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HomeMy WebLinkAboutMiscellaneous - 34 WEST WOODBRIDGE ROAD 4/30/20189700 ,40RTN 0 4L Date ..... /P . — . / . j--1 . 0 .... ...... .. . ........ .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................. .. . .......... ... ............ has permission to perform .......... C.'F ....... .. .. ......... wiring in the buildinlg of ........... T'q ................................................................... at ....3Y Sz ? a) North Andover, Mass. North Andover, Fee ... Lic.No. l?y/'.�g� ............................... ............. L 1 0 I L NSP R Check # Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev.1/071 leaveblank 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: 10 /14 110 City or Town of NORTH ANDOVER To theI pector of Wires: By this application the undersigned gives notice of his or her intention toDcrform the electrical work described below. Location (Street & Number) 3 WESE WatAnAv. Owner or Tenant N ,qmvc =4 Telephone No. I - ( r Owner's Address W4— Is this permit in conjunction with a building permit? Yes ❑ No (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 L,qcation and Mature of Peopose4 Electrical Work: t" N„ a��^ WD A D 6iftk 1 I Comnletion ofthe foltdwmv table may be waived by the Insnector of Wires_ No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tabs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑o. grnd. grnd. of Emergency Lightmg Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners N&—oT DetectionN&—o an Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Rent Pump Totals:I Number Tons KW No. of Self -Contained Detection/Alertine Devices No. of Dishwashers Space/Area Heating KW local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Sems: No, of Devices or Equivalent No. of WaterKW No. of No. of signs Ballasts Data Wiring.Heaters I No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiingg-- No. of Devices or uivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /y 1 1,,C-[ I & Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE RAGE: 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 tuns tm pe aloes of p juthat the information on this application is true and complete. FIRM NAME ,: N �. L LIC. NO.:jyq IT C Licensee: Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) Bus. TeL No.: 6 o;`1'-_fq.3- 312-1 Address: Alt. 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. Signature Telephone No. PE ,KNIT FEE. $ ✓' I {�, � _ ��j� "� ' C � I ,; i - .� 3�c a't r V k, k 11 The Commonwealth of Massachuseas Department of Industria! Accidents Offwe of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Address: City/State/Zip: & rkvl�,,.j p . Tl %i 3;t3 3 Phone #: 4 ® 5 ? 3 71 % Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ 1 am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction i ti employees (full and/or part-time).* 2J I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet t 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its q, ❑ Building addition required officers have exercised their 10.0 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.❑ Roof repairs insurance required) t employees. [No workers' 13.