............................................................................ . >Qfth Andover, Mass.
Fee ....... Lic. No�� .... .. ... ........ . .
2Vi .. a ............ ....................... ELEC,;I IAL INSPECTOR
Check #
,C
Commonwealth of Massachusetts Official Use my
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS[ Occ 0 y and Fee Checked
° (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 7 ` 1Y '%
City or Town of. NORTH ANDOVER 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) gao/ Toxo -r "5;,
Owner or TenantO dJ Telephone No.
Owner's Address .
Is this permit in conjuction with a building permit? Yes ❑ No ,� - (Check Appropriate Box)
Purpose of Building_N EC.Ga N G Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: � JEP 7a C pU M at' ,4)2 A
Completion ofthe following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators K -VA
No. of Luminaires
Swimming Pool Above ❑In- F1o.
rnd. rnd.
o Emergency Lighting
Battery Units
No. of Receptacle Outlets
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 Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
"K.
Tons
f ' �'�'
KW
"""".............
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
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 Ea uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: < of ; (When required by municipal policy.)
Work to Start: 'y 'I ki Inspections to be requested in accordance with MEC Rule 10, 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 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: 1NSURANCE'V[ BOND ❑ OTHER ❑ (Specify:)
I certify, under the sand pen es of perjury, that the information on this application is true and complete.
FIRM NAME:. Atlo !lu7tV44 .�,AQ ECe-C7Rzt C3,AW LTC. NO.:4E-S 16I�'
Licensee:-\. )gtj C'S X4 0-/ay n -J--'94n1 Signatuff, LIC. NO.:
(If applicable r exempt" in the E se ber ine.) Bus. Tel. No.:�'X� Id -
Address: Z� L D • ' I�IEI'90- U 6 PA . 0Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.'
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE. $
Signature Telephone No.
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012.
❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑
❑ Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass M
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 151
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass 0
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass M `
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature: U
Date:
FINAL INSPECTION:
Pass 0
Failed
Re- Inspection Required ($.) ❑
Inspectors Comme
Inspectors Signature:
Date:
V
DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com
I
The Commonwealth of Massachusetts
Department of IndustriqlAccidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeAly
Name (Business/Organization/Individual):
Address:
City/State/Zip;
Phone #:
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (fall and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I 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.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roofrepairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they a're 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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company
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 requiredunder 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 DTA for insurance coverage verification.
I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct.
Simature: Date:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
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 dwelling 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 required"
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 contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) 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 maybe 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 if 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 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 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 permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any 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 officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is ou file for future permits or licenses. A new affidavit must be filled 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 burn leaves etc.) said person is NOT required to complete this affidavit.
ti
The Office of Investigations would like to thank 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 Commonwealth of M-assachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Stwd
Boston, SIA. 02111
Tel. # 617-727,4900 ext 406 or 1-877 MA.SSAFB
Revised 5-26-05 Fay, # 617-727-7749
vwwwamass,gov/dia
MOO
Date. ........
04` - TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..%??"<f4S ..ca. ..............
has permission for gas installation ... A641. !*� ..............
04! .............................
in the buildings of . . A
at eS� ST North Andover, Mass.
Fee. �-91 .� Lic. No...'�.. . .
GAS INSPECTOR
Check # Z 190
s � s
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ®O GAS FITTING
City/Town:. Date:
a e. ml
Y
Building Locaticj �� ���.• j Owners Name:
s , Industrialr
ntialType of Occupancy: Commercial sl
New: Alteration:[J RenovatiowL Replacement: Plans Submitted: Yesl No
caxro IPPQ
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL: Ch. 142 Yes , INci�7—
If you have checked Yes, please indicate a type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity 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
Owner Agent
5lgnaiure of Owner or Owners Agent
By checking this box j]; 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
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Clty/Town
APPROVI
~- I Type of License:
pli vnbr6r
15s FitterSic iature of'Licensed Plumber/Gas Fitter
Master �•�
Journeyman License Number:
LP Installer 4_,_;
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MOM=MM
WIMMMM
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mm
MM
MOM=
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Corporation
Partnership,W
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL: Ch. 142 Yes , INci�7—
If you have checked Yes, please indicate a type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity 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
Owner Agent
5lgnaiure of Owner or Owners Agent
By checking this box j]; 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
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Clty/Town
APPROVI
~- I Type of License:
pli vnbr6r
15s FitterSic iature of'Licensed Plumber/Gas Fitter
Master �•�
Journeyman License Number:
LP Installer 4_,_;
Date ......
