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Home My WebLink AboutMiscellaneous - 40 MOODY STREET 4/30/2018 (2) 40 MOODY STREET / 210/081.0-0017-0000.0 FILE Dat-31 .........I.1.5.................... OF,AORTN 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHU .. .. .... .......... This certifies that .... ....... ................ ......... ................. has permission for gas installation. ............ ... ............... ................. in the buildings of ... --7-0j L- -North.... *N**o**r**t-h- *And... A-*n-d**o-v***e-r**,**Mass.*********** at......A�o...... ........... Fee.�Q....... Lic. No. .................................................. GASINSPECTOR Cheek# 5-2 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MOIL:V" AoJ66-v e.ft MA DATE 3 -2-q-(S- PERMIT# --- JOBSITE ADDRESS 46•- M«scQ S T r cl OWNER'S NAME Cofu,,..be A e F W1 GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[g-" PRINT CI.EARI.Y NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO[` APPLIANCES I FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OT' E R -e'-f(i.._ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES DJ NO ❑ 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the bes my 9A edge and that all plumbing work and installations performed under the permit issued for this application will be in compliance w' ertin t Gisi he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# /s-ws 19 ATURE MP�GF El JP E-1JGF[-] LPG[El CORPORATION D I q PARTNERSHIP El# / LLC Q4r COMPANY NAME �7&e je�,e �iCDT��2 �R�'rceS ADDRESS /a 3 CITY ,STATE / ZIP QCT'/,,jot TEL FAX CELL SdI' 726-/g S'F EMAIL aCOMMO -� • Nwl~,NLTH OF • • MASS��}jU,��TTS . PLUMBE • , ISSUES > SFITTEIS THS POLLOWIJdG LIGENSED` AS A MASTER LICENSE PLUMBER zc; W GARF I ELt 27WILLOW b � c� gf OGKTON W 156 $ o MA 02301-14 1., /01/16: 226442 COMMONWEALTH OF MASSACHUSETTS ` • • • ' • • WWI BOAF�D OF - PLUMBERb Gt SF ITTERS ISSUES THE FOLLOWING `LICENSE � + REGI S1=RED AS A PLUMBIhNR �},; DAV1D,W GARFIELD `EENEY BROTHERS': SERVICE, L �C 21 WILLOW .ST AR 64 O' N MA 02301. 36T9 goy/o1/:lb 221413 Date. . . 9434 °'<".5.T"'�o TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING 41 ;�Ss�cHUSE�This certifies that . . ..C;�54 has permission to perform plumbing in the buildings of . . . . D, , /700.^,1 r . . . . . . ., N Andove , Mass. at . . (/ !�o. Lic. �3Bg. . . . . . . . . Fee c. o.. . . �� /q PLUMBING IN PECTOR Check # Date.. .(aA �.... . ... .. NORTH °f �j TOWN OF NORTH ANDOVER O A PERMIT FOR GAS INSTALLATION �,5 �,SSACMUSESS '' This certifies that . . . .V.�. . . .... . " . ..► y� ! has permission for gas installation . � -� . .!.`7 0? .. . . . . . . . . . . in the buildings of . . PP!? .r . . . . . . . . . . . . . . . . . . . at . . . . . . . . . .-5 . . . . No rt {Andover, ass. Fee.,:?e>f J. Lic. No.. .X. . . . .r/!r GAS INSPECTOR Check# X31 C 8*189 D , 3 d. sd MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYA'/ �c.Q„1— — - f MA DATE'_. 02p/01, PERMIT# JOBSITEADDRESS Ir �/lj /%:Ltz , ;OWNER'S NAME -- GOWNER ADDRESS ;TEL-776 a p$ 8 i.3 g FAX - TYPE OR OCCUPANCY TYPE COMMERCIAL i_j EDUCATIONAL ' RESIDENTIAL' CLEARLY NEW:, RENOVATION: REPLACEMENT:- PLANS SUBMITTED: YES _I NO APPLIANCES 1 FLOORS esnn 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER — - BOOSTER - - - . — - CONVERSION BURNER GOOK STOVE _. -_ .�-._--_ - -- ----- --:--------=-- - --- -- = -- , DIRECT VENT HEATER - DRYER FIREPLACE _ FRYOLATOR FURNACE -- - -;------ - - - - -- -. . _ __ �_- - -- - GENERATOR --:__ ._-.----..-__-- -------___,___--,• _ _. ___ ._ _ _ - - - - - GRILLE M INFRARED HEATER - --; - - -, LABORATORY COCKS - - =----- --- MAKEUP AIR UNIT - - - - - - --- -- - - - r -- - --- , - OVEN POOL HEATER _ � __ -- ------- ----- ----_-- --�•-- - -- .:. . - ROOM/SPACE HEATER ROOF TOP UNIT TEST - UNITHEATER -____- _---:-----'_--____-----. - - -�- -- _. -- - -:__ UNVENTED ROOM HEATER -= -- =---- - - - - - - WATER HEATE-R --- - - - ._ -__----,.