HomeMy WebLinkAboutMiscellaneous - 37 GLENNCREST DRIVE 4/30/2018f0f62
Date. .... .�...—... �/„
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that �7 �...
........:....................................................................................
has permission to perform ..... ........�.. . `�...............
wiring in the building of ..W.. /.!. `''...:....../r�.� l ...........................
at ., .... �� �{' .`l...G. �' s . f ............ ...... , North Andover, Mas
Fee. ......... Lic. No.. U,�-?�G ..... . ....rz............ . f.4-:� ? .
%tLECMCAL INSPECTOR
Check # //� � `//
Commonwealth of Alass
achusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Uthcial Use Only
Permit No. /(// &'-7
Occupancy and Fee Checked
i�_tev. 1/071
APPLICATION FOR PERMIT TO PERF®RM E (leave blank)
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 52�CIC
� 00 WORK
®R�
(PLEASE PRI T IN AW OR TYPE ALL N,ORMATIOA9 Date:
ol
City or Town of: NORTH ANDOVER
By this application the undersigned gives notic of his or her intention to perforin the To the, electrical wof
ices.
Location (Street & Number)k described below.
Owner or TenantC. e� 7 , A A _ _ _
Owner's Address
Telephone No.
Is this permit in conjunction with a buiidin permi ,
Purpose of Building �.. Yes N° ❑ (Check Approriate B)x)
Utility Authorization No.
Existing Service %
Amps / /2 Volts Overhead
New service �m� Undgrd No. of Met
�J 1l GC_ Amps U / Z Volts Overhead
Number of Feeders and.A.mpacify Undgrd No. of Meters
Location and Nature of Proposed Electrical Work:
o. of Recessed Luminaires
o. of Luminaire Outlets
D. of Luminaires
-------------
i. of Receptacle Outlets
�. of Switches
1. of Ranges
No. of Ceil: Susp. (Paddle) Fans
No. of Hot Tubs
Swimming Pool Above ❑ �.
d.
No. of oil Burners
No. of Gas Burners
No. of Air Cond. Total
10. of Waste Disposers
Heat Pum 1 ons
Pump Number Tons
Totals: —_ — __.
o. of Dishwashers
Space/Area Heating ICW
o. of Dryers
Heating Appliances
o. of Water
Heaters'
KW
No. °f Nn_ of
Hydromassage Bathtubs
Ballasts.
of Motors Total HP
table may be waived by the
Generators KVA
uow_ency g —
._Tmr
AULARMS ING.' of Zones
of Alerting Devices
t►on/Aiertina Devices o
Municipal
Connectins ❑ Other
No. of Devices
Data Wiring;
No. of Devices or
Wires.
Estimated Value of Elec cal Work: Attach additional detail if desired, or as required by the Inspector of Wires.
Work to Start: (When required by municipal policy.)
Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE C VERAGE: Unless waived by the owner, no e
the licensee proof of liability Permit for the performance of electrical work may issue unless
undersigned ty insurance including completed operation" coverage or its substantial equivalent. The
fined certifies that such coverage is in force, and has exhibited proof of same to the ' ermit issuing of
CHECK ONE: INSURANCE BOND [] OTHER �
I certify, under the pains and pen 'es o ❑ (SPecify;) /�%p ya� Ar Ll o ? %g,
FIRM NAME (perjury, that the information on this application is true and complete. lo/
Licensee: C LIC. NO.:
(If applicable, enter exempt " 'n the lice a nu r er line.) Signature
Address: .C, LIC. NO.:
*Per M.G.L c. 147, s. 57-61, security work requires D �l F us. Tel. No.: 2; fZ
OWNER'S INSURANCE W aPm4rnent of ublic Safety "S" License: fit' Tel. No.: ZS
required by law. B �R' I am aware that the Licensee does not have the liabili Lic. No.
BY my signature below, I hereby waive this requirement. I am the (check one insurance coverage normally
Owner/Agent ) ❑ owner owner's agent
Signature
Telephone No. PERMIT
ELECTRICAL PERMT NO, EVSPECTION REPORT[':
ELECTRICAL INSPECTOR -DOUG SMALL
•L
1. ROUGH INSPECTION:
Passed — Failed — [ ] Re -inspection required ($50.00) - [ j
Inspectors' comments:
(Inspectors' Signature -no init' s) '
Date
Z. FINAL INSPECTION;
Passed — Failed — [ ]
Reinspection required ($50.00)
Inspectors' comments:
(Inspectors' Signature - no initials)
Date
3. UNDER GROUND INSPECTION:
Passed — [ ] Failed — [) Re -inspection required ($50.00)
Inspectors' comments:
r
(Inspectors' Signature -no initials)
Date
4. INSPECTION— SERVICE: -
DATE CAf_ IED NATIONAL GRID: ®j // NAM:
Passed — [ Failed — [ j Re -inspection required ($50.00) = [ ]
Inspectors' comments:
(Inspectors' Signature - no init als)
Date
5. INSPECTION - OTHER: `
Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] 1
Inspectors' comments:
- no initials
Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE ANS7PECTED IS NOT
ACCESSIBLE AND A RE_INSpECTION OF $50.00 IS TO BE CHARGED.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office ofInvestigations
600 Washington Street
Boston, AM 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: B>ceders/Contractors/Electricians/Plumbers
optic int Information
Name (Business/Organization/Individual):
Address:
City/State/Zip:��
#: d c� 7
Are you an employer? Check the appropriate box.,
P(Iam a employer with 4. El 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
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
Insurance required.] t
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
C. 152, § 1(4), and cve have no
employees. [NTo tilorkersI
COMP, insurance required.]
".-Wy applicant :hit e .L- box 41 must also .rill eut the section beloiv shoe,;n . their workers- cnm..
;-A-1Y
h b � "._b
Type of project (required):'
6. New construction
7. Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
1 - Plumbing repairs or additions
12.❑ Rcofrepairs
13.❑ Other
w os mrt this affidavrt indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such.
r on puLluy m1orm-aron.
$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 insuran� for my employees. Below is the policy and job site
information.
Insurance Company
Policy # or Self -ins. Lie. #:
Expiration Date: 12
Job Site Address:_
City/State/Zip: Q
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 u der the pains/�nd penalties of perjury that the information provided above is h ue and correct
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
6. Other Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector
Contact Person:
Phone #:
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
G
I%1 O.14�tr��l,� , Mass. Date V-14 - i , 1 g 7 fo Permit # v ! J
c� 1 pk, AU
Building Location_ � tr � rrc�<.v � S � '7 Owner's Name J T(e�� e ��tC- ( CA0 u'a"
Type of Occupancy \ � �'S i c,Eea, c�
New ❑ Renovation ❑ Replacement's;, Plans Submitted: Yes❑ No ❑
Installing Company Name EASTERN PROPANE GAS Check one: Certificate
Address 131 WATER STREET Corporation
DA VERS MA 01923 ❑ Partnership
Business Telephone 508-774-1930 %� �}, /❑ Firrmmr/Co.
Name of Licensed Plumber or Gas Fitter ( /�
INSURANCE COVERAGE: `-J
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes X No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy X 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:
Owner❑ Agent ❑
Signature of Owner or Owner's 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 ap lication wiM.-t=:7
'pliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General La }
By T of License:
Plumber gnature of ensed P mbar or as ter
Title sfitter
Master License Number
City/Town Journeyman
APPROVED I U NL
i
i
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_
■11■111111111
■•
1■■11
11■;
MEN
MEN
W-24MA
INEENEEMENNEE
Elm
RMEENNEEMENSEEMIN
NEI
RESIMEN
on
MEN
Installing Company Name EASTERN PROPANE GAS Check one: Certificate
Address 131 WATER STREET Corporation
DA VERS MA 01923 ❑ Partnership
Business Telephone 508-774-1930 %� �}, /❑ Firrmmr/Co.
Name of Licensed Plumber or Gas Fitter ( /�
INSURANCE COVERAGE: `-J
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes X No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy X 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:
Owner❑ Agent ❑
Signature of Owner or Owner's 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 ap lication wiM.-t=:7
'pliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General La }
By T of License:
Plumber gnature of ensed P mbar or as ter
Title sfitter
Master License Number
City/Town Journeyman
APPROVED I U NL
i
R'
qg 3 -ib -
T? 2 i c) Date .....................