TOWN OF NORTH ANDOVER
0
"PERMIT FOR WIRING
US
This certifies that ..... L4;�A ................fir.............
has permission to perform ......... l 571ha.-C-1 ..... ........
wiring in the buil 'of ........... n%/..................................................
ng
at ..... :59, ................... , North Andover, Mass.
Fee,�49..!7 Lic. No. ..... ....... . . ....... . ..
ELECTticALINSPECTOR
Check # ZZ 7
10550
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Oficial Use Only
Permit No. _ 1 bj-.
L
ncy and Fee Checked99] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 Z -q
City or Town of: nj • Mdua, MA 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) 2)21111 -1 G0 &t.
Owner or Tenant
Owner's Address
7.79 -/yZ
Is this permit in conjunction with a building permit? Yes ❑ No a (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
1.4 Location and Nature of Proposed Electrical Work: i (47,U �y �j� L
� "`�1 ' TU
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
Luu{C ff'"y UC Wulveu Uy ine Jns ecror oi n'tres.
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above ❑ In ❑
rnd. grnd.
o. o mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. o Detection and
Initiatina Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat PumpNumber
Totals:
Tons
KW
No. of Self -Contained
Defection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
No. of Dryers
No. o Water KW
Heaters
Heating Appliances Kms,
No. of No. of
Signs Ballasts
yConnection
Security of Devices or E uivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
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 to the permit issuing office.
CHECK ONE: INSURANCE Eg" B TND C OTHER ❑ (Specily:) I Z 34 — I I
Estimated Value of Electrical Work: 3�'%�(�%j, 0()(When required by municipal policy.) (Expiration Date)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NA E: I'Ih J^A
LIC. NO.: `r Mf(-
Licensee: (lY l V1i11 1� )� Signa re LIC. NO..:! ��9
(If applicable, enter "exe t' to the lice�`e um* yline,)� j� [� Bus. Tel. No.
Address: 5 '.'" eGGI na- -- 11 4 Alt. Tel. No.:
OWNER S INSURANCE WA VER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No.
l
Date .././!!.Z ..........
TOWN OF NORTH ANDOVER
• PERMIT FOR GAS INSTALLATION
This certifies that .. .�C�1E'j'�� 5 .�� !?�- r"
has permission for gas installation ... �4?�! .. �� ......
in the buildings ofZ?r.C,!? ..'.............. ...... .
at . d3? G..T..r ........... North Andover, Mass.
Fee. ZS Lic. No..M/�_� ..
GAS INSPECTOR
Check # %ZZ
r • a �
•
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO UA:e H I. I INN
City/Town. _ AFP ... � Date: Permit# 1
Building Locatic� �% S �• �� Owners Name: �L�__, .�Cl/�.
Type of Occupancy: Commercial Educational Industriah4� Institutional Residential
New:t'ZAlteration:L Renovation: Replacement:T,� Pians Submitted: YesC3 No C
MYTI IR1=C
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL: Ch. 142 Yes, N
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity Ej fond
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
Owner Agent
Signature of Owner or Owner's Agent
By checking this box LI; 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 Knwledge and that all plumbing work and Installations performed under the permit issued for this application will be In
compliance wits] all Pe"ent;rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
1 Type of License:
By'.. Plupber
as Fitter
Title: Si ature of Lice se Plumber/Gas Pltter
Master
Cflyrrown! .
