Loading...
HomeMy WebLinkAboutMiscellaneous - 34 SAUNDERS STREET 4/30/2018 (2)ff, 5 :..Ico Date .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /, pew.... ....... 2z . ................. 10 has permission to perform ........ .......... wiring in the building of ................... ................................. at ............... Srl .......... North Andov r, Mass. Fee..S���. Lic. No.c? 7, �v . .................... ........... ........ 6� . . . . . . ..... ELECTRICAL INSPECT6 Check # zs-7 I Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 13 f 6 p 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 (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/16/15 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) 34 Saunders Street Owner or Tenant Ellen Rademacher Telephone No. 310-966-7398 Owner's Address 34 Saunders Street North Andover, MA. Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Dwelling Existing Service 200 Amps lao / LgoJ Volts New Service Amps / Volts Number of Feeders and Ampacity ring in C No ❑E (Check Appropriate Box) Utility Authorization No. Overhead Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters 1 No. of Meters Location and Nature of Proposed Electrical Work: Service damaged from ice falling off roof. Replace PVC & feeders from point point of attachment to top of meter socket enclosure. Meter socket enclosure may also need to be changed. Completion of the 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 KVA No. of Luminaires Swimming Pool Above ❑In- rnd. grnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of OR 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 Number - Tons J.KW .......... No. of Self -Contained Totals: 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 No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No, of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Replace PVC, Weatherhead, Point of Attachment, & Feeders (Possibly Meter Socket Enclosure) Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1,170.00 (When required by municipal policy.) Work to Start: 3/16/15 Inspections to be requested in accordance with NEC 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: INSURANCE ❑■ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete FIRM NAME: Steven M Parker Electric LLC LIC. NO.: 21502-A Licensee: Steven M Parker Signature LIC. NO.: 12903-B (If applicable, enter "exempt" in the license number line) Bus. Tel. No.- 1-978-360-9592 Address: 633 Riverside Avenue Unit 8 Haverhill, MA. 01830 Alt. Tel. No.: 1-978-918-1004 *Security System Contractor License required for this work; if applicable, enter the license number here: 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Print Form viDepartment of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): STEVEN M. PARKER ELECTRIC Address:633 RIVERSIDE AVE APT 8 HAVERHILL, MA. Phone #:978-360-9592 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full 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. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' coma. 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 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address:AII Locations in North Andover, MA. 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 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 certify under the pains 4 penalties o perjury that the information provided above is true and correct. Phone #:978-360-9592 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 #: I Date. P:..�'. C.�....... pyao ,•�a O TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . %� ..( I ..................... has permission for gas installation ..... ... ................. . in the buildings of ..`. at 14 :.`....................... North Andover, Mass. Fee..E!