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HomeMy WebLinkAboutMiscellaneous - 53 FERNWOOD STREET 4/30/2018 53 ��NWoa� st BUILDING FILE Date.. j.................. t raOR7M, 3j;.';�`"-;•�"�o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41 SACMUSEt This certifies that ........................ ...... M r-e_a.. r�.t-tee has permission to perfor�I�,,.�.... ..............-�..............:...../.�.�...�.�rrr� , wiring in the building of ................. .... ........................../.......... y at:v`3..........,......................................................... .North Andover,Mass. Fee... ......... Lic. ..................... .......... ELECCR(CALINSP CTORR Check # 6656 N Commonwealth of Massachusetts Official Use Only u Department of Fire Services Permit No. 661-S Occupancy and Fee Checked ` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) ,573 ?-,rAyOp cf f J� Owner or Tenant LT-4(d' Mc4al�4y Telephone No. ?,2dr Owner's Address S-3 L,7x-& S� Is this permit in conjunction with a building permit? Yes ❑ No Li ' (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 9do Amps h�&Co Volts Overhead [9"' Undgrd❑ No.of Meters New Service Qoy) Amps /86 /&40 Volts OverheadE]' Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1790U Completion of the following table may be waived by the Ins ector 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 No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ig mg rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No. of Air Cond. Total No.of Alerting Devices Tons No. of Waste Disposers Heat Pump Num erTons KW No.o elf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mun'cipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the h7spector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: r_C29--O L 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 ©/FOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that dee information on this application is true and complete. FIRM NAME: ct! P/Yc77&"C5 vvrK7. LIC. NO.:f/y�?/3. Licensee: Pe'.4,z7r"vc-7? � Signature / LIC. NO.:llq/ 1�—,b (If applicable, enter "exempt"in the license number line.) Bus. Tel. No.: 427_9V619217 Address: L.r�f tt,�.� S7` �t„r�✓ �— -` !i(-�K} Q/�(o Q Alt.Tel. No.: 47k366_5-677 *Security System Contractor License required for this work; if applicable,enter the license number here: 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 PERMIT FEE: .$ Signature Telephone No. Date. f 40RT1y 3?����`•',;���Oo� TOWN OF NORTH ANDOVER PERMIT FOR/PLUMBING s o� �• a ,SSACHUS� This certifies that . . . .... .. . . . . . . 5. . . .. `` . . . . . . . . . . . has permission to perform . . .(.",.�'�` �` �`° plumbing in the buildings of . /" . . . . . . . . . . . . . . . . . at . . .'L. �`. `� . . . . . . . . . . , North Andover, Mass. Fee.y.7 Lic. No.:> 1.r.': .: . IF PLUMBING INSPECTOR Check #11- 1 8479 p MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: J) l�- , MA. Date: a��� Permit# Building Location: 'S3 WuD S Owners Name: Type of Occupancy: Commercial❑ Educational ❑ Industrial [] Institutional ❑ Residential] New:❑ Alteration: Renovation: ❑ Replacement: ® Plans Submitted: Yes❑ No❑ FIXTURES z z 0 zWIL 3 = z I— z to z a ¢ V) z M o � Q W Q a W z o 9 W z W N 0 v a Q LL LL f— gQ D H N J W W u1 0 = a Op 0 3 v > > 0 0 p z ? is 1-- 1-- U) ~ _ a m m o o � = Y g g W° CO W M 3 0 'SUB BSMT. BASEMENT 1 FLOOR ftA LI N Ac 2 WFLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# ^ ',�,�n ,n Corporation Address: Address:. r r I City/Town: C L State: ❑Partnership Business Tel: 5�nx Irm/Company Name of Licensed Plumber: INSURANCE COVERAGE: i 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. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee doesof have ve 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 Owner's Agent I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under theermit Issued for P this appflpation will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the eneral s. By Type of License: Title ❑Plumber Signature of Licensed PI tuber City[Town ❑Master APPROVED OFFICE USE ONLY Journeyman License Number: �J earrll of Jlassaclrrtsetis F?:rint�orrt� --' --��. De partment of"'dustrial Accidents Office of Investigations 600 ff ashingtort Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: Bu y/dna . alders/Contracto>"s/Electricians /Plumbers A Iicant Information Nallle(Business/Organization/Individual); Please Print Leaibl) Address: City/State/Zip: Arene#: you an employer?Checic the appropriate box: Pho • —�J 1•❑ I am a employer with_ 4. ❑ 1 am a general contractor and 1 Type of project(required): Pmployees(full and/or part-time),* have hired the sub-contractors 6. ED New construction 2. am a sole proprietor or partner- listed on the attached sheet. slip and have no employees These sub-contractors have 7. M Remodeling • vrorl* forme in any capacity, employees and have workers' g' ❑Demolition INN workers' comp, insurance comp, insurance,+ 9• El Building addition � TV,Ll 5. [l We are a corporation and its 10.