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HomeMy WebLinkAboutMiscellaneous - 65 WATER STREET 4/30/2018w y v� PERMIT FOR GAS INSTALLATION This certifies that ......... P -0, P //k k- T� has permission for gas installation ............ .?/............ . in the buildings of .../. V.. ./I. ....6?S �, ../ .(.. ............ at .. ............ ........ , North Andover Mass. Fee .� 57z .... Lic. No. ........ .. '... �C� ... . GAS INSPECTOR Check # �Z 8394 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 10I2Y112 J PERMIT #� JOBSITE ADDRESS I 65A Water Street OWNER'S NAME M.M ASSOC. MGMT. CO. GOWNER ADDRESS 163WaterStreet = TE FAX TYPE OR OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES NO E] APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR �® FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ®® ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE 1 have a current liabiliq insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: 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 com fiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMB ER-GASFITTER NAME James Greene LICENSE # 15152 SIGNATURE MP MGF ® JPE] JGF ® LPGI ® CORPORATION ®# PARTN HIP®# LLC ®# COMPANY NAME:j J.P Greene P&H ADDRESS 174 Bridge Street CITY I Salem STATE =ZIP 103079 JTEL.j FAX CELL 978-423-7694 EMAIL jamgree33@comcast.net �� � �Y j� .. _ .. _ _ The Commonwealth of Massachusetts .Department of Industrial Accidents Office of Investigations UT. 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): (;,yf 5yr Address: y) I'le City/State/Zip: 5'A%,v.AA A)4 638 Phone #: 3- 7� 91 Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors Z. I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I LK Plumbing repairs or additions 12. ❑ Roof repairs 13.n Other kny applicant that checks 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 affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. tsurance Company N :)licy # or Self -ins. Lie. #: ►b Site Address: Expiration Date: City/State/Zip: ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. lo hereby certify under the pains and penalties of perjury that the information provided above is trite and correct. gnature Date: V / Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall.withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department -has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE -vised 5-26-05 Fax # 617-727-7749 r .CONTROL# H396144 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege, and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. . WARNING THIS D!)( d ENHANCED SECURITY FE ,j i' 1 r 1 , Date HORTM0 TOWN OF NORTH ANDOVER" 0 PERMIT FOR GAS INSTALLATION .. . . ....................... This certifies that .. has permission for gas installation in the buildings of .......................................... attr` North Andover, Mass. F,e2n Lic. No44. (F7 -�AS PN�SFP6r4TORW­ Check # 6,830 .t MASSACHUSETTS UNIFORM A►PPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date .— Building Logations � p Permit ## Owner's Name Amount $ New Renovation Replacement � Plans Submitted ❑ zG� 7zitcu!)) �' ae w 14`�W e x a c i- a SU B -BASEM ENT x F W C a > o w o° U .4 C z w 0c S o BASEMENT .� U > a F O 1ST. FLOOR ZND. FLOOR 3RD, FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. "FLOOR 8TH.FLOOR (Print or type) Name rvarne oT.Licensed Plumber or Gas Fitter 155 9 'c, ev Check one: Certificate Installing Company Corp. ElPartner. 13 Firm/Co. INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent, Check one: Yes If you have checked yes, please indicate the a cove13 Liability insurance h'Pe by checking the appropriate box. policy Other a f' d NoE3 typ o n emnity U Bond E �MASIIE,eneral Owner's Insurance Waiver. I.am aware that the licensee does not have the InsuGLAW) th my s u this permit appi— ic�aivesthis requiremnrance �erequired by Chapter 142 of the l = DJL Signature of O. iffier Oor wner's Agent Check one: wner I hereby certify that all of the details and information 1 have submitted (or entered) in 191 Agent Eltrue and ac 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 S G g curate to the Code ��ad PayCer 142 of the General Laws, my; 0, of Licensed Plumber Or Gas Fitter Title Plumber City/Town ® Gas Fitter icense um er Master , APPROVED (OFFICE USE ONLY) 0 Journeyman nH.. 1. r The Commonwealth Of Massachusetts Department of •jnd=tr'ia1 Accidents Dff"ce of .rnve,76gations 600 Washineaton Street Boston, AIA 02111 ' wwx�. mass.gov/dia Workers' Compensation Insurance.Afda'Vit: Builders/Contractors/Eleciricians/Plumber Acant Information s Name (Business/Organizabon/Individual): Address: City/State/Zip: Are you an employer? Check tate appropriate box: ❑I Phone #: r am a employer with_ 4. ❑ I am a trf'neral employees (Hill and/or part-time).* ?.,� I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No, workers' comp: insurance required.] t L_ contractor and I have hired the sub -contractors Iisted ort the attached sheet I These Sub -contractors have workers' comp. insurance. ❑ We area corporation and its officers have exercised. their right of ex- c. per MGL c. 152, L (4) and we have no employees. [No workers' comp. insuranc TYPe of project (required): 6•. ❑ New construction 7• ❑ Remodeiing 8. ❑ Demolition 9. ❑ Building addition .0 Electrical Electrical repairs or additions i 1.❑ Plumbing repairs or additions 12.❑ Roof repairs erequtred] I 13•[] Other Any applicant that cheeks box # 1 .must also fill out the section below s`ho wing their workers' comp:rtsation policy mrortnatton. + r iomaowners who submh.ihis of idavtt indicatitt, tltei at- duit:= �onttactors that checb; this box must attached an additional sheet showing the Even hire outside contractors rnusi �obmri a new amdavii indiing se ah. tune of the .,,,brco aactots end their workers' comp. oIi I am an employer that is providing worirers' co enation i p information. information assurance for ng' en+pLnyees. Be" is the policy andjoh site Insurance Company Name: Policy # or Self .ins. Lic. #: Expiration Date. Job Site Address: City/state/Zip: Attach a aoP3� of the workers' compensation Ipoiicy declaration page (showing the policy number and expiration date . .Failure to secure coverage as required under Section 25A of ) fine up to $1,500.00 and/or one-year imprisonment, as well as civil persalt} 52 as in the formlead to e of imposition STWpR tO slots of a of up to 5250.00 a day against the violator. Be advised that a copy of this statement may , ER and a fine Investigations of the DIA for insurance coverage verification. ) be forwarded to the Office of -. ___1 :r.r' yP=.pze pains and of periiily that the information provided above is true and correct Official use onip. Dn not write in. this area, 10 be completed b3; city or town ojlcial Cite or Town: PermitJL,icense ;T Issuing Authority (circle one): I. Board of Health 2. Building Department 3. CityJTown Clerk 4. Electrical Inspector S. Plumbing 6. Other b Inspector Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined. as ".. every person in the service of another under any contract of hire, express or implied. oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal anti rP g t), or any two or more of the foregoing engaged in a joint enterprise, and includi-n.g the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house.having not more than .three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state a r local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buiidings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the coniraaiing authority." Applicants Please fill out the workers' compensation affidavit compi-etely, by checking the boxes that apply to your situation and, if necessary; supply sub -contractors) name(s), address(es) and phone number(s) along with their c—errificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or. partners, are not required to carry workers' compensation insurance. if an LLCor LLP does have -_ employees, a policy is required_ Be advised that this affidavit may be submitted to the Departrnent of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions rega_rdirg the law or. if you are required to obtain a workers' call the Department at the nm- nbe�r:lis�ed below. Self insured companies should enter their compensation policy; please self insur-ice license n=umber on the appropriate line. City or Town Officials Please be sure that the affidavit .is complete and printed leg�biy. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant: Please be sure to fill in the permitricense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/hcense applications in arty given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each year. Where a home owner or citiz.n is obtaining a licens` or permit not related to any business or commercial venture (i.e. a. dog license ar permit to burnleaves etc.) said person is NOT required to complete chis affidavit. The Office of investigations would like to.thank you. in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of lmdustrial Accidents Office of Lavestieations 600 Washington Street Boston; 1viA 02111 Tel. # 617-727-4900 C= 406 or 14 7 7-MASSAFE Revised 5=2645 Fax 4 61 7-72.7-7749' ww%k.IFia s.Dov%dia U Date. . ...... "ORTol Of .. .... 6 4. TOWN OF NORTH ANZDO VR PERMIT FOR GAS MST L LLATION This certifies that ....QQ has permission for gas installation in the buildings of ..... "-.7 ........................... at ... K J–. .1,,<-. ki -......... North Andover, Mass. Fee. Lic. No..?-./ .. ...... GFS INSPECTOR Check # 6457 .. . -- j' MASSACHUSETTS UNEFORM APPUCATON FOR PERMIT TO DO GAS FrrnNG (Type or print) Date NORTH ANDOVER,. MASSACHUSETTS Building Locations f�,} %� p t� Permit # o% -- ` Owner's Name Amount $ Ta New Renovation Replacement Plans Submitted G SU B-BASEM ENT BASEMENT IST. FLOOR 2ND. 3RD. FLOOR FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. STH. FLOOR FLOOR (Print or type) V Name w wrA � zwz a O a vi O = a F F Za, F Wj w C ca F Z V w Q x w E,rA Fw- F C C > d C o d vu Gy /,, Name of Licensed Plumber'or Gas Fitter R U Check one: Certificate Installing Company 11 Corp. 0 Partner. RFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes No13 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond 13 Owner's Insurance Waiver: l 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 13 Agent 13 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 ins tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach ep State Gas Code 46d )Chapter 142 of the General Laws. By: Title own, I PROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 9j 9-c-) 5 ElGas Fitter License Number Master 13 Journeyman zwz a vi O = U F ca Fw- F C C > d C tat F � F Name of Licensed Plumber'or Gas Fitter R U Check one: Certificate Installing Company 11 Corp. 0 Partner. RFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes No13 If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond 13 Owner's Insurance Waiver: l 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 13 Agent 13 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 ins tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach ep State Gas Code 46d )Chapter 142 of the General Laws. By: Title own, I PROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 9j 9-c-) 5 ElGas Fitter License Number Master 13 Journeyman t Date . .....^�`.J� o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION n� This certifies that .C;� ...`:.... ... ....... . has permission for gas installation .:..../. /�:!.............. . in the buildings of /�..!. .... ....... ..................... . at l6� f ....... , No h Andover, Mass. F Fe .. .. Lic. No ^`G INSPEG0 Check #/ 6133 MASSACHUSETTS UNIFORM �APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) t� - NORTH ANDOVER, MASSACHUSETTS Date — % ' — Q Building Locations %� C1 12 1 � 4 ZAa//e.t-.perinit # Amount $ QST Owner's Name /�� New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print or type)t Check one: Certificate Installing Company Name 1 l t2T_S (�� ❑ Corp. Address .5 OVI(o nl ► ; /WIt rid ri �G 14 ! ,( �/1F1—ElPartner. Business a ep one El- Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy IT 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 I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installations perforr compliance with all pertinent provisions of the Massachusetts State GAC Title City/Town (APPROVED (OFFICE USE ONLY) above application are true and accurate to the ern H d for this application will be in ,K4 oflhh. Ggperal Laws. Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 2crn X ❑ Gas Fitter License Number ❑ Master Journeyman Ed w V� V1 O Z Cpq� 0+ V1 Cw9 � W O0 V Gw W U w h i dFd � d C7 F Er C �'" W C w a I] FO fQs7 E" 7' Z d Z w Q m Z O w a o z z > A SUB-BASEM ENT a F O B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOGR 6TH. FLOOR 7TH. FLOOR STH. FLOOR.� (Print or type)t Check one: Certificate Installing Company Name 1 l t2T_S (�� ❑ Corp. Address .5 OVI(o nl ► ; /WIt rid ri �G 14 ! ,( �/1F1—ElPartner. Business a ep one El- Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy IT 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 I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installations perforr compliance with all pertinent provisions of the Massachusetts State GAC Title City/Town (APPROVED (OFFICE USE ONLY) above application are true and accurate to the ern H d for this application will be in ,K4 oflhh. Ggperal Laws. Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 2crn X ❑ Gas Fitter License Number ❑ Master Journeyman I Date. # 7�y ©. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s ..o •:ts This certifies that .... �? � . S P* has permission for gas installation ... in the buildings of . A :� .9 ���.� � � � � ................ at North Andover, Mass 70 Fee..aSrLic. No..o?1cU� `(('.n?.Z.t ...... 391-5 Q GAS INSPECTOR 1 r Check # J lJ 1— .