........... ""F Journeyman License Number:
::.....,
.:.,,..._. .............:.........:....:.. LP Installer
APPROVED (OFFICE USE ONLY) i":--
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.
0
MOM
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Ch ck • - Only Certificate.#
Corporation
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r
...
��� ` - Ilii
Partnership
1.
..
L
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. . LUAU
YVI
�_..y
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL: Ch. 142 Yes, N
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity Ej fond
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
Owner Agent
Signature of Owner or Owner's Agent
By checking this box LI; 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 Knwledge and that all plumbing work and Installations performed under the permit issued for this application will be In
compliance wits] all Pe"ent;rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
1 Type of License:
By'.. Plupber
as Fitter
Title: Si ature of Lice se Plumber/Gas Pltter
Master
Cflyrrown! .
........... ""F Journeyman License Number:
::.....,
.:.,,..._. .............:.........:....:.. LP Installer
APPROVED (OFFICE USE ONLY) i":--
f
N° 33437 Date ................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
r _ _ , �—
Thiscertifies that.............................................................! ,l. ...................
has permission to perform .-
wiring in the building of --�--a--�—-�
,.._,......,.............................................
........... ................ . North Andover, Mass.
.......
Fee ---.-''5.............. Lic. No..................s:..{-•......................
' ELECTRICAL INSPECTOR..
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked�'�
[Rev. 11/991(leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cock (MSCI 527 CMR 1200
(PLEASE PRINT IN INK OR TYPE ALL ff0R&fA770JV Date: Q — a-? —01
Cityor Town of: Q . Y\& 0 VfX To the Inspector of Wires.
By this application the undersign ves notice his or her intention to perform the electrical work described below.
Location (Street & Num er) Y -�
Owner or Tenant CL r Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz)
Purpose of Building
Existing Service
Amps / Volts
Utility Authorization No.
Overhead ❑
New Service Amps / Volts Overhead ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: n
Undgrd ❑ No. of Meters
Undgrd ❑ No. of Meters
rmmMlorinn nrLho 1^11—;— . ...... i... —:.._i L...L_ 7_—_____ _PfVr
No. of Recessed Fixtures INo.
---------•—•• — —•.. •..••..^•••
of Cell.-Susp. (Paddle) Fans
w•.•c n.ur uc •.u•rcu w we 111jDCc1Dr U/ rrlres.
No. of Total
Transformers KVA
No. of Lighting Outlets INo.
of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above ❑ In- ❑
rnd, grnd. (Battery
o. of mergcncy tgnung
Units
No. of Receptacle Outlets INo.
of OR Burners
FIRE ALARMS INo. of Zones
No. of Switches
INo. of Gas Burners
No. of Detection and
Initiating Devices
No. of Range
ITotal. . n
No. of Alerting Devices
No. of Waste Disposers
Vicat Pump
Totals
Number Tons KW
No. of Scif ontatned
Detection/Alerting Devices
No. of Dishwashers
Space/Arca He ating KW
Local RMunicipal
Connection ❑ Other
No. of Dryers
Heating Appliances KW
SecuritySystems:
No:
No. of Devices or Eouivalent 13
o. o Water
Heaters KW
o. o No. o
Signs Ballasts
Win
No. of Devices or Eouivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER
Anaaddiuonat detail Vdesired, oras required by the Inspector of lf'ires.
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 tLbited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work $ H U —'(When required by municipal policy.) (Expiration Date)
Work to Start -0 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ADT Security Services Dr •• bol ] is NH 03049 LIC NO.: 1533C
Licensee: John S. Bassett Signatu IC NO. 1533C
(If applicable, enter •'exempt"in die license Bus Tel. No.:_603 594-5900
Address; U Alt. TeL No.:_603 594-5928
OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owncr/Agent
Signature Tc!_Lphonc No. PER/YIIT FEE: .S 35*• 0 0
3973
Date ..'7.....:.....z'
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .........................................
has permission to perform-.,....;<`.:.:.._... . '....._-* ...............
wiring in the building of ...... :J c n!- ...................................................
at --Q..'-;./ �.......-r`?... ... , North Andover, Mass.