/ .... Lic. No...... ........ GAS INSPECTOR Check # , - MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS WrING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date r/o? .• D,3 Building Locations �% � �+� �T Permit # ey Amount $�= Owner's Name��� New Renovation Replacement Plans Submitted El (Print or type)Y14e: Certificate Installing Company Name /Oy�)V � f�l•�i� f�iy�1'/ri� corp. �/>2 AddressEl Partner. Firm/Co. Name ofLicensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes Noo If you have checked M please hAcate the type coverage by checking the appropriate box- Liability oxLiability insurance policy Other type of indemnity 0 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 0 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 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. (OFFICE USE ONLY) (signature of Licensed (lumber Or Gas Fitter 1 ✓1 Plumber �;w3 as Fitter License NurnSFr Master Journeyman !2ND. FLOOR 13RD. FLOOR (Print or type)Y14e: Certificate Installing Company Name /Oy�)V � f�l•�i� f�iy�1'/ri� corp. �/>2 AddressEl Partner. Firm/Co. Name ofLicensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes Noo If you have checked M please hAcate the type coverage by checking the appropriate box- Liability oxLiability insurance policy Other type of indemnity 0 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 0 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 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. (OFFICE USE ONLY) (signature of Licensed (lumber Or Gas Fitter 1 ✓1 Plumber �;w3 as Fitter License NurnSFr Master Journeyman Of NORTN ° O A ,SSACMUS� This certifies that Date.//-. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ......... r-7"............... has permission to perform . !'/ I- .. r .......................... plumbing in the buildings of .A .................. at .. 3.`.' .. ?.... �..�` ....'`'.............. . North Andover, Mass. Fee ...... Lic. No.., -'.i . ................... PLUMBING INSPECTOR Check # ') -� t/! 575-C, t 17 - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS t Buildin Location ' / Date 9 a D3 g 3�" c !/ E,2� ST Owners Name i /J%� e �y� Permit —# Amount Type of Occupancy New Renovation 0 Replacement ID/ Plans Submitted Yes 0 No ❑ FIXTURES (Print or type) Installing Company Name fail( 'e/o! AZ'WA,'16 Check ne: Certificate orp. Partner. Firm/Co. Name of Licensed Plumber: 9,6DXCE X4l ecl�� Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond nN Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StqX Plumbing Code andChjer 142 of the General Laws. y: Title City/Town APPROVED (OFFICE USE ONLY T ype of Plumbing License 17 ense umo r Master Journeyman CSC (-� 6 � � � � 35 -�3 � � N° J 6L' Date`............ ............. I TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ' } .. L L-, has permission toperform%. , r. ................... ..... �,.................. t wiring in the building of � �' r' f' ►�"'_. r s 8 / S .................,.A... at ... 3.�:.=F'-r� -�^�4 .................... . North Andover, Mass. ............................... Fee.z.� ........... Lic. No............................................................................. ELECTRICAL INSPECTOR 10/02/98 11:26 105.00 WHITE: Applicant CANARY: Building Dept. %K: Treasurer 2 Date.Q? ..... !/.:.3...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ........................................... has permission to .............. wiring in the building of /7' IVI L-' ............................................ at ... $.� ... :�Z ............ . North Andover, Mass. Fee ..... Lic. No. ......................... ........... ................ ELECTRICAL INSPECT Check # f,> THECOMMONWE4UHOFMA.SSACHUSETTS Office Use only DEPARTAIENI'0FPUBIICS4FETY Permit No. BOARD OFFIREPREVEMONRF.GULAHONSR7CM12:01D � Occupancy &Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wire; The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant _ I Ary) C:'—' fn J i Sa Owner's Address Is this permit in conjunction with a building permit: Yes F-1 No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpsVolts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work i b{L AGb No. of Lighting Outlets No. of Hot Tubs Iha,&aomaYliabl7ityhlsm=Po yinchxla Ihaveahiittedvandpfo4cfsmwtotheObioe. YES No. of Transformers F)mhavudrclodYES,pleaseic><licatethetypeofoovwaWby Total �-� Esfim&dVahleofEkhicalWotk$ wotictoSta<t s hrspectionD*ReWested Rough Final Signedl�altay FIRMNAME P riC�3t'LNei�TUr-L� cel Q AC sa I �G.2 cC.� S LicawNo. KVA No. of Lighting Fixtures Swimming Pool Above Bt>simTdNo. (c1O� Below Alt, Tel Nb. OWNER'S INSURANCE WAIVER; I am aware that the Lioaw does not have the instlrattoe coverage or its st>1:61antial egnvalat as reqs Bred by MasmNi,,cts Ganaai Laws Generators J -IV KVA round Telephone No. ground tgna ure ot . wner or gep No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals 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 Other No. of Dryers Heating Devices KW ED Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• hMa[XCCovetagaPutst>anttotbei WMYICWdMWMdlMttSG=rallaws cmf Cowaageoritsabstan leg ivalat YES tt]NO Iha,&aomaYliabl7ityhlsm=Po yinchxla Ihaveahiittedvandpfo4cfsmwtotheObioe. YES F)mhavudrclodYES,pleaseic><licatethetypeofoovwaWby dlada<tgthe box INSURANCE ` BOND E (PaseSpecafy) �-� Esfim&dVahleofEkhicalWotk$ wotictoSta<t s hrspectionD*ReWested Rough Final Signedl�altay FIRMNAME P riC�3t'LNei�TUr-L� cel Q AC sa I �G.2 cC.� S LicawNo. Liar>�e�� /\-) P�--ice`' ` ` t"� Signahne LicamNor L�J� SS� �� (bY►'� 5�� / Bt>simTdNo. (c1O� arirlrPcc / Alt, Tel Nb. OWNER'S INSURANCE WAIVER; I am aware that the Lioaw does not have the instlrattoe coverage or its st>1:61antial egnvalat as reqs Bred by MasmNi,,cts Ganaai Laws and thatmysignatureondopermitapplic iwaivesthistecgmanatt (Please check one) Owner " Agent J -IV PERMIT FEE Telephone No. $ tgna ure ot . wner or gep The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance. Co. Policv # Company name: Address City Phone #: Insurance Co. _ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as_yell_as_ciariii.penaltiesjnlhelar m-faSTOP WORK ARDERand a.fine-d_($I.OD A)ajday.againstme. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. M1 l do hereby certify under Me pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official' city or Town PermM icensing El Building Dept E]Check ff immediate response is required 0 Licensing Board E] Selectman's Office Contact person: Phone #. � Health Department Other fu •� e vll� uu)tlt►lulllltlfllll! t►! ?1tI�tlUllll(l�lZ12:00 Pellnil No. �40`r dlcllarhncut of 1lulllic ollfct 0 Occupancy ,& Foo Checkod BOARD OF FIRE PREVENTION REGULATIONS 5219/90 (loavo blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be porformod in accordanco with 1110 Massacllusolts Eloc)rical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dalo City or Town of .#Yeitl!!Cf' �1fQ Ajr,�L To Iho Inspector of Wires: Tho udorslgnod applios for a port -nit to porlorm tho oloctrlcal work doscribod bolow. Location (Shootmor R Nu bor) JI_! S UA(�t� S Ownor or Tonanlr�%/') Ownor's Addross r Is this pormit in conjunction with q building pormit: Yos U' No ❑ (Check Appropriate ©ox) Purposo of Building -CC,. >ng if Alt I4 Utility Authorization No. Existing Servico Amps _J Volts Ovorhoad ❑ Undgrnd ❑ No. of Motors Now Servico Amps _J Volts Ovorhoad ❑ Undgrnd ❑ No, of Motors Numbor of Foodors and Ampnclly Location and Naluro of Proposod Eloclrical Work No. of Llghling outlets % No. of Ilot Tubs No. of Transformers Total KVA No. of Llghling Fixtures Swimming Pool Above grnd. ❑ In- grnd. ❑ Generators KVA No. of necoptaclo Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch outlets • No. of Gas Burnors I FIRE ALARMS No. of Zones No. of nangos No. of Air Cond. Total tons No. of •Dolocllon and Initialing Devices No. of Disposals No.of Hoat Total Pumps Tons Total KW No. of Sounding Devices No, of Olsllwastlors Space/Aroa Floating KW —7. No. of Sell Contained Dolocllon/Sounding Devices No. of Dryers I Healing Devices KW Local( Municipal [1011101 uu Connoclion No. of Water Ilealors KW No. of No: of Signs Ballasts Low Voltage Wiring No. llydro Massage Tubs No. of Motors Total IIP V l l ll• 11: INSURANCE COVERAGE: Pursuant to file requirements of Massachusetts general Laws 1 havo a current Liability Insurance Policy Including Completed Operations Coverage or Its substantial equivalent. YES O NO ❑ 1 havo submlllod valid proof of same to the Office. YES O NO ❑ If you have chocked YES, please Indicate the typo of coverage by chocking Ilio appropriate box. INSUnANCC ❑ BOND ❑ OTHER O (Plonse Spoclly) Estimated Value of EI ctrl al ark S dt9(&.60 Work Io Stall Inspection Data noquostod: Rough Signed tinder Ilit/rontif ffos of porlury: FInM NAME Licensee nature (Cxpiratlon Data) Final LIC. NO. fi_7 c- �/ LIC. NO. F= J P— �% Address / r /�� ®f�� v U�' Bus. TflrNi3 lir — Z Y'%W'Z�p All. Tel. No. OWNEws INSUnANCC WAIVER: I am aware that the Licensee J.1119 not have Ills Insuranco coverage or its substantial equivalent as ro- quIted by Massachusetts General Laws, and Idol my signature on this permit application waives Ibis roqulrornont. Owner Agent (Pio. s -chock o n Tolophono No. / PEn%I,T FCC S (�lynnlur 1 Owner or Agonl) t GSG5 Date.. � (- 0 n'"40RT#Nj TOWN OF NORTH ANDOVER Y7 PERMIT FOR GAS INSTALLATION ...... This certifies that .. m. has permission for gas installations ... .4 :a .............8. in the buildings of • • • at ..... -,5� .1... �+.--.�-=? ...... North Andover, Mass. �f Fee.-?:..... Lic. No........... .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4. J_ MASSACHUSETTS UNIFORM APPLICATION FOR PrMMI-1-1*0 DO GASFITnU' G (Print or Type) NORTH ANDOVER Mass. Date 6 Building Location (S�— Permit 2 � Owners Name &8bv 9f - New Q Renovation Replacement Q Plans Submitted Q FIY-11oac G11 (Print or Type) f . Check one: Certificate Installing Company Name iry'�,nt ��l%►'ll?�'L/ Q Corp. ---b � ` _ - Q Partner. Address - ct. Q (eQ Firm/Co. Business Telephone: acs^ -r5c3G�r_O Name or Licensed Plumber or Cas Fitter kiV- E),P-tknc It I Insurance Coveraee. Indicate the type o` insurance coverage by checking the appropriate box: Liability, insurance policy C Ct: er tvpe or �--� - - indemnity Q . 6ond t Insurance Waiver: f, the undersigned, have been made aware that -the licensee.or this appi. do does not have ar.v one o; the above three insurance .coverages._. _. Owner z Agent Q -- - Signature or caner/agent or property _ I h=ebY ccrtify that ill of the dctaik and information, I have zu!:mitted (or entercd) in above aopaczaon are tine and accurate to the best of my kno-icd;e and ttut aft plumbint vara and intcadatioss urn=- r==it i=u d fox this sgrdctt�a Wdl be 4t compliant with all :ctSaat provisions of the 4ta41at:4uactf$ State Cat GJde sttd CiaptC Is—' e'. t:w Cre—n=Li LaWL c m I tr = m ` = a Y < Cts m C W ul Y w '� O t"" a 17 C G > 4 - -- _ _ca = - tz W <> C W , < t O O to O as l— 1 t< SASE1fAE:iT I ..I :I I .I I I I I I I F �.I_ F= I t ST FLOOR VIM FLOOR j 3RM FLOOR I ( I ) I i I I I I i I I I I I I ( ..I ._.I. I I 4TH FLOOR .I_...I -� .L 5TH FLOOR 6TH FLOOR TrK FLOOR I I I I I I I I I I I { I I 1 I ( I 1 I aTH FLOOR ( I I I I I I ( ! I L. --I I -. .7 (Print or Type) f . Check one: Certificate Installing Company Name iry'�,nt ��l%►'ll?