------- .. . -- ------ -- r -- INSURANCE COVERAGE I have a current liabilfty insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' j 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT — 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 will be in co pfiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. q, _ __ _ _ ____ /,- PLUMBER-GASFITTER NAME'James G.Corey LICENSE#9389 — SIGNA E MP' MGF JP ' JGF LPG[' CORPORATION J# 1285c PARTNERSHIP # LLC # — COMPANY NA�E:;Joseph G Perry P&H ADDRESS 129 Homestead St. —� Lw CITY [Acton_ - STATE Ma ZIP 01720 TEL 978-263-5595 FAX CELL EMAILIjoeperryplumbing@yahoo_com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY *,t 7 MA DATE _ 'PERMIT# JOBSITE ADDRESS ell - OWNER'S NAME,_� OWNER ADDRESS �- _ SC�/1 -� --- - — --- - - - TEL 38 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL;J EDUCATIONAL :^; RESIDENTIAL I PRINT CLEARLY NEW:17 RENOVATION:^� REPLACEMENT: PLANS SUBMITTED: YES NO -' FIXTURES-. FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE --"- DEDICATED SPECIAL WASTE SYSTEM ;' - DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM -'- - ----r- " --- -""—'r— - - rzk_ DEDICATED WATER RECYCLE SYSTEM ^ ,DISHWASHERDRINKING FOUNTAINFOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ---- , --;r--- --- - ----;�-----�-- �----- 1--.--- r ROOF DRAIN r — SHOWER STALL SERVICE MOP SINK --•-- - -- : -------- - - .- ;'�- - - - -,• --- -� -- - TOILET URINAL - - -- - � _._, �•-- ---- ----� -_. - .._ r--- ___ .'r-----�--- �--- _ - WASHING MACHINE CONNECTION -- -___ WATER HEATER ALL TYPES r----J�---� --�' ---- --- - -- -- -- --- --- ------ --- ---- WATERPIPINGOTH -- - - ------, - -- ---- - --= _ r --- - WATER -- - -- - - - -. ---—� --` _17-- -- — - — 1. INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ^j IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY",- 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT . 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 will be in co pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME James G^Corey_ LICENSE# 9389 SIGNATURE MPE JP'- CORPORATION'-;#- PARTNERSHIP—#'---- COMPANY NAME Joseph G.Perry P&H ADDRESS 29 Homestead St. CITY Acton � _]STATE1 Ma I ZIP 01720 TEL 978-263-5595 FAX CELL EMAIL joeperryplumbing@yahoo.com — —� J t__ -_ AV Date...... ....... Z"_ NORTH °�, °:•�"° TOWN OF NORTH ANDOVER Siam& p PERMIT FOR WIRING AcHusE� This certifies that .......*^r�.f...u.z ....... il.. � ............................... has permission to perform ...W<. ..c............. '. .! .`..t 7 3 r:.................... wiring in the building of....Q.... f..h. Z.............................................. at �.d /7��e�� ........ .. ....... ... . .... ......... ��.-........... ,North And r,Mass. Fee�. 7r.....��`� Lic.hi ........... Tj�...... ....e....... ., � . LECTR[CAL INSPEKR { Check # `f 0875 ,a Commonwealth of Massachusetts Official Use Only a Department of Fire Services PermitNo,— --r 7S' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE P=T flV NK OR TYPEALL INFORMATION) Date: -Suko_ &, Q a— City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned 'ves notice of his or her intention to perform the electrical work described below. Location(Street&Number) awv s4— Owner or Tenant 6 j�()a, �A LQ Telephone No. Owner's Address Is this permit in conjunction with a building ermit. Yes M No ❑ (Check Appropriate Box) Purpose of Building12QVl,Dtm4-� Hzwtj-_ Utility Authorization No. 1136 Existing Service Amps -1-2-06 �olts Overhead P6 Undgrd❑ No.of Meters New Service -Z�eo Amps / Volts Overhead Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �} `f Comletion o the ollowin table m be waived b 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 id Swimming Pool Above ❑ In- ❑ o,o mergency ig ing rnd. nd. BatteLy Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches (y No.of Gas Burners No.of Detection and Initiatin Devices No,of Ranges No.of Air Cond. Toonsl No.of Alerting Devices No.of Waste Disposers Heat PumpNumber Tons ' KW No.of Self-Contained Totals: "'"W " Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal Municipal ❑Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:*. No.of WaterNo. No.of Devices or Equivalent Heaters KW