HomeMy WebLinkAboutMiscellaneous - 425 FOREST STREET 4/30/2018 425 FOREST STREET
210/106.A-0189-0000.0
Date....
NORTH
TOWN OF NORTH ANDOVER r ..
p PERMIT FOR WIRING
SACHUS� -
u
S
This ce i efthatZEO4i&7��......................................... ....... ...................................... :.
has permission to erform �✓ � �G'"��2• !"mac.
` wiring in the building of......... /'��CC�y'..........................................
Z �e2C5 .. 5.7..
.. North Andover,,,Mass.
M 7 4
Fee..................... Lic.No.............. .. .
E ECTRICAL INSPE^ R
Check #
10774
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,§K.
Permits shallbe limited as to the time of.ongoing construction activity,and maybe_deemed_by the.Inspector_of_Wires abandoned.and.invalidafhe—. ._
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 S�ctions.74 and 75 of Chapter 238 of t
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 conceming 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.
le 8—Permit/Date Closed: Dote:Reapply for new permi
0 Permit Extension Act—Permit/Date Closed:
f
/� I,
C,onuno LMA o`///aeaackoe�e Official Use Only
20ral ed 015ira Jew Permit No.
upancy
BOARD OF FIRE PREVENTION REGULATIONS ey.1/jo7] and Fee Checked
� leave blank
APPLICATION FORT PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed�accordance with the Massachusetts Electrical Code(MECO 527 CMR 12.00
(PLEASE PRINT RV BVK OR TYPE 4LL DVFO� �TIOA Date: L-161)
aty or Town of
/Ud''1
. � To the Inspector of Wires:
By this application the undersigned giv notice of his or her intention to perform the electrical work described glow.
Location(Street&Number)
Owner or TenantO f-� Telephone No.
Owner's Address 9 79 ,(0 2 ::-3 0)3 !'
Is this permit in conjunction with a b#ding permit? Yes ❑ No ❑ (Check Appropriate Boa)
Purpose of Building Utility►Authorkeat'oon No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Voits Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
a Location and Nature of Proposed EWork: 1 V�f /Yec>( g CPN'lP
�ompletion Ofthe ou"' table ag be waived by the Ins ctoro
Wires
No.of R Luminaires 11 Na of Cei1 (Paddle)Fans o.Of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
' i$ cy'Lighting
No.of Luminaires Swimming Pool 1rud e ❑ d. ❑ Bao ttpa Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burn'rs ITOK-07 Detection as
Initiating Devices
No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices
No.of Waste Disposers eatp r ons o.o ontam
TotaLc• Detection/Alertin Devices
ams pa
�I Q No.of Dishwashers Space/Area KW Local❑ Connection ❑ Other
No.of Dryers Heating Appliam es KW ce of Devices or Equivalent
o.o Water KW o.o o.of
Data Wiring:
Heaters S No.ofDevices or Eauivalent
No.Hydromassage Bathtubs No.•of Motors Total HP T ecommumcationsungg-.-
No.of Devices or aivalent
OTHER
ach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: j en required by municipal.policy.)
Work to Start: fhispecionstobe requ in accordance with MEC Rule 10,and upon.completion.
INSURANCE COVE GE: Unless ved by the owner nopermit for the
performance of electrical work may issue unless
the licensee provides proof of liability"his irance including" pleted operation"coverage or its substan" 'valent. The
undersigned certifies that such cov e' in force,and has tiled proof of same to the pemtit issuing o'ce.
CBECK ONE: INSURANCE Bo ❑ OTHER '�] (Specify:)ZV t-t e Gi —`TA'5c� n c�
I certify,under thep*and pen 'es a pet a,that the�formation on this application is true and co�lete
FIRM NAME: �s rM-e--5 e c)it r LIC.NO.: _ 3 ff19 2
Licensee: Signa re i
I !:cable,ewer" �' _ LIC.1410.:
Addy ' mpt the license Bus.TeL No.: 77—Y--775-7
Address: P r E' ✓ , �( ��� Alt.Tel
*Per M.G.L.c. 147,s.57-61,security wor r.requiresDep t of Public Safety"S"License: Lie.No.
OWNER'S INSURANCE WAIVER: I aware that theIicensee does not have the liability insurance coverage normally
rNWnd by law. By my signature below,Thereby waive this requirement. I am the(check one)❑of 0 off: ent.
Owner/Agent
Signature Telepho te No. PERMIT FEE. $
_ 1
G
' r
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTIN�
(Print or Type) _
NORTH ANDOVER Mass. Date
= 5� .�uilding Location � Permit .
#
Owners Name
• - _ New -7 Renovation D Replacement JZJ/ Plans Submitted �]
FIXTUP.=1
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to a pf 0. .p � N _
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o ►- x J f- z F• O > U. f- W .1 l.- tri
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t= x v c7 Y u. a .s c� rz �• a s t- o
S1Ja--BSTMT. t
BASEMENT
t ST FLOOR
2HO FLOOR
G1
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TK FLOOR
STH FLOOR
(Print or Type) Check one: Certificate
Installing Company Name C• y��,� /��g, -� �� Q Corp.
Address O �7 c>- ice,-, /Lc�. Partner.
7 w�lS�SwJ r/�� Firm/Co.
Business Telephone:
Name of Licensed Plumber or Gas Fitter
Insurance' Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Ri Other type of indemnity Q Bond Ej
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 coverages.
Signature of owner/agent of property Owner _1 Agent
L_ ri
I hereby certify that ail 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 lnstAllations perforated under Permit issued for this application will be in compliance with ad pertinent
provisions of tho Massachusetts State Gas Code and Chapter 142 of tho General Laws.
By TYPE LICENSE:
Plumber
Title Gasfitter ig Cita of Licensed
City/Town: Master Plumber or Gasfitter
Journeyman
APPROVED (OFFICE USE ONLY) License Number
'� :N+ A`^r tF*,tfg1'li.a+L�` -t.:^i-• .,,t=,�,..:.�r#'ri JaAJ A.S". 3:. .. "'Ser , ;,;•gip x�
Date.
17
NORTH
TOWN OF NORTH ANDOVER '`"
3? �� PERMIT FOR GAS INSTALLATION
SSACHUSE ;w
This certifies that . .� Y .< . . =.. . . . '!1- a
r
has permission for gas installation Az� . . . . . . �--
in the buildings of . . ac' ►i /' rr! f . . . . . . . . . .. .
at ` . . f �= ? . . . j `-f North Andover, Mass.
Fee/t `. . Lic. No. 2. ,
d P GAS.INSPECTOR
WHITE:Applicant CANARY: Building.Dept. PINK:.Treasurer GOLD:File