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Home My WebLink AboutMiscellaneous - 455 MASSACHUSETTS AVENUE 4/30/2018 455 MASSACHUSETTS AVENUE 210/045.G-0040-0000.0 J I e? Date......................-............ tAORT" TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4L This certifies that ............ ... ............J/ ................ ............. ......... has permission to perform ...... ................. wiring in the building of....... ......... ✓ ..................................... at...........4/ 57 ............. .North Andover,Mass. ............. Fee..��. Lic.No.97.40Y.L)................41 .....�/. ELECTRICAL INSPECTOR . y Check # 6921 ,r. r Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Z I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS i[ Occupancy 9/05] (leave blank) — —-- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the�ivlassachusens Electrical Code(MCC).527 0,111.12.00 (PLE,4SE PRLVT IN INK OR TYP i ALL INFORI1IATIOIV) Date: Cl- 6-G fv City or Town of: IN 0-b00e Q To the Inspector ol'Wires: By this application the undersi�,ned ��ives notice of his or her intention to perform the electrical work described below. Location (Street Sc Number) �5 �'I t1ss, A U2_ Owner or Tenant K a b b l j Telephone No. 1`7�- Owner's Address _ Is this permit in conjunction with a building permit? Yes ❑ 'io (Check Appropriate Box) Purpose of Building Utility Authorization No. Existinc-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 Works Completion of the following table may be waived by the Inspector o ;Vires. 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 Swimming Pool Above ❑ In- ❑ o. o mergency ig mg rnd. arnd. Battery Units i No. of Receptacle Outlets No. of Oil Burners FIRE Al•ARMS No. of Zones No. ofSwitches No. of Gas Burners No. of Dccection and _ Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices t, Tons b No. of Waste Disposers Heat Pump Number Tons jI K .............. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Cb.n.n.ection No. of Dryers Heating Appliances KW Se urity Systems: Y ie or Equivalent No. of Water No. of No. of Data Wiring: Heaters KW _ Sims _ Ballasts No.of Devices or Equivalent ] No. Hydromassage Bathtubs No. of Motors Total HP Tel ecommunications No. of Devices or E uivalwiring: ent OTHER: ,attach additional derail rf desired, or as required by the Inspector of Wires. Estimated Value of E ectrical ork: (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 ® BOND ❑ OTHER ❑ (Specify:) certify, under the porins mrd penalties of perjury, that the information on this application is true and complete. FIRM,NAM`E:- ADT Security Services, Inc. LIC. NO.: .1533 C Licensee• N V46WS14-ND Signatu (lf applicable: enter -exempt•'in the license number line.) Bus. Tel. No.:--03- 4-1902 Aciclress: 13 Clinton Drive Hollis N.H. 03049 Alt.Tel. No.: X94-i9;0 "Security System Contractor License required for this work; if applicable,enter the license number h,cres's(� 3 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. 1 am the(check one) ❑ owner ❑ owner's agent. Owner/AgentPER1VfIT FEE:—5 Signature Telephone No. Date. . .�. °T.,�!!'..? .... . MNORTH [ �Orya„ao ,a,tiOO _ 3 TOWN OF NORTH ANDOVER • . PERMIT FOR GAS INSTALLATION SSACHUS i 1 This certifies that . . . r`'.1''. `�`.?ll. .". . . • . • . has permission for gas installation . . . . . . . . . . . . . . . . . . in the buildings of . . . . . '�?.��?!�'. . . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. . >. . . . Lic. No.'�. k~ GAS INSPECTOR Check# % l r 5981 G� MASSACHUSETTS UNIFORM APPLICATION FOR'PERMIT TO DO GAS.FITTING (Pri t or Type) ass. Date 20 Per t ty Bull ng Location wren's Dame , r -� N, Typ�4 ju. e of occupancy New❑ Renovation❑ Replacements Plans Submitted: 'Yes❑ Ido❑ W fin. }n W O m G to z 0 0� H } z z OLLI Ln �2 LU Lu o: to LU z w a �� z .o .o . "' o i a � o ° ' > o a o. SUB-BSMT BASEMENT 1ST FLOOR 2ND FLOOR ; 3RD FLOOR. 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR $TH:FLOOR : .: lnstailing Company Name [� � L�/.�'j/f/f kA'? 'T p�t--Check one: Certificate _ Ll�� Address -. Iy` ❑ Corporation Business Telephone �3'' 23 (�Lj��j ❑ Partnership Name of Licensed Plumber-or Gas Fitter INSURANCE COVERAGE- 1 have a current ti btllty insurance policy or its substantial equivalent, which meets the requirements of MCL Ch. 142. Yes No p if you have checked yes,please indicate the type of coverage by checking the appropriate box. A liability Insurance pollcyle---,� Other type of indemnity 0 Bond n OWNER'S INSURNACE WAIVEttr 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 tffls permitapplication waives this requirement Check one: Signature o Owner or owner's AgentOwner ❑ Agent [) 1 hereby certify that all of the detalis and Information 1 have submitted for enteredi in a application are true and accurate to the best of my knovdedge and that all plumbing work and.lnstallations performed.under the.pe t.is ued_for.this a;ediuymber on.. fl.be.in co.mpliance.vdth all pertinent provisions,of the Massachusetts s tate cas Code and chapter 142 of the7xz� Type of License . . . By ❑Plumber na re o L or Cas Furter Title ❑Casfitter City/Town fifer License Number 9� APPROVED(OFFICE USE ONLY) 0 Journeyman i �V Office Use Only� � 014tC�AIITIIIUnWralth III 49UJjar#ME#� Permit No. �q. t _ �E�IIIItIiIPIi2 ,1ftlbl(L $tsfP2g Occupancy& Fee Checked a � ygp (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 Ct�1R 12:00 �tJ(� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electricat Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date QM or Town of NORTH ANDOVER To the Ins p�ctor of fires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L /u �I��A� Owner or Tenant (g " 1. yr Owner's Address SI) "�7 Z�'~ Is this permit in conjunction with a building permit: Yes - No ` (Check Appropriate Box) Purpcse of Building D&J4 Utility Authorization No. /`oVoits Overhead Unogrnd I No. of Meters Existing Service 60 Amps J New Service A(9 Amos 2, _2_(Z—�'VOlts Overhead Uncgrno No. of Meters Number of Feeders ane Amcacity617.1-7 /t r Lccatien and Nature of Prcoesed Electrical . �11cn< P� / 6120 'ZG� / /1 'a �2 �G- ✓t V / Lcr- Tdtat L. I No c. Hct -,bs No. of Transformers . KVA No. of shuns Outlets I ; I Abcve�- In- No. of Lighting Fixtures I Swimming ?cal grno _ crnc. ! Generators KVA No. of Emergency Lighting No. at Receptacle Outlets I No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners I FIRE ALARMS No. of Zones To[at No. Detection and No. of Ranges I No. of Air Corc' Initiating Davtces tons No.of Heat Total To[at No. of Disposals PumCs Tens K'rV No. of Sounding Devices No. of Sett Contained No. of Oishwasners SoaceiArea Heatina KW Oetect:aniSouncing Devices Local — Muntcmai —Other No. of Driers Hea[tng Devices KW Connecnon No. at No. of Low Voltage No. of '.Vater Heaters KW I Signs Satlasts Winric No -Ivaro Massage Tubs I No ^f Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant :o the redutrements at '.lasSac-uset s general Laws I have a current Liabiiity Insurance Policy inctucing C�mo:etee Operations Coverage or Its suastantlal equivalent. YES _ NO have submitted valid proof of same to the Office. YES = NO _ If you nave cnecxed YES. ptease inatcate the type of coverage cy chepKtng the appropriate box. INSURANCE = BOND = OTHER = (P!ease Spec:ty) (Expiration Oa[et Estimated Value of E!ectrtcal Work S Wcrx to Start Inspection Oa[e Recuestec: Rough Final Signed unser the Penalties of perjury-. LIC. NO. FIRM NAME G LIC. NO. Licensee Signature Sus. Tel. No. Alt. Tel_ NO, Address as OWNER'S INSURANCE WAIVER: I am aware that the L:censee aces not nave the insurance coverage or its suostannal ecuivale tonto au red by Massachusetts General Laws. and that my signature on :n:s permit application waives this redutrement. Owner Ag (Please cnecK ones Teiecnone No. PERMIT SEE S (Signature of Owner or Agents '�=0� S 'z" " � S i ` Date.....� .. �..� . .3 620 Of ,,00TM�1 "°oma TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMuSEt CS This certifies that ....... f..� ......................... has permission to perform ..... .. . � .. U�z` . ., wiring in the buil ' g of......... .. ............... y � at....... .1 ........:..... . ?'a....... .... .r......... ,North Andover,Mass, M Fee.. Lic.Nd;! ..., � ELECTRICAL INSPECTOR � WHITE:Applicant CANARY: Building Dept. PINK:Treasurer -a�•�L^.3.�ifa:.Y+::� -':.i .a..:Y,.--:.w=.s..•Tnye_J-_c�.e4-".��df:.r-...0---�--a..:_ -� x...:�µ1i_usi�-:tic_ t_.`--"_..ti+�a_-�^.:,....r ` 3 1 U 6 Date.. .�.... .` . . ......... �,Of•MO oT c 100` a TOWN OF NORTH ANDOVER g i PERMIT FOR GAS INSTALLATION l f 9 p SAC NUSES This certifies that :y. . ."/ . . . . has permission for gas,installation `�'" ' " `r-! r„ in the buildings of ' - � : . . . . at . 7' ''� , North Andover, Mass. Fee. :? . . . . . . Lic. Noz�-�?l . . . �.��: .�M . . . . l/ GAS INSPECTOR�� WHITE:Applicant CANARY:Building Dept. PINK:Treasurer U4E LDIlIII1 nwailth Df Ea5at4u = P,,,,tk 0"111:1111 un 0* r� - Er artintiit of ublit: *aft R � nI V Olx;Lparxy 1,Fie CMcgd BOARD OF FIRE PREVENTION REGULATIONS 521 Cti1R 12:00 W90 Peaw blank) APPLICATION performed IPERMITn accordance WTO PERFORM ELECTRICAL WORK MassachusettsAll work to be Electrical Code. 527 CIWR 2;00 (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) Date TA or Town of NORTH ANDOV R To the Inspector of Wlnsi The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address , Is this permit.in conjunction with a building permit: Yes _ No �✓ (Check Appropriate Box) Purpose of Building Utility Authorization No. 142 �3 Existing Service Amps o Voits Overhead '�� n �J- a(��-- Undgrnd ` No. of Meters _,,_,_ •' New Service Amps l.Wi 7Z 4ZL- Volts Overnead '�n —�T U a rn a - 9 C Na. of Meters Number of Feeders and Ampaclty Location and Nature of Proposed Electrical 'Noris No. of Lignting Outlets I No. cl yot ' cs I No. of Transformers Total KVA No. of Lignung Fixtures i Swimming P^a Accve.— :n. r Srro _ crno I Generators KVA No. of Rocaotacto Outlets I No. of Oil crrners I No. of Emergency Lignung eanary Unita No. of Switcn Outlets I No. or Gas =:rrers FIRE ALARMS No. of Zones No. of Ranges I No. ct Air Czr.c. 'Ota' No. of Detection and cns Initiating Oevicss NO. 01 Ois00aa13 I No.ol Heat -oai ,otat ?ur-zs 'ons -(W No. of Sounding Oevicss No. of Sail Contained No. of pianwasners SoaceiArea Heatira ic.v 0614cnanisounaing Devices No. of Oryers I Heating Cevices KW L•ocai -- Municioat --.0 Connection • i No. of Low Voltage No. of water Healers KW I Signs 9atlas;s Wiring No. Hybro Massage ivaa ' I No. of !aotcrs ata HP OTHER. INSURANCE COVERAGE. Pursuant :o Ina rsouirements --t %iassaccLser.s ;eneral Laws 1 have a current Liability Insurance Policy -ncluaing Can�e-e c Ccerations Cove.age or its substantial aouivaNnt. YES � NO 1 have aYbmiltad valid proal of same to in* Office. YES Q VO _ If you nave cnecxoa YES. phase inoicatehe ttype cnecicing the aaorob��iaato box. INSURANCE ��00NO = OTHER = (Please Scec.`,j) Estimated Value of E!sctncat Work S ( auon Datet Worm to Start Insoec:ion Date ;;acces:ec: Rougn Final Signed under the Pe stiles perjury: FIRM NAME Licensee UC. NO. S gra:cre LI PID. Address �L Sus. T 3 •1. No.44' m. Tel. Nb. OWNER'S INSURANCE WAIVER: 1 am aware inat the L:censee aces not nave ins insurance coverage or ltd substantial egwvaNnl lee►♦ Q irea(Pie by Mascnec aCnWIIa G•MtL Laws. dna Incl my signature Jn :itis �ermrt a0pliCation waives this redultentent. Owner Agent ?: IPIUN cneuc on•1• (; is sieonons No. PERMIT FEE S ft 151natws of Owner or Ageno g a�aY < /9 � N-2 4 U � 3 Date......,1.... ......... ........ i �aORTM °:,s�".;•�"°° TOWN OF NORTH ANDOVER PERMIT FOR WIRING AFFMAWA �sS�cHusE� This certifies that .........L!. .��....�(�?rt.SS P..............�... ......................... has permission to perform C.......... wiring in the building of .<r.., �. ............................................... s - .................................................4ss ��r - at.....Z....... ..v .............. ,North Andover,Mass. Fee... 5�..C�v Lic.No..v�. /O/��.......................................................... ELE=icAL MpEcm �' �` C ! /19/98 09:10 75.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer z- / Office Use Only 1 Permit Na o57�u$.$t��JE�s Occupancy 8 Fee Checked Z7t�eat.+aawl 06�a6lLe Sa6cry BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod=Inspecto (Please Print in ink or type all information) Date To ths: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number v G Owner or Tenant Owner's Address ZZ—1- v Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work Total No.of LightfIng Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimminq Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners BatteryUnits No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone / Total No.of Detection and No.of Ran es No of Air Cond ( Tons Initiating Devices Heat Total Total No.of Diposal No. Pumos Tons KW No.of Sounding Devices Nod of Self Contained No.of Dishwashers Soace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER' INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type ' ge by checking the appropriate box INSURANCE BOND = OTHER = (Please Specify) o/f�5� (Expfratio ate) Estimated Value of Electrical Work$ Work to Start Inspection Date Rasquested Rough Final Signed underthe Pen Itle of perju FIRM NAME !/C.0 00, �G �� LIC.NO. t ?GG�d r Licensee rc Signature LIC.NO. us.Tel No. 3 Address Alt Tel.No. 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 appllcatlon waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $�`� (Signature of Owner or Agent N2 t`7 5 Date... ,y poarH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING I d ,SSAcMUSEt This certifies that .....�:. �'.`.!........((..�! ........... ...................................... has permission to perform ....... ...................................... wiring in the building of.....�✓.. C �/\ �f � a+ at.....(S.5 .... .cr>'.. /t. ........................ .North Andover,Ma§. ✓�.... ...... Lic.No. r........................................................... . Fee..� - � ..........�.<�h ELECTRICAL INSPECTOR 60 C �7 H AqY7 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) / / O r-*I� s /t/d ,Mass. Date 7 19 Permit aM Building Location S /4 4 ss Q �OwneesName C/h ,JC,_ Map: Lot: Zone: Type of Occupancy r' S L d -e New ❑ Renovation ❑ Replacement Q--**, Plans Submitted: Yes❑ No ❑ T_ Fee: w 0 Y ¢ Mi y N V W M N W ¢ N O . y = O J N 2 O Q O f S N Z ¢ W ~ t 0 Z F- Q 0 W Q Q = = O O Z W 2 m U$ < W W 0 0 d Q U Q W S Z N W W L N Z V W y W Q K 0 0 F- 2 W N _ CC M Z F Z J H Ch Z W W O O > U. f- W J F W V Q W _ Q R F- > 0 m Z O Z Q O y S _ Q W > Q W D Z Q Q Q Q O O W - O W = O C7 x a n 3 0 .0 J v ¢ > 0 a F- O . . . . . _ _ all SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR I/ STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name / t'7�2� p, I /n Check one: Certificate Address `T p' ❑ Corporation Estimate Value of Work: RQ >� uI C c-s- 44 y.c D/!)—Z3 ❑ Partnership Business Telephone 7 `] (-.Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current 1!,4bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have.:hrvcked y ti,V;east;iii%i:,aiu iiia iy}-sea:;averagd Uy.:i tseklny'1 u ai.rFrupriatts uox. A 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: Owner El Agent ElSignature of Owner or Owners 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 Ty of License: cl Q- Plumber Signature of Licensed Plumber or Gas Fitte Title Gasfitter ter License Number 12—-L, 9 I City/Town Journeyman �— APPROVED (OFFICE USE ONLY) Ot' BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFIT"ING NAME 8 TYPE OF BUILDING 1r ' LOCATION OF BUILDING _ PLUMBER OR GASFITTER 1 UC. NO. i PERMIT GRANTED DATE 19—_ s r GASINSPECTOR �,j'.'`�4,�-�--"a,.,�,,.,•_,,, .-�...,.�.,...-..�.:r'^'..-o.•�----Y..-x.,.i::...n-ti�t;...,irr .�st'1�i�,, V ..,,.a., _ Date N"R 402 . t0RTjj �'.��•° •'�o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s o� __',�•'a SSACMus� This certifies that has permission to perform . . .-C>;S. .t:L�,O�s l c r� „ ; 6li�Lplumbing in the buildings of . . /� . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ., North Andover, Mass. � Fee..�Q.'`. . .Lic. No.. .I 4?`t . . . . . . . .�-�z�• �„ rl . LUMBING INSPECTOR $ WHITE:Applicant CANARY: Building Dept. PINK:Treasurer S ..Arte/99.11:21 30.00 PAID 30 � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) t+ �.^, Mass. Date 19 Permit # a Building Location_ u Q Owner's Name ,(a f, Type of Occupancy--Ll[Y _ ra New ❑ Renovation ❑ Replacement 13' Plans Submitted: Yes ❑ No ❑ FIXTURES 2 N IA 2 Y Q F o) N O Z ►' h W Y J N U < N = W w w ¢ O Z W < ¢ ¢ = Z O = H ¢ O I „r In W y = N F- U W tn Y < N U. = a a IL Z a F- U Z O O ¢ N W ¢ ~ H Z O 4 N d K a < Q X 0: W 1- !- W < H O < W G J Z ¢ J k H U < S � x 0 = S x a C r- < x WU- V) 4 ¢ a y 0 �' z 0 0 ti = i W t- o i r < < z _ _ < < O < J J < ¢ ¢ ¢ < 0 < U. C�� BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR BTHFLOOR Installing Company Name_ f e.6 r d If 4 Check one: Certificate Address A ❑ Corporation OL n e w s-S (7 /9 2„Z ❑ Partnership — Business Telephone9 7 u — '7 7 V— Q'Firm/Co. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements Yes of Agri Ch 142. C11-- No LI If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy B'` 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: S+gnature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 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 Stale Plumbing Code and Chapter 142 of the General Laws. Ely Title �+gnarure of licensed Plumber City/TownType of License: Master [}i Journeyman ❑ 4'ROVED(OFFIC E USE 0NLY) License Number. j Z Z BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FINAL INSPECTIONS SK CHE,7 - - FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING I _ NAME&TYPE OF BUILDING LOCATION OF BUILDING i . PLUMBER i i PERLUT GRANTED DATE .,._,_.........._19 I PLUMBING INSPECTOR 'J,0 16 5 1 Date.... NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ACHUS This certifies that ... ...Ut.5.................................... has permission to perform ..... ..Q.. 6�..................... wiring in the building of..... ...... .......................... 441...... ......A ...... ..................... .North Andover,Mfiw Fee .......... Lic.NoJ..... .... ............ ........ EGTRICALINSPECTOR 4 D��1-2i99 11:22 25.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 13 M The Commonwealth of Massachusetts Onky 19 rr welt 'W. Dtfiartmenf of Public Safety o«"oacy a raa oaekaa BOARD OF FIRE PREVENTION REGULATIONS STT CMR 12:00 3/90 (I*ays blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be periortned In accordance with the Massachusetts Ekctrkai Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INF RHATION) Date City or Town of�/ -� ��(��` Io the Inspector of Sures: The undersigned applies for a�p�ermit to perform the electrical work described below. Location (Street & Number) Owner or Ienant Owner's Address --Is this permit in conjunc on with a bui ing permit: Yes Q'No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No.�Y _ Existing Service Amps / Volts Overhead1:1Undgrd❑ No. o: Meters New Service Amps / Volts Overhead ❑ Undgrd❑ ; No. of Metes Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work i No, of Lighting Outlets No. of Hoc tubs NTotal ,o, of Transformers KVA Above In- No. of Lighting Fixtures Swimming Pool grnd. ❑grnd. ❑ Generators ! PA No, of Receptacle Outlets No. oNo. of Emergency Lightingf Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners ; IFIRE ALARMS; " No of Zones f ;t No. of Ranges No. of Air Cond. Total NO. of Detection,andtons Initiating Devices No. of Disposals No. of HeatTotal Total No. of Pumps Tons KW Sounding Devices ' No. of Dishwashers Space/Area Heating KV No. of Self Contained'Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑Municipal ❑Other Connection z No. of Water Heaters KW No, of Ballasts `'No. of LowWirVoltage Signe No. Hydro Massage Tubs No. of Motors Torn HP OTHER: ` INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current L ilit Insurance Policy including Completed Operations Coverage or i substantial equivalent. YESO[] I have submitted valid proof of same to this office. YES�O If you hav�IBOND ecked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ OTHER❑ (Please Specify) (Expiration ate Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under t p alts of perjury: FIRM NAME _ IC. NO. Licensee S piature LIC. NO. S7G ..19".� ..1 . Iel. No. Address ( ��sG� " 4 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee d s not have the insurance coverage or its su stantial equivalent as required by Massachusetts Generalvs, and chat my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent