HomeMy WebLinkAboutMiscellaneous - 514 WINTER STREET 4/30/2018G
Date . -.&...i.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ! C ...
has permission to perform- (,� �d�� ��'L'�-'
�r .. ............. .................. .....................
wiring in the building of .... s L!�n f .........................................
at... &t........67 -4)e j . J' .............. . North Andover, Mass.
Fee. S4� <7...... Lic. No. ./. ............................. .................
ELECTRICAL INSPECTOR
68'/5
Unum VW Vary
Permit No.
O
efflAW9W,4.?W OP 7Xr4S.S4enS877S
S Occupancy
BOARD OF FIRE PRION RE TIONS.527 CMR 12:00 &Fee Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1200
(Please Print in ink or type all information) Date
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street &
Owner o
Owners
WON
Is this permit in conjunction with a building permit Yes ❑ NoZ-'(Check Appropriate Box)
Purpose of Building Utility Authorization No.
basting Service Amps Voits
NeHr Service Arr>ps Volts
-a
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
Odd ❑ Undgmd ❑ No. of Meters
Overhead ❑ Undgmd ❑ No. of Meters
— -'
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers INA
Above ❑
In ❑
No. of Lighting Fixtures
Swimming Pool grnd ❑
gmd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di sal
No. Pumps
Tons
KW
No. of Sounding Devices
Noi of Self Contained
No. of Dishwashers
Area Heat
ISN
Detection/Sounding Devices
❑ Municipal ❑ Other
tNo. of Dryers
Heating Devices
KW
Local Correction
No of
No. of
Low Voltage
NLA! Water Heaters KW
Signs
Bailases
Wiring
e
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 includi pleted Operations Coverage or its substantial equival t NO =
h ubmitt valid proof of same to the �NO = M YW have checked YES please indicate the by checking the appropriate box
SUR
ANC
- ND =OTHER = /�(�lease Specify) (� Vie)
s mated Value of Electrical Worki R Z 2 O o
Work to Start Z -l1 Inspection Date ResgNested Rough Final
Signed undert a Pe altapj of perjury:
FIRM NAME �( /v u +w S (� LIC. NO. i� y�
. 1-----L !-t — / fe�P�. , LA-kLe-@ t�..� Cin..arum Y — 2.✓1.��.rhJ�•'r LIC. NO. 2-13
J S �s
I, - Bus. Tel No. 'l l Y �f is —OA U t
Address Z. oo&L U�1 a.. w � "� Aft Tel. No.�� b If;
OWNER'S INSURANCE WAIVER: i am aware that the LVAnses does not have the Insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit appikation waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITTEE $
(Signature of Owner or Agent)
I:�cation
No. `� n
Date -- -,5�/ I�?
�aRTh
TOWN OR NORTH ANDOVER
n
Certificate of Occupancy $
Building/Frame Permit Fee $
�'�s'•••°.•��
Foundation Permit Fee $
CHU
Other Permit
Sewer Connection Fee $
Water Connection Fee $ --
TOTAL $
Building Insp r
Div. Public Works
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Date .-L.?
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .....l::... `. /'. .............
has permission to perform ................................
plumbing in the buildings of .................
at ... ? . `.:.. 1 !,. F. t .'.�:.. f. ! ............. North Andover, Mass.
C
Fee. .... Lic. No .......... ..... t - ... .........
PLUMBING INSPECTOR
Check # '
5144
19
I
�v
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Mass. Date 1�7 2,x 2 Permit #
Building Location_c6j (stJ �/i� Owner's NameA,: SLS an -�Lle rreIez
b, Type of Occupancy 51 DEW TI r-') (r
New ❑ Renovation ❑
Replacement 2 Plans Submitted:
,' . 1�
FIXTURES
Yes ❑ No ❑
Installing. Company Name Aor3£e7 _�i 1j,46lrY►F}?r4e7 Check one: Certificate
Address c R C H.lY1 r1 n) pi ❑ Corporation
Ir E TW I') 157A) YO t 011 (/L/ ❑ Partnership
Business Telephone (4Z -C/97 1 9-6;m/Co.
Name of Licensed Plumber '&r3 ee T fig �An�ldvl�4 tr4 ��
INSURANCE COVERAGE:
I have a current I}'�bility 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 coverage by checking the appropriate box.
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 ❑ 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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
By v[, L
re o U6insed Plumber
Title
own Type of License: Master % Journeyman ❑
APPROVED OFFICE USE ONLY) License Number D3-5
Y
•
•
•
•
mom
Installing. Company Name Aor3£e7 _�i 1j,46lrY►F}?r4e7 Check one: Certificate
Address c R C H.lY1 r1 n) pi ❑ Corporation
Ir E TW I') 157A) YO t 011 (/L/ ❑ Partnership
Business Telephone (4Z -C/97 1 9-6;m/Co.
Name of Licensed Plumber '&r3 ee T fig �An�ldvl�4 tr4 ��
INSURANCE COVERAGE:
I have a current I}'�bility 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 coverage by checking the appropriate box.
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 ❑ 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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter of the eral Laws.
By v[, L
re o U6insed Plumber
Title
own Type of License: Master % Journeyman ❑
APPROVED OFFICE USE ONLY) License Number D3-5
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