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Home My WebLink AboutMiscellaneous - 39 HEPATICA DRIVE 4/30/2018Date ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform ........ .................................................. wiring in the building of ........ :�A— :�— .................................................................. ... Jl- �.* .......... North Andover, Mass. &0 � 0 1 A . ................ .. . ....... Lic. No . ...... 4804- ......... .. ........ .................. ............. ELEc-mcAL S CTOR �,'heck # 12" 22 14 101 Commonwealth of Massachusetts Official Use Only -7-1 Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. i/v] ocaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code OaQ, 527 CMR 12.00 (PLEASE PRIATHHK OR TYPEALL NFORMATION) Date: I City or Town oh 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) 'Scl �Apeik-, W, 0, A4 k1k Owner or Tenant Owner's Address TelephoneNo. 1_609j-3-� t16� 30 Is this permit in conjunction witfi a building permit? Yes P No LJ (Check Appropriate Box) Purpose of Building 6CLS"e-4A -- Utility Authorization No. Existin g Service Amps I volts Overhead UndgrdE:l No. of Meters New Servic Amps Volts Overhead Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe followiniz table may be waived bv 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 D In- Ei Ao. of Emergency.Lighting grnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches 1� 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 Reatrump Totals: J.NI!M� M J.KW ............ .......... No. of Self -Contained Detection/Alerting Devices A_ No. of Dishwashers Space/Area Heating KW LocalEl Municippi F1 Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW 0. 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: Estimated Value of Electrical Work: Attach additional detail ifdesired, or as required by the Inspector of Ores. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with WC Rule 10, and uponicompletion. 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 operation7 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: INSUIRANCEIQ BONDE] OTHER 171 (Specify:) I certify, u n der th e p ains an dp en alties ofp erju ry, th at th e information on th is applica tion is tru e an d complete. FIRMNAMR. &ccJck'c_ Iy\c - .11 Lic. No.: -,,o I bo A Licensee: "�c Signature— LTC. NO.: —J-0 I 5�_Q A (Ifapplicable, enter "exempt" in the Wgnse number line) Bus. Tel. No. 9) 2,- A q I -� i �O Address: �A kk-1 VA 62-1 M k owJ3�; Alt. Tel. No.: 61A-`�D&- 1� ba *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. �Q I go & - 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 (che one) D owner D owner's agent. Owner/Agent Signature Telephone No. PUMITFEE: $ J 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. 0 Rule 8 — Permit/Date Closed: Note: Reapply for new permit 0 0 Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) 0 Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) 0 Inspectors Comments: Inspectors Signature: Date: PAPUIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required 0 Inspectors Comments: Inspecto/s Signature: Date: ROUGH�SPECTJON: Pass Failed Re- Inspection Required 11 Inspector4omments: -- --------- - (01- �T r Inspectors Sig ture: Date: FINAL INSPECTI Pass n? V Failed Re- Inspection Required 0 Inspectors Comments: AV Inspectors Signature: U Date: U DEBWEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com FROM <TIUIE>DSC 10 201S 15:S1/ST.15:60/N--O0OOOOO87S P I P �.— 1 ACC>RD�- MMMONYYY) CERTIFICATE OF LIABILITY INSURANCE F'��1211(012013 ThJS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS' CEOTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiFicate holder is an ADDITIONAL INSURED, the policypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phme: 978-688-"74 Fax 978-327-6558 CONTACT DEGNAN INSURANCE AGENCY NAME: DEGNAN INSURANCE AGENCY PHONE 85 SALEM STREET A,,, . EXII 978-688-4474 978-327-6558 0 E-I"L LAWRENCE MA 01843 AnncF-�, cdegnan0deqnaninsurance.com COVERAGES CERTIFICATE NUMBER: 24122 INSURER(S) AFFORDING COVERAGE NAIC VSURERA NORFOLK AND DEDHAM VZC�EY ELECTRIC INC. 21 HYATT AVENUE HAVERHILL MA 01835 WSURER 8 INSURER C WGUREP 0-. FSURERE --MRER F COVERAGES CERTIFICATE NUMBER: 24122 