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Home My WebLink AboutMiscellaneous - 41 JOHNSON CIRCLE 4/30/2018 41 JOHNSON CIRCLE 210/097.0-0061-0000.0 J U 7 -/ Date.1z. ..3�.f. . -/-7/ NORTH TOWN OF NORTH ANDOVER 6 H p PERMIT FOR GAS INSTALLATIONS 8 ,SSACHUSEt This certifies that—, � ... ... .[. . . . . . . . . . . . . . . . . . . . . . . U9. has permission for gas installation . . . . ... .. . . . . . . . . . . . 9 in the buildings of . . .: :. . f.. .: . . . . ... . . ...... . . . . . • • • at . . . . . . . . w. . . . . . . .. North Andover, Miss. Fee. ... . . . . . . Lic. No.. .1�`::4J. GAS INSPECTOR •� WHITE:Applicant CANARY:Building Dept. PINK:Treasurer FMASSACHUSETTS UNIFORM APPLICATON FOR P DO GAS FITTING or print) Date / - 3 ( 19 NORTH ANDOVER, MASSACHUSETTS q Building Locations Permit# �J Amount 7� O�Lr%Se� Owner's Name New�� Renovation ❑ Replacement ❑ Plans Submitted ❑ n s n n U z E- C n C - n �. z �- z C w =92 t C m G ,n n L - n z =r z C 4 n z :d L r C: z =t :� „� z -t it sus-sASEVI ENT BASEMENT IST. FLOOR 2`1 D . FLOG R 3RD . FLOOR 4T if FLOOR 5TH . FLOOR 6TH . FLOOR 7T 11 . FLOOR ST If FLOG R .a (Print or type) Check one: Certificate Installing Company ?'dame 6"lee" /—X/ 51v14i°V/9.41 ❑ Corp. I Address �� 0h,44EA2d,e./ 4(/L-- ❑ Partner. Business Telephone y�� ^,�ll� irm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑� No❑ If you have checked ves,please indicate the type coverage by checking the appropriate box. 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 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 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: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber l -5 City/Town ® Gas Fitter License Nurnuer asie: Journeyman APPROVED WFFICE.USF 0K Y) ® J J Date... :... ...�...... a H NORTH TOWN OF NORTH ANDOVER 8 3r pyait�ao ,s,'�'p0 lfa O PERMIT FOR GAS INSTALLATION' � F 9 SSACNUSFd Etty M .-a T This certifies that . . . . ':. . • • • • •�'• '� • • . . . . . . . . . CU has permission for gas installation . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . ... .. . ... . . . . . . . . . . . . . . . . . . ... . .. . at .`: . .. . !. . . . . . . . '. !! . . . . . . . . . . . . .. North Andover, Mass. Fee. :r. . . .�. . . Lic. No.. . . . . . ... . . . . . . . . . . . . . . . . . . . . . ... . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer e�Sls., ..... ...�.. .. . .. ......�■■v■. ■ v■■ ■ v■u�ut ■v vv %AP%4%J1-11 IIIVV (Print or Type) ;Mass. Date 19tam Permit# Building Locatlon `7 A0�4V5�Q,A) -C,/Z. Own iType ncy New Renovation p Rdplacdmdfit`p Plans Submitted: Yes[] No sA. . .. : .. '� Z•lit, .t/1. .' • ' 4• .•:. Q 03 CC - :�. .O �.. .� UA' Zwl •• �••-�/ ,i\' Y .. \ .a'•►-RT/SnJ1 .t` ir •f/Iv Ti.t '..'.W •��•,5, ,'Y. M/.. 4 1TaSF yy�'• � .�• ?`1F� ' r .•� ut 10. .. -. •. _ :•C '-r. ••ice .r•�. •,. SUB—BSMT. BASEMENT 1ST FLOOR VT 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X1 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone 508-687 -1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have acu renntNo a t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. r If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ' � Other type of indemnity O Bond O 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 abo plication are true and accrue to the best of my knowledge and that all plumbing work and installations performed under the permit issu i this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene gf, T :bfikense:' ` . Plumber Signature of Licensed Plumber or Gas bm Title Gasfitter Master License Number 8697 City/Town Journeyman APPROVED OFFICE USE ONLY) - J Date..' ....r. ,.`........ A H N0R71y TOWN OF NORTH ANDOVER 9 3? '� PERMIT FOR GAS INSTALLATION 8 p ; CU 7SSAC14 S Z M This certifies that . . . . . . . . . . . . . . . 4 has permission for gas installation . . .. . . . ... . . . . . . . . . . . . . . . . cc in the buildings of . . . .. . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . at .: . . . . . ., North Andover, Mass. Fee.<�.'. . .". . . 'Lic. No.. . '—. . . . . . . p GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO ASFITTING a J e (Print or Type)/ r s /Lo Aa�ol1- Mass. Date �'/9-?9 ig 9 c7 ermit # 3 y 3 Building Location y1 ja/nson C Owner's Name&a Telephone- Type of Occupancy /fc'Si`Gfe�Ite . New.❑ Renovation ❑ Replacement Igo Plans Submitted: Yesp No❑ • N Q ^ N N V fr F 5 ¢ N ¢ O W J N. W O U i o u r- < 'z a ° ~ W a c o 0 W O —' d o M rn fr W z V W a W < a 0 G f, W PRerEI. Z < W w r i < ¢ < < o o W a S x '2 O d t w .� v ¢ Y Q a ti O SUB—BSMT, BASEMENT 1ST FLOOR 2ND FLOOR 9RD•FLOOR 4TH FLOOR J STH FLOOR 6TNFLOOR z 7TH FLOOR 8THFLOOR Installing Company Name EnergyUSA, Inc. Check one: Certificate Address 2000 West Park 'Drive, Suite 300 9 Corporation 1150 Westborough, MA 01581 ❑ Partnership Business Telephone 1-800-82271300 ext. 8051 0 Firm/Co. Name of Licensed Plumber or Gas Fitter William. Kent Corson INSURANCE COVERAGE: EnergyUSA has XMO a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes W No ❑ If you havfi checked Yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy 0' Other type of indemnity O Bond O 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: OWnefO 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 application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Te of Licenser Plumber Signature of Licensed Plumber or Gas Fitter Title ;;VGasfitter 'Master License Number 3707 City/Town J Journeyman APPROVED(OFFICE USE.ONLYT— BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPEC7I0'4 FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE 19 GASINSPEC-^p Date.... t 554 f t NORTp 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� This certifies that ......... ....... ...... .................. has permission to perform .......K.�±...... ,,uc...Tf. ........RS.,;., ....... wiring in the building of.........vo.,.,.....6i.J.y........................................ at.... .... ......CI.R..t.!: ....................North Andover,Mass. Fee.... f�....4J.. Lic.No. ............................................................... �} ELECTRICAL INSPECTOR 10/31/91k:20 cf 5�l 00 PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer 6 The Commonwealth of Massachusetts office e"o. D"rtmant of Atblec Scfety ►•�•" �'. (� DWO OF FIRE PREVENTION REatlLATIONS sV CMR UW0eir+ts a/.e a�w_,.._- �/90 (lave .lata) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK . N1.�.a1 a,k res++..e�.deese rMll the ilaweAwenS oset.ies)Code.3!7 CMR t2..o0 (YT = ran ID Ea of =z ALL niFo I Dsto "Viref. City o= Tout o! Yo the Inspectorof ms undarreiplsd applies for a Persil to Peden the eiecttfiical work described below. Location (Staset i M»bes) ` .o w Clones or Zeaane ' c amer•s Address L this Dessit Is cou3wtti60 with a buildia= pew= Yu ❑ 1b (Mock Appropriate U4 par"" Of �- ��Ijtafty Autborisecioa N0. ads"As �_...�Ds- / Voitf Overhead ❑ WSrd❑ Ib. of Mentees ME!seS,zos_ .._L_ _ .�' —» �_.._�P!� Yoly Overhead ❑ UWV4❑ No. o!Meters Umber of Tenders Pad-lrpicitl ' Lssatlon Pad Navas of !topes*# Electrical stork Mto • o! 1i=h tLi; out tela• Mo. of Botillbs y !b. of triasfotsass �A $be of LiSht"S Tixtuns Ski tool Q . 0 Generators , xVA to. of leeeptsels outlets Ib. of oil turner No. of l�nastencr int ' 40-- of �iteb Outists No. of Cas Sunwra Satre Units I= ALAAHS No. of Zones �. of Eas=es No. of Air Coad. teas No. of Detection and MIO. at Disposals � of t Total ?oral Initiating Dsvieec s No. of Sowlding Devices 06. 0991 sAvaeheri space/Area lyatiop ty 110. of Set Contained Ili. of Dsteetion/Sounding Davie*$ omen 1katigt Devicesto . LOW❑1hinuLpal Othe r_'~ so. o9 water BostonxW + o o. o Colnlactioa0 Sallasts voltage >fo. 11J'dm yassage tabs No. of Motors Total 1W futsuant to the sequiswats of Xsesaehwetts C*niral Lsys I hews �i Insur nes Lollop inti as Y"lso a udias CoOpleted Opssatloas Covera=s or its substantial idsT�ha�e�y�l�ad �S, pisasewai�adt.a�t+t1tt� valid ��p� checkingto this theoftica. YLS�'HO❑ Era=❑ oZMt❑ t1Tleaao specify) aPp �ta box. Utboted Vslus of tricel Lurk $ ro is ti4s1c to start 1 Inspection Date !requested$ 11py Snsd.e�4r the pearl ins of pee ur;rgh_ Final lisp 1fAIQ . Lteensee 1 C. NO.A Signature �d=ws 1C. saps sa ent s INSSAMIQ sins _ as avew-that the Lieeosea141ft A34. zel. No.www ttawta� �'byosstta gyralthe iwlsrailcs covssap9 osat. �*rAssn( trapcj 1�tseatun on thls penIt cbeiillstur* o ,rot enr =*ispAoae No. FxW= nm -- Of No°TW 1h 3: �• ..�.� TOWN OF NORTH ANDOVER PERMIT FOR WIRING • i i i o++� `ter• ,Ss4CHU5f This certifies that ... .�A.. ............�.O.1... ...... .. ... ... ........... .......... ................................ has permission to perform ....R-" P\AQ ])R m GS D o)"4" ............................ .......................................... wiring in the building of...........1 .. ...!. y....................................................... , at.... .� �..............�X.)....�.................. .a J ................. ..... .North Andover,Mass. Fee...a. .......... Lic.No. .33 93........ ...��Ca l � ............. ......................... ELECTRICAL INSPECTOR Check # CA S 5 , 8 Official Use Only Permit No. g4_ -;i w£em wmms4Z-,P SS,4e;MS577S D t 4�uGlia S Occupancy&Fee Checked&y V BOARD OF FIRE PREVENT!)NR06'LATIONS 527 CMR 12:00 APPLICATION FOR PETO PERFORM ELECTRICAL WORK All work to be performed in accorda the Massachusetts Electrical Code 527 CMR 112:00 (Please Print in ink or type all information) Date GZ 110/o 3 To the Inspedtor of:w1res: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 1 /1 1 70/7Ns010 Owner or Tenant A/ L Co,yNO��/ Owner's Address S,4 Is this permit in conjunction with a building permit Yes U No (Check Appropriate Box) �/ C Purpose of Building SZNGLE �1� -zG�' Utility Authorization No. Existing Service '?--0 Ampsz oz'2'-/UVoits Overhead 0 Undgmd 0 No.of Meters New Service Amps Voits Overhead U Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices Nol of Self Contained No.of Dishwashers Sp2cefArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Si ns Bailases Wiring No.H`dro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalentYE = NO have submitted valid proof of same to the Office YES ANO - If you have checked YES please indicate the type of coverage by checking the appropriate box. NSURANC = BOND - OTHER - (Please Specify) --5-00 ,00 00 0 (Expiration Date) Estimated Value of.E ctrl 1 Works Work to Start 0 0 Inspection Date Resquested Rough Final Signed under the enatbes of perju FIRk NAME 16-C S rt/ 6k,,-,- LIC.NO. Licc see // Signat / LIC.NO.Z�5 p CP HTer S /. Cj7'd✓>"/A�� vr9SS Bus.Tel No. x/79-3 7y- 774,6 Address Alt Tel.No. - — 3 �i7 E' t/�7 (0 7 S . OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing,workers' compensation for my employees working on this job. Company name: Address City Phone# Insurance Co Policy# Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of afine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties of perjury that the information provided above is true and confect. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' Building Dept ❑Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person: Phone#: Health Department Other f FORM WORKMAN'S COMPENSATION