No.Ri Bal as Data Wiring: Si s Ballasts No.of Devices orE uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices ox 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. �D.fp ` l�— 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 BOND ❑ OTHER ❑ (Specify:) f I certify,under the ains a udpenalties ofperjury,that the information on this application is true and cove"ete. FIRM NAME: /C, C,LC. LIC.NO.: l S r Licensee: Signature g LIC.NO.: (Ifapplicable, a "exe in the license nu ne. Bus.Tel.No.6m e9AII/ Address: C�f�l th f D3 ,Alt.Tel.No.: D aa- 1,(063*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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)El owner Owner/Agent ❑owner's agent. Signature Telephone No. PERMIT.FEE:$ w a _ - ELEM&AL PERMT NO. U PORT. Inspectors'Comments: - L L.r ( appectore Sigu.ature-)ao J2assec�-- Yailed--j I ate-xnspectioxtxequixed($50.00)- [ yu5Pectors'coxxun.extfs: (ffispectoxsCigna a•- o' 'fials) Date 3.T NDER GRODND WSPACTXON. �'assed•—[ � p'azIec�—[ ] ate-zaspection,xeciuixecT($s0.U0)�[ ] • inspectors'comments: C=,pectors'Signature-•no initials) Date ' 4.!'�TSPECTXO�1—��CJG'�': Passed—[ p'aRed--[ IRe-' ect' xegtured($50.00)• [ d, Xnspectoxs'Commepts: (.Tiasp ectoxs'signature-xta)niiials} Date` l --�Z INSPECTION•-OMER: 'assecl--[ J pailed--[ ]- ate nspectzottrequized($50AQ) [ aspectoxs'colAm.erts: �w—sp ectoxs' zgnature xto xnifza�s} date B 0 O TAGS.AM TO BE MIND OUT A"IEFT ON SITE IF TOE.A_PXA.TO 3E INSTEGTED J'S.WOT ACCESSIBLY,AND.A.RE-WSPECTION O)T$50.00-16 TO$E CHARGED, - - The Commonwealth of Massachusetts - Department of IndustriglAccid'ents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ Address:,,a-3 46!6eMe A4W j& - City/State/Zip s )I") /4, Phone#: ?SO,--" 60l Are you an employer?Check the appropriate box: Type of project(required): 1,01 am a employer with - 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have lured the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.x 7•'ORemodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. F1 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑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' comp.insurance required.] 13.❑Other 'Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:. e Policy#or Self-ins.�Liie.#: Expiration Date: -� j3 Job Site Address: "G;!� I-))ernq City/State/Zip:x0 f5�/�wd'M Ay Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Xdo here cerf� nde the p ns and a tie of ' ry that fhe information provided above is true and correct. - Si afar : Date: J/ate Phone#: �� — 0z)l/ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: - Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture /(i.e.a dog license or permit to bum leaves etc)said person is NOT required to complete this affidavit. i The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts - Department ofIndustrial.Accidents Office of Investigations 600 Washington.Street Boston,MA.021 It Tel,#617-727-4900 ext 406 or 1-877:M.ASS.AFF, Revised 5-26-05 Fax#617-727-7749 www.naass,gov/dia Date........—.. .. .v.. f HORTI♦, 0ma TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSES This certifies that . .......Q.A...l..� . ! .... .. . ... ....�...�... G...t. ..r.. . .. . has permission to perform S Y 7 wiring in the building of..................... ............................................. at.............:.a... .......5,;- ..................... North Andover,Mass. 3�- Fee............... Lic.No.............. ...... r ............. ...... Q J�0r9� ELECTRICAL INSPECMR Check # 74 ` 7663 FROM FAX NO. Sep. 13 2007 Oe:23AM P1 Cln$WnWaalgt a/VaddaCILadOM Official Use Uraly Pennit No. 6 f;',.CJe��ar�+nenl o��ira J®ruicod l� Occupancy and Fes Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (!cave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wort;to be performed in accordance will)the Maasaehusetts Slectrical Code(MLC),527 CMR 12.E (PLEAsEPRINTININK ORTYPL'ALLINF,ORWTION) Date: �j��v City or Town of: No 4Th A N r_)DL R yC To the bvvpeelor 0f'Gf�ireT, By this application the undersigned gives notice of his or peer ii tenuon to