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Home My WebLink AboutMiscellaneous - 611 SALEM STREET 4/30/2018 J 1 m n i e m i r, 611 SALEM ST Date.. Ile ?.. .... .. e ,NORTH TOWN OF NORTH ANDOVER p F PERMIT FOR GAS INSTALLATION O� SAC IIUSEtS .germ . 6.� This certifies that . . U./T? �q. . . . . ./` . . . . has permission for gas installations. . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . ...North/Andover, Mas Fee. . ' Lic. No.. �Z�. . GAS INSPECTOR Check# 8208 +^ �. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK MA DATE;�o \� �Z_._._..._ PERMIT# CITY ` ----- -� JOBSITE ADDRESS G�\�_ �. _ - -_--_-- _ OWNER'S NAME : r.�4_��thy.) OWNER ADDRESS PRT O OCCUPANCY TYPE COMMERCIAL j EDUCATIONAL I., RESIDENTIAL'x CLEARLY NEW RENOVATION: REPLACEMENT:± PLANS SUBMITTED: YES . NO X APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE _. DIRECT VENT HEATER DRYER FIREPLACE - - FRYOLATOR FURNACE - GENERATOR (MLLE - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER RAF TOP UNIT TEST _...._ UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policyor its substantial equivalent meets the requirements of MGL.Ch.142 YES WINO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY --1 BOND OWNER'S INSURANCE WAIVER:I am aerare that the licensee does not have the insurance coverage required by Chapter 142 of the { Massachusetts General Lirms,and that aty signature on this permit application walvea this requirement. i - CHECK ONE ON LY:-- OWNER--..;_AGENT--__---_-- --.. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Inkmr,ation I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing worts and irutaltations perforrrred under the permit issued for this application wllt be in compliance eminent proviso of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME � .r�e k `C�?ox1+c�._�n_'LICENSE# Z$ SIGNATURE 1 PARTNERSHIP LLC # MP'X MGF'_ JP 1GF - � LPGI . ; CORPORATION X I# Z S _., i COMPANY NAME:G1 all _ CITY L.� ►C_�`n _. ; STATE T ZIP.O Z4S 6.5_,ITEL Li G t� i -, -- _ _ ..__. ..- FAX CELL'i ;EMAIL' ROUGH GAS WSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes .No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I i I i _ I I. i i I - I COMMONWEALTH OF MASSACHUSETTS \ COMMONWEALTH OF MASSACHUSETTS ° • ° -• o :° -r • MIT- 1:11 PLUMBERS AND GASFITTERS AS •, MASTS R-UNRESTRICTED LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO. ISSUES THE ABOVE LICENSE TO: 1 FREDERIC:<, J MOXHAM FREPFRTCK J MOXHAM GEM PLUM.9ING ",ERVICES ro 9.1 _°WEST ST 1u 9 1 WELLIN13TON F'D ; LINCOLN R �A ATTLEBORO MA 02703-3.339 =" I 02865-4411 , 3875 05/ 8/14 9628 05/0.1/14 158;313 . 162523 II!I • COMMONWEALTH OF MASSACHUSETTS: COMMONWEALTH OF MASSACHUSETTS REGISTERED AS A PLUMBING CORP RHUMB"ERS AND GASFITTERS LfCE`ISED A.S A JOURNEYMAN 'PLUMBER ISSUES THE ABOVE LICENSE TO: ISSUES THE ABOVE LICENSE TO i FREDERI.G.K J MOXHAM i GEM ,PLUMBING & W.EATINO S.ERVI F REgEf'IGK J MOXHAM 991 .--;WEST. ST ;a ,-1 ,WEA T ST ATTL,EBDRO MA 02703-3'3:39 _ AITLEBOI?O MA 02T>03 3:339`` � . 2899 05/01/14 144;742 I6.7T6_ 05/01/14 158314 ' UK17,E a; , o : � 36oarb of 3ftegi5tration of-4:zfjeet-tletat Dorf cry Our iwlltg 5att5fteb file renuirement5 of-01a5nrim5ett5 6eneni katu Lf,Itapter 112,*—erttott 231 through 251 v Oen Plumbing 'weating Co Tnc E5 Iterebn grauteb flits certiftratr no.4116 a5 eoibenre to practice a5 a Ricediseb *beet Ifletat �a�ine�s on this 611 Dap of-jebruarr 2012 !In'irrstimonn althr rrof,is brrranro affiseb the nan,r of the(emutiue T)irertor of fhr coara Ydti B lGl1K �k«..K/S ZO/2 Date. A/k/�z4 9454 .. .1 + TOWN OF NORTH ANDOVER 49 PERMIT FOR PLUMBING SSA�Nus� C j This certifies that . . . has permission to perform . . . ./ 4!111tP.�.f". l`/4 plumbing in thp buildings of . . , . . . . . at . /5-: orth A/r�dov r, Mass. Fee.3�'.001-ic. No.. . 1� 4' �Y.,, l? ?i"T'1. . . . . . . . / PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i CITY - cr ._�tr.0 oY e..!r.