. .....................
Fee�......... Lic. No.
-�....
ELECTRICAL INSPECTOR
Check #
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
Official Use Only
Permit No.%
Occupancy & Fee Checked �I?
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information)
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number �Q�t0 ��7l�
Owner or Tenant M R K r
13— ® �-�-
Owner's
•'
is this permit in conjunction with a building permit Yes ❑
Date
To the Inspector of Wires:
N , 1?-Va) L)C9 , 4 e� 64
No 9, -/(Check Appropriate Box)
Purpose of Building Pa R C if Vb 415 CP�5 0 N 111�0 G 4t ' Utility Authorization No.
Existing Service Amps Voits
New Service Amps Voits
Overhead ❑
107- . 0
Undgmd ❑
Undgmd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
i
No. of Meters
No. of Meters
OTHER:
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 NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate they a of coverage by checking the appropriate box
INSURANC - BOND = OTHER (Please Specify) �' `10 /a -?
75—
Work
� /Expiration Date) /
Estimated Value of Electric I W rkS .�O (Sp❑- Rough r✓ Final
Work to Start A i, Y9 Inspection Date Resquested gh
Signed under t�6nalti of pe 'u
FIRM NAME LIC. NO.
Lienee Signature C� GG LIC. NO.
-k' ""-6- C)
J(// Bus. Tel No.
Address, ` Sa / . Alt Tel. No.
OWNER'S INSURANCE AIVFR: 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)
o&C'Telephone No. PERMITTEE ScVO L/
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
60*
No. of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Lighting Fixtures
Swimming Pool grnd ❑ grnd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di sal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
J
-'-No: of D rs
Heatin Devices
KW
Local Connection
_
No. of
No. of
Low Voltage
No. Water Heaters KW
Signs
Bailases
Wiring
V
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
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 NO =
have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate they a of coverage by checking the appropriate box
INSURANC - BOND = OTHER (Please Specify) �' `10 /a -?
75—
Work
� /Expiration Date) /
Estimated Value of Electric I W rkS .�O (Sp❑- Rough r✓ Final
Work to Start A i, Y9 Inspection Date Resquested gh
Signed under t�6nalti of pe 'u
FIRM NAME LIC. NO.
Lienee Signature C� GG LIC. NO.
-k' ""-6- C)
J(// Bus. Tel No.
Address, ` Sa / . Alt Tel. No.
OWNER'S INSURANCE AIVFR: 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)
o&C'Telephone No. PERMITTEE ScVO L/
(Signature of Owner or Agent)
i
I
Location
No. d!J Date
�oRTM
TOWN OF NORTH ANDOVER
�c
I.. a
+ ;
Certificate of Occupancy $
;
�� s'"�'° • Eta
AC NUS
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
y
TOTAL
Check # 4,%ya
r
X6547
Building Inspect
.
Y
,TOWN OF NORTH ANDO'R
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP `-RENOVAT OR:DEMOLTM.W.0NE Olt TWOVAMII YMING__
BUILDING PERMIT NUMBER. / �'J.DA-TEISSM'
SIGNATURE:.