crfortn the electrical work described below. Location(4trret&Number) d /t'jch�ct11 s Owner or Tenant 144e L!S3 A n 1 (,L Telephone No. 27T 2($ gf3� Owner's Address S n 4-P is this permit in conjunction with o building permit? Yes 0 No (Cherie Appropriate Box) Purpose of Building Utility At horWition No: Existing Service � Amps / _'Volts Overhead ❑ Undgrd No.of Meters Naw Service Amps - / Volts Overhead❑ Undgrd Q No.of Meters Number of Feeders and Ampaciq Location and Nature of Proposed Liectrical Worst: Completion qf the following table mar,be waived by the Inspector ofirer, No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)lf'ans r at eta P Transformers KVA No:of Luminalre Outlets No.of Hot Tubs Generators KVA Above h- u.a mergence ,g rag No.of Luminaires Swimming Pool rad. � urnd, ❑ Batten,Units No,of Receptacle Outlets No.of 011 Burners FIRE ALARMS No,of Zones No,of Switches No,of Gas Burners o,o eon an initiatting Devices al No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Na.01'Waste Disposers eat 'orae um,er ons o.o e - ontaine `Totals: " "" """ """"" ""' Detection/Alertin Devices pal No.of Dishwashers Space/Aran Heating KW BCT Connci ion El Other No.orDryers ers Heating Appliances KW ecu)ty,'ystems: � No,of 1Llovices r L uivatonf No,of Water K o.o70-70r— Da �r Heaters Signs , Ballasts No,of Devices or T urvalent i No,Hydromassage Bathtubs No.of Motors Total HP 1'e eeommunicutionswiring: No.of Devices or i; uivaent [OTIJE, Ailaah addilivrTul decal!if destrad,or a,P r•e�airerl by ihr.1nspPrtnr q/'I•{�ires. Estimtlted Valeo of Liectricnl Work: 3USl (When required by municipal policy.) Work to Star(: _ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERA.CK:: Unless waived by the owner,no permit for the perforrnauce.of electrical work may issue unless the liccnsce provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned ccrtifim that such co rage is in f"oree,and has exhibited pruof of sarne to the permit issuing office. CHECK ONE: iNSUJtANCF. BOND 0 OT-IRR ❑ (Speulf'• :) 1 cer'l1fV,tattler thr.ansae and penalises+�/'pery+n;y, thrri flat infor+r+ario a nrr this application is true and con+plete. FIRAl NAAlE r.. �� v . __ LIC.NO.:+C)C);nC, Licensee: 7617)'1 aannef Signature 1 LIC.NO.:_ (7)0 7 0 � (!f npplicable.e - " ' •••0"rt..-., „l. 1„ r Bus,Tel,No 7 7F-6S 7 Q'Y'✓3 Address! �� J 3 W e-3 T S" t � stir'G Mt N�7-0-1 /N1 i) AIL Tel, No.: *her M.G.L,c. 197,s.57-61,security work requites Deparlmcrnl Of Public Safety"S"Liconse; Lic,No. 5_5 CC 000 0$ OWNER'S INSUIZANCE WAIVER-. 1 tam aware that the Licensee does nor have the liability insurance coverage normally required by law. By my signature below,1 hereby waive this requirement, 1 urn the(check one) ❑owner ❑owner's a ent. Owner/AgentPxJl9I 'FSB: J Signature Telephone No. Date. 0' 4, TOWN OF NORTH ANDOVER A 3r , 0- 10 '19010. 0% PERMIT FOR PLUMBING SSACHUS This certifies that C.(. 13P f!P. . . . .n ). . has permission to perform . . . . .� 5. '^ plumbing in the buildings of . . �`.?`. . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. . ?. ? Lic. No.. . . . . . . . . . . . .C)�i PLUMBING INSPECTOR Check # 7209 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS _, Date �a�—l�G7 Building Location 1-1614,06Q-1.g-4 Owners Name �� l/ l d}h 2,qA Permit# Amount 2 Type of Occupancy o/tle New Renovation Replacement Plans Submitted Yes No FIXTURES Or A A SZBEM e, &�41VIIVT � 1ST I:ID(R , 2ltJ rl.►Ail 3M 10 M FLOOR 5M ffflm 6M MfIOCR 0mHnm (Print or type) / /��n� /J/ Check one: Certificate Installing Company Name ` rci USCF [Y`l. j,�� ❑ Corp. Address ElPartner. Business Telephone f — ® Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box Liability insurance policy m Other type of indemnity 1-1 Bond ❑ insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three 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 worst and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus S Plumbing Code and Chapter 142 of the General Laws. Y By: rgn lizensed riumver ype of Plumbing License Title 6 9 City/Town (cense um er Master Journeyman El(OFFICE USE ONLY