—__' MA DATE 6 1 2`, (PERMIT# 7UV .OBSITE ADDRESS \\ 5� � _._ OWNER'S NAME; ��Q, _ �--r t�,. Vh°►rl OWNER ADDRESS -- __.._ _.. �`n -._ ± TEL y TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL j RESIDENTIAL PRINT CLEARLY NEW: `M RENOVATION-Lj REPLACEMENT:i PLANS SUBMITTED: YES!_- NON FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 ;8 9 10 11 12 13 14 BATHTUB - _ — CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASlO USAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM - DISHWASHER V DRINKING FOUNTAIN - FOOD DISPOSER -- FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY - ROOF DRAIN - - - SHOWER STALL SERVICE I MOP SINK TOILET - - URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING ~ OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES.)(! NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i i I LIABILITY INSURANCE POLICY,,)( OTHER TYPE OF INDEMNITY ! j BOND I-, 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 I I hereby certify that all of the details and infarnaticn I have w-bndted or entered regarding this application are:MA and accurate to the Crest of my knowledge, and that all plumbing vxrk and installations performed under the perrnit issued for this application will bein— 1 Pertinent provision of the t4assachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME rQ.a Zr�ck `M o x�, 'LICENSE# Z� SIGNATURE gin_. _.._` —_� -- I QIP X JP CORPORATION #;_t:,� g- PARTNERSHIP; ff# LLC. COMPANY NAME 'ADDRESS,` CITY 1-\h c a`-r1 STATE �Z ZIP Z cB to S _ TEL: �� r. ` .4 F kX CELL EMAIL i ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY— FINAL INSPECTION NOTES a Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: S PERMIT# PLAN REVIEW NOTES r , ,t r" i Date.5�7... ........ .... .... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU Thiscertifies that ................................................. . ................................. has permission to perform .... ....... K f wiring in the building of...........r....... ........................................ at..... ........... .................. North Andover,Mass. Fee... `..5........... No. .... Z�or..... A'L-I'N*'S*P**E'C**rOR Check # Se) 6 F'3 8745 �r �` �: \ �„�,onw•ra .a�///mss�rhus.��i`s �� Of',�icciia`ll USc�Oyy Only -� _CJ�Parrm�rcf o�J'ir� Sarvcca� , a ' Occupancy and Fee Checked BOARD,OF FIRE PREVENTION REGU.ILA T IONS [R,,/. 1/07] leave black) - •J APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Allµ�odcI to be performed in accordance with the,Ylassac;•tu.sctu E'ec:.-real Code(MEC;,S?,^Q4R 12•00 . (PLEASE PRINT N INK OR TYPALL LVFORIAIAT1 Ot' Date: 3/S/6 LJ City.or Town of: /ti/or I-A 4AJ rV-U�- To the Inspector of W-iiree.s: By this application the undersigned gives notice of his or her 'ntencion to perfot„t the electrical work described below. �! I Location (Street & Number) // ,_Jv Owner or T enant 0 er f /C�A1h.J Telephone No. 9 7 -96 dvd Owner's Address �y-� Is this per mit in conjunction with a building permit? `!es E] No U (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Sc:,,ice Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters New Service :. Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity --- ' I ocatio:. and Nature of Proposed EIectrical Work:. cc u.r t ;0.r r 7: `J LSTe In Co!(owinR table,n be waived b the lns ector of Wiris: ompletion o the t o.of otal No.ey Recessed Lumir_aires No.of Ceil-Susp.(Paddle)Fans Transformers KVA _ N o.of Hot Tubs Gerierators KVA Outlets u_lets r,o.of 3_,u.ntnaire O .- t n- 1N 0-o meraency rg.runo. No. of Luminaires Swimming Pool- No. � Qrnd- ❑ Battery Units . No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones i o.of etection an No.of;Switches No.of Cas Burners *--bating Devices oral No.of AIertina Devices No.of Ran,ges No.of Air Cond. Tons i eat ump ,tm er ons o.o Self- ontarne No.of Waste Disposers Totals Detection/Alerting Devices No.of Dishwashers Space/Area Hestina KW Connectio Other Heating Appliances r Securityyyste.ms-* No.of Dryzrs No-of De or E uivalent No.o o_of to Wiring: ter t 0.0 heaters, KW Signs Ballasts No. -of Devices cE uivsicnt Telecom niunicatrons iring: No_H}'=lromassage$athtubs No_of