Building Commissioner r of Buildin Date
SECTION 1 -SITE INFORMATION
1.1 Property Addrow
r"19
1.2 Assessors Map and'•Parcel Number,
/04
MaPNumlhr Number
.3
Zonin Di Proposed Use
1.4 Propetty Dim"ods:
1A Area Frotua '(1
I BUILDINGSETBACKS 1t
Front Raid Side Yard, Rees - 'Yard
Required l'rOvtde:: ed,,_ Ptovldcd Cd PrRd d
1:? Wacar Svpfy M t3LC 40. 34) 13. Pbod;2oas Iafocuutioa: 1.8 Sewmage Dupossl Systant
t'atlic ❑ Pri"W ❑ oamideiFioaaZoee :❑. admieapi ❑ oasde a.sysroa,''❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORMI) AGENT
2,1.0wner of Record
Inc, CA- 3/ Oa0l 3 P G ec S-4re-e
Nama(Prin Address for:Service,:
-102!e—
Signattire Telephoner
2:2 Owner of Record:
Name Print Address for Setvioc;
-signature Telephone
SECTION 3 - CONSTRUCTiON.SERVICES-
3:1 Licenser: Construction Supervisor
Licensed Consttuction:Supervisor.
Address
Signature Telephone:
Not Appficable u
License Nurriber
Expiration .Data
3.2 Registered home Improvement Contractor
Not Applicatite , i)
CompanyName
'Registration Number
Address
Si nature Telephone
F-viration-Dato
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SECTION 4 - WORKERS COMPENSATION.(MOL C:152'9,: 25c(6)
Workars Compensation Insurance affidavit must be edinpleted add submttieds*ith this appli a#6u,� failure to provide this affidavit will anuli
inthcdeaialafthoissuance�ofthebuildi it: -: ..
Signtd6f6d4vitAUarhpd Yu...—.0 No...:.. -D
SE•CTION-'S De' 6 tion otPrd 'okd Wolk: dikkkall lleabk:
NewConsttucion- 0 Existing$uilding 0 'Repair(,) 0 Alterations(i) p Additign .0.'
Accessory Bldg. 0 Demolition 0 'Other 0 specify
BriefDescrip6on of Proposed Works
l o )c 2ti S r� V`Q g e 1n w c� l N
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SECTION 6- ESTIMATED' CONSTRUCTION COSTS
Item
Estimated Cost'(Dollar) to be
Com 'leted by permit'appAcant
-
l:w
Building
(a) Buildmg Peimit Fee
O6O
Mdlu tier
2
'Electrical
(b) Estimated Total Cost of
•Cott9t rale
3
Plumbing.
Building Permittee (s) x.,(1)
A. .
Mechwiical AC '
/
30
5
- Fire Protection
6
Total 1+2+3+4+5 '
A7,000
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TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENM OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: /
DATE ISSUED:
SIGNATURE:
Budding Commissioner rofBuildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
3A& Fore%. S%reef
t
Noy 6A Aw�we r., M,9
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 PropertyDimeasions:
Lot Arca Fronts it
1.6 WELDING SETBACKS
Front Yard Side Yard Rear Yard
Required Provide Provided Required Provided
t
1.7 W,ur sVWty NALGILeao. sal ts. Hlood zone rafoaa.ti�: i:s sewenga t>isposat syuem
Public ❑ plivsto ❑ 7aan Outsidt loodZoao ❑ islttaic* ❑ On sitortispo9system ❑
SECTION 2 -PROPERTY OWNERSIIIP/AUTHORIZED AGENT
2.1 Owner of Record
Inr. r f 8/ oMcY; 3 ;t 4 Fares IE S -&et 4 -
Name (Priv Address for Service:
71L 771 -1102!e.
Signa re Tdephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Cons"etion Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable 0
License Number
Exo ation Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company'Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.L, C 152 g 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this ap*,00n. Failure to provide this affidavit will result
in the denial of the issuance of the building it.
Signed affidavit Attached Yes .......0 No...... D
SECTIONS Description of Pro used Workdiwec&coonamei:
New Construction- ❑ '
Existing Building 0 Repair(s) ❑
Alterations(s) '❑
Addition ' 0. -
-Accessory
Accessory Bldg. ❑
Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
W Sri �I 10 )c 2t> g �r� ✓� g t �S 1tiw lav r.c�r
SECTION 6 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed byapplicant
1. Building
000
(a) Building Permit Fee
Multiler
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing.
