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HomeMy WebLinkAboutMiscellaneous - 60 WOODCREST DRIVE 4/30/2018 (2)i IV O O c W O � v � �n m 0 0 0 i° Date ../. ///. 7. /�*/ ........ TOWN OF NORTH ANDOVER k: PERMIT FOR GAS INSTALLATfON This certifies that ../.�{'.rri�9C!� I/�..�ar'� ..... . has permission for gas installation . 4�014<,,hti !�.rr!1y Ge . in the buildings of��..J).vT4y"mp`:�'I..................... at .. �o ..lam �i .?'� .,1/1 %�"ey�' /Northh doves ass. Fee. SO t0!J Lic. No. %/7�... /�ich4�d!.�,�t?o!" . . GAS INSPECTOR Check # 0,00 6�� ,} C ,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 the permit issued for this application will be in compliance with.all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: I MICHAEL HOUSE LICENSE # 7173 __ STG ATURE ' { OMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS: 1-15 AEGEAN DRIVE, UNIT #3 CITY: I METHUEN STATE: MA ZIP: 1-2244— FAX: 978-68972206 ,,,,, TEL: 9787689-8312 CELL: 1 978.884-3427 EMAIL: LLITTLE@MVALLEYCORP.COM MASTER 0 JOURNEYMAN SLP INSTALLER ❑ CORPORATION ❑■ # 33TIC PARTNERSHIP ❑ # LLC ❑ # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GOWNER TYPE OR PRINT CLEARLY CITY ja MA. DATE /� /. l . _ 3 PERMIT # JOBSITE ADDRESS OWNER'S NAME / P ADDRESS: TEL: — FAX: I OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW: ❑ RENOVATION: ❑ PLACEMENT: PLANS SUBMITTED: YES ❑ NOX r FIXUTRES 7 FLOOR— Bsmt 1 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOKSTOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER OOM / SPACE HEATER "OOF 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 ❑■ 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 ,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 the permit issued for this application will be in compliance with.all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: I MICHAEL HOUSE LICENSE # 7173 __ STG ATURE ' { OMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS: 1-15 AEGEAN DRIVE, UNIT #3 CITY: I METHUEN STATE: MA ZIP: 1-2244— FAX: 978-68972206 ,,,,, TEL: 9787689-8312 CELL: 1 978.884-3427 EMAIL: LLITTLE@MVALLEYCORP.COM MASTER 0 JOURNEYMAN SLP INSTALLER ❑ CORPORATION ❑■ # 33TIC PARTNERSHIP ❑ # LLC ❑ # ,4 lWe Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: _d City/State/Zip: ///��.tI J. /////-/ t'91A`T Phone #:. Zj Are you an employer? Check the appropriate box: 1.;d I am a employer with , � 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance required- comp• ins rranceJ 5. E] We are a corporation and its 3. El am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.) t c. 1522 § 1(4), andwe have no employees. [No workers' comn.-insurance required -1 _.. Type of project (required): '6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.0 Plumbing repairs or additions 11M Roof re ' s 13.p Other =% *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. XContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. I/ ) --- _ . . / _ I Insurance Company Policy # or Self -ins. Lic. #:///q�o S�?/.3%//9/f Expiration Date: Job Site Address: i AKiJC City/State/Zip:A). Ar� �/ % d/gw Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I Flo that the in ornati n provided abov is true and correct: OfJklal use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Auihority (circle one): L' Board of Health 2. Building Department 3. City/Town Clerk' 4. Electrical inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: r- . COMMONWEALTH OF MASSACHUSETTS LICENSED AS A MASTER PLUMBER ISSUES THIS LICENSE TO °Ly MICHAEL H HOUSE 0 63 MARSH LN T5 R9 TWPn EBEENEt: TWP.. _ ME •04414—;613- 7173 05/01!12 763715 J L•d 6LL9996LOZ esnCH eliW dgL:£0 LL 9L des Client#: 79303 MERRIMACKV17 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 06!10/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HUB International New England CONTACT NAME: PHONE 978 657-5100 866- - _INC, No, Ext): .'