❑ Other comp. insurance required] *Ary applicant that checks bed # l must also fill out the section below showing their workers' compensation pol icy 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 dtedc this box must attached an additional sheet showing the name of dee 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. Lie. #: Expiration Date: .lob 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 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 er the pr a penalties of perjury that the information provided above is one and correct Si ature: Date: Phone #: 19__�, �. Oflieial ase only. Do not write in this area, to be conpleted by city or town ofj`uxd City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person• Phone#: 9300 Date. 41A�- . . TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING Ss CHUS 0 This certifies that 4!:S.... ........ ..... has permission to perform .............................. plumbing in the buildingsIS P. ......................... at . .4�w ......... . . prth Andover, Mass. '7 'Oe. '4'. 1 �1 C ...... Fee ?;S . Li No. NF.Y, A:� ... Z;��4a PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK WECITY _ `J 7A!W c7c� yr _ MA DATE a,`�y� \ a PERMIT JOBSITEADDRE W C`A_1.�; ppb Ow _ OWNER'S NAME U � 4 1L OWNER ADDRESS '._ - w _ I !ELI. _ ]FAX.j . _ TYPE OR OCCUPANCY TYPE COMMERCIAL jA EDUCATIONAL RESIDENTIAL PRINT PLANS SUBMITTED: YES 71 N01,1 CLEARLY NEW -1-1 RENOVATION �.- REPLACEMENT: [ �� FIXTURES Z FLOOR-+ BSM 1 2 3 4 5 6 7 a 9 10 1t 12 13 14 -- , - BATHTUB CROSS CONNECTION DEVICE t 1 DEDICATED SPECIAL WASTE'SYST. EM DEDICATED GASIOIUSAND SYSTEM DEDICATED, GREASE SYSTEM LLL DEDICATED GRAYWATER SYSTEM DEDICATED WATER RECYCLE: SYSTEM i FOOD DISPOSER I FLOOR /AREA DRAIN S 6 MOP SINK . URINAL WASHING MACHINE i WATER HEATER ALL OTHER I. +IIIb L• Y.F/.M� .... � • . •r � k .. ie. ♦V.M- YfJY.:r�. .-._ �� ._wri. A xi ..i«T�•:.i. � . have a current liabelit " uisurance policy or its substantial. equivalent which meets the requirements of MGL Ch. 42. YES (✓ NO .� IF YOU CHEC.KEDYES, PLEASE INDICATE THE TYPE OF COVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHERTYPE OF INDEMNITY F BOND I._ I OWNER'S INSURANCE WAIVER: I ant 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 regtiereinettt. CHECK ONE ONLY: OWNER (_ AGENT j SIGNATURE OF OWNER OR AGENT I hereby certify, that all of the details and WDffnafion I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that ail plumbing Yrork and installations performed under the permit issued for this application will be in compliance tnth all Pertinent provision of the Massadiusells State Plumbing Code and Chapter 142 of Hie General Laws. .0 1 SIGNATURE PLUMBER'S NAME I ]� v Jl �j Cc��LICENSE# ,� MPI -1 JP_ I CORPORATION'S „111'Rp y #PARTNERSHIPLLC[�/ COMPANY NAME t� C ADDRESS . �7 Y'c CITY += ---STATE ZIP (�`� p�(a TELE EMAIL FAX CELL.. r`� O b i z 0 \ aa4 w , J OEI W Q Z ® CO) t5 ja ri) y 4 W f= F- J C a a e� ui LU LL. z z . 17t��jititioafitt�e�illt Pf1t2�stri�tltse�s ,be�7r��furer�t'o, j'Xctrl�sfi�ol.4eeht�ilfs r Qf�Jfc ©,)`Iiitse figit iOw �, 6i�{� �Yasl�tngfon Sdi,�el - I3g.�Yvtr, iitftf (t�tl� tt+ieitatr�tt�:ssgai/art '��`arl�c�s�' �}[���[tsmo[�,�tt�t�t;�zit�� ic�cn`f B�Ic�c�sfCattfrit�fo�lf�ie��rtc�a�isl;�l`eti�i �tl[�Ii�arittI'in%t�[tnfHiit ._ _ . • :..':.. i"leiisi��'�iEt�iC>'ft ��tii3��Iitt�uttttc0iihlu'�itio'ttlludi�idualF� �J?5 �G� n f.ln. . JiUIP (f14;QJ!%�IIJI�c�rlkcrtisl;�vt tddtrb� nrork��rs' con�,�nshii�rc trrsrrrriraee,�arr�l�eirptvi�e�s. I3eioff*ts fli��ullcn°rstirC,�oGsi[e°�. ir�nrrcrnflart. - 1..E0urautcccompatty.,lgitrire: _ flofiG�sfEorSEjfii}s;.Lto if ��jiIrttdoliiliite. JolrSilo l4iciress:- CI)�1lSt.S[efzti.,�0...� i �LttiEeltacalrl ofttie.�cac[tits`co�ali7aEsatioifpD[tcy.ectaratiolrpage(sitoii�lttgtlieliaiteSs[tstEtl�gt_ntttl�EsliTEa►tiatttTftf�.: ra[lard 16 25f ofMbF c.,1552'cnrrteadtotheiitittosliion.t►€crpiiiria€�>rttottlesQLa flits Iqr to S ,5t ido as %ccib E;s CIO[ renalticsiit d;6 form ofit STOPAVORK OR.t?L'ti''dattia;lieti IiftlinfoS2�o':(j�ti(t2j+Roo:titi5ttitG�Y0It08. E3cadtisciitiE;dtaccoarybFgliisstateluc�tikra}•tic fans%ariTedi[attioOfEiceaf turestigatiottsoffheIYTAfor iosnraticecoEcrnge4ettfiG<Rtion. PhAffeM 1.:.0 *-I- /PX - h i -i 1,jtit>i`trrr:arritP�ortciGtVPeifl}i7it%tlttc'[tlloff�eolrlifE%litll'Lyctortvrv�lnjjlcfrrl. -- --- G�13•:o1•'t'otiTq�•Fe1-tlkttll:4reifsclB` IssuiligG;titltori�,ti'�cifsiroalej: I. AgartUof "Out, 2, RtizIdIng Ileparlfifly t 3. GifFlrfourt efer t. A. Ci'ge(rjcc f nsktcttor �::1'In.EEEGfEig lils}�e�faf+ 6. Other G.ilifad I'ewil;`- ljliotii !!r Are tF�tneirtjiFrt�xr?tccTitf►e11p1»aprtntebde Ts�t�bflttocet�reelttlEe: I It+ntaelnplo erE�itfr fsm. ageneral contr6ctoralidi �,: Net�Cbiis[rticlj tt cniiila ccs(ftlltuutrmtt<ufi t tio) have-Uredt lteSub:coamctor& 2.0 fmttasoir-proprictorol partiter- listed't tTtenttecltetls ieet.= 7. ] Rclnodc[ing Sflij]•RE[Ci[1R�to`lia'CIR!)IO�CGS MICS¢Slll?-CdlltT[ItCTUkSQ11�i} 8 �]Deettofttio�t SCOrTrtRg for kilo fit',pay cniaRslq'.Ivoclerc.coftrp. iRsiEinitce to^1COFkerS`'fQ111.Cn pinstirauce �• ❑ \Vo �reR catpora[iba snit its „ plElkliligttd(tiliOA rii.tdtincij QfticersiEa<<ecserclsedf'theit =i 16��jeclciealte�air.ulRlCdiceon� .{�Iantatialtieowitertlohlefill Wolk rigTitofcremptioltpofmOL 11 Qr1'itEnttiTvgnliaitsQrRddit'ons rlt�se CIROttorkers'comp. 1. i32�.y1(3j nnd.I�ettg�retta - t2.E[1Roofrepaiis itistdrat►e0rcqutecdJ elliployces.(No otbc€s` i3JI'Otlicr . comp insulancctegltlecdj +'tit} F�Stkt C lkt (tk ICTIYtx t»xtt fikGitftua tNoi�t ll a S�tti� 1 [� �tRkk tIS�IUISkcithlf kkOkt a(y ta•1GPailll1011('�ilis. Tl4IUrU71i1R 1 �tfAto atulrtl\Sti�SutlniltlfiiCtlt3:triEtf7Otfi:I47gIC.CjFtd4i'Jl�p�tttiark[:fGtlltitlk[kltClSUtilQtf�ltltS.rW3li[ll3l£U[+.111tilt3YlYOff(:�ll'11,iticta2in�SlriG_ . Etta!amafc(tuelihatAtUtk\'(tPiI8: idwAnafiditio�tilsF-tctsikaks'nlr ttensatz fltitsvti-r.nuatY�+nrctUe:iitii+if cr3'e�i:.r�iiirGiC.ieua!'icu JiUIP (f14;QJ!%�IIJI�c�rlkcrtisl;�vt tddtrb� nrork��rs' con�,�nshii�rc trrsrrrriraee,�arr�l�eirptvi�e�s. I3eioff*ts fli��ullcn°rstirC,�oGsi[e°�. ir�nrrcrnflart. - 1..E0urautcccompatty.,lgitrire: _ flofiG�sfEorSEjfii}s;.Lto if ��jiIrttdoliiliite. JolrSilo l4iciress:- CI)�1lSt.S[efzti.,�0...� i �LttiEeltacalrl ofttie.