Building Permit feet.) :. (b)
- .
Q
4 Mechanical (HVAC)`
57 Fire Protection_
6 Total 1+2+3+4+3 0 0 0
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My beltal f, in all matters relative to work authorized by this building permit application.'
Si tatureofOwner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION,
1, as Owner/Authorized Agent of subject
propatly
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
apd belief
.Print Name
Si atLire ofOwner/Agent Date
NO. OF STORIES SIZE
13 aSEMENT OR SLAB
SIZE Or FLOOR TIMBERS 1 2 No 3RD
SPAIN
WME-NSION3 OF -SILLS • .
DI-NIENSiONS OF POSTS
D11MENSIONS OF GIRDERS
MGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING x
MATFRJAL OF CHWEY
IS [3[i I [.DING ON SOLID OR FILLED LAND
IS BlA,WNG CONNECTED.TONATURAL GAS.LINE
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro
m�
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
__.___----API-LICANT FILLS OUT THIS SECTION********* **** *** *
v� 4n-�S�f- o5'7Z C
APPLICANT /Gci`j ��p,�d, X77$-%7S-yoQ�y ff '_(&ONE�
LOCATION: Assessor's Map Number t p PARCEL
15
SUBDIVISION LOT (S)
STREET ST. NUMBER. 50
*****.OFFICIAL USE ONL *** ** *
,46 CONSERVATION
COMMENTS
TOWN PLANNER
COMMENTS
AGENTS:
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH DATE APPROVED
11 yQ--; DATE REJECTED y
stP 1 IU INSPECTOR -HEALTH DATE APPROVED DO
DATE REJECTED
COMMENTS_~'
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9197 jm.
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\i2G S T Zone A k X outside Dwellirn lone X
8utaide
TO THE ( Provident Dank
AND ITS nTLE TNSLNR IM )
MORTGAGE INSPECTION PUN
I CERTIFY THAT THE BUILDINGS SHOWN DO ( )CONFORM TO SETBACK REOUIRa*NTS IN
IE (FRONT• SIDE t REAR SETBACK ONLY) OF Worth Andover "1"r I 1y, 1
WHEN CONSTRUOTED. OR ARE DOAPT FROM VIOLATION E?1FpRCD/QJT ACTION UNDER MASS. GL—
TITLE VII• CHAPTER 40A. SECTION 7, UNLESS OTHERWISE NOTED.
. MASSACHUSETTS
I FURTHER CERTIFY THAT THIS PROPERTY IS LOCATED IN THE ESTABLISHED FLOOD
HAZARD AREA.
COMMUNITY PANEL NO.: 2,5nrn° Inm9c DATE: 6_2_93
DEED
THIS COMPANY IS NOT RESPONSIBLE FOR ANY RNDDNTURES MADE SUBSEQUENT TO THE RECORDED BOOK Sun -1.1.0 by Ai'.';;.
DATE OF THE LATEST DEED OF RECORD.
WHENEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED PAGE
THAT A MORE PRECISE SURVEY BE MADE TO VERry THESE MEASUREMENTS.
1ARTIFICA710N
CERT. NO.
IS BASED ON THE LOCATION OF SURVEY MARKERSV
REPRESENT A PROPERTY SURVEY. VERIFICATION OF SURVEY MARKERS OES
NOT PLAN BX. PACE
MAY BE ACCOMPLISHED ONLY BY AN ACCURATE INSTRUMENT SURVEY, qyS
ON ��g L,q�'
THIS CERTIFlCATION TO
SHOWN, 33 531 A
EPICTED PLAN / DATED
BE USED FOR MORTGAGE $E �,y,
G J l g
OFFSETS AS SHOW ARE NOT TO B BOUOIO
USED FOR THE ESTABLISHMENT OF PROPER y0•Y529
01
SCALE: I'. Bo'
`�BBU.R�•�°P
BRADFORD
ENGINEERING CO.