�'L/ Q Corp. ---b � ` _ - Q Partner. Address - ct. Q (eQ Firm/Co. Business Telephone: acs^ -r5c3G�r_O Name or Licensed Plumber or Cas Fitter kiV- E),P-tknc It I Insurance Coveraee. Indicate the type o` insurance coverage by checking the appropriate box: Liability, insurance policy C Ct: er tvpe or �--� - - indemnity Q . 6ond t Insurance Waiver: f, the undersigned, have been made aware that -the licensee.or this appi. do does not have ar.v one o; the above three insurance .coverages._. _. Owner z Agent Q -- - Signature or caner/agent or property _ I h=ebY ccrtify that ill of the dctaik and information, I have zu!:mitted (or entercd) in above aopaczaon are tine and accurate to the best of my kno-icd;e and ttut aft plumbint vara and intcadatioss urn=- r==it i=u d fox this sgrdctt�a Wdl be 4t compliant with all :ctSaat provisions of the 4ta41at:4uactf$ State Cat GJde sttd CiaptC Is—' e'. t:w Cre—n=Li LaWL TY?-=- LICZNGE 1 ?lt:.Ttber l Gasiitter Signature of License I ;haste- pl. be_= or Gasfitter %O Jot:=Heyman License Isurttoer . Date .. . . 9.410- 1.- 3717 No °T :��c TOWN OF NORTH ANDOVER - PERMIT FOR PLUMBING CHUS�th This certifies that ........ .............. has permission to perform ...... cf . plumbin in the b 'ldings o. ! . `'^'�'�'............. . at ...... .......... ....... North Andover, Mass. Fee.��' �...Lic. No.' ......... .............................. PLUMBING INSPECTOR x/18/98 10:22 r 50.00 PAID 1.w WHITE: Applicant CANARY: Building Dept. PINK: Treasurer - I I r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING :ype or print) 6 NORTH ANDOVER, MASSACHUSEMj Date Ouilding Locations sP� £lz5 Permit #�� t,�� Amount Owner's Name ..� New 17 Renovation Replacement Plans Submitted r FIXTURES .(Print or type) / Installing Company Name /_ a 4 � -a GY1ti vt � (��_ Check one: Certificate ri Corp. Partner. Firm/Co. Name of Licensed Plumber: A -a ,I1t l�Ylfl� `C Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ID , Other type of indemnity 1-1 Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three i urance Signature Owner rill/ Agent 11 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 installa ' ns performMunr Permit Issued for, this application will be in compliance with all pertinent provisions of the Massac tate Plu ia4Chapter 142 of the General Laws. ;D (OFFICE USE ONLY Type of Plumbing License Z (oS .i icen um er Master Journeyman ❑ • J /I .(Print or type) / Installing Company Name /_ a 4 � -a GY1ti vt � (��_ Check one: Certificate ri Corp. Partner. Firm/Co. Name of Licensed Plumber: A -a ,I1t l�Ylfl� `C Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ID , Other type of indemnity 1-1 Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three i urance Signature Owner rill/ Agent 11 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 installa ' ns performMunr Permit Issued for, this application will be in compliance with all pertinent provisions of the Massac tate Plu ia4Chapter 142 of the General Laws. ;D (OFFICE USE ONLY Type of Plumbing License Z (oS .i icen um er Master Journeyman ❑ M ainjeu61S w w a- x a E Ln N n. 0 w r U)w W WCQ Cl) w Z V N. LL o (Aw Cl) a w W C� z U) w I LL zz x z O L a 0 - F- a x u - U- J U) J H • W� w w J Ww Q CO O � ' zo a z z MLU O J to U) a w Z H n. w U O V za F- UZ H H w O J U- N w w a- x a E Ln N n. 0 Njo 2 JN '/; S Date......