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HomeMy WebLinkAboutMiscellaneous - 45 HEPATICA DRIVE 4/30/2018 I Date....1.......�y.... .... Th�� TOWN OF NORTH ANDOVER PERMIT FOR WIRING i oma: �88�cHU This certifies that f 17 r` ct�c ........................................................ .................................................................. has permission to perform .... v............. v .....C...... wiring in the building of.... , at ..y ..........Ike *. �%.�-..�.............�t..l�.............,North Andover, ass. qi��� Fee�f<Z 5.:....y�...Lic. ......... ..... ..... . . ...--+ ..... ..................... ELECCRI AL INSPECTOR a Check# _ Commonwealth of Massachusetts official use only c%' * Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REOULATIONS [Rev. ]/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 PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: 1V0XrH- AN DO V FF_ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Lai �T Location(Street& Number) (C / Owner or Tenant 8� 7y A� SNC• Telephone N Owner's Address 3TUlZ1� t -S, /X N�[/ � Ci Is this permit in conjunction with a building permit? Yes X, No ❑ (Check Approate Box) p Pur ose of Building $ A(IL Utility Authorization n� _ 3 Existing Service Amps / Volts Overhead ❑ _. Undgrd-❑ No. of Meters New Service L0j2_ Amps J:l/ZYQ Volts Overhead ❑ Undgrd No.of Meters Q I� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �G 0 r yesw //© C� Completion of the ollowin table may be waived by 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 Above n- o:o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. Baitery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones and No.of Switches No.of Gas Burners o. o Total Initiating Det ng D vevices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat upum er ons o.o e - ontame No.of Waste Disposers TotalDetection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ untc�pa ❑ Other Connection No.of Dryers Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent No.of Water KW o.of No.of Data Wiring: N Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications irin �n No.of Devices or Equivalent \� OTHER: .y 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: 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 a BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC. NO.P,1 1983 Licensee: LOUTS CONTTNO Signature . LIC. NO.. \ �2A788 (If applicable, enter "exempt"in the license number line) Bus.Tel. No.•a 7 8—3 6 3—5 4 0 Address: 1 nnnTnVnN—LIR -, W-EST—NPW$tdF.Y-' 1 QB..S Alt.Tel. No. *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 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)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 45- tgk � ( a Sr COMMONWEALTH"OF MASSACNUSE L • •ELECTRICIANS ELECTRICIAN REG JOURNEYMAN AS A - LICENSE TO z THE ABOVE ara=.• ISSUES- , ... CONTINO,. �. =LOUIS T T1 DOR ' "p }t0 198,5-1929 WE :.NEWSUR STY Mr 881220 2878E E 4 07/31/13 • j Date./� �� . . . . . •' f TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . .; ./.�J��. . . . . . .r�v . . . . . . . . . . . . has permission for gas installation . l-!! '����?� 15;�. . . . . . . . . U in the buildings of. . . . . . - -a-'. . � •�- - , . . at . . . . Q,, ,_. .�/ .<: . . . ... . . . . .North Andou r, Mass. Fee a�S:o . Lic. No. GASINSPECTOR V Check# jq 8815 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: NORTH ANDOVER MA. DATE: 08/13/2013 PERMIT# 'J l JOBSITE ADDRESS: 45 HEPATICA DRIVE OWNER'S NAME: KEYLIME BUILDERS GOWNER ADDRESS: TEL: 978-683-3163 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT �/ CLEARLY NEW: rL/1 RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED:YES ❑NO ©— APPLIANCES FLOOR Bsmt 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 FURI\ACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 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. LIABILITY INSURANCE POLICY 0 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 permit application is true and accurate to the best of my Knowledge. I certify that all plumbing work and installations performed under the permit issued,will be in compliance with all Pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME:;/ � A&�" LICENSE# SIGNATURE COMPANY NAME:OSTERMAN PROPANE LLC ADDRESS: 321A Merrimack St CITY: Methuen STATE: MA ZIP:01844 FAX:978-738-0118 TEL: '800-368-9956 CELL: EMAIL: INFO@OSTERMANGAS.COM „n MASTER El JOURNEYMAN OLPINSTALLER RPORATION ❑# PARTNERSHIP -19 ]# LLC 0#45- 6-331`1'' `�\