Motors Total HP No_of Devices'or Equivalent OTHER: /97-� sSLd9 Arta h additional detail f desire-d or as required by the Inspector of Weer. t Estimated Value of Electrical Work: (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 fol•the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalenL T1rc undersigned certifies that such coverage is in force,and has exhibited proof ofsame to the permit issuing office_ CHECK ONE: INSURANCE 3 BOND F1OTHER ❑ (Specify:) I certify,undr ethe pains and penalties of perjury,that the information on this application is true and.camp/etc. C�GLtrt'>�' S�C'tilLGPS LIC_NO.: FIRM NAME: gg ---� LIC_NO_: Licensee: � �t � j /O� Signature-- ---�--- ,,r•9� / a lrcab/e,enter a t"in a licenr�wn erline.J /�t5 UH a �P Bus.Tet.No.: P �_ /7`o AIL Tel.No.: Address: t — *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety S"License: Lim No. S Cnortnall OWNER'S Ii`{SURANCE lar'AIVER: I am awa c that the Licensee does not have the liability insurance coverageo nL required by law. By my signature below, I he waive this requiremenL I am dhe(check one)❑ owner ❑ owner's Owner/Abent rh.o i e.e FERrYlXT FEE.S ' Signature Tie Nc s 4 ;y S , MIT,rip j3 I _ .:JS t. 7 y. V . hM'a'�2• , Resp • ' Y` .M`•,`` t,as;;►'`G: }� aPNGE 9j2oo9 ��M st�e ol In l °a,�,o \,ark° c Q ��NG Q�IJE E ew �P of 'N. CNG CNpQ��49 'q6 Department of Public Safety One Ashburton Place, Rm 1301 Poston, Ma 02108-16-18f',. License: CERTiFICAI"4 (?F CLEARANCE' `Number: SS CC 001975 Expires: 10/09/2009 Restrlctec,To: 00 KENNY WONG — 't 18 CLINTON DR I-(OLLIS, NI-I 03049 '•fir. Tr. no: Q39.0 Keep lop ►or recelpt and change of ad,"" CO(% WICI�'t','�.ALTH OF (OASSACH"SE I`. orsr.A, 0 50M•07/07•PCa490 /ic '�na�n�ilonn.rnl(� nw'��nunc/,,,�1� LEC IT REGISTERED SYSTEM UEPARTMEN7OF.PUBLIC SAFETY •TECHNICIAN ^11 G{ CERTIFICATE OF CLEARANCE IGi J'cS 1HIS LI:EIdSE i0 . Numbor: SS CC 001975_ ' • KENNY Q. WONG Expires: 10/0912009 Tr. no: 459.0 22 FIELDSTONE DRIVE S-Llconse: ADT SECURITY BURLINGTON KA 71803-42-13` KENNY WONG 1GCLINTONDR 5466 D 07/Z1/1'0 284072 HOLLIS, NH 03049 DIG SAFE:CALL CENTER; (080)344.72�� Commissioner C: .. • .. f,1 D'.'1..'il:�M•. . �• •.I.I_!.;" G . .. .._ .. . . . .._....DRIVER'S LICENSE...,. ... .. ►291 p[6r s,Aix eu.lr r,esl -x5-Ooel'R M ti 10.09.1969 D '.' pcnA11 i .. -0.09-2009 , VVONG 'r , KEIINY Olt) 'r Y2FIELD51,014DR u�.IHI DURING10N0AA Vii` --__ - 11 � 0180)-d217��. .^ �/ ✓`J v�� _� 5,�,.i`/�. t o , CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 279 (10/10/06) Date: June 21 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 611 Salem Street MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Belford Contruction 85 Johnson St North Andover MA Building Inspector i F NpRTfl Town of : t over 0 w: , w:. No. E dover, Mass., z- sw COCKICKEWICK AORATED `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System UIL ING INSPECTOR THIS CERTIFIES THAT......46ftJANOW-60AO r ........................................... ound }- has permission to erect.......................................: buildings on....!�j.A..... ........1 c� to be occupied as.. ... .. ........ Chimney provided that the erson acKetolng'As�e--rm X*&�f i con rm t rm of�ie a ation on file in this office, and to the provisions of the Codes and By-Law relating to the Inspection, Alteration Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ��O PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS u /-z z-eq .... Service B G T TOR f p Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove ina 111167 No Lathing or Dry Wall To Be Done FIRE DEPARTM T Until Inspected and Approved by the Building Inspector. Burner Street No. f07 SEE REVERSE SIDE Smoke Det. 1 µO�TN AATO APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit# «� 7 ADDRESS/LOCATION OF PROPERTY : LIZ L54 ie a�7 I Map Parcel :Z Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION o--7 CLOSING DATE ON PROPERTY: w a � FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. 