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Home My WebLink AboutMiscellaneous - 619 SOUTH BRADFORD STREET 4/30/2018 619 SO BRADFORD STREET - _ 210/104.D-0145-0000.0 ,984f ,IORTN TOWN OF NORTH ANDOVER PERMIT FOR WIRING ii _ � .. �,SSACNUSE� This certifies that 2 . .... .........(............................................ has permission to perform .......l.:r.:!l� .S��fix... ............................. ............... ........... wiring in the building of...........D®&.1. ............................................... at....�.�.. g.....566'7./�R9 .fes. .......S T Andover,Mass. Fee.' uc.No. a 13102 T'.\... ......... ELE cnt.l.r! R� s Check # 3 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �� 11' BOARD OF FIRE PREVENTION REGULATIONSOcc 1p0ncy and Fee Checked [Revleave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORAJ4TION) Date: City or Town of- ARE To the Inspector of Wires: By this application the undersi ed gives not' e of his or her intention to perform the electrical work described below. Location(Street&Number) 4IQ Owner or Tenant ��,9,y a;"iTelephone No. Owner's Address Is this permit in conjunction with a building permit/? Yes PJ No ❑ BLDG PERMIT# e/ 7; -c7b j( Purpose of Building „i�sh /3A exp v 7 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires f No.EofHot :Susp.(Paddle)Fans No.of Total. Transformers KVA No.of Luminaire Outlets No. Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In ❑ o.o mergency Lighting rnd. rnd. BatteKy Units No.of Receptacle Outlets 5 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 7 No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. TonsTotaNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons. .......................W No.of Self-Contained To Detection/AlertiniF Devices No.of Dishwashers Space/Area Heating KW Locag Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or E uivalent No. of Water 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 Inspector of Wires. Estimated Value of Electrical Work: 2 000 (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 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 ❑ BOND ❑ OTHER ❑ (Specify:) I cert,under the sins and penalties of perjury, hat the information on this application is true and complete: -- FIRM NAME: LIC.NO.: v Licensee: {OC VV. f iV P_-� Signature LIC.NO.: (Ifapplicable, enter "exempt,, license number line.) Bus.Tel.No.- Address: es 2ao 03 7 G� Alt.Tel.No.: *Per M.G.L. c.147,s.57-61,security work requires Department of Public Safety"S"Licen LIC.NO.: 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. $ ELECTRICAL PERMIT NO. INSPECTION REPORT: , ELECTRICAL INSPECTOR-DOUG SMALL I.ROUGH INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: 4 , (Inspectors' Signature-no initials) Date 2.FINAL INSPECTION: Passed Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: r (Inspectors'Signat re-nA initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: 1 (Inspectors Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. tThe Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia 'workers' Compensation.Insurance Affidavit: Buildelrs/Contractors/FXectlriciaus/JPlumbelrs Applicant Information Please Print Legibly Name(B.usiness/Organization/Individual): J�S�� 6,0 1z.z- y Address: og/q 10,g l4d tl IZGl City/State/Zip: C,;'3 ?Z�� Phone#: 9--3/ .-,3 76-6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.g 7. ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions i myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /— Insurance Company Name: �zz /Z f. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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. Ido hereby ce tify under the ins andpenaldes ofperjury that the information provided above is true and correct. Si ature: Date: /10/0 Phone#: (41 'Z 3/ `-3 74W Official use only. Do not write in this area,to be coin by city or town official City or Town: Permit/License# -Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectricaI Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r Date. 8763 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNUS� - i ` This certifies that �. ' . . . . . . . . . . . . . . has permission to perform plumbing in the buildings of . . . 6 .ft.� ,` . . . . . . . . . . . . . . . . . . . . at . . /.Gj . .S'. . . . 3Jz � .(-c ti,c�. . .:;. . , North Andover, Mass. • j v Fee A Li c. No..2 . . . . . . . . .�: �l��. . . . . . PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: V'\N -x.15' F MA. Date: i7_ Permit# Building Location: -b0� yy � ?�Owners Name: Type of Occupancy: Commeicial❑ Educational❑ Industrial❑ Institutional❑ Residential yir if0 New:❑ Alteration:EL Renovation:® Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED Z SYSTEMS Uj z O D W Y O 0 H Q N } U H Uj Vr C r Q� Z C Z W Z G' Z VI Z ¢bd (Aa N Z M N (A W W oac O m N w Ln U 4A~ it Z Ln l7 oa— x = a 3 o U. a a W oU. ° W H z os o N 3Uj ¢ Y x x a p >' z a 3 a x z in W Q ce a Q �, o o > > o = o a a a a u aUj = = < a co m i] c LL x x g g z C � 3 3 3 0 a c� 0 0 3 SUB BSMT. BASEMENT 1 i 1sT FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Check One Only Certificate# Installing Company Name: ❑Corporation Address:'% � &Cittyy/�TToown: State: 11 ❑Partnership Business Tel: 17-k7 Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes 2g No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Q 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ 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 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. By Type of License: N' /--.4 [/L--\� Title ❑ Plumber Signature f Licensed Plunher City/Town ❑ Master _ APPROVED OFFICE USE ONLY (journeyman License Number: Zak 4;6, 1 EAt 10 A SACHU'. , ... . «w LA\ \ . 2 ' \ E SEb k& J0§R§§YANPLUUR� ISSUS m&AOE�m7 m: m. . . , . JASON C EVERETT \ 2 & NORTH - MARTIN RD � � \w \\AMESBURY � . y ,MA 01913-414 26848 05/01/12 78852- 6 I