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ........................... ............................................................... has permission to perform,- ............................... ...... wiring in the building of ... .............. .... ........................................... It ........... .t- ................................................... . North Andover, Mass. Foe..................... Lic. NE .9,7 ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer its `- r,Tr£ �r�+Grad 06 �.l1le Sa6cry BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only PeNo_ � Permit 70^ Occupancy & Fee Checxes30, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AJI work to be performed in accordance with the Massachusetts Electcal 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. Owner or Owners Address I Date Ito — is A C/ ly To the Inspector of Wires: Is this permit in conjunction with a building permd Yes IJK No ❑ (Check Appropriate Box) Purpose of Ebsttiing servicer� Am�p/s f C� wits New Service 4 ,%C Amps (✓ oits Number of Feeders and Ampactty I_ocadon and Nature of Proposed E!ectncal Authorization No. ©L / �b Overhead 0 Undgmd ❑ Overhead Gd' Undgmd ❑ No. of Meters _ No. of Meters OTHER v 1% +c r li�'il �A 15 Sf� �af1�t 120ilra\4 Vd - N4t�,l INSURANCE COVERAGE. Pursuant to the requwremen6ts of Massacnusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate Me type of coverage by checlang the appropriate box INSURANCE = BOND = OTHER = (Please Specify) t `/ (Expiration Date( Esdmated Value of Electrical Work$ LLL) Work to Start Inspection Date Resquested Rough Final Signed under the Penattles of perjury: UC. NO. FIRM NAME +, J/, Llcansee � ��/ ►� � —signature C4,& G _UC. N0. t-- 7i� - //,� �/ Bus. Tel No. s =� `J /" { Addres,)1V"t Vi �S �iiews �'i A, Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware at the Licenses does not have the insuranc . overage or its substantial equivalent as required by Massacnusec[s General La s. An that mx signet on this permit application waives this requirement.rn�r Agent (Please Check one) Telephone No. t/ a' ` Si PERMIT FEE 5___— (Signature of Owner or Total No. of Light8nq Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixrures Swimming Pool qmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receomc!es Outlets No. of Oil Bumem Battery Units No. of Switch Outlets No of Gas Bumem FIRE ALARMS No. of Zone No. of Detection and Total No. of RGpges No of Air Cond Tons Initiating Devices Heat Total Total No. of Dioosal No. Pumos Tons KW No. of Sounding Devices No./ of Self Contained DetectiorvSounding Devices C Municipal C Other 1 No. of Disnwasners Soace/Area Healing KW No. of Drvers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Hearers KW Bailases Winn fn's, No. Hvdrd Massage Tuds Motors Total HP OTHER v 1% +c r li�'il �A 15 Sf� �af1�t 120ilra\4 Vd - N4t�,l INSURANCE COVERAGE. Pursuant to the requwremen6ts of Massacnusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate Me type of coverage by checlang the appropriate box INSURANCE = BOND = OTHER = (Please Specify) t `/ (Expiration Date( Esdmated Value of Electrical Work$ LLL) Work to Start Inspection Date Resquested Rough Final Signed under the Penattles of perjury: UC. NO. FIRM NAME +, J/, Llcansee � ��/ ►� � —signature C4,& G _UC. N0. t-- 7i� - //,� �/ Bus. Tel No. s =� `J /" { Addres,)1V"t Vi �S �iiews �'i A, Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware at the Licenses does not have the insuranc . overage or its substantial equivalent as required by Massacnusec[s General La s. An that mx signet on this permit application waives this requirement.rn�r Agent (Please Check one) Telephone No. t/ a' ` Si PERMIT FEE 5___— (Signature of Owner or 7 Location No. - ���� Date 1. TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee $ ° J Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector i <. J • O kMfl 13:4639.00 PAID. Div. Public Works ^ 3 '4 iW L. LU z z a d b LU w Q c z 1 ^ 3 LLI z it x .r Cl) C/I y J w u O C N 3 v z L v tl cn N 1r E- X J Z w w w Ln `t a V) UJ LLI Y.