2 Permit Issued to: I �,n�Ll, oLS4, -n yl ---u� AddressC---�,(A.0&nn cdo@4 SIGNED i RO CONSERVATION PLANNING DPW-WATER METER SEWERIWATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCY/INSPECTION REQUEST DPW ignature Fite: Application for OC form revised Jan 2007 Gelinas 5tndural �ngineerinq L. C Phone 978.465.6436 Daniel L. Gelinas, P.E. Fax 978.465.5160 579A North End Blvd. ` Salisbury, MA 01952-1738 email danlgelinas@adelphia.net February 4, 2007 Gerald A. Brown Fax 978.688.9542 Inspector of Buildings, Town of North Andover 400 Osgood Street Phone 9545 North Andover, MA 01845 Copy: Mark Rae Fax 978.682-6397 Bedford Construction Inc 1049 Turnpike St. North Andover SUBJEC 611 Salem St,North Andov , MA Dear Mr. Brown: Per the request of General Contractor Mark Rae, Gelinas Structural Engineering LLC (GSE) went to the above site on 2.2.07. The purpose of this trip was to perform a walk thru and confirm the LVL framing satisfies code. The following are the results of our observations: Executive Summary: All LVL framing observed is per the drawings and satisfies the Massachusetts State Building Code 6t' Edition Chapter 36. Please call with any questions. a OF MA C, ti DANIEL L. GELINAS STRUCTURAL N0.33994 �Q . . 11 FSSIOtdA� Ve Yours, mel L. Gelinas, RE H LVL framing only 06113.doc Feb. 4. 2007 2 :37PM Dan L. Gelinas , P.E,978-465.5160 No-9980 Gel has 5hcturai �rgineerinq LLC Phone 978.465.6436 Daniel L.Gelinas,P.E. Fax 978.465.5160 579A North End Blvd. Salisbury,MA 01952-1738 email danlgelinas@adelphia.net February 4,2007 Gerald A.Brown Fax 978.688.9542 Inspector of Buildings,Town of North Andover 400 Osgood Street Phone 9545 North Andover,MA 01845 Copy: Mark Rae Fax 978.682-6397 Bedford Construction Inc 1049 Turnpike St. North Andover,MA 01845 SUBJECT:-- 611_Salem St,North Andovei;MA Dear Mr.Brown: Per the request of General Contractor Mark Rae,Gelinas Structural Engineering LLC(GSF,)went to the above site on 2.2.07. The purpose of this trip was to perform a-walk thru and confirm the LVL framing satisfies code. The following are the results of our observations: Executive Summa All LVL framing observed is per the drawings and satisfies the Massachusetts State Building Code 6`s Edition Chapter 36. Please call with any questions. SqC I DANIEL L. o� GELINAS STRUCTURAL ti o No.3399� ANAL Very Truly Yours, Daniel L. Gelinas,P,E H LVL tt=iog only 06113.doc Date. -7 N0R7Fr a TOWN OF NORTH AIDOVER PERMIT FOR P UMBING �,SSACMUSE� �,s-�• / � ( �` I l This certifies that s.;!:�. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .`1. . . . . . . . . . . . . plumbing in the buildings of . . . f` . . �t 5 . . . . . . . . . . . . . .. North Andover, Mass. Fee. .>. . .Lic. No..A). . . . . . . . PLUMBING INSPECTOE t; Check #-�¢U 7243 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS J i Date {—Z O— O`7 Building Location I Jet le✓w s T Owners Name o L� Permit#___2 4- Amount Type of Occupancy New Renovation ❑ Replacement Plans Submitted Yes ❑ No FIXTURES 1z Cr ss>EE &1,4UvM 21�D FiDOt Z Z. M FUIM aM FUIM sMFUXR 6M HIM 7M FLaR sIH FiDIIi (Print or type) j Check one: Certificate Installing Company Name ro l ❑ Corp. Addresser. fa Ll ? 1 Business Telephone ❑ Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ®� Other type of indemnity ❑ Bond 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)' above application are true and accurate to the best of my knowledge and that all plumbing work and installations perfo ed un it Issu this application will be in compliance with all pertinent provisions of the Massachusetts S ing a ha 142 of the General Laws. By: ,gam t,qsea um er Type ofPLicense Ttle City/Town PROVED(OFFICE USE ONLY i m Aen e Master Er Journeyman 13APPR Date.,II!.-r/. O'<".0. T" TOWN OF N OR/HANDOVER how � p PERMIT FOR PLUMBING 4 ,SSACNUSE� This certifies that . . . . G lr s ` /. . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . �-. ... . . . . . . . . . plumbing,in the buildings of . . . .P-r < (: ':�' . . . . . . . . . . . . . . . . . at —1 .6. . . . . . . . .. North Andover, Mass. Fee. Lic. No../4.3�! !. . . . . . . . . . . PLUMBING INSP-CTOR Check # 7244 I0 () (.) `' MASSACHUSETTS UNIFORM APPLICATON FOR PERNIIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS I Building Locations �/ ��t LC^/" C '`js Permit# 7 L Y 6( f c Amount$ /a d Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ x C F a e o w w w O u m x v z x �. a z z o H z m v F w O ;D O zs F w z d z a x y F w a d � > w F= < y m �z O z w O vF x x x O m w � 3 0 a Cv a > o a E~ oI I SU B -B A S E M ENT BASEM ENT p 1ST. FLOOR 1 2ND . FLOOR 3 R D . F L O O R 4 T H . F L O O R A 5 T H . F L O G R 6 T H . F L O O R 7 T H . F L O O R { 8 T H . F L O O R (Print or type)�� Check one: Certificate Installing Company Name G� ❑ Corp. Address `' ��U/ ❑ Partner. YYI d ! h Business Telephone 7[� '?L ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 63'c v-e __ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®� No❑ If you have checked}_es,please Ind' to 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 abov a plication are true and accurate to the best of my knowledge and that all plumbing work and installations performe der Per i ed fort '6 application will be in compliance with all pertinent provisions of the Massachusetts State Gas C d C er of eneral Laws. By: nature of censed PlumberG itt Title Plumber City/Town ❑ Fitter kens um er EAT Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date.................................. NORTH 0 .-.ff .— . TOWN OF NORTH ANDOVER PERMIT FOR WIRING 04 ,Z- This certifies that ....r 111—x ............ - .......................................... has permission to perform--l-Ic........L..:...... ........................................ wiring in the buildinj of .............................. at ...........i........................... ............... .North Andover Mass. Fee l ?`?�.....I Lic.No.............. ................................. ELECTRICAL INSPECTOR Check # 7152 Commonwealth of Massachusetts Official Use Only V' Permit No. Department of Fire Services z� Occupancy and Fee Checked y w BOARD OF FIRE PREVENTION'REGULATIONS [Rev.9/05] leaveblank 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: / o ( 'l City or Town of: NORTH ANDOVER 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) j �/ ;✓1 j Owner or Tenant �y L x,2.0 C d ;/V (-1 C A-) Telephone No. 966; Owner's Address (}�-" "9/ e ' T Is this permit in conjunction with a buildiinn�permit? Yes No ❑ (Check Appropriate Boxe), f Purpose of Building ,j 1 N 6 G� 1" M,LI Utility Authorization No. 18 9 t 7 Existing Service 1 Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps I / )YO Volts Overhead Fo� Undgrd ❑ No.of Meters r Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: i J , rJ 61 4 �!�'I 10-1 y 1 iA14 1-t (N6 Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.o Total. Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting t No.of Luminaires Swimming Pool rnd. ❑ rnd. E] No. Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners !Vo—.—or—Detection andInitiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g ra No.of Waste Disposers Heat Pum umber Tons K No.of el - ontae Totals mDetection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Munic'pal ❑ Other Connection Heating Appliances Security Systems: No.of Dryers g pp KN' No.of Devices or Equivalent No.of Water Kia No.of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent 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 Inspector of Wires. Estimated Value of Electrical Work: (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 liabilityrinsurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove(age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of�erjury,that the information on this application is true and complete. FIRM NAME: '71h /`� .) 2 t7 LIC. NO.: Licensee: ' (`/fy M.45 94'2 t!ySignature ' 1 i LIC. NO.: dkycg (If applicable, enter "exempt"in the license num er lane.) y Bus.Tel. No.: Address: Alt.Tel. No.: *Security System Contractor License required for this work; if appricable,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 Signature Telephone No. PERMIT FEE: $ Z0 } .�I