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HomeMy WebLinkAboutMiscellaneous - 42 ROYAL CREST DRIVE 4/30/2018 _ T - I, 1 42 ROYAL CREST DRIVE BUILDING FILE J cm .. ....................... i NORT/� TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CH This Et�9 4 This certifies that ....1".1..�- .yAe .................................................... has permission to perform ... ) .0 QVJt1 Qr �/1 ..._........ wiring in the building of...:`;...........�i`!1 '.. . ....................................................................... at ........ 'G . ! 1. ........................................................North Andover,Mass. Fee..la. ..............Lic.No. , .................................................................................... ELECTRICALINSPECTOR Check# omnwntuea[# o�//lus��chude Official UC�se Only - c� Permit:No. _1 `..�.apart►nenl,'o��.t� .arrfcmn Occupancy and Fee Chocked BOARD OF FIRE PREVENTION REGULATIONS (1kev. 1/07) peavctilank.) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pedbrmed in accordance with the Masstichusett:v l"loctrical('odo(MEC),527 CMR 12.00 (PLI ASE PRINT 1N.INIC OR TYP ALL INI'l.)RMATIO.N) Date: �—C7—f 5 City or Town of: PQY'`5"4s6N��e� 7'0 the Inspeclor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical jwork 1described bel iw. Location(Street c�Number) qkseC��, Gc�eSt'�1( Vt? 1 -_ �i ` ��71�1� Owtner or Tenant ��'y ,b 40 I'cicphone No. 1 �d3°i�bU5� Owner's Address -..{�o-y.,l ILW-St '0"Z_-- k14T Qr MA.�_�T Is this permit in conjunction with a building permit? Ves No (Cheep Appropriate Bax) Purpose of Building I11:ility Authorization No. Existing Service Amps / Volts Overhead ❑ l,lndgrd❑ No.of Meters New Service -- Amps ... I Volts Overhead I Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Worlt: �it,�t� Uft � 57d.1)` w � 11r�6on.�0 �t,Au i$ ►`cY,M + __To_Q1? I aca C'om Flet/ono'the ollowin tahle may be mgived b 1be lns ector r, Wb,es.Li$Tt't No.of Recessed Luminaires No.of Ccil,Sus Paddle > im$ o Total p (Paddle) TrKVA No.of Luminaire Outlets _No.of Hot Tubs __. Gepernt:ors ICVA No.of Luminaires Swimming Pool Above Q�„7 o.oT mergency eg mg rnd. rnd. Batter Unita No.of Receptacle Outlets No.of Oil Burners TIRE ALARMS No.of Tones No.of Switches No.of Gas Ourners T o.a Initiating ng D an Devices No.of Ranges No.of Air Cond. otal Total No.of Alerting Devices I-lentI-lumpum._er 'Tons l(vv o.o Sell-rontnine No.of Waste Disposers Tot , I)etectlon/Alertln Devices No.of Dishwashers Space/Area Ideating KW Local Q Cotxrletdn eictido �”, �j1:lAer n No.of Dryers ers Heating Appliances RW T Security Systems: No.of Devices or E gulivalent -Ivo,_0T Water No.of o.o' Data Wiring: llcatcrs KW Signs Bal#alt's No.of Devices or E uivnient 4 No.H dromnssa a Unt:lttubs No.of Motors I'ntnl FIP a ctOmmltn enttnns trttt ` Y >? No.of Device's or Eq ttiva�cnt OTHER: �Meech addhional rtr:t0i!it riL_,vi•rd,or as reyrdtred by the lnspector,�f)llfre,s, Estimated Value of Electrical Work: i000 (When required by municipat policy,) Work to Start: inspections to be requested in accordance with fvlf C:Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for l.he performance of electrical work may issue unless the licensee provides proot'of liability insurance including`completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof ol'same to the permit issi.ting office, CRECIC ONir: iNSURANC E O BONi) El OTHER [] (Specify:) certify,larder the,pains and penalties gf perjwy,that the il(formatlon on this application is trice and Complete. FiRM NAME: Newport Eloctric LiC.NO.: A20808 a Signature Licensee: David McMullen ..._. LIC.NO.: mom (Ifapplieahle,enter "exempt"in the llCerirse number 1lrle.) taus.Tel.No.:401.-293_0527 . Address: ?Oo_hpoinl,Ave. Portsmouth,,R1.02871_ ._ — Alt.Tcl.No.: 617-9084193 *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 doe's nol htive the liability insurance coverage normally required.by law. By my Signature below,I hereby waive this requireincnt, I not the(check one x owner owner's agent, Owner/Agent Signature _ Telephone Na, _, �., PBWIT l+EE: $ )a 5- t' Date&2.z .tq............... 's i l NORTHOf f 3� "`; TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACHUS� This certifies th � �-.. ✓�� �. C. . ..., Mu(�' t... ....................... . :- ..... ... . ....... ........... .. has permission to perform wiring in the building of....�; .... 1..4M.t'.. ..:.................................................................... a ...... AS.C-!.A.5......1-`Z;North Andover,Mass. r e......1.7. ?...........Lic.Nod,AG',` ....`..v`. ..... ../ .(1... .. .. v ELEC IALINSP CTOR I � Check# ''� Commonwealth of Massachusetts Official UseO y Department of Fire Services Permit No, BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked _ [Rev, 11/99) leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MBC),527 CMR 12,00 (PLEASE PRINT IN INK OR TYPE 4 L4 INFO TION) Date: City or Town of: 1�0�ITkAN ®��� TO th o� By this application the undersigned gives notice o 1s or er intention to perform henele tricar�f fires: Location(Street& Number) � ` _ 1 work described below, Owner or Tenant�` � � `rE ' mu'- ©i t415 Owner's Address © CYTS Telephone No, 9 7fr 6'a. ZaOC ' NcI,Dv� O__'14 �nprop Ts this permit In conjunction with a building permit? Yes - ❑ NoPurpose of Building DvJ e-L; (Check riate Box) ~ Existing Set viceAmps Utility Authorization No. / N v -- /______Volts Overhead[l Undgrd❑ No –� Amps f–�r. volts Overhead . of Meters Number of Feeders and Ampacity Undgrd ❑ No,of Meters Location and Nature of Proposed Electrical Work: iN ""fie T IN 9.1At I a � Qr1A tea ;U �5 it letien o 'the ollowin table ma be waived 6 the Ins eclor o Wires. No.of Recessed Fixtures No.of Cell.-Slisp.(Paddle)Fans o.of To No.of Lighting OutletsTransformers KVA No.of Hot Tubs Generators KVA No,of Lighting Fixtures Swimming Pool rnd a M rnd o,o rnergency g ng No,of Receptacle Outlets Bane Units No.of Oil Bursters FIRE ALARMS No,of Zones No.of Switehes No.of Gas Burners 0, o etee on an No.of Ranges eta Initiatln Devices No.of Air Coud• ns No, of Alerting Devices ea um No,of Waste Disposers p um er ons Totals; ' Deteedon/Alertin nb No, of Dishwashers Space/Area Heating KW evices ❑ un c a No.of Dryers Heating Appliances Local onneetion r]ion NOK U Ater ecusty Heaters KW 010 KW' No.of Devices or E ulvalent 010 . Data Wiring: f or E trivalent No. f Devices No,Hydromassage Bathtubs Signs Ballasts No. of MotorsTotal HP a ecommun cat ons r ng: 5`t"� ^e,,►T OTHER: 6 L=let�`r(C No.of Devices or E uivalent L tV}1`s vii w G,II, U Nti �A Mp S�fA� INSURANCL COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue Attach additional detail 1J'deslred,or a1 required by the Inspector 0J,Wires. the licensee provides proof of liability insurance including`bompleted 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, unless CHECK ONE: INSURANCE & BOND FJ OTHER (] (Specify: ^ Estimated Value of Electrical Wor __ (When required by municipal policy,) (i xptrahon llate) Work to Stader �' Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains acrd penalties of ons t o ,that the y information on this FIRM NAME: 1`12UJ �S application is true and complete, Licensee: '1 G LIC.NO.- �f' — ' �=U SIA ___ Signatur Adds licable enter "exempt''in the lice se number line,) LIC.NO.; (a c) Address; 0 - Bus.Tel.No. OWNER'S INSURAN WAIVER: I am aware that the Licensee does no�haa��liability required by law. By my signature below,I hereby waive this requirement. I am the Alt.Tel,No, 3 insurance coverage normally Owner/Agent owner Signature (check one owner's a ent, Telephone No. PERAHT FEE: $ d -50 r i Id- ,/ I 11 t.nitlyJ1011r+realth of"AfassaChmsetu ��a�i"FIRE9, 07121 Deparoizent 0,f,ri1drrstt'ial Accidents � Of lee ofIrlvestigatiorls 1 Co"gr'ess Street,Suite 100 I Boston, MA 02114-2017 1•VMVrtl-TrtaSS-govI ia. Workers' Compensation Insurance Affidavit. Bui)<ders/Contin.etors/Electrilcians/PZurni�cx s A licant T>litfaxlrnatxo;a lease P>r'>Tnt lac >ilb)< N31ne(Business/Organization/Individual): ( r+ 1 c_ � Address: ,f M. t'1 D 1n City/State/lip: a rs'1'aA14 Phone#: �.� Ar ou an employer?Cheep the appropriate box: I)N I am a employer with 4. D I am a.general contractor and I Type of project(required): employees(frill and/or part-time).' have hired the sub-contractors 6, (1 New construction 2.Q I.am a'sole proprietor or partner- listed on the attached sheet, 7. E]Remodeling ship anti have no employees These sub-contractors have working, for mC in any capacity, employees and have workers' S' D Demolition ns [No worlcet:G' comp, insurance comp, insurance.I y• [� wilding addition irs4 required.] 5. We are a corporation and its I00E,lectrical repairs or additions 3-❑ 1 am a homeowner doing all work officers have exercised their I 1.0 Plumbing repairs or additions myself [No workers' comp, right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.0 Roof repairs employees. (No workers' 13.0 Other ' comp. insurance required,] *Any applicant that ehdrks box#1 must also fill out the section below showing their workers'compensation policy information. .h Homeowners who submit this airldavit indiesting they are doing all work and then hire outside coptractcrS must submit a new affidavit indicating such, tGon ypusrs thsiIC check this box mast a tat�hodernplo an aclditional sheet showing the name of the sub-contractors and stare whether or not those amities have employees. It the sub-contrpctors have employees tltey must provide their workors'pomp,policy number, I seri an etrtPloyer that is providing workers'compensation ins arance for my ettaployees. Below is the policy and job site iormation. nf Insurance Company Name: �r (f 7ate— )r Policy#or Self-ins.Lic.4: Expiration 0/Job Site Address:�dCity/State/?ip:_` vcg. jJ/ 'y�.�Attach a copy of the worl�ers' compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage its 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 imprison.men.t,as well xs civil penalties in the form of a SCOP WORD ORDER and afine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be:forwarded to the Office of Investigations of the.DIA for insurance coverage verifcation, ,i do here�b cerci 1,under th at.n nd enalties o yet'xtr,that flee in orltr.atiorr rovided aIt hove is frac and correct, i nature: � �� ate:Phone L.:J3 ial rise only. Do not write in this area,to be completed by efty or#own official,CTown Permit/License# Ig Authorl:ty(circle one): ard of 1rTealth 2,Building laepar'tment 3,Cliy/Town Clertt 4,D+lectr real 1<nspector 5. Plumbitrg InspectorCterCct Person: Phone#: I ;¢; OIII�MONWEALTH ©F MAssACHUS EVE E Cl ISSUES THE 'FO.LLOW.ING I�iCENSE;?AS A, . REI;t T: D ,MASTER ELE:t-A C j:Ai� NE�1P(IRT ELECTRIC CORPORAT'I OFf, Jc EIAVI'D A F # ULtrEN, L,OWELL r MSA 61852 4�2fi "20805W.,:n° -7/3- J,6 t t t 039 �^fi� ' 'MONWE1xLTH'OF Mh► �' x�H�$ETTS ` • • • - • • - y EWOAO� T. - ELI€TRl C ANS SSUES1THE 'FOLLUWING Lt CENSE 'JQURNEYMAF� ELECTRI AAV1b A MCIMULLEN ' ,�j , ,S,� { 6 KA 4 ,t POITSIhOUTH 1028)1 5802 �---- CERTIFICATE OF LIABILITY INSURANCE NE�rP013 OP ID: LS DATE InuvpurYrrrj `S THIS CERTIFICATE IS ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLpE/ROT4 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOYV, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS HIS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SU INSURER(S), AUTHORIZED the terms and conditions of.the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certiflcate holder In Ileu of such endorsements. BROGATION IS WAIVED,subject to PRODUCER DF Dwyer Agency D,F. Dwyer Insurance Agency 30 Be11eVUaAvenue P �••-_-______ Newport,RI 02840 401-846-9629 c NO 401.846.9629 Daniel F.Dwyer III -MAIL dfd((rDdfd O L----84— wyer.com _ INSURE S AFFORDING COVERAGE __ NAIC M INSURED Newport Electric Construction^ -'- INsuRERA:Foremost Corp iNSURII Scottsdale Insurance Com an 200 High Point Ave,Suite B6 INSURER C.Beacon Mutual insuranc@ .. - 41297 Portsmouth, RI 02871 — INSURER o: INSURER C: IL;ll ES CERTIFICATE NUMBER: P THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE,BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE of INauRANce _..---...._.._...._..._._�___-•- GENERAL LIABILITY FOLIC NUMBER --— — LIMITS A X COMMERCIAL GENERAL LIABILITY SCP006046448EACH OCCURRENCE $ 1,000,00 F 12/30 CLAIMS-MADE ocCUR /2013 12/30/2014 ` ag [LQa4e_l_.. $ 300,00 MED EXP An one arson S -- 10,00 PERSONAL&ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY PRO- PRODUCTS-COMPfOP AGG $ 2,000,00 LOC AUTOMOBILE LWBIIITY $ A ANY AUTO 0 8 N 0 SIN LEU IT ALL E accl ani) �'_ 1,000,00 AUTOWNED X SCP00604644$ 12/30/2013 12/30/2014 BODILY INJURY(Per person) $ _ SCHEDULED AUTOS HIRED AUTOS X AUTOS NON•OWNED BODILY INJURY(Per accident) $ PR PERTY D GE --.—._.. E UMBMLLA LJAB X OCCUR B X EXOEss UAB $ CLAIMS MS-MADE EACH OCCURRENCE NCE S D ETE 12/30/2013 12/30/2014 AGGREGATE QRS COMPENSATION _ $ 6,000,00 AND EMPLOYERS,LIABILITY $ C ANY PROPRIETOR/PARTNER[EXECUTIVE Y/N WC STATU• OTH. OFFICERNEMBEREXCLUDED? ❑ N/A 68861 01/18/2014 01/18/2016 as,ndst In and E.L.EACH ACCIDENT $ 600,00 If es describe under D GR PTI NOF PERATIONS below E.L.DISEASE-EA EMPLOYEE 3 600,00 A Empi p Prac Llab E.L.DIS SCPO06 CY LIMIT 04644 $ $ 12/30/2013 12/30/2014 600,00 60,00 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attsoh ACORD 101,Addltlonai RertuItcs Sall If more apaoe Is required) CERTIFICATE HOLDER CANCELLAT ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE InSUred'e Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel F. Dwyer III ACORD 26(2010/06) The ACORD name and logo are registered marks2of CORD D CORPORATION. All rights reserved. 9391 Date. Is. . . 1 . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING • MIN- USf ' This certifies thatc(vrl-`!'`u`.'!:I.�. has permission to perform--i. ., . . . . . . . . . . . . plumbing in the buildings of . . . ..101. 'rpS� . . . . . . . . . . . . . at . . . G."}Vii" . . . . . . . . `�n?-A t�Z, North(Andovner Mass. i Fee. !?a.... .Lic. No. �P07. . !.�` 5 PLUMBING INSPECTOR Check A l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING I City/Town-_/V jr/�p� ,ly ` MA. Date: permit# Building Location* �D%!KG C �d' 1 144E' # y y4e y Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation: ❑ Replacement:Q Plans Submitted: Yes❑ No Q` FIXTURES DEDICATED H z SYSTEMS z to V) U O z a W z ` 'a _ju r W o 0 Q m En OaC w Ln ~ W z W t„ N z O d a W W o Q ❑ a z o z H ° a Q a ' a _ ° _ ❑ ❑ W �, j z z a 3 Q m m Cn Ln Cn Ln LL ~ Fv- O ° 03 a bd Z c) z v=i H FW- W 44 O in W 13 44 Ln Ln 15 W a SUB BSMT. 3 ° ¢ 0 0 3 BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR ST"FLOOR 6T"FLOOR 7'FLOOR 8'FLOOR Installing Conripary Name: Check One Only Certificate�t /Lt Address: �Gid/�1 City/Town:_�F�iJ�,Q ,G ©"C`orporation Stater BusinessTel:- �7WI El Partnership Z9y �� 7 Fax: ElFirm/Company Name of Licensed Plumber: : e g!E INf URANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesNo If you have checked Yes,please indicate the.type of coverage by checkingthe ❑ E]appropriate box below. A liability insurance policy. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the ins urance Massachusetts General Laws,and that my signature on this permit plication waives this requirement. required by Chapter 142 of the Check One Only Si nature of Owner or Owner's A ent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate 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 Chapter 142 of the General Laws. ate to the best o;my By Type of License: Title ElSI n Plumber Signature of Licensed Plumber ,ityrown ❑Master APPROVED-(OFFICE USE ONLY) Olourneyman License Number: Xl,�P(>7 7767 . .. .. .. .. NpRTIy pf ,.io o: �` TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION S^CHUSESS .. This certifies that . . .0 Q`'�E`�'tr�`.�. . .��:`: . .�-��k^� :.. . . . . . has permission for gas installation . .`� ?`.`!�`� . . . . . . . . . . . . . . . . in the buildings of . . . . !� . . .�. . . . . .�(1 QST . . . . . . . . . . . . . . . . . at . . . �-?;�`~.�. .�. �. ., «.�.?. , ., North AndovejMass. Fee.�� �J. Lic. No...�'f. . . . . . GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: AAJDc)VcP MA. Date: Fr—Z—(( Permit# Building Location: 1!Z0'/i4L 686 . ( Eta. *'(Z Owners Name: (-ay4LL <��.rii- Type of Occupancy: Commercial ❑ • Educational ❑ Industrial ❑ Institutional ❑ Residential ] New: ❑ Alteration: ❑ Renovation: ❑ Replacement: 0 Plans Submitted: Yes❑ No FIXTURES 0: X vi LULU z F' fn v _ cd o m = 0O LU w V CO F O = 1z W z z z m o m Lu o a > LLI z O W CO) LUW O F wQ a 1Q- W w w x W ❑ O W N z �- Z LU co JLu Z ~ F- O z -u c7 u- F = w F w w 0IX W :3❑ ❑ u_ C7 t9 LU x i m > O z O w z z w a I SUB BSMT. BASEMENT -i'FLOOR 2 No FLOOR 3 FLOOR r 4 FLOOR 5 FLOOR 6 TH FLOOR r 7 FLOOR 81HFLOOR Check One Only Certificate# � Installing Company Name: �flmi5ee/� c 'F-6(L.e S'ys El Corporation Address: fS`? Dt ,)l-tAiSti1 - T City/Town: State: 414 ❑Partnership Business Tel: Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: ` 10-1 4 ,z INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy [- Other type of indemnity [:1 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 Signature of Owner or Owner's Agent Owner El Agent E] By checking this box❑;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 Chapter 142 of the General Laws. Type of License: By ❑Plumber (� EI Gas Fitter v Title El Master Signature of Li ensed PlumbeNGas Fitter Cityrrown [MJourneyman License Number: �f(o07 APPROVED OFFICE USE ONLY ❑LP Installer Date.................................. HOR71{ "° TOWN OF NORTH ANDOVER OL 0 p PERMIT FOR WIRING40 *VIWNNW CHUS� This certifies that ...................................... ................ ................................ � has permission to perform '00 ........... .. wiring in the building ofIgMt D ............................................................................... at....�fZ/�6L/,OI—aFs/ �.S ..............................................North Andover,Mass. Fee—t_S`...-.. Lic.No41303?.................. ./.......�%......��l! ELECTRICALINSPECTOR Check # r 7806 Official Use Only CommonweafthofWassacFiusetts Permit No. -7 �C>(, Department of Fire Services Occupancy and Fee Checked: Completed: k,.t Date: BOARD OF FIRE PREVENTION REGULATIONS Inspector's Signature: APPLICATION FOR PERIVIIVTO PERFORM ELECTRICAL WORK NO ELECTRICAL PERMIT WILL BE ISSUED UNLESS IT IS ACCOMPANIED BY A VALID ELECTRICAL LICENCE NUMBER All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TION) Date: — TOWN OFkvTo the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical wor described below. . Location(Street&Number4 L0 t Owner or Tenant 0 Telephone No 'Z Owner's Address __ Is this permit in conjunction with a building permit? Yes ❑ No B�� (Check Appropriate Boxy Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical—Work: 2:5a- Completion ' Com letion of the oll wing table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ . In- ❑ No.of Emergency Lighting d. gmd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No of Gas Burners No.of Detection Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Numbers Tons KW No.of Self-Contained Totals: Detection/Merting Devices No of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:No.of Devices or Equivalent No of Water Heaters KW No.of Signs No.of Ballasts Data Wiring: No.of Devices or Equivalent y No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No of Devices or Equivalent OTHER: Attach additional detail if desire,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the license provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in fore/e,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [? BOND ❑ OTHER ❑ (specify:) (Expiration Date) 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. I certify, under the p itis and pp(n of perjury,that the Information on this application is true and complete. FIRM NANIE: — O C, k LIC.NO.: 3 03 _ Licensee: e,/ Signature LIC.NO.: If applicableent r "e mpt"in the license number line. Bus.Tel.No.: - Address: Alt.Tel.No.: t- OWNER'S INSIMNCE'WAIVEIZ. ram aware that the License doe not have the liability insurance overage normally required by law.By my signature below,I hereby waive this requirement.I am the(check one) ❑ Owner o Owner's agent Owner Agent Signature Telephone No. PERMIT FEES: J r t