JAMES W. BOUGIOUKAS` • R:L.S. #9529
P.O. BOX 1244
373 01831
1HAEL�N9( ft
• l7urlruyX 4F I NVE2760 TOTE
C>i51E+ �—t-t-
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SIT"
ANO G15Po>Gp OF IW A�.1 Arrf we17 LOUTIOI�
5E�(IL TA I� IJ : 9f„p2 2.) Aa Ae[A 10' dtl. AQW JO Yxla 'Pgwo68D 1-atwc4" I"s I GjO'
SEPnc TANL�x qy,q� 1""Up9Nb'Nf' FKIynu6 i,,.ALH F16cD SWC 4E
Drr, BoKI� qS.I? 1AVAArW"l l AN 5uP .ui�,-Ty s016, AND $PLL 0
O ¢GPIA"O W1TM SQEU FISP FILL,
vrif, gaco r '15 f.o 3.) ALL PIPiN(A aN•w gE icrl.�o•'i'I WG
EAIp TP°?TZ"i.IW . 95,30 '4.) n u�I.! Igoo ,E�•L. SEpnc TAI.IL
Be 1NSYA µ.ED
vD Favf �oNs BY 3vr. wloc gY IFerr
PraP iItENGNa! >Na I 9c IN •r'AWtp P61L oUN s 'Y•' �B
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3e IN cONcocrulJCE wITN -qjg: -TYPICAL 56o Mx Nj
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PLA k] 4Aotj I II c, P_EpAIL OF
SUBSURFACE DISPOSAL. SYSTEM
LOCATEDIN
doe.TH ArJpovice, M�S�ACIa�I�ETTs
AS PREPARED FOR
&Og II°aesY TOWN OF NORTH ANDOVER
DATE: AF2I L_ t5, Approved
SCALE: 1"r4ol. Date
Signature
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET. 0 ANDOVER, MASSACHUSETTS 01glo 41� TEL (617) 473.3553, 373.5721
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TOWN OF NORTH ANDOVER
X49
t PERMIT FOR GAS INSTALLATION
h
This certifies that ..l`I �t l r ..6� r ... ............. .
has permission for gas installation (-. X" �c . ........... .
in the buildings of ...j? 1.Q ...............................
at..?� .C.. f . C.!7.-' .� ....,e ... , North Andover, Mass.
Fee. 3 �? .�... Lic. No. �'........ ...... .
GAS INSPECTOR
Check # ) �- ? `,
4 4 35
Mass. Approval #
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or T e) - �
5:�1 nt WdpyeAl , Mass. Date Z 63 a Permit #
Building Locatrna
Ow er's Name
T �� Type of Occupancy
New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑. No ❑
FIXTURES
Installing Company Name
Address 140 SOUTH
YANKEE GAS
MAIN ST
MIDDLETON, MA 01949
Business Telephone 978-774-2760
Name of Licensed Plumber WILLIAM R. HARRIS
Check one: Certificate
* Corporation 1 Q 3 Q
❑ Partnership
❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 54 No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 14 Other type of indemnity ❑ Bond ❑
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.
• Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
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 Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title C3 Plumber
3 Gasfitter
City/Town ® Master Signature of Licensed Plumber
APPROVED (OFFICE USE ONLY) ❑ Journeyman License Number 3785
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Installing Company Name
Address 140 SOUTH
YANKEE GAS
MAIN ST
MIDDLETON, MA 01949
Business Telephone 978-774-2760
Name of Licensed Plumber WILLIAM R. HARRIS
Check one: Certificate
* Corporation 1 Q 3 Q
❑ Partnership
❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 54 No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 14 Other type of indemnity ❑ Bond ❑
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.
• Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
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 Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title C3 Plumber
3 Gasfitter
City/Town ® Master Signature of Licensed Plumber
APPROVED (OFFICE USE ONLY) ❑ Journeyman License Number 3785