.Inlc, No)__ _475 7959 —- 299 Ballardvale StE-MAIL-- Wilmington, MA 01887 978 657-5100 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Travelers Property Casualty Co INSURER A : p •7 y 25674 INSURED Merrimack Valley Corp etal 15 Aegean Dr #3 Methuen, MA 01844— INSURER B: _ - INSURER C - INSURER D - INSURER E _ 4 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD 1 POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY) LIMITS A GENERAL LIABILITY X X C01A653551 COF1 1 06/13/2011 06/13/2012 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) s 300,00() X COMMERCIAL GENERAL LIABILITY _ 4 1$5,000 CLAIMS -MADE OCCUR MED EXP (Any one person) PERSONAL &ADV INJURY 1$1,000,000 X BI/PD Ded:$2,500 Incl ALAE GENERAL AGGREGATE 1$2,000.,..0.....0_...0 ._—._.____..._... ._. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG ! $2,000,000 POLICY 7X PRO- JECT LOC $ A !AUTOMOBILE LIABILITYX _.....Ea X 8102A91436000F11 6/13/2011 06113/2012COMBINED SINGLE LIMIT accident — S1,000,000 BODILY INJURY (Per person) IS 1 X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS —__.. AUTOS PROPERTY DAMAGE S X X NON -OWNED HIRED AUTOS AUTOS _.. Per accident $ EACH OCCURRENCE 0000.0W A&NY A I X UMBRELLAr AB �,. X,a OCCUR 3F�_ X:. :•X•,`: `.QY'l�Et:; 1)��-�l0 6/1312011 06/13/2012 FADE IAGGREGA7E`i+.. EXCESS,LIAB ..v..U. >Ctp;IMS-M rInN $10000 FRS u Fr F 'h A X;. DTHUMA64 r...:, 'i7 n !L011I061113/201 r -tel nlU 0RY W:" AND EMr� LR rL Y�NL, Y - ANY PROPRIETi, i\ ti a! i . OFFI^FRIMF.MBER E'L'P'EACH Ac,IL it ,:: OO OOO , . L."' Ml 1 Mandato u Mli; (Mandatory i r E.L. DIScF,SE EA e_MI'.Cii;._.i'y_ f10 000Y i j If yes, describe under j DESCRIPTION OF OPERATIONS below 1 - E.L. DISEASE - POLICY LIMIT j $1,000,000' A ;Install Floater C01A653551COF71 6/13/2011 06/13/2012 $500,000 A Transit Limit $250,0001$500,000 $1,000 deductible DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Blanket Additional Insured included as per written contract, Blanket Waiver of Subrogation included as per written contract, primary & non-contributory wording applies as per written contract. Named Insured includes Matz-Rightway. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1&V440z IV ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #547398 EH002 Date .2-. :.`... I...... TOWN OF NORTH ANDOVER 9 PERMIT FOR GAS INSTALLATION This certifies that .. )f �Y. �� �.:.' ... . ��'. f ... ........... . has permission for gas installation ...�:'. `,J ............ in the buildings of !Z. w Q4 ........................... at .. °. �. L.° . c ! Z ' i , N, orth Andover, Mass, Fee.. fir..... Lic. No..3.�,). .�.... ' : ......... GAS INSPECTOR Check # 3e43 A30 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO (Print or Type) Ndi:& , Mass. Date Building Owners Type of DO GASFITTING 'wooer Ne*;f!�\ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET ® Corporation 103C MIDDLETON, MA 01949 ❑ Partnership Business Telephone 978-774-2760 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: I have aY usrreent liability InsuNo rance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy EX Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 OwnerO Agent O 1 hereby certify that all of the details and information I have submitted (or entered) in above appfxxtion are and accurate to the st of my knowledge and that all plumbing work and installations performed under the permit i for this f will be in com a'� 'th all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ra Laws. By T of Ucense: Plumber Signature o Plumber or as atter Title Gasfitter 3785 aster Ucense Number City/Town Journeyman APPROVEff O C I• Y • ■�����t�������■ EMMONS ■E■ MEMERMEMMEMOMMEMIN MONOMER r My .. ■������������������t�■ MEN CM Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET ® Corporation 103C MIDDLETON, MA 01949 ❑ Partnership Business Telephone 978-774-2760 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: I have aY usrreent liability InsuNo rance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy EX Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 OwnerO Agent O 1 hereby certify that all of the details and information I have submitted (or entered) in above appfxxtion are and accurate to the st of my knowledge and that all plumbing work and installations performed under the permit i for this f will be in com a'� 'th all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the ra Laws. By T of Ucense: Plumber Signature o Plumber or as atter Title Gasfitter 3785 aster Ucense Number City/Town Journeyman APPROVEff O C k Location 6 a No. y.19 C 'Check # /1 96 Date 023 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL `c6388 /'` Building Inspectdr,/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING „ ...: '4 .fi. -.0 j a' •tt yr L"§1 d3 a ,� 9R 'P__. ,z'i^: s.. qm BUILDING PERMIT NUMBER: DATE ISSUED: a 40-64 0 f, k A IV V I SIGNATURE: Aa4&f Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: y 1.2 Assessors Map and Parcel Number: 00 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record M e C)VA �E, E)(0CCt/'zS' b game (Print) ` ! Address for Service: #gn'ature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: i ignature Telephone Not Applicable ❑ ` License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ ( z) V Company Name 'f" r F 7 SJL I%(�: �%s S `jl�U Registration Number Address Expiration Date Si na re Telephone O z M 90 O Mn M ror z Q SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed atiidavit Attached Yes .......❑ No ....... 0 SECTION 5 Descri tion'of Proposed Work(check all applicable) New Construction ❑ - ..: %Exi g B�g ElRepair(s) t ElAlterations(s h Addition ❑ Accessory Bldg. ❑ Demo tion ❑ Other ❑ Specify -.V M i '1� Brief Description of Proposed Work: r y 2Oe f12.f—Vt1— Q- q ( C SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant b QFFTCIAL�USE QIVLY " 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) /� f 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZAYION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BU 1LDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters r laY1 -WO �V5—edb�44 s building permit application. Signature of Own / Date SECTION 7bOWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date I NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DWIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE IS k z CL r c c '• m c :ccs • o � C H O C j W O Ci C.3 c' cc ev ID C :s o C3C13 CDN Ea CF ._ C.3 «. CD o c. N O = C, :�� CD : N R �9 ®® CDCS) �3 N : :I. CD N O A- N :Em a.C� .41% _N y m rte.+ C a c s m o� cc :11, s : oc o O y CD « N �dt C Q.0vy ® cm o®�c m og A y t � 0.= m :c E CDCL 4- N �O O N c O c 75cmCD cm m `D cm c C N CD t O 2 0 45 C) -10 � 911. 0 a IN _0 U) U) Ir w W vJ b-13 a Cl) O A Cc: . z w0 xa � w w O b 2 w O U � U w to 2 :)w U c a O � d 0w co w W w w v z ' Q cn z CL r c c '• m c :ccs • o � C H O C j W O Ci C.3 c' cc ev ID C :s o C3C13 CDN Ea CF ._ C.3 «. CD o c. N O = C, :�� CD : N R �9 ®® CDCS) �3 N : :I. CD N O A- N :Em a.C� .41% _N y m rte.+ C a c s m o� cc :11, s : oc o O y CD « N �dt C Q.0vy ® cm o®�c m og A y t � 0.= m :c E CDCL 4- N �O O N c O c 75cmCD cm m `D cm c C N CD t O 2 0 45 C) -10 � 911. 0 a IN _0 U) U) Ir w W vJ 0 W 1 ✓ire �ayrznznraurea�� P�j✓L"�.iJao%rude�d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR, Number. CS 078130 Birthdate: 06/02/1872 r Expires: 06/02/2004 Tr. no: 78130 Restricted To: 00 RICHARD J DECOITO 50 WHITE STREET [ E.••a al. HAVERHILL, MA 01832 Administrator A North Andover Building -Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be ' disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector ivame The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers' Compensation Insurance Affidavit Please Print Name: Location: CltyPhone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for rrry employees working on this job. Company name: L E2-, an vf Address J S'7 L 1AC IJ S 1-1 C tU A Company name: Address Crty Phone. Failure to secure coverage asrequited: ur>der Section 25A or MGL t52 can d to -the irripasAion oPe **' al pew of a fine op°bo $1,5 and/or one years' irtrprrsorunent_� vi[e1Las_c l peva sin nrio l�YJK"(DfUXR- nct afore-aA= M)-aJgr-againstme understand that a copy of this stere a 'moray be forwards to the Office of tnrestigat s of the DIA for coverage verification. / do hereby eeddy imdar of pesjwy that the ff fornmhon provided above ,is Eve and correct Signature 1_"' pate Print name F= 1 G �i l T O Phone.# % 9' y Official use only do not write in this area to be completed by city or town official' City or Town Permit/[ icensi Building Dept E]Check if immediate response is required 11 Lice[W09 Board El Selectman's Office Contact person_ Phone # E] Health Department E] Other Date............. .................. 01 TOWN OF NORTH ANDOVER A . PERMIT FOR WIRING , 4 This certifies that ...��= a y �� .......................................... ........................ has permission to ? perform z/4'� ........... .... ....d / .... . ... / ...... 4 wiring in the building A) ............. at ................ . North Andover, Mass. IFee. No............A. A ........... Lic. N ............. ELECTRICAL INSPECTOR C�ck # 5,572 I� a£,MSP�4 Use Only The Commonwealth of Massachu Us Office � Department of Public Safety Permit No. 5- �j 7-P- V1 "°'�� BOARD OF FIRE PREVENTION REGULATIONS 527 MR 12:00 Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO P RFORM ELECTRICAL WORK All work to be performed in accordaVthechusettsElectrical Code, 527 CMR 1200 (PLEASE PRINT IN INK OR TY E ALL INFORMATION Date - 1f4 �U� City or Town of Qf4 �J O�Q�+ To the Inspector of Wires: The undersigned applies for a permit to perform theelectrical wor des bed below. Location (Street & Number)_` t0� "JooJe S - ��� Owner or Tenant �-y ICS 1 elrn Q Owner's Address__ S� Is this permit in conjun:tion with E. building permit yes ❑ no C (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps /—Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ �J),)QSA_ No. of Meters --- No. of Meters OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO L1 I heave submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YE please indicate the type of coverage by checking the appropriate box. INSURANCE L� BOND ❑ OTHER ❑ (Please Specify)__ _ (Expiration Date) Estimated'Value'bf Electrical Work $ So • rtn+ Work, f& ­_tart - Inspection ' Date�3niRequested: Rough final__ / -- --- - Signed tinder the penalties of perjury: , FIRM NAME- Q h /v S �� P C/�l C G>? '--:� . _ c_. LIC. NO.�U =L-_ Licensee -7-6/4 Aj G R1 � �£ Signature 1 �`j / 9 LIC.p�N�O_Jg Q/_ AdAress �. ��i w 1 �l• r h G �� _C� 2U Bus. tel. Noll? t a - 53 V� Alt. Tel. tta.