�cac[tits`co�ali7aEsatioifpD[tcy.ectaratiolrpage(sitoii�lttgtlieliaiteSs[tstEtl�gt_ntttl�EsliTEa►tiatttTftf�.: ra[lard 16 25f ofMbF c.,1552'cnrrteadtotheiitittosliion.t►€crpiiiria€�>rttottlesQLa flits Iqr to S ,5t ido as %ccib E;s CIO[ renalticsiit d;6 form ofit STOPAVORK OR.t?L'ti''dattia;lieti IiftlinfoS2�o':(j�ti(t2j+Roo:titi5ttitG�Y0It08. E3cadtisciitiE;dtaccoarybFgliisstateluc�tikra}•tic fans%ariTedi[attioOfEiceaf turestigatiottsoffheIYTAfor iosnraticecoEcrnge4ettfiG<Rtion. PhAffeM 1.:.0 *-I- /PX - h i -i 1,jtit>i`trrr:arritP�ortciGtVPeifl}i7it%tlttc'[tlloff�eolrlifE%litll'Lyctortvrv�lnjjlcfrrl. -- --- G�13•:o1•'t'otiTq�•Fe1-tlkttll:4reifsclB` IssuiligG;titltori�,ti'�cifsiroalej: I. AgartUof "Out, 2, RtizIdIng Ileparlfifly t 3. GifFlrfourt efer t. A. Ci'ge(rjcc f nsktcttor �::1'In.EEEGfEig lils}�e�faf+ 6. Other G.ilifad I'ewil;`- ljliotii !!r itfiassachustits,Genetitl,T,atvs aTtapfer X52 refli►u'esoll eiitpIb�ters�tofy�tavid'e�xor�crs' c4inji{sii�toif fo>-1ite3Cetnp%�ees. 'Notlatrtto--th4stafttfc�otrell) 7oj� t53gcle itedas" t �eiJ�pecso tliesetvieeofattotlteitiaderJittyeottCractofiiae,; bxpto s osititpdieci� grttl or+s�iEtettw" +/lv3errsale#ittetlas "gig mtllgkitEa?y paiiitetsirip;gssoeiatioh� cpr�}ton Qi otherZegt�edittyiolrany habt:ltioie o�fttefoi�gotng,eng�getl nra�omFettttrprtse,arts'iiuolitcTmgtFiei�gatiepreseEytatit�s:bfa tlecease�e»ptoy�er, ori recenetortiusteee£atFGtdttid�;al,IarHtersiript.assoc[attonoroUteriegaTenitt'ttl�iQktiitJrem�sloyces, H'er.e�t0 otLncr o€a cluel6ggii0use hlv ng notttibrz ibaft thin-tpa> tnientutuAvI o resines tfiereuts ora (lie occupant oftite citSeTiiitgilott` ofntrotiiern�ltoen3J�log�spetsnnst6tio-niamtenauCe-,constmctionortepairtiEoti:onectcl dt'rollinghoifs eo►t'thl gcotnzds or lttdldingtlppurfenaatttltereto•�hairno&becttttse of suet.eiuploymentbe-&-eme(ho be Au gmpldor.' 464 chapietI52,° '15C{6) ulsp'slate s tTtat'"OY01- Rstnte ok kcal ltcens trg agency Ann itimol f ilteisSuance or et►etE 1.:oda ltc �tsC o1 Jtr-rmifto operate g Gitsjnessoe f4>cotisii itef buntings in the connnoiirYcaifi: tai mitt ,"Multcaltf�tbo1►asifotptgtiueerl_ttccepfnbleid e 'eitceofcoiuilliaitce_with.tbehistirhuccOvCrageregtdrea ElclditiotiaTl,T; AGI; cTtepterl52, �25C(7) stltes `Neither litecotnnrontvt:aTtlt noraa}= of its palitical.Subtiivisian�si?ail Ogt�y into any contract for tileperfommUe of publip ivorkutttit acceplabTe evideltce ofpmpliancelvia.I the insurancs reijuiremenis oFtius cTtapCerllave �eett prese tCetCfo tiieeonirasting,autliority." "lease.ftl[ottt titeitio[:ers';ca2lapensatiouuit`tilatitti6trtJ3l tal�yxb3�ahepkitlgtltoboxesih tapplk�f4yoiusitttatEulttlnd,if .r►Ccessatj;sttppli�sttb conCrac�or{s)neiue(sl,ttdtT'cess{esj'Pndphonenmii��t�s}.alotult�itirfiteircecYiGe2iets}q� lnrtiratim. iitntted .tabtittyCompa[ties(LLC)orLimitedliabiliijtPaitiieishipstLLl'j}FitltnoenlpFo}�e�sotiteriliat:tite lttchibers orparfncrs; Aro no[ required to early Workese coitrpensation insntpnce. lfan LLC or LLP dors lints �nipioy ccs, apolicsr is ►egitired..Bt;advised'ftiaf this si�dac+if uuiy be stibn2ittect fa the�Dep<•ttiinent o£ IndustrialACcidetttsforconfirntationofitlsncattce:coverage. A�sbbesitre-fosighnlldtlntetilt:Otfidnvit: Ther'ftidavifshould beretu ile6to tits cify or totva that fTte appiioation for the ttaindt or ItceISeisbeing requested, viol, liteDcparmieutt os Fndtasit ial �t ccideitis•. Should yon Itntz mt}'�ueslfgns rcgncdirtgdhe late itr ifyQft are required to -obfa€tt a �4rorkers' Okli dMationlolicy, please call theyajiattinettfrjttliennntber isted.ltsfoty-Sel4isarettcomprit'tesslrotticlentertheir k-lf uistftance license numberorLtite Appro riate,line. Cfkv of T91vp Officials Please b &Et a tltaf.ilie afCitavit i� i oitr letoaittlprinte T.iegibly. 