� z Z .r J Z lei w Z Lu CA 7 L. LU z z a d b LU w Q c z 1 ^ 3 LLI z .r z y J w Z a 3 v z L 1r J Z w w w Ln `t V) UJ LLI Y.� z Z J Z w z w Z Lu CA 7 Z Z Z Z wi N LL) N H V L LL; ^ C N 2 Z.1' N N C � C N G. O Z 9 O I� Q 1 � U ..7 Z LLI J w u w �{ 1, w _ p �RC1 � Z C v C � a Lt ? O J y LLI W z W Sy w wH O z F w O u z v? E.. — C H Z O z Z ¢ V :n W W u: :J w :J w U Z_ Z_ Z_ w Z � Z _ ¢ ¢ 2 _ C R z L. LU z z a d b LU w Q c z 1 ^ 3 � z z z y J w Z L 2 w w w Ln `t L. LU z z a d b LU w Q c z 1 ^ 3 HOME. IMPROVEMENT CONTRACTOR Registration 112610 Type - INDIVIDUAL Expiration 04/15/99 KENNETH M. BURRIDGE 17 VALLEY RD oJEHAM MA 02180 ADMINISTRATOR Ile 6101Mi 041410rnl/1 r/1. llrci eIC//nw//; i DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: CS 054029 10j03J1999 1003/1965 Restricted To: 00 KENNETH M BURRIOGE 17 VALLEY RD STONE_HAM, MA 02180 �cZ4�Lk tt 1140 Fe>K- A,VdhiEnk KqYWM K� w4 loo Cir\ v- y6o " l Sc ,? �- OT- Ce©f\%e AQ, D,, T-f.�j 6 U�- ,2 �� ?��Gsft i�"c'L T►�Y N4 k� IA1Ci1� �� `j -LS w— IM Cl�nsils�- ol�-- 'r rRtpkAc$n &V\�- li✓�'n ®w S , R(MOvAl 0)7- 1 � N�- �-2�n � w 11 ec3 � � t21`f� t Ps �2 t �1) on ' +,.��� `i_�c �-t - t � 1S � -cz �-r�s �1H,.�^•� ly �, ,s �t�n►2� :f -rr2rm ON 2r..L Picot. 3 sAf&v,'K Is G�V\P� 'r �� bL; �\� n9 5 a-cASt A& �£ t4�- �'C 'b MR 1<c � t2 � t�$�'f'/Z �J_ r you �Av� �n QL s �.� s �afz V11f- ���r�s� gfLp rA I �— 3'D& -Z�ai-- 59 37 c��n�-�.�.-,L� r��� Dov �2i��i g ock y,,L, `.,j2 YOV4 Tiln-t 6'a C kAvck FRAL bvl 7 M M 0 w a �� z 0 0 U MILON co O CD • L 0 V Z co CL O H D C CD Cm LA O O 'E m m CD CD 0� O i cc O d CL CMC C o Cc •v O C Z ts V W O C C . C cc CO2 a � ID C a c� a CAC H � C 0 w chi w w U x � w ii w w o w i�. a o c� C P. z cn 8 cn M 0 w a �� z 0 0 U MILON co O CD • L 0 V Z co CL O H D C CD Cm LA O O 'E m m CD CD 0� O i cc O d CL CMC C o Cc •v O C Z ts V W O C C . C cc CO2 ID C c� CAC H � C 0 V CL C c o m CCD �4 Z r y.r O ID C� A E 3 C o c _CD o co A`oo m CDCA s HGo �J Com 3 H C H C=u C 'p0 _ acs H H t z o m cm � oQ C aC o m m C Chi evZ O c S o a CD c Q H m C m OCL _ COD W CO N C °c �E CZZ �H CC3, .0 Z o LU �a � y mCM - =� Am` H �LWrCLOW M 0 w a �� z 0 0 U MILON co O CD • L 0 V Z co CL O H D C CD Cm LA O O 'E m m CD CD 0� O i cc O d CL CMC C o Cc •v O C Z ts V W O C C . C cc CO2 s �� 24_ Location No. U Date a Ma^TM TOWN OF NORTH ANDOVER a p Certificate of Occupancy $ - }° Building/Frame Permit Fee $ '��b'•n° -'<�' SSACHUSE Foundation Permit Fee $ Other Permit Fee $ r° Sewer Connection Fee $ Water Connection Fee $ TOTAL $ i T+? a t- Building Inspector Div. Public Works I A Is Location ' No. Date r MORTN TOWN OF NORTH ANDOVER O • • OR p Certificate of Occupancy $ 41 Building/Frame Permit Fee $ CHU <� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ " Water Connection Fee $ TOTAL $ "v r Building Inspector Div. Public Works I C y LLI z U q - �� s V1 1 a V O z G k � m ' n . LZ LL, J y OF- ► 0q z N < z N z ` y - Z LL r O F O z +0 m v1 a ¢ u LL) i D Z D G z O t, z y y :J y oJ j O z L z0 z Z U z z 0 z z O z z LU Q � Q B > m o > m 0 > m 0 5 m Muj a ) R, i m Lu y LLI z U q - �� s V1 Z V G Z m ' n . LZ OF- ► 0q z O p z z O¢ z z ` y - Z W to 5 N ;5 ¢ m m N m N R, i m Lu cz Q z U q - s Z z M G � m ' n . ► 0q z p y - Z W W , r 6 00 u _ O p z u Muj a O J v„ J Z a m cz Q U q - L y Z z M m ' n . ► 0q p W W � z r � d a Ci 00 u _ U d o� T s �s to O w LV LU 4A c: LU LL F Q z V. tww 0 1 ✓/C G! II/iI6IIfe"",/l/ Il 14,JIII' /,!J(f16 t j r DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: CS 054029 1003/1999 10/0311965 1 I Restricted To: 00 1 KENNETH M BURRIDGE 11 VALLEY RD STONEHAM, MA 02188 I HOME IMPROVEMENT CONTRACTOR ' Registration 112610 o Type - h INDIVIDUAL Expiration 04/15/99 I KENNETH K. BURRIDGE 11 VALLEY RD iCkHAM MA 02180 ADMINISTRATOR I a �w3 ---- 00 -o �W w:_�► C o 0 I i ,I S ' I -3'i 5A nOEQS 4poVE 4 o - - - A 1� ti. v tit M r � r /rrfjT �j�11 �S /W v V 14c,n d 17 i 1 � y 6 z W W 70M c c �a� O H c O a c a a o � x w O U y5� U ac rco0 V V •dam U w CL C a°' w W o w w" v a°' ca w rA cn 0 cn 70M O� �O 0z wo a I O c c o•- V� Q O H O O •� m m CL ♦_•+ •O O G O L =C O CL C cc .0 'o as c Z CD O a v c c • C C43 Q c c �a� c c o � c •- O y O V V •dam CL C 41�o A A . m C y.r O � 4 ccK CA Ea v rA O G. c 41CD ; c r E o Z' GO cm 3 m y `C m C y cc fA C O Em � Amo cm nw . y ` m; m r r.. O c as oa CM C iso m Ad LOS •� Z O C � O CL C � N m CS�CQ _� = p N COL. y O ma~ y O t O .y o H c w Z or= s COD a �go s 064-m O� �O 0z wo a I O c c o•- V� Q O H O O •� m m CL ♦_•+ •O O G O L =C O CL C cc .0 'o as c Z CD O a v c c • C C43 Q Date..." — _3 – 6 �7 ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... ) ... ofie.q C ............................ M Z- ./" . . 14 .................... . ... .... .. ...... .... has permission to perform ........ witeeA7 7( e- ........................................................... wiring in the building of ........................................ ................................ at .............. 3 41 5V 11'410t-12 �- North Andover, Mass. ...................................................... 0 e-- I-Ie5 - 73 75��c. No . ............. .... ... ...... Fee.?? �.r,L��.'�...�....f ELECTRICAL INSPECTOR Check # 730 '01 -/ 0 Ir r Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. '? :,; L Occupancy and Fee Checked [Rev. 1/07] (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: 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 electrica work described below. Location (Street & Number) v/v /V d � Q 16- q Owner or Tenant %1 �� f ,5� �,�Q ��� Telephone No. (7 7w ,' -7 Owner's Address Oc1 f e Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service2_60 Amps 20 &1#0 Volts Overhead R1 Undgrd ❑ New Service Amps Number of Feeders and Ampacity Volts Overhead ❑ Undgrd ❑ Location and Nature of Proposed Electrical Work: 6— No. of Meters I No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed LuminairesNo. of Ceil: Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑o. rnd. grnd. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches n L- No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat PumNumber Totals Tons KW No. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Mun'cipal ❑ 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 Equivalent OTHER: p� p Attach additional detail if desired, or as required by the Inspector of YVires. Estimated Value of Electrical Work. 7 (When required by municipal policy.) Work to Start: —2T -Q % 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: INSURANCE J4 BOND ❑ OTHER ❑ (Specify:) / certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: j/t/ LIC. NO.: Licensee: 111t1A Signature LIC. NO.:q6 S 73 (If applicable, enter -49;G t - in he license number line.1 Bus. Tel. No.:01'- Z d 06 ro Address: ,�f /✓ A1,4 Q% 7,0 2 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires 6epartment 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 FPERMIT FEE. $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ,M mss. www. mass.gov/di a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly yt Name (Business/Organization/individual):�� �� � M „�/l- l/(%!q OK Address:' ( ( �/ moi/ a4-L"- City/State/Zip: 4-LC City/State/Zip: 2 Phone #: // -/ 2 .3 f Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.I am a sole proprietor or partner- listed on the attached sheet. I 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.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors 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 Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # - 2 7, :1? 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 #: