HomeMy WebLinkAboutMiscellaneous - 63 MAIN STREET 4/30/2018 i
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u4E LIIIIIllWTI111EFI I Af Naficar#1151tt Permit No.
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BOARD OF FIRE PREVENTION REGULATIONS 527 CIN1A 12:90
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 52za�9
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(XX or Town of NORTH ANn0VFR To the Inspector of Wires:
The udersigned applies for a permit to perform ttheelectriC�work described below.
Cf'
Location (Street & Number) 3 ��" " ' � CCyy
Owner or Tenant / �6� �� �
Owner's Address
Is this permit in conjunction with a building permit: Yes _ No (Check Appropriate Box)
Purocse of Suildina Utility Authorization No.
Existing Service Amos _J Vcits Overhead Unegrnd No. of Meters
New Service Amps _I Voits Overheao ' Uncgme _ No. of Meters
Numoer of Feeders ane Ampacity
Lccaticr: arc Nature of Prcpesee E!ectrical :11crK
Total
No. of ' to Outlets i No. of Hot T--=s ! No. of Transformers KVA
�.gr: g
I Abaver— 1n-
No. at Lighting P;xtures I i Swimming =aoi grna. _ crnc. - I Generators KVA
0 I I No. of Emergency Lighting
No. of F�ecectacie Outlets No. of Oil =urners ; Battery Units
No. of Swncn Outlets No. or Gas Eurners I FIRE ALARMS No. of Zones
Total No. at Detection and
No. of Ranges I No. of Air Cana. tans Initiating Oavtces
Heat Total ictal
No. of Oisoosals No.af Puc_r5 Tans K'.v No. of Souncing Oewces _
i No. of Sart Contained
No. at D•isnwasners - Scace/Area Heating ' Oetec::oniSounoing Oevtces
ecat
L — Murnciaai Other
No. of Orvers Heauna Oev,ces KW Connect:on
No. of No. of Law voltage
No. of Water Heaters K`PJ I Signs 9ailasts Winric
No. :Hydro Massage Tubs No. of Motors Total HP
OTHER `�lI `(V� C�%'t/l� (!-�Iv!/l l �`�Cf'! ydl es
INSURANCE COVERAGE. Pursuant to the reeuirements at r.tassac-users ;enerat Laws c NO = l
I have a current Liaotiity Insurance Policy inctuc:ng --cr etec Ocerattens `average or its suns:antral ecuivaient. Y_5
have suomntea valid proof et same to the Office. YES /�/ NO _ It you nave checxea YES. please notcate the ryce t overage cy
checwng the app nate cox. l/
INSURANCE VBCNO = OTHER = tP!ease Scec:'y) (Exciration Date)
Estimated Value of E!ectncat WorK 5
t Worx :o Start
Inscecaon Date Racuestec: Rougn Final
Si ea unser i Pe Rtes at r)u / /�,
l uC. uC.
i';RM NAM
S; attire 1C INC.
Licensee
g- G
o Z/) 3 No.Tet. No.
ALJ Att. Tet. o.
Aaaress
OWNER'S INSURANCE WAIVER: I am aware that to !:censee apes r.ot nave ;tie insurance coverage or its suoscanual eauivate Agent
euirea ov Massacnuseas General Laws. aria mat my signature on :n:s permit aoptication waives this reawrement. Cwner
(P!ease cnecx one)
7e+ecnone No. PERMIT PEE S `
(Signature of Owner or Agents <�S
-.,.�. .-., .� `�=yZ+n '�s.,�yx�a:»bi'slrs+'n�4a.1'z'.S.?piTa'i'�+—'%�'�•.'Y:.�-.t'..a,9�y".+'�y?'as-+...---^fa,�i.+L..'e7!'....._. .a..._,i,.,� f
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A Date.......�.:.f.......... .........
a 3' 1112
NORTI{
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACMUSE<
Paeu, � � cG� C�
Thiscertifies that ..... .......................................................................................
has permission to perform ... ........ T............................I............
wiring in the building of .�.` �� P ��'
..................... .North Andover,Mass.
Feek......... Lic.No..�Jh.it ................................................................
ELECTRICAL INSPECTOR
08/14/ 7N .tk2 07 20,40 PLAID
WHITE: Applicant CANARY: Building Dept. ",surer
a ,
.
42
zfHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
r ,, (Print or Type) E
NORTH ANDOVER Mass.
Date zcad
kulldin§ Location
Bel P Permit 2
Owners Name
• t
• ' NeW Renovation D Replacement Plans Submitted
} FIXTURES
W • . .• v
SC 2: O •
01
to lr .Q
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d m > aW , z 4 tL d a O O W O w N
,.r o 0 x aa. a t7 u x > ci rs, f- o
a n
' Sua—tlsw.
BASEMENT
IST FLOOR '
t ,2HO FL:OOa.,
s:F
3Rtl FLOOR
_. ,
4TH FLOOR
_+� dtii FLOOR
+' 'j - - -
t;g STEL FLOO.t(
$ TT, FLOOR
STs!#Loon
(Print or Type) Check one: Certificate
F `
M Installing Company Name C��j� ' j,� Q Corp.
�-IJ
Address Zl! �� Partner.
Firm/C6.
Business Telephone:
, Name of',Litensed Plumber or Gas FitterQCi L �� ,� S"'t1 L �(
} lh rarii-e 'Coverage: Indicate the type of insurance coverage by chegking the
. E appropriate box:
Liability insurance policy [ Other type of indemnity Q Bond
Insurance
Waiver: 1, the undersigned, have been made aware that the licensee of
+r this application -does not have any one of the above three insurance coverages.
�iP G
4!
' gnature of..owner agent of property Owner Agent
,., Si
Al I hereby Cando the"t all o[the details and information I have submitted(or entered)in above application are true and aocuratt to the best of my
Iulowtedge and that all plumbing work and Installations performed under'Permit iuued for this application w in complisrux rritlt all pertinent
Oavisians of the Witichuietts Slate Cas Code and Chaplet 142 of the General Laws.
� fTYPE LICENSE: -
` "� Y Plumber
title Si nature of Licensed
Gasfitter g
1".� +� Plumber or .Gasfitter
CityJTowriz Master
Journeyman
APi�ROVl p (OFFICE USE ONLY) License Number
2" 5 7 / Date. .......
j
OF N�oT e.,tio TOWN OF NORTH ANDOVER
0? y`' ° O
~ � �
9
PERMIT FOR GAS INSTALLATIONS i
i
� a •
a � • N
�,SSACHUSEI 'y
This certifies that . . 1:�.�. . :/. .S . . . . ��d. .�t. . . . . . . . . . . . . . .. . ?
has permission for gas installation .E a . . . ... .`. . . . . .
in the buildings of . . ./. . . . . . . . .
at . . . . . . . . . . Andover, mass.
Fee.).? Lic. No..�. .`.. .0 1.� . . . .. . . �.
AS INSPECTOR . .
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
^'^���"�•v.�G i J ++rviruhM Arruot A i aum r%jh rrnmi i s u uu rwrvr93161%A
(Print or Type)
NORTH ANDOVER
9 . Mass. Oats v
Building Parma 3 3
Location
Owner's D
Name / 0 C. l'S' 1zA)-I�
New ❑ Renovation ❑ Replacement Pians Submitted: Yes❑ No.❑
FIXTURES
a{ w
w ws of w
J w u° i e/ v s
.°� w w M • H a w � 2 = s H
Z a • s s «
s M a rYi a s ~ a s s a s a � s.
I- u ; oY ; � WXaa �1 X s K � � �
; ,te1i « aos j °sem « �' ioe o
s
ua—
fOMT.
/ASSMINT
IST FLOOR
SND FLOOR
$NO FLOOR
4TH FLOOR
sTH FLOOR
GTH FLOOR,
1TH FLOORTA
STH FLOORIvI
1 / Check one: Ca lilcate
Installing Company Name T ❑Cep.
Address--,/ ICJ cu ❑Partnership
0/�-LlT�`I /�'✓ 14 9MIrm/Co.
li Business Telephone 1�y
Name of Licensed Plumber_ X d Do hl/z S'd
INSURANCE COVERAGE: check one
I have a current Ilablfty Insurance policy or Its substantial equivalent. Yes ❑ No ❑
If you have checked y". please Indicate the type coverage by checking the appropriate box
A Ilabllly insurance policy Ef . Other type o1 Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the Ilceniee does not have the Insurance coverage required by
Chapter 112 of the Mass. General Laws, and Itut my signature on this perad application waives this requirement.
Check one:
a urs o er or Owner's en
Owner ❑ Agent ❑
1=cartlty that aM of the detalls and Intonation i have submitted for enleredl applicalkm are bus and aocwate to the best of my
lnowledge and that ell plumbing work and installations performed under the p Issued this ap tkm will be h compliance with all
pertinent fps
of the Massachusetts State Phimbing Code and Chapter 112 d laws.
By
Title w•
City/Town License Number CJ�J
Type of PlumWg license: Master C1
(OFFICEUSE ONLY) Type
a
Date
_ 2 3380
HORTq
TOWN OF NORTH ANDOVER
Y PERMIT FOR PLUMBING
,. SSACHUS�
This certifies that . . 1.4. `. ` S �°`
t has permission to perform . . . ". . . . . . . . . . . . . . . . . . . . . . . .
s
plumbing in the buildings of 9.7 S. . . (/x. . . . .
at. . .6 . /!ylf9l.y . . . -. . . . . . . . . , North Andover, Mass.
Fee., ? .-. . .Lic. No. .. . . . . . . . . . . . . .
PLU 48ING INSP CTOR
46/23/97 11:53 15.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer