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-•• �••••• �.rrs.r..r��wn t-uH PERMIT TO DO GASFITTING
NORTH ANDOVER
. Mass.
Building
Location J `�, Permit #_ a J•�
Owner's
r� Name
New Renovation D Replacement p Plana Submitted: Yes No
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1!T FLOOR ,
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)RDFLOOR
4TH FLOOR
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7TH FLOOR :H41
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Check one: Certificate
Installing Company Name
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a ryl ��._ s
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Address // l7`pc �L �J �•
Partnership
Business Telephone o O Firm/Co.
Name of Ucensed Plumber or Gas Fitter 2
INSURANCE COVERAGE: Check one
I have a current liability Insurance policy or its substantial equivalent. Yea
It you have checked yes. please indicate the type coverage by checking the appropriate box..
A liability Insurance policy I�
Y Other type of Indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not
Chapter 112 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
nature o Owner or Ormer's enl Owner Q Agent 13
I herelry certify that an of the details and Information I have submitted(or entered)M above or ars Trus and accurate(o the best of my
knowledge and that an plumbing work end(nstelletlons performed under the permit issued for this
perunent provisions of the Massachusetts State Gas Code and Chapter 142 of=na
�plkatlon will be(n oompllance with ali
TR�au",Mte
f License:
TIt� bIt
a( o nae um or or&39�rown
,
� r lkenss Mrmberourneyman
/1f'f'MVED(OFFICE USE ONLY)
I
•" 2 6 5 tJ Date. .�........
�f
A
NORM, TOWN OF NORTH ANDOVER
OF, e11'
S PERMIT FOR GAS INSTALLATION
o �}
~ p [U
SACeNUSEtt
M
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This certifies that
has permission for gas installation . ., %. ?��. to F.-e. . . . . . . . . . .
0
in the buildings of . .1-19/71. . .C_?o c.. . . . . . . . . . . . . . . . . . . . .
at . . . . , r. . .�!� d. . . . . . . . . . . . .. No Andover, Mass.
Fee,�O.s. .'. . Lic. No..-,?.f !�. . . . . . . . . . . . .
s-IN'SPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
5�1— 0lf Ice Use Only I
The Commonwealth of Massachusetts
[` �a/3
r—iE b.
Department of Public Safety
Occut.ancy b Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12-00 3/90 (leas blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachuserts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date
City or Town off p. To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street lig Number)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box)
Purpose of Building ��e-16, �f,�� Utility Authorization NO.
Existing Service Amps ) / �,(j Volts Overhead ❑ Undgrd❑ No. of lieters�_
New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
Naaber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work /r g!
No. of Lighting Outlets �T Total
8 8 No, of Hot Tubs No. of Transformers RyA
No. of Lighting Fixtures Swimmin Above In-
8 Pool grnd. ❑grnd. ❑ Generators . RVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
BatteryUnits
N.P. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No.,of RangesNo. of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of DisposalsNo. of Heat Total Total No. of Sounding Devices
Pumps Tons RW 8
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Local❑Municipal []
Other
Connection
No. of Water Heaters KW Sir sf No. ot Ballasts Wirinoltage
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES❑ NO U I have submitted valid proof of same to this office. YES❑ NO ❑
If you have checked YES, please indicate the type of coverage by checking the ap riate. box.
INSURANCE D4. BOND ❑ OTHER❑ (Please Specify) ^' / �R
pirationate
ex
• Estimated Value of Electrical Work $
Work to Start Inspection Date Requested: Rough Final
Signed u..-ter the penalties of perjur;•:
FIRM NAME r LIC. NO.-.,eg�
Licensee r Sign ture l LIC. N0.���3��
Address us. Tel. No. Q�-qs���7
Alt. Tel. No. �511�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have h insurance coverage orscs sub-
stantial it
stantial equivalent as required by Massachusetts Generalwsaw,,and that my signature on this permit
application waives this requirement. Owner Agent (Please check one
Telephone No. PERMIT FEE S
Signature of Owner or Agent
Date ...........................
2 T'
'4IM
NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SSACHUS
Thiscertifies that C .......................................................................................
has permission to performer ...... ............
wiring in the building of...
.......................................................................
at.......0......... .......... .......................... .North Andover,Mass.
T — 01W I
Fee 1-5.............. Lic. og No.
."IX. ...............................................................Ec rR ICAL INSP ECTOR
10/10/97 10:45 15.00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
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F.
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