[1 Electrical repairs or additions " J.❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL I I El Plumbing repairs or additions insurance required.] t c. 152, §1(4),and we have no 12•❑Roof repairs • employees. [No workers' l 3.E] Other comp.insurance required,] app]icant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information.. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 'Contractors that theca:this box must attached an additional sheet all the name,of the sub-contractors and state whether wnot those enmloyees. ];th;sub-conuactors have employees, aot thoseindicatingttleh such. !o ees,they must provide their workers'co ose entities have I am an emplot er that is prot=r.'ding 11)orkers'cmpensation insurmice for n��employees Below ' iuformati°n' oN 1s thepolicji and job site Insurance Company Name: Policy 9 or Self-ins,Lic.#: Expiration Date: job Site Address: Attach a cop}.of the w orl:ers' compensation policy declaration page(shol,gngitile tpol,c3 number and expiration Fai_]ure to secure coverage as requited under Section 25n of MGL e, 152 can lead to the imposition fine up to 51,500,00 and/or one-year imprisonment,as well as civil penalties ui the form ofa STOP W ptration date), 1 of criminal penalties of a o; up to S250.00 a day against the violator. Be advised that a copy of this WORK ORDER and a fine I;;;estiU ` anon o tine DIA for insurance coverage v p statement may be forwarded to the Office of I g erification. aR/tnj•,�l;l•Hotta fi•.:!:Ifs;'fl.`f%a.Ji^ ....J 1, ` p es ff�c�:%u%��trat flat irfornratiarr provided above is true and correc4 Stynature. Phone— Date: 14 Official use oltlr. De oto;i,�r ate ir, oris area, to be completed 6y cltt�or ton,11 o acia ff L Cite or Towri: Issuin Authorir� (circleone1; Permit/License# 1.Bois ` 0"Health ' a c:Health 2,Building , Department ;, Citi;Town Clerk 4.Electrical Inspector 6 O it`r p for 5.Plumbing ' corl :et Person: b Inspector Phone#: Date. .. . ... .. pOHTH TOWN OF NORTH AND.0 PERMIT FOR GAS INS4LLATION SA S This certifies that . . . . .. . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . at . . . f . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . Lic. No. . . . . . . . ..... . . . . . . . . GASINSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATON FOR PERI�IIT TO DO GAS FITTING (Type or print) Date 5 a,Z -C3 6 NORTH ANDOVER,MASSACHUSETTS Building Locations -�� c'�'.vA/oo 4 S7- <y eyjlo 4cC4�T�`� Permit# Amount$ eell4!J / G 'A 4,7)V ' Owner's Name New❑ Renovation ❑ Replacement © Plans Submitted ❑ w 0 v, �n w ° Uas x z o w aco w N o o a z F U z c x o x 3 A cal U a > a F SUB-BASEM ENT BASEMENT IST. FLOOR 2ND. FLOOR 3RD . FLOOR H . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR (Print or type) eck one: Certificate Installing Company Name T y4 L L o f/-1 r✓ /�4 1-/ Corp Address /' 0. Q d X 5-7,k ❑ Partner. e-4ki4eeve-P Al Ig aid' SQL Business Telephone 9.71 to b'5-- 9 -15-0 y ❑ Firm/CO. Name of Licensed Plumber or Gas Fitter 7!'y v/Ys r✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ Ifyou have checked ves,please indicate the type coverage by checking the appropriate box 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: Signature of Owner or Owner's Agent 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State GGasCode an Chapter 142 of the General Laws. 74 By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber � Y � 33 City/Town ❑ Gas Fitter License Number ❑ Master APPROVED(OFFICE USE ONLY) © Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS /� - Building Location .-3 Aeewwoab Owners Name 64e4* !0 ��L'i9?>�1y Date Permit# Amount Type of Occupancy pw ell;Al 5i New Renovation Replacement © Plans Submitted Yes No FIXTURES L=.� &B-ME BASKVI NT �SEkI�EIt 71�IIF>1D�t 3D.110OR 4II�l��Qt � - B- M 1H1" (Printor type) Check one: Certificate Installing Company Name T 14 Pi L(.o r�.A-r1 Corp. Address P.O . d n 57), Partner. 1')r2 .NCe tMA O1 sq Z Business Telephone 9 7 6 5—9 5,6 y D Firm/Co. Name of Licensed Plumber: 7-7-10 M t4,S 1-14 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityD Bond D 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 ...Signature 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P ppbing Code and Chapter 142 of the General Laws. By: SignTo1 1_1censeQ FlumDer Type of Plumbing License Title 1103 City/Town TIMM 74umoer Master D Iourneyman F APPROVED(OFFICE USE ONLY