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW W A—VE REVISION NUMBER: INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI PERIOD ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED TO WHICH THIS BY THE POLICIES DESCRIBED EXCLUSIONS AND HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS OF SUCH P LICII S. LIMITS SHOWN MAY HAVE BEEN RED CED BY PAI CLAIMS. - INSR — LTR TYPE OF INSURANCE �ADDI SUBR POLICYEFF POLICY EXP INSR WVD POLICY NUMBER folwouryyyy] IMMtD11TYYy) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY 7ET--1. DE TO REATED PREMISES (Ea occurence) ----�CLAIMS-MADE 0 OCCUR MED- EXP (Any ons person) $ PERSONAL & ADV INJURY $ GEKERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG POLICY M jpERCOT M LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UNIT A14Y AUTO (Ea acaueni) $ ALL OA'NED — SCHEDULED 80DILY INJURY (Per �erson) $ —.A.UTOS — AUTOS NICIN-OWNED BODILY INJURY (Per acciderd) HIREDAUTOS AUTOS FRL*'I;RIYIAAAtAGE (per accideT) UMBRELLA LIAB OCCUR H= EACH OCCURRENCE $ :�EXCESS LIAB CLAINIS -I&LADE AGGREGATE JOEO I JRETENTION� $ A WORKERS COMPENSATION r AND _MPLOYERS' LIABILITY WE132614A ---il—/13113 -- —�1113114 OTH ANY PROPRIETOFt(PARTNr;R/EXECU71VE YIN ER $ E.L. EACH ACCIDENT :L I $ 100,000 D0'000 OFFICEMEMBER EXCLUDED? (mandatory In NM) lf)ss, describe under NIA El- DISEZASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E -L. DISEASE -POLICY LIMIT — $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLrS (Attach ACORD 101, Additionai Remarks Schedule, if more is space required) re: Brian Wrisley CERTIFICA I t HOLUER CANCELLATION Town of North Andover Town Offices 120 Main Street North Andover, MA 01845 Attention: SHOULD ANY OF T14E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESUTTAINE ACORD Z5 (2010105) @ 1999-26 The ACORD name and logo are registered marks of ACORD e 1 ):0 - - V1, -6(-ru?x- - Carla M. Degnan 30RATION. All il7gfits —reserved. FROM CT4JIE>OEC, 10 2013 18:14/ST.1l6:O8/N�.00OOOOO80O P I I ACCORDr CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 12110/2013 I —4 - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL — CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policyfies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone: 978-6W4474 Fmc 978-327-6558 c"TAC' DEGNAN INSURANCE AGENCY NAME: DEGNAN INSURANCE AGENCY 85 SALEM STREET LAWRENCE MA 01843 P ,ZII,E -6884474 IFZ. 978-327-6558 ,, 978 Noy. E-MAIL ADDRESS: cdegnan@degnaninsurance.com INSURER(S) AFFORDING COVERAGE NAIC 0 CL 2651542 INSUPFPA MOUNT VERNON FIRE INSURANCE COMPANY 26522 INSURED VALLEY ELECTRIC INC. INSURER 8 21 HYATT AVENUE INSURER C HAVERHILL MA 01835 INSURER 01 INSURER E To RENIED =S (E.....a) $ 100,000 INSURER F 11WVtKAtjt-j UtKill"ICATENUMBER! Z4124 RF -VISION NUMFIF-R' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWNMAYHAVE BEEN REDUCED BY PAIDCLAIMS. INSR LIR TYPE OF INSURANCE ADUL INSR SUOR WVD POLICY NUMBER POLICY EFF fMMfDDNYYY1 POLICYEXP fMMIODNYYYI LIMITS A GENERAL LIABILITY CL 2651542 11/14113 11/14114 EACH OCCURRENCE $ 1,000,000 MERCIAL GENERAL LIABILITY CLAIMS -MADE 0 OCCUR To RENIED =S (E.....a) $ 100,000 MED. EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,600,000 GENL AGGREGATE LIMITAPPLIES PER" PRODUCTS - COMP/OP AGG $ 2,000.000 PRO- —] S POLICY r] JIECT f LOC AUTOMOBILE LIABILITY COMOVED SINGLE LIMIT (Ea aCchlent) $ ANY AUTO ALL OWNED pSCHEDUILED A.UrOS AUTOS HIREDAUTOS NOI*OVWqED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERT �E $ (per aCcf�'T UMBRELLA LIAO OCCUR EACH OCCURRENCE EXCESS UAB HCLAJMS-MADE AGGREGATE $ DED I IRETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 11VC1S1T=1S E.L. EACH ACCIDENT $ ANY PROPRIETORfPARTNER/EXECUTIVE Y/N OFFICEIVIVIENIBER EXCLUDED? (Mandatory In NMI NIA ISEASE-EA EMPLOYE F If yes. describe under DESCRIPTION OF OPERATIONS below - E.L_ DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) re: Brian Wrisley ... � --n I IVIN Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Offices THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01945 AUTHORIZED REPRESENTATIVE ),) - Attention: D Carla M. Degnan ACORD 25 (2010105) 1988-2010 ACORD CORPORATION. Ail rights reserved. I ne At-unu name ana logo are registereci marKs 01 AGORD . p Date. . .7. .2'0 k Z 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING "Z& . This certifies that . G:C) ........................ ?.' tA - has permission to perform ............... W6�� plumbing in the buildings of '10\ \Aenr\ at .......... ................ Ngrth-Andover,Mass. Fee. Check # -7,5 17 PLUMBING INSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK POWNER TYPE OR PRINT CLEARLY CITY WA 6j- --- MA. DATE PERMIT# JOBSITE ADDRESS. 9 ?D!J+j C4 OWNER'SNAME ADDRESS TEL FAX OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL El RESIDENTIAL NEW: RENOVATION: REPLACEMENT: El PLANS SUBMITTED.- YES 0 NO El FIXTURES I FLOOR BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECI AL WASTE SYS DEDICATED GASIOIUSAND SYS DEDICATED GREASE SYS DEDICATI) GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER --- FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTE IOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE. I have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Yes &No El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent CHECK ONE BOX ONLY: OWNER E] AGENT [:1 I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chap er 1 2 of the General Laws. PCUMBER NAME STEPKI50 C- GALIPSKY SIGNATURE LIC# 1031tS MP 2' JP CORPORATION X# -31916 PARTNERSHIP LLC COMPANY NAME 66031 -SKY P1-VM04Jb, *- RVATIIJ(- ADDRESS: Gox 1?01 CITY— i4AV61Z"IL'1- STATE M.A- zip Pilli - EMAIL—wvvw. mrplumbegWI, com z TEL 4'7V-37q-1?1t3 CELL SOB-50cl-510'4 FAX Q?6-57,v-&4j3f m x 'U r C/) 0 z < m m > (n tt m ECD lin E0 l z It t7' It MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: qPA —MA. DATE: PERMIT# :�W JOBSITEADDRESS: ?-,I OeN OWNER'SNAME.-'-6(41 OWNER ADDRESS: TEL: TYPE OR OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL PRINT CLEARLY I NEW:M RENOVATION: REPLACEMENT:E] APPLIANCESI FLOOR, BOILER BOOSTER CONVERSION BURNER COOK STOVE T HEATER DIRECT VENT HEATER DRYER PFIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER' ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED RODM HEATER WATER HEATER I have a current liabili!y nsurance Bsmt 1 1 ] 2 1 3 1 4 [---5---T---6---T --- 7----F-8 FAX: RESIDENTIAL P PLANS SUBMITTED: YES F1 NO n 9 1 10 1 11 1 12 1 13 --- [ 1-4 T— Date. 5. .-. 3.-. - - TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 0, L i This certifies that ........... ........................... has permission for gas installation t-4- .......... in the buildings of - P��- - - - ............... at ............... North Andover, Mass. Fe. .... e.,Oq .... Lic. NoA �3-Xf GASINSPECTOR Check# -�Z -5-1 -7 8141 If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY g OTHER TYPE INDEMNITY [] BOND n OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER El AGENT F1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in m with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �m PLUMBER/GASFITTER NAME:.. STEPNEN C. GALr?45KY ' LICENSE# I03Lq1116 SIGNA r5l� COMPANYNAME: C>ALW3K%1 pLjrA6l#j(.. + gm -f -W& ADDRESS: P.D. WX 1-701 CITY: OAVEP-H I STATE: 111 - A - ZIP: 01,931 FAX: W79- 6all-i4j3j. TEL: 979 - 3 7q - 17 q 1, CELL: 5of - 6'64- 5qOq — EMAIL: w vvw. mrpl unbe MASTER [j JOURNEYMAN D LP INSTALLER El CORPORATION /k- -.-3l9i6 PARTNE RSHIP [I # LLCD# x 0 C) cf) OOV -0 m GqD :zi M m _0 m ;a ElCD El Ln cn Date ..... ............ ..... .. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... .0 ..... TL, . C -z ................ ......... .................. ......... ...... has permission to perform .... /Le7w ..... t4n-?A.,�� ............................... ............... .... ........ .. wiring in the building of ........ -.-7�.L .................. atj.4? .... #,C-,6?7-z4,V ....... �) le ........ North Andover, Mass. Fee....... . . .......... Lic. No. ......... ..... ELECrUCAL INSPEC-rqA Check 'I _�7 1�bl 10862 .C_N Commonwealth of Massachusetts MMEM Department of Fire SerVices BOARD OF FIRE PREVENTION REOULATIONS Official Use Only Permit No. Occupancy and Fee Checked Lev. 1/071 .(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 (pLEASEpRINTIN INK OR TYPE ALL INFORMATION) Date: CityorTownofi A/Oa7;�' 4/UPOcA� To the Inspector -of Wires: S'�_r at work desctibed below. By this application the undersigned gives notice of hi herTn—tention f6 perform the electric, Location (Street & Numbei) /Y, C -PA T-1 C A 02 Telephone No Owner or Tenant h�TYILIAF- T_ ,U C Owner's Address IZ39 770 /Z V 12 1 kE S L /C)&/Z TH /74,4/p a VC/a Is this permit in conjunction with a building permit? Yes X No El (Check Appropriate BoA) Purpose of Buildine',511Y&L6 r-4MILY I -OM F— Utility Authorization No.IAL�_.2 �C>Ild Amps ) ZO / 7 Volts Overhead [] e t e r s Existing Service Ato- _ Undgrd-,Z_ No. of M' New Service Amps ____/--.Volts Overhead Undgrd El No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed- Electrical Work: ' V, I (Z /J C VV //0 (A�E ro letion qf the 641owino, table may be waived bv the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets 0 No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above o 15- 0 grnd. grnd. N-6775TEmergency Lighting Batte,ry Units No. of Receptacle Outlets lf:7- No.. of Oil Burners FIRE ALARMS i INo. Of Zones-. No. of Switches 3 5r No. of Gas Burners CNC_ No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Numb!�r.. T.O.n.T... I KW ........................ No . of Self-Co0i—ned Detection/Alerting Devices No. of Dishwa shers Space/Area Heating KW Local 0 Municipal El Other Connection No. of Dryers Heating Appliances KW Security -Sy -stems:* No. of Devices or Equivalent No. of Water 0 Ha KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP 7'ere—cominunications Wiring: No. of Devices or Eq uivalent OTHER: Attach additional detail �(desired, or as required by the inspeclor 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 I undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a BOND F-1 OTHER [I (Specify:) I certify, under the pains andpenalties ofperjury, that the Information on this application is true and complete. FIRM NAME:- roNTTNn F_T.JF(-_TRTC. 9, CART.V, TNr LIC. NO.:AJ 1983 LIC. NO.,y9 Licensee: T,QTJTq rQNTTNQ Signature (ffapplicable, enter "exempt" in the license number line) Bus. Tel. No.:978-361-c;4 0 Address: I DONOVAN DR PST NvWBIMY NA 0192r, Alt. Tel. No.: *Per M.G.L c. 147, s. 57-6 1, securiti%�owk requires Depart meAt 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'm'y signature below, I hereby waive this requirement. I am the (check one)Elowner El owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ef�t b-f7,—j--L P(n a a 6 M�3 ,,ORTm TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION This certifies that . . ............... ...... has permission for gas installation . .......... r ... in the buildings of . . ............ at North Andover, Mass. .............. Fee. Lic. No.. .................... r.Aq IN.qPrrTnP Check#,/ 0 //� - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) oz M;ass., Date 20 /a Permit # 4, /y, 3 Owner's N Building Location ame Telephone Type of Occupancy New Renovation F1 Replacement E] Plans Submitted: Yes NoE] 0 AI Installing Company Name EnergyUSA Propane, Inc. Check one: Certificate Address 100 Myles Standish Blvd., Suite 101 Corporation 132 C Taunton, MA 02780 Partnership Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891 Firm/Co. Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660 INSURANCE COVERAGE: EnergyUSA Propane, Inc. has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes El No n If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy El Other type of indemnity F1 Bond 1:1 IOWNER'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 M 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 Code and Chapter 142 of the General Laws. By Title City/Town ,APPROVED (OFFICE USE ONLY) Type of License: FlPlumber MXGasfitter F-1 Master Miourneyman Signature of Licensed Plumber or Gasfitter License Number 3707 RFIT =@a- MT-er Installing Company Name EnergyUSA Propane, Inc. Check one: Certificate Address 100 Myles Standish Blvd., Suite 101 Corporation 132 C Taunton, MA 02780 Partnership Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891 Firm/Co. Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660 INSURANCE COVERAGE: EnergyUSA Propane, Inc. has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes El No n If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy El Other type of indemnity F1 Bond 1:1 IOWNER'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. 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