1
aF H° o' a TOWN OF NORTH ANDOVER
O A
3r '� O PERMIT FOR GAS INSTALLATION
� A
This certifies that
has permission for gas installation . �y(/ /::.► I/.. ?-..J
in the building sof
f
at ... North Andover, Ma!a
c.
v
Fee.. 0.
Lic. No. Q .... ..........................
o� 3 I f, GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
En
A%,"Ust t 15 UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
NORTH ANDOVER, Mass. Date A _10
Bulldlna/ Permit /'/,
Locallon O jo `P.A U i� }— lam`'(
Owner's '
NameL
New p Renovation p Replacement ae-- Plans Submitted: Yes ❑ No. p
FIXTURES .........
Z Check one: Cerillicale
Installing Company Name a4 -Me s 32 - -T-O4 t. p Corp.
Address \�- 0-o-
0 Partnership
1�2f �C✓� ►�^v G1 �7/
itm/Co.
Business Telephone SUSS C- 6,7-
.Name of Ucensed Plumber 11,An ��� 7
INSURANCE COVERAGE: Check
I have a current liability Insurance policy or No substantial equWar;L Yes [y No p
If you have checked y", please Indicate the type coverage by checking the appropriate bo X, - _
A (lability Insurance policy'_ Com'^ Other type of kidemnity ❑ Bond ❑.
OWNER'S INSURANCE WAfVER:'I am aware that the licensee does not have the Insurance coverage requlre'd by^
Chapter 142 of the Mass. General Laws._ and that my signature on this permit application waives this requirement:.w.
y Check one:.. - - - -- - - -. _ .
§Fnature o er or Ormec s . en _ - -
Owner CI-.AQ�_p
I hereby cerlity that all o1 the details and information I have submitted for entered) In applicalbn at T and,.aoanatE la tha bast of-rzsy
knowledge and that -&A plumbing work and-instaRatlonsgerformed under the perms! I� ilia apls%:S
will M h Aanp with all -.
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 112 d the ai l�wa_�
By .
Title
Ctty/Town
Mf'fiWED (OFFICE USE ONLY)
Number #7j/ -f U
Plumbing Lkense: Master gr ---
Journeyman 0
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IST FLOOR
INDFLOOR
-
SAO FLOOR
4TH FLOOR
STH FLOOR
4TH FLOOR.
_
ItTH FLOOR
STH FLOOR
Z Check one: Cerillicale
Installing Company Name a4 -Me s 32 - -T-O4 t. p Corp.
Address \�- 0-o-
0 Partnership
1�2f �C✓� ►�^v G1 �7/
itm/Co.
Business Telephone SUSS C- 6,7-
.Name of Ucensed Plumber 11,An ��� 7
INSURANCE COVERAGE: Check
I have a current liability Insurance policy or No substantial equWar;L Yes [y No p
If you have checked y", please Indicate the type coverage by checking the appropriate bo X, - _
A (lability Insurance policy'_ Com'^ Other type of kidemnity ❑ Bond ❑.
OWNER'S INSURANCE WAfVER:'I am aware that the licensee does not have the Insurance coverage requlre'd by^
Chapter 142 of the Mass. General Laws._ and that my signature on this permit application waives this requirement:.w.
y Check one:.. - - - -- - - -. _ .
§Fnature o er or Ormec s . en _ - -
Owner CI-.AQ�_p
I hereby cerlity that all o1 the details and information I have submitted for entered) In applicalbn at T and,.aoanatE la tha bast of-rzsy
knowledge and that -&A plumbing work and-instaRatlonsgerformed under the perms! I� ilia apls%:S
will M h Aanp with all -.
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter 112 d the ai l�wa_�
By .
Title
Ctty/Town
Mf'fiWED (OFFICE USE ONLY)
Number #7j/ -f U
Plumbing Lkense: Master gr ---
Journeyman 0
Location. �.
No. in Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 22—
Foundation
2—Foundation Permit Fee $
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
TOTAL
I
�40
( V��
02/13/96 12:49
9557
79.00 PAID
Building Inspector
Div. Public Works
Date....
TOWN OF NORT4' ANDOVER
PERMIT FOR PLUMBING
SACNUS
---
�
This certifies that ... 1
�,...1.... .......... ............ .
9 ' C� fid -G
has permission to perform ..... , . .:.
.. ... . .
plumbing in the buildings of
at .. �... u�,C ,r- .� -'.� ... , Nol Andover, Mass.
,N
Fee. Lk� .. Lic. N01.1..I I .� S. U ............................. .
PLUMBING INSPECTOR
44.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
PERMIT NO.
-01
APPLICATION FOR `PERMIT TO BUILD - NORTH ANDOVER, MASS, V
PAGE 1
MAP d-40.
LOT NO.
2 RECORD OF OWNERSHIP iDATE
(BOOK PAGE —
ZONE
I SUB DIV. LOT NO.
�—
LOCATION lemOor A/
w
PURPOSE OF BUILDING G
OWNER'S NAME
�—
NO. OF STORIES SIZE
OWNER'S ADDRESS
IIMAWi
BASEMENT OR SLAB
ARCHITECT'S NAME
BUILDER'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
SPAN
DISTANCE TO NEAREST BUILDIN
DIMENSIONS OF SILLS
DISTANCE FROM STREET A f
POSTS
DISTANCE FROM LOT LINES - SIDES ll/ A /A REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION 0 G'+
IS BUILDING ON SOLID OR FILLED LAND '
WILL BUILDING CONFORM TO REQUIREMENTS`OF C45DE
VW'
IS BUILDING CONNECTED TO TOWN WATER <�T
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER �lol
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
SIGNATURE OF OWNER OR AUTHOR ED AGENT
V,el.._. AA -.-1-_
F E E
PERMIT GRANTED
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST 60
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
UILDING INSP&MR
OWNER TELJ
CONTR. TEL. # l `
CONTR. LIC. M
H.I.C. N
0
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY,,,#lSiOPIES
MULTI. FAMILY
OFFICES
APARTMENTS
__
CONSTRUCTION
2 FOUNDATION
8 INTERIOR
FINISH
CONCRETE
PINEHAR
B
1
2 13
CONCRETE BL K.
BRICK OR STONE
D
PIERS
PLASTER
[TRY W
DRY WAIL
UNFIN.
_
3 BASEMENT
AREA FULL
FIN. 8 M'TAREA
_
V, 1/1 V.
FIN. ATTIC AREA
_
NO B M T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
_
4 WAILS I
9 FLOORS
CLAPBOARDS
B
1
2 3
�_
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
HARD\,,/ D
COMRACN
VERT. SIDING
_
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. 6 FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I�POOR _
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLEHIP
BATH Q FIX.)
_
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. d COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd
ELECTRIC
_I
i.r 13rd
I NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
-4' 4-o 60
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t
(Print or Type)
C NORTH ANDOVER Mass. Date
�uilding Location ' �y- (� h G f GS Permit #Z-
-Owners Name _M L bo A ek9l
? - New '7 Renovation D Replacement Plans Submitted D
FIX?"Uo_c
(Print or Type) p Check one: Certificate
Installing Company Names- P^es 12. l GncT e)LA 1 Corp.
Address_\L L�-ts (� Partner.
1 1�
e4, G +A-_ &,A, G i Q I D_� i rm / Co .
Business Telephone:
Sj�-- (o6? -`370
Name of Licensed Plumber or Gas
Insurance Covera -
appropriate box:
Liability insurance
e: Indicate the
Fitter � A
type of insurance coverage by checking the
Policy �ther type of indemnity Q Bond 0
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 17 Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are
knowledge and that all plumbing worst and lnstxllations performed under Permit issced to: this application will -1
provisions of rho Massachusetts State Cas Code and Chsptes 142 of rho Central Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY1
TYPE LICENSE:
Plumber
G- sf itter-
aster
Journeyman
I 1
and accurate to the best of my
compliance with all cat
(M .
g
ature of Licensed
ber or Gasfitter
SAA ) 1 ,"V 5i- d
cense Number
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
I
STH FLOOR
6TH FLOOR
TTH FLOOR
STH FLOORLJ
(Print or Type) p Check one: Certificate
Installing Company Names- P^es 12. l GncT e)LA 1 Corp.
Address_\L L�-ts (� Partner.
1 1�
e4, G +A-_ &,A, G i Q I D_� i rm / Co .
Business Telephone:
Sj�-- (o6? -`370
Name of Licensed Plumber or Gas
Insurance Covera -
appropriate box:
Liability insurance
e: Indicate the
Fitter � A
type of insurance coverage by checking the
Policy �ther type of indemnity Q Bond 0
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 17 Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are
knowledge and that all plumbing worst and lnstxllations performed under Permit issced to: this application will -1
provisions of rho Massachusetts State Cas Code and Chsptes 142 of rho Central Laws.
By
Title
City/Town:
APPROVED (OFFICE USE ONLY1
TYPE LICENSE:
Plumber
G- sf itter-
aster
Journeyman
I 1
and accurate to the best of my
compliance with all cat
(M .
g
ature of Licensed
ber or Gasfitter
SAA ) 1 ,"V 5i- d
cense Number
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN* G
(Print or Type) t
c NORTH ANDOVER Mass. Dat 2•
building Location7ulc—s-i
S
Owners Name
.
Permit # p(J�
enovation �II Replacement Plans Submitted D �y FiY—�to.c
(Print or Type)
Installing Company N
Address .a?08 /
business Te ephone: (6/7)
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Address .a?08 /
business Te ephone: (6/7)
Name of Licensed Plumber or Gas Fitter nzv
Check one: Certificate
Q Corp.
Partner.
[�f Firm/Co.
Insurance Coverage: indica--e
.he -,/pe of insurance
coverage by checking the
appropriate box:
Liability insurance Policy
C OZ;-er type of
indemnity = Bond
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undersigned, have
been made aware that the licensee of
this application does not have any one of t; e
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I hctchy certify that IU of the details and information 1.have submitted (cr entered) in Above a0piies
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provisions of the 5ta1saehuaettS State Cas Cade and CSapte: ;a-' 6f Ise iencr:i Lays.
By TY?E LICENSE
l�rtber
TZ`Ze I Gasfitter Sign cure of Lic nsec
City/Town• waste= Plumber or Gasfitter
APPROVED (OFFICE USE ONLY} Journeyman
License Number
2152 Date...- .. ..
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that v .....
has permission for gas installat),9n
in the buildings of ... .................
North Andover, Map.
at L j
Fee. .*.tru. Lic. No. .................. Co
GAS INSPECTOR
WHITE: ApXa.—i L91 Building Dept. PINK: Treasurer GOLD: File
?ATO 2127
NORTI,
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Date ..) '
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIOIE
1
This certifies that .... /4 ,........ • , , , .
M
has permission for gas 'nstaiiation .. N
in the buildin s of �,t,� • ,.� •'•C' Vn4dover,
U41:llC°/1at .3 �. �, .�.�'� . .... North Masi.
Fee Z.?.. . Lic. No. /0 .0.. ..........................
GASINSPECTOR
WHITE: Appll"caix.- CANARY: Building Dept. PINK: Treasurer GOLD: File
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) Q
V 1 !'7NC�a e^ Mass. Date19 Permit # "I 00
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Building Location c�--� C tel.Cv eS + RJ Owner's Name She Q -e 1Mcb�\, o- 2.
Type of Occupancy u FFG; c.le , c P
New ❑ Renovation ❑ Replacement K— Plans Submitted: Yes❑ No ❑
i
Installing Company Name EASTERN PROPANE GAS Check one: Certificate
Address 131 WATER STREET X Corporation
DANVERS MA 01923 ❑ Partnership
Business Telephone 508-774-1930 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter &A
INSURANCE COVERAGE:
I have a currknJ liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked res, please indicate the type coverage by checking the appropriate box.
A liability insurance policy X 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 Gas Code and Chapter 142 of the General Laws.
By T of License:
Plumber Signiture of Licensed Plurn r or Gas fitter
Title Gaslitter C
Master License Number
City/Town Journeyman
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7TH FLOOR
8TH FLOOR
Installing Company Name EASTERN PROPANE GAS Check one: Certificate
Address 131 WATER STREET X Corporation
DANVERS MA 01923 ❑ Partnership
Business Telephone 508-774-1930 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter &A
INSURANCE COVERAGE:
I have a currknJ liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked res, please indicate the type coverage by checking the appropriate box.
A liability insurance policy X 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 Gas Code and Chapter 142 of the General Laws.
By T of License:
Plumber Signiture of Licensed Plurn r or Gas fitter
Title Gaslitter C
Master License Number
City/Town Journeyman
APPHONED O IC U NL
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TQ2 � v Q Date ... ........ `...... .
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PERMIT FOR GAS INSTALLATION $
s � a
This certifies that
has permission for gas installa 'on
in the buil •ngs of . 1� i
at3.7.. . ..... No Andover, Mass.
Feed%.. "". Lic. No..q j -3 ... ......................... .
GAS INSPECTOR
WHITE: Ap t -"CANIRYBuilding Dept. PINK: Treasurer GOLD: File
Date. d .
4019
�<<�•° •'tio TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
F
This certifies that .............
has permission to perform -de
plumbing in the buildings of
at..... ........
F eV. "' .. Lic. N ....%3..... ....
....................
;. . . . . -; .......
Andover, Mass.
/l .
05/05/99 01:46 25.00 ppi
WHITE: Applicant CANARY: Building Dept. INK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print) ��
NORTH ANDOVER, MASSACHUSETTS `
r�p�► Date
Building LocationiJfp t �v `TtS % Owners Name ���� h . Permit
Amount
Type of Occupancy�e��..r,
i.
New Renovation Replacement Plans Submitted Yes No
FIXTURES
(Print or type)
�c/�
/ ,
G- j
Check one: Certificate
Installing Company Name
�C���C
1'�
Corp.
Address
��'t' P`
1ir� Y
Partner.
�-i
•e/7
� / � U
Firm/Co.
Business Telephone
Name of Licensed Plumber:
1r;o74
4,
Insurance Coverage: Indicate the type of in urance coverage by checking the appropriate box:
Liability insurance policy
E^
Other type of indemnity
❑
Bond
WMMMMMMMMMMMMMMMMMMMMMMMM
MMMMMMMMMMMMMMMMMMMMMMMM
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W1116% MMMMMMMMMMMMMMMMMMMMMMMM
milisommmmmmmmmmmmmmmMMMMMMMMMMMME
(Print or type)
�c/�
/ ,
G- j
Check one: Certificate
Installing Company Name
�C���C
1'�
Corp.
Address
��'t' P`
1ir� Y
Partner.
�-i
•e/7
� / � U
Firm/Co.
Business Telephone
Name of Licensed Plumber:
1r;o74
4,
Insurance Coverage: Indicate the type of in urance coverage by checking the appropriate box:
Liability insurance policy
E^
Other type of indemnity
❑
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 perfo der Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachus!Me PI g Code and Chapter 142 of the General Laws.
By i 01 LicensectPlumber
Type of Plumbing License
Title
City/Town License i um er Master ET Journeyman 0
APPROVED (OFFICE USE ONLY
uhP �IImuw�u� ui ��nr:.�
r�
BOARD OF r'tRE P9Elc'MCN R'- LAM G'UIR 12:10
c"ke use cwY
Permit No.
C=panty A Fee Gleckadt
leave blank) ak t 7
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All weric to be performed in ac.• —lone-- with u e Massacrusetts S:ec:ricai Ccde, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFCRIMATICN) Date 4110ooze
QM- or Town of NORTH 4NDO _2 _ To the Inspector of Wires:
The udersigned acclies for a permit :o perjorrt tr.e eiec:::cat went described below.
Location (Street 3 Nurtcer)
Cwr.er or Tenant r���l/�
Cwner's Address s '�
is this permit in ccnjurc:ion with a ouilcing .or._u: Yes _ No ILS (C`eck Apprccmate Sax)
t=;;r^Cse C' Buticinc Utility Autnorization No.