7iieDepatfttient ltasprovide i 8 tvst•.a tattli6boitdin _q4AVaftrdavitforyofctdfill'bifE�in.theeventtlteOffimo€Investigations-hasfo cottfitc(puregtnclin l5-Vplicant. Pleasa be sure to fill in the permit/liceuseamniber igltich ti itl.be used as a. reference ii uitbat. In additiar, an applic,tirt tbatmustsubinit itutldpTe pemtit/license Applications, iii anysgiVen year, need'only sabmitone affidavit indicating cinTent. policy information (if necessary�and-im erjobsirOL»duress" the applicatiCshottlitvvcite�`ni[locations itt (city or fOVVh)_" -A copy ofthe affidavit tharbas beets offfciallyslatnped ormarked by the city or tomm maybeprovided fo lite npplicWasproofthatalraliel'a€ftlavit sotiilCeforfittureperntifso licenses. AifewTldavitmust. 6pfilled out each e,�r: �t'Iterea Monte btvnet orcitizett is tibfaittivg.a lCcense ot*permit not related to anYbttsntess orcommercialvatttaie (ise• a ciog;license or permit to Gttrn Laves etc-) said persottis NOTrequired to complete tins vffdavit. 'ritebffiCeafXiluestiJ;afionsscot:ltlli(Deto€lt-lil }�onitiadviutcefor}'otucot►p ritfioii tfttlst iltlyottlitibriitygtiestiotts, pltse do not ltesitaleto- The - I ev'hv l:.2ii•0S xldcess tele.01bite miA fax rutttil e ; The ContixipnnMtE1t o���ais�t2liflseff� _ .I?epa:•tiuetEt of It>;dtts€rid!' �xetcict�tlts �1'tice of<1ta�e��igQt'i�olt� 6QO�Vaslttigtbtz St�eei- ROS1011,; Ii &ON 11 T01. # 617M774PQQ eKf,4Q6-o t1-$77 MASSAIzp, l��s � G1.7'�727 fi7'49 Yt�t�v iTiass.go�/clta Date. . .......... OF 'to H TOWN OF NORTH ANDOVER 4t PERMIT FOR -GAS INSTALLATION This certifies that .................... ....... ......... . .. has permission for gas installation hpikr ............ in the buildings of *'***p0*r*o at ... - .% ..c *—# * * ... North Andover,,Mass. Fee.'P'.04-"?. Lic. No........... R�PECTO� Check # Gi' M MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO (PERFORM GAS FITTING WORK t" - CITY Ct,,) v�. ._ ...:.,.. - MA DATE L \.1►, �- : __PERMIT # JOBSITE ADDRESSValc7IS _OWNER'S NAME4 OWNER ADDRESS TYPE 01(t OCCUPANCY TYPE COMMERCIALPRWT. EDUCATIONAL _ RESIDENTIAL , CI'F,ARLY NEW: 171 RENOVATION: 0 REPLACEMENT -,1d PLANS SUBMITTED: YES 'I�,.m.� NO[j APPLIANCES Z FLOORS- BSM 12 3 4 5 6 7 8 9 10 11 12 13 14 BOILER_ BOOSTER CONVERSION BURNER COOK STOVE i I i DIRECT VENT HEATER I DRYER UVEN J, -- POOL HEATER I ROOM/ SPACE HEATER ROOF TOP UNIT I TEST ^ I { I UNIT HEATEP. _ - UNVENTED ROOM HEATEP, t WATER HE - OTHER h INSURANCE COVERAGE I have a current liabiil insurance policy or its substantial equivalent which sleets the requirements of MGL. Ch.142 YES�.; -s,NO -j 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1.7, OTHER TYPE INDEMNITY[ .. BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the lUlassachusetts.GeneraVLaws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER._ AGENT,y= SIGNATURE OF OWNER OR AGENT 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 ovill be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ��9 . ,, ;LICENSE #% l! y r SIGNATURE MP J. MGF f _ I JP �JGF j LPGI CORPORATION i n PARTNERSHIP ,r LLC - COMPANY NAME:. _ ADDRESS CITY j .. ,. STATE 'AA IZIP p �?. TEL FAX-_._..,�CELL� z z O z z W u h j 4 ol r4l N ,.Q LL LJ,J 4h H B LLI !Y CA a. O Q U rL a S( 63 w H! u I-- Lt. I z z W u h j 4 ol r4l N ,.Q 711rem-niff4sawan vfA&"(a*,mfls 04P,47ij vartgottwis- fimsf r T 1. 1a�nane�ngCQ;catlia Ef .. imorkfiggg forint -falsat} -etly. Cap wO*OrecqjIqx,-Hmu*dfCv. 9f F) COMP. Omer policy J6 SRO A*kesk- . -- t"k -,)) "her"a C*'M-'," OVOO W,0061PVC0111110 i0ft PIDIky doeth r exPrunowaft. 'As -.I,lttw ro'soomeaveinge, M.", t., - sojuneit tifupto bray, WO 44C afff V&aKe , fIg pa #01CM107rew, . `r I' M Ur -or, - ---------------------- Is . aslill,.escustal,T: s ¢IiapfEF Y52 reggiires�eotpIbrsianridcttfii frflteu ettiee� , 6 Eiatt 4,iI�{$ st 6i aiFel}ploj� e.is refithe`&as a..*wYmemolf fmile se�'.icV"of'-aRO& ti�i@QF >rot cito .r tt�s alt�iibpIiexl3.eraEo�nrvi>ilf�=u� ft&ltpfPjT iAe ed as "aii tndivittetal, palatileis ibg, c gtioh; cs oration euvllter t "x.ally. Ety i`more. fg�ng;eiigagetlninia��oirtt;'eizteiprise�,ant'�uiciuci�g tPi�;Il:i�preseilfat� af"asdbased'�mpSb;�>.or the re as�$ro€3i tsi ol'antncif fcihat„pai�iIler-s i ,� ss�ci�%ma o ie Iega to'fit, Hb3MOVWthe tear®�'eadt�eitulg;�otlse.iiu�ngnatiuo� fSia�rt'fb�e:apai�taeIlifs,ans�t��]Insr�ici�s�f�r�mfar�•rcupar��`flre sliteiliilgboiis Ofanoiiier I}Oeitiglm3S`P s; �d rtlauiYenaace cIlensiisIlciianoitnepai Bri onmrpgvelt"uqlitius or mn: fbegrtielIlldssol llur�dfirgappctrtenmittfierefaishallinoClieeirS�of�elitrnivelo3 nten€ tie ddb lin emgYo}e' 1" ?, cLaprfEr I,S% 2506 aalScrst� fliaf'"e cry sY:q or IOe� liceais a aic s lilfelF{I6. js naitce or° t at S l x lice�pse s Pel tnii fti.oger. e a e ot'tbleollst"utt bliBdings;ikutfieeoltrtMuki gni, Plii�atit tzhbill as mb'f plroducedaccepiar&l .ev. tr e o co�npi'iattee 'llfsfiie irsa iite, o � dionall 1Vb chi ec . tge requited: Pt §l} ss `2�if itC7erf`ue eonnb�realtft?itnrancrS'pol�fswFielstons shall' et�tc�•iilfo aat}�rcoutraet €©r t£e?�urfSr�aol'pul�i� i>vttrlt t�'1�`accepFe"�tizT°c�ettnip}iaot�,tlLfhe=,iasttrattre= r�au-,�inercts=airtT�'•°clapfc�ritat��6cetrp�s�ct%zi�to�fli�celt�cffautli�Et�,�` MM oat' file WeffieW coznpellsaf'iolr a1'fFribi tt t oiripi�ttsS�, Fi��e�eckiiig:.tlie.6o��,fJia�a�rly tojyour'siictation end, if mem'9%salpP4fmb-contactor(s),malue( adt �s atic i�laenui ei(s)"aibi ,r f ce cater IIiS€traeCe;, �liiii Sti .ta t R'COtli `' `S)'Qf � P�f�'�� nor,1:.t��dilittbilit�`2�ai�eislttps(�S�'���:iliIlr���eazYplo3�soit•er ftiat�'tlae, lllemisers,orparFtters:ar�toYreautredfo::caIltSft��orleasy"co�lelisafrou�itiszu.I€arn. = LFd®elta��e e#ilslb5T,ees,va*polky,fs--requIlrecp .BeadVfSed'ttiat flrts a lacil itla3r ii, sulfmiiietGfa tiie I7epaitinouti of Inrirtstri l AccFdentsfOr.:coaflrlalaf3ott,ofn)stuance.coverage.. RFs'o':L�eslrle.tosigaIl,a�ad'dateFleuftiila�cif� TfIle cstAkInlioul�i ll�getuxlied' fO Elle cid or Yobbrtt tTtaf fhe:applieafimu,�foi t1i�IZemiiE'Or a l�ceilse ns beiug:retltrestr-ds BaQLfiie I'iclr3t�tttlettfate�d:iasfei�la �cci anis'. SlIOE>Stl }�oit ltab z ropty clues�enus regar iry.dire+lrr►b� br itYP't"�gre requBed fort raiina wo&ers'' a 6zupeei$ati®tt }I�Iic3 ,,presse call the DEji�efineit atufti nuutlieri.bstedJlrel'Env: Sem ieisu i€ s�fftp�umnIl�eliceirs�xutmberaniflie . i� c°tnFa `'�euier:>flieac �Ip pr�attr•Iiue:. ef4wor Town O9'iieuk, i'ie a b&slu vtlfattlie �iie;aaffidavit is colilpleta au d"PriitE Ieg[bIy T1te Tat ParEitIletai:Iaas pro al space at flee: bntdonr� t das t`fanyourfo fill olltfn elle D'VCnf tfie Off'-Inuestigorib :;l mfio,-eontacty,,an segaF'd the" appikanLI I'Ins&be surto fsli+m;flipentiilNiceiise luiirerivdiicC3;:bvfll l} Userlasaireference�iraurFazr:,. I an,,applicatrf f1�Grxnlstsciiilit�`tried�aPle:permli�ficetise.�appl'�caf"ivitsrt>r�ati�gi;¢eii���ea;;,lieecdonl�st�ilif�t��iiicii�'' euIls-enf pA�e�±�•blfel�lraliios3��t��eeessaiy,�arttputuier���'o13���f�ress'�tlTe;app�caitis�irnel�:�s�'fe;�a{li�tbcai"irsris.� �Oc nor C - -- -w �• .--y,x K���.�t.��iii�is.vr llee�esr. �,trec� ai€�Tauttst�i�irllErClot�;eaefla gear' �i�fiere:a,l]'Oate obs�rea~ol-e7i€i�mis,o6tadmltg;.a:Srceilse:©isperms'S.iaaf;�x�Sufed�ta�aitgnlitisness:e�eolilttlercaaS�F:ant'tir� �:e.. a:cigig�Fiisense; os.perilritf��l5urk.I�ihses,ate.�'Asafd:'persQu,�i;�1�T�,Ta'isequis�l`ifo-,eoalpS�euffi'asFausu'l~. . e<Cli�c�of'piiaae�igatifllls xvotIlld Ii6�e:.>:e tiiall�;3�nr�ai�adir,�ts�e fOs:�tazic,cU�►�Clut+fia:ltls�di.1�'be �!,o�tiestifa�is;�, p1stianO Bicsate fe�gave its a cal lei . ��xddie��,f The: ? s : .JOIia t of,%dttsft 'lAcc€t rts Office aflhrv"e afi6n , - 1��1�1 Tel. iR 617' 7Z'7L4'9 'eXt4W ov 14774MSgApH, ql`f , I- \ 4425 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that'z—:''``''' has permission to perform—�--r ..,-�. ....... plumbing in the buildings of .....�- ........................... . at . 3. ��!�... �11. ` ... -North Andover, Mass. Feed.. Lic. No/ 7 . "--PLUMB)N'G Ifo // PECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS I _ Date Building it7-�' New [3-' Renovation Replacement ❑ Plans Sub ed Yes ❑ No (Print or type) PI Installing Company Name A411`i 16tAC- -1 PI-VmL�7if%� Check one: Certificate Corp. Partner. Firm/Co. Name of Licensed Plumber. %�/f ! N 1 cuce.4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy" Other type of indemnity E] 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 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 Pegwit Issued for this application will be in compliance with all pertinent provisions of the State PlumbingCod d Chapter 142 of the General Laws. By: igna oI -Licensea riumoer Type of Plumbing License Title 12 7 City/Town License Number Master Journeyman (_ APPROVED (OFFICE USE ONLY u N2 2298 Date..A-...F2 ........ TOWN OF NORTH ANDOVER 0 0 0 PERMIT FOR WIRING This certifies that ...... ................................................................... has permission to perform-�*�.'a ..................... .......... .................................. wiring in the building of ... . . ...................... ;7=71 ........................................ ............ .......................... . at el� ....................... North Andover, Mass. n c7 Fee:�� ................ Lic. No-IVMC ................ k ........... �7 ELECTRICAL MpEcrm 03/2k/99 15.53 WHITE: Applicant CANARY: Building Dept. PINK: Treasa Ulll' �11Ij111111111UC1llt.l� 11� ?1'�'Ic(!i!icll�lll!il l�!i \� ^r ';� t1c}lurluu:nt ut 1.ltllllic ' ati c(Ir 1. Cy EOAH Of: FIRE: PREVENTION REGULATIONS 527 Chill 12:00 — - — -� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All .vork to be performed in accordance with the fvlassachusells Electrical Code, 527 CNIttR 12:00 (PLEASE PRINT IN l N l P -, 11 �_LF A �A���%�lO t t r: •- ------ -- City or Town of _.—i —_ to I:ic !n::pcctor of \vire::: Tho udcrsigncd applies for a permit to, perrtR`nII)pIcciricawort; dc::cribccdbe!ov..Compa[ly Codc:(5Location (Street fiIuj,nbcy) �5����4,��'1-�� � 4/'�.I.c11:1);uaisd Vendor Coctc_ Owner or Tenant 1/11 Owner's Address Is this permit in conjunction with a. building permit Puroose of Guilcino Exislincd Service Nov, Scrvico limps _/ Volts Nurlber of Focdors and Ampacily Location and Nature of Proposed LIccIriCal Work Cil:coil: U I— I- (00# Yes ❑ No ❑ (Check Approprialc Box) _ Utility ^.uthorialion No. OVeI'hcad l�] U(, No. of 'vic;ur5 —_ Overhead 11Undgrnd tj No. of tvlcicrs — No. of Li h;in Outlots g 9 IJ o. ul I•lot Pubs total No. of -Iran: Iornu:r. KVA No. of Lighting Fixtures 9 9 _ I S•.vimmin9 Pool -- Above In' ❑ ❑ - grnd: grnd. Gonorators KVA No, of Aoceptacto Outluts No. of Oil Gunlors No. of Emergency Lighting Gattory Unit:; No. of Switch Outlots No. 01 Gas Gurnors PInE ALARM,, Na. or ioncs No. of Ran os Rangos i•: o. OI Air COnrl. TO al No. or Ootecuoo and IOn. Initialing) Devic J:: (No. of Disposals r No.of Licit li�tal Total I Pumps Tons KW No. of Sounding Oi vicris No. of 019hava.hOrs I - Spaco/Arc, I-loating KW No. of sell C,)ngamed Detection/Sounding Devices Lo Inicipal [, Othr.r r)nnCClir,r, J No. of Dryers Hcaling Dovices KW No. of No. of —.. �— Low Volt:,r,c ! IrIIv :o. of Wa:or HCatur. IC`/J Si,nr Onllasts gs CC,I No. Hydro Idassago Tubs -LNo. of Molor:; Tot:)I HP OTHER 010 V INSUPtANCC COVL•nAGE: Pursuant_to fho n:quiroments of t�tossocl,v ,:lis general Lo ­:; I h3v0 a currortt Liability In:,wanco Policy including Cumploicd Operations Coverago or iu; :;ubslanlial C(µ;ivalCnt. YFS % NO �; 1 havo.cubmittod valid proof or carne to the OIIiCO. 'rES C, NO ID It you havu chocked Yl'$, )lease_ indi,:a;c n,c ty u: of Coveragn ') chocking tho';.ppropriatu box. I I • ) INSURANCE C 001,10 U 01'1-1E11 Q (Plua.oSpeci(y)—I1�£lVC:1.0%ti l'1�)cll:)r Cal.l'y Co. 9/10/99 Cstimatod V;tluo o: EIOCIriCal Work S .Ix piration Work to Slarl Inspection Date Requested: Rough Fin:)I _[ Cc5 Signod undor tho Ponattios of periury: LIC FIRlvi NAIIAE A..a) IhRkI ll c( Inc. 14333 . N Uccnsoo" Nich;lel A. -DeCost:a '% UOU5171'ubllc S�gnatu �: � IC. IdO. ACdres" 110 Florence SL, P.O. Box 667 Malden, Ma 02148 Dus-Tel. No. (790338-U00 700 �cifcLY) a (-l-r--fir• r.------- _—-------- -- All. Tel. P.10._�sjli0 _l�?-1?(%) OWNER'<, INSU; WAIV[:!i: I am aware Ihal 1110 Lieuw;oC rlgn:; not h ivo the in6vr;j, e0v Crlge of it:-, :u :0;;4anli;il equivalent rc- wirod by Massaehusutls Genoral La::s, and that ray signaturu on This )erfnit apJAC11ton waives This rc(jui:cn••cnt. O::nt:r Agent (PI0350 chock ono) -- —•—----•---..__._:.. 7CICphonc NO-..__ P�bU�a'r F(: ii r_`� _