�r%����� Oi l9 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one) Telephone No (Signature of Owner or Agent) tM1T FEE $ TOTAL No. of lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Above In Swim -Ming Pool grnd. ❑ rnd ❑ Generators KVA ` No. of Emergency_Lighting... No:.of Rece, tacle Outlets- - +7', No. -of Oil Burriefs Battery Units No:. of Switch..Outlets :..; - No. -of Gas Burners FIRE ALARMS No. of Zones No. of Detection and TOTAL No. of Ranges No. of Air Conditioners TONS Initiating Devices No. of Sounding Devices HEAT TOTAL TOTAL No. of Disposals No. of Pumps TONS KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection ❑ Other No. of Dryers HeatingDevices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. of Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO L1 I heave submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YE please indicate the type of coverage by checking the appropriate box. INSURANCE L� BOND ❑ OTHER ❑ (Please Specify)__ _ (Expiration Date) Estimated'Value'bf Electrical Work $ So • rtn+ Work, f& ­_tart - Inspection ' Date�3niRequested: Rough final__ / -- --- - Signed tinder the penalties of perjury: , FIRM NAME- Q h /v S �� P C/�l C G>? '--:� . _ c_. LIC. NO.�U =L-_ Licensee -7-6/4 Aj G R1 � �£ Signature 1 �`j / 9 LIC.p�N�O_Jg Q/_ AdAress �. ��i w 1 �l• r h G �� _C� 2U Bus. tel. Noll? t a - 53 V� Alt. Tel. tta.�r%����� Oi l9 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one) Telephone No (Signature of Owner or Agent) tM1T FEE $ _1- i ,.r Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� / This certifies that . ............... f / has permission to perform .... . .6:.. .. �..:.....: . ... � plumbing,in the buildings o ............ .... . at .1�.tii�/./ f. �....... , North Andover, Mass. Fee .... Lic. No. d ..................:.......... . / PLUMBING INSPECTOR Check # 6326 MASSACHUSETTS UNIFORM APPLICATION (Print or Type) /0'q 4vvdau. 'C' ///7 Mass D t Building Location New ❑ a U W e6,d &Q Sf Renovation ❑ R FEATt F F PERMIT TO DO P�UMBI G , 20 Permit # ''������`�� Jier's Name �t-1` _/ �Y_M4V Al ment E4� Type of Occupancy Plans Submitted Yes ❑ No ❑ Installing CompanyNameltr4a1 6�cAlt'-p-L��1yJ�/ yl)(eheckone: Address l� 6 orporation ❑ Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber_ Certificate INSURANCE COV AGE: I have a current ' 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 of coverage by checking the appropriate box. A liability insurance policy ther type of indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have theJnsurance 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 ❑ _. Si nature of Owner or.Owner's Agent ; nereoy cemTy ,tnat an or the oetaus and �nto the best of my.knowledge and that all.plurn—W r be in compliance with all pertinent provisions By Sign t ve submitted (or entered) in above application are true and accurate to work d installations ormed under -the permit issued for this-application""'will the assachusetts te- lumbing Code and Chapter 142 of the General Laws. Title Type of`Cicense: Master urneyman ❑ City/Town License Number APPROVED 0FFICE USE ONLY) • •0 z .. - logo• ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ M.111922 i • • - ■■■■■■■■■■■■■■■■■■■■■®■■■■■ Installing CompanyNameltr4a1 6�cAlt'-p-L��1yJ�/ yl)(eheckone: Address l� 6 orporation ❑ Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber_ Certificate INSURANCE COV AGE: I have a current ' 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 of coverage by checking the appropriate box. A liability insurance policy ther type of indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have theJnsurance 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 ❑ _. Si nature of Owner or.Owner's Agent ; nereoy cemTy ,tnat an or the oetaus and �nto the best of my.knowledge and that all.plurn—W r be in compliance with all pertinent provisions By Sign t ve submitted (or entered) in above application are true and accurate to work d installations ormed under -the permit issued for this-application""'will the assachusetts te- lumbing Code and Chapter 142 of the General Laws. Title Type of`Cicense: Master urneyman ❑ City/Town License Number APPROVED 0FFICE USE ONLY)