HomeMy WebLinkAboutMiscellaneous - 38 PLEASANT STREET 4/30/2018�1
Date..... �� .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... ..............................................
has permission to perform ...............f-s.........��..............................................
...................
wiring in the building of
o_ff .......�'.'1 ...
l� ..
at ........"..�°... �..--�:�:�--�:�--:�.:................. .North Andover, Mass.
er
Fee? - .......... Lic. N&?./�?...................................................�........
ELECTRICAL INSPECTOR
Check #/�
7671
-C-\ Commonwealth of Massachusetts Official Use Only
- . Department of Fire Services Permit No� ��
i tv �
t Occupancy and Fee Checked. �'S
BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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: V— 2 J —O -7
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned giv s notice of ijl or her intention to perform the electrical work described below.
Location (Street & Number) 3 �J lVo /&C-% 5V'—
Owner or Tenant A&I
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service 108 Amps /&/7, 7j Volts
New Service 200 Amps /20 / 2?'OVolts
Number of Feeders and Ampacity
Telephone No.
Yes ❑ No � (Check Appropriate Box)
Utility Authorization` No. _; ?,5-60
Overhead Undgrd ❑ , No. of Meters
Overhead Undgrd ❑ No. of Meters
Location and Nature of Proposed Electrical Work: 100
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
o. of Tota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above El In- El
rnd. rnd.
o mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
of Detection and
No. Initiating Devices
No. of Ranges
No. of Air Cond. Tonal
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Number
Tons
...
No. o Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Connecta) El Other
Connection j
No. of Dryers
Heating Appliances Kms,
Security Systems:
No. of Devices or Equivalent
No. of Water KW
No. o o. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Te ecommunicationsfiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 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 V BOND ❑ OTHER ❑ (Specify:)
I certify, under th pains and penalties of per' , that the information on this application is true and complete.
FIRM NAME: >2 LIC. NO.:2irg 2� e/
Licensee:06r�-i�- elwwAfIr . Signature C. NO.:
(If applicable, enter "exempt" in the license nunyib6er line.) Bus. Tel. No.
Address: < /}- A UP -501 4�7 .�At- 036 7 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.
Owner/Agent °=
Signature Telephone No. PERMIT FEE. $ 5Y
<�N\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASF11TING
(Print or Type) Uzi
Mass. Date fibo/ 19 qD Permit
Building Locatiorx11-18 P%SSa V f 9�- Owner's Name LA) A
Type of Occupancy 3I
G
New ❑ Renovation ❑ Replacement p Plans Submitted: Yes❑ No;❑
1
MOUfa-PLLJVIB I Nb - -Ht HI i NU i , .
Inst2 290 Broadway Suite # 101 Check one: Certificate ' #
Addl rl e t h u e n M a, 01:344 � Corporation
❑ Partnership
Business Telephone � Vj �, a ❑ Firm/Co.
1�4111ai'VI uv.c.11JC.V ( IYIIIVGI VI VQJ 1 IllGl
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes dK1 No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IS 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
1 hereby certify that all of the details and information I have submitted (or entered) in abpve application are true and accurate to the bestof 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 e of Ucense:
Plumber Signature of cense um er or Gas Fitter
Title Gasfitter
Master Ucense Number l Z S
�y/Town O C S _ O Journeyman
������■�����lY�
iii
�O�
���
won
MOUfa-PLLJVIB I Nb - -Ht HI i NU i , .
Inst2 290 Broadway Suite # 101 Check one: Certificate ' #
Addl rl e t h u e n M a, 01:344 � Corporation
❑ Partnership
Business Telephone � Vj �, a ❑ Firm/Co.
1�4111ai'VI uv.c.11JC.V ( IYIIIVGI VI VQJ 1 IllGl
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes dK1 No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IS 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
1 hereby certify that all of the details and information I have submitted (or entered) in abpve application are true and accurate to the bestof 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 e of Ucense:
Plumber Signature of cense um er or Gas Fitter
Title Gasfitter
Master Ucense Number l Z S
�y/Town O C S _ O Journeyman
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t. Date. . .'x). 2.7 a
NORTH TOWN OF NORTH ANDOVER
PERMIT -FOR GAS INSTALLATION
0
This certifies that
has permission for gas installation n/N.,
in the buildings of ...
at ... North Andover, Mass.,
..'
Fee... Lic. No
't lu� ->, -3 1 GAS INSPECTOR
A
WHITE: Applicant NARY: Building Dept. PINK: Treasurer GOLD: File
Location C U P E t. A L`h2E-t'�'
No. Date 4,91
0
TOWN OF NORTH ANDOVER
N
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee epi{' $
Sewer Connection Fee $
Water Connection Fee
TOTAL
2 ?813
H
Building Inspector
Div. Public Works
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