— r--•
ccszmg Semite Ames ` `/cs Cverme-_ — Uncgrnc �=
�1e'r. Service Ames ` `tc::s Cverr,ea.
r-
Nc. of Meters
No. at Meters
Vu^ter cf=eecers ar.c Arrcac:r�
Va:, _- reset'. _•oc:..�-i.
Nc. _. _ _ .:rg .....:e:s •�• _=- -__ ?1e. _. -anstorrners C
No. :t _:grt:ng = x:.:res Swtmratrg =_ct _.e— _n — I Generators KVA
I :No. cr E-nergency L gnnng
No. _. Ca :_.vers =entJntts
Nc. .r=___c:ae:e Curets � =-..
No. _. Swttcn cLxets No. _. 335 =_.-_._ I =.=E ALkp..Ms No. ct _rtes
No. :. Ranges
I NC. :r _d _c::Cn anc
.ors Ir.t:tanng C'avtces
Nc.=:
No. =t =isccsais _-_ No. ct Scunc:ng Cevices
NC. cr Sett Ccntatnee
No. --r Cisnwasners Scacer3rea=ea:.-- C.•t Cetec::cntscunctng Cevtces
Munic:oat C;nar
No. =r Crvers-!eac-g Cev:c_s to -=`31 Connec::cn
Nc_ cr No.. I _=%v I/cttage
•.Virna
No. =t '.Vater iea:ers K;t S:ens-_•--s:s _
No. =•.cro Massace -,.;Zs
C --E=.
tNS;;�ANCc " :•IE .LGE. Pursuant :o -.r-.e recuue rens =: »:assac-_sa-s ;er.erat Laws
I nave a current L.acuity Insurance P:ttc-/ �nr.::c:rg Czr.=:erect ^_=era=ens '.'.overage cr :5 sucs:anttal ecutvatent. YE. NO = t
nave sucmtr:ee vatre c _ct of same :o Me Ct:ice_ YES = NC = •t you nave cnecxec Y__ -tease tnetcsts :ne Nre of coverage =y
=necxrng the accrccnate Cox.
INSt;PANC= = 3CNO = OTHER = tP'ease S=ec`!t
_ /�O� (Exctranan Oa -et
_s:::r=:
atee Value et Elseca�t^'Nerx S
tnscec=cn Ca:a=re_as:a:: =cugn
S:gaee mincer ; e ?enataes of ;egury; /
=PM NAME � r�!/�r /cl . .�.�GIS�� uc. No.
_tenses % /J S:yea^.:re _C.. NC.
/if/c�,^ Sus. :at. No.
G
Aecress��� /��� ����0 Au. Te1..to.
CwNE:a'S INSUFIANCE 'NAIVE=I: t am aware Tat =a _-tenses =ces met nave :no tnsurarce coverage or its suawannat eeutvalent as re'
eutreo ?/ MassaCn'lsettS Genera' Laws. area mat -y _re cn =:s =er-:t accttcatten waives :rets mcuuement. Cv ner Agent
;Please cnecx one'
aecncre No. PE.=,MIT F=-_ S
i5igrtatute of Cwner =r AgwT' •ri=__
��.tw..... •s•.ry.Mr.�_..,.� }^.-vr+-M+.T ..ter'' .'2 +r+: --i'•'.: -,iii. s ••�- � rati._.�..-ti..S1
ig•. - (/� Rf}(J� Date ------G-' /.S �%
Ot ,tORTH 1M
O p
7SS^CNUSE�
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies th ...... ., f r -L -J ..,lCw...I,-.-r:. �.
has permission to perform'�?�rxaf ........... . . ......
......,,��..
wiring in the b ' ding of ....... ilp '" ( ......."'06.Y1. UlYA
..........
at../... ,..<rE..^/17........ i. . .i ...... .... .......... , North Andover, Mass.
Fee. , 0...'....... Lic. No.1.16)151q............................................................
j � ELECTRICAL INSPECTOR
_�% d PAID
02!15/96 14:14 55•�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File