� 4540 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations ,` Ib Al J f P 1 J Owner's Name New ® Renovation ❑ Replacement ❑ Plans Submitted ❑ FITTING Permit # Amount $ )Pop �vu (Print or type) I) , , n V 1 3, check one: Certificate Installing Company f y� r Corp. Address T. '% A 11 10 W � AL & � SA- �� A a ❑ Partner. Business Telephone m/Co. Name of Licensed Plumber or Gas Fitter I.INSLIRANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [M No❑ )fyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy [3 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. 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 Gas Code and Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumb r Or Gas Fitted ❑ Plumber . 9 C ❑ Gas Fitter License Number ❑ Master ❑ Journeyman • IMMV 3§0 0 OW (Print or type) I) , , n V 1 3, check one: Certificate Installing Company f y� r Corp. Address T. '% A 11 10 W � AL & � SA- �� A a ❑ Partner. Business Telephone m/Co. Name of Licensed Plumber or Gas Fitter I.INSLIRANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [M No❑ )fyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy [3 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. 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 Gas Code and Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumb r Or Gas Fitted ❑ Plumber . 9 C ❑ Gas Fitter License Number ❑ Master ❑ Journeyman M Date.../....1... // TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... 14. //0 ...... has permission to perform ........ ..... . .................................... fdl h4 e, wiring in the building of .......1...:. q t?y .... . ............... ....................................... I.... .. at .......... N :h Andover,Misso, d/4V .. ....................................... F j ee........ ................ v ELM ICAL Check # r-;, — THE COAMOATW LTHOFA14 S4CBUSE7 Office y DEPARTNRV1'0FPUX1CS4FE7Y Permit No. BOARD OFFIREPREVFVHONREGUTA7IONS527aMl2.M t Occupancy & Fees Checked — APPLICAHONFOR PERA4UTO PERFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 J, �d (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / 03 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -ST * Owner or Tenant ��,, // Owner's Address �I�/.// Y/ ,9; /1110 y94WO✓LW Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) . Purpose of Building pv5 .- Utility Authorization No. Existing Service Amps /O / d Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work L•wm*, - No. of Lighting Outlets No. of Hot Tubs No. ' or Transformers Total KVA . No. or Lighting Fixtures Swimming Pool Above Below Generators KVA V ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Other F Q Connections �. No. of Water Heaters KW No. of No. of Si s Bailasis No. Hvdre. Massajze Tubs No. of Motors Total HP h>StumxeCovt� Ptusilar�todlele�I��r�ofNlas�a>sensGalaill.aws Iba,maomatLmbiltyhmu =Pbbcynrkx g arple� Cowrageorilsst> alegri�alai YES NO IhavestlbrndmdvvaanddproofcfsamlotheOffice YES r ff3uuha�e&dodYE Pcw the -- -- --------- P4SURANCE BOND OrIHER (Plea9eSpec�y) / Dai 771//Cl��� Esmr&dVahteofPbctacAWck $ WotictoStatt hnpecfionDak�Rerpeged Rough Final Signedund,rtTrF FIRMNAME GSL v�//l' �cT/'rc /- /tel IiceriseNo. 77 0 sig IicenseNo BusuiessTelNo. 4rtrlrPce '0. ACA CA X93 �O W�1/ /f /� L✓`�/Jr AILTelNo. OWNER'S INSURANCEWAIVE2;Iamaware that theLicemedoesnothavetheinsiranmometageoritssubstantialegmvakntasregriedbyMassachis ttsGeneralLaws uxidial mysignatuieonthis permtapplication waives this iequaie ent Please`check one) Owner ® Agent Telephone No PERMIT FEE (J Signature o wner or gen Date.. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Oww 5k? This certifies that . ..............� .... `� .. ............ . F' n hps permission for gas installation . e A N c� 'k h• v r N C in the buildings of at ....J... ..... i.. .............. . North Andover, Mass. Fee.. .. Lic. No. fAG 3Sq GASINSPECTOR Check # 13 4296 MASSACHUSETTS UNIFORM APPIKATON FOR PERMPT TO DO GAS FITTING fi (Type or print) ,"Date{ CJ l U j 3 NORTH ANDOVER, MASSACHUSETTSr� Building Locations Ce�'4 /f? �%�lG�d?)"l Permit # Z f Amount $ �- ©2 Owner's Name W' QA I -s �—;7 ,g New ❑ Renovation ❑ Replacement Plans Submitted ❑ (Print or type) l c _ one: Certificate Installing Company Name L,"� 5�� Co / rp. Address )i- � � - �G` d ��� ILI dl el b ❑ Partner. Business Telephone q'7 — e175_ g� Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ Ifyou have checked M, 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 annlication 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 Std Coded _Cha�2 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber �$y� Gas Fitter License Number ® Master ❑ Journeyman • • • (Print or type) l c _ one: Certificate Installing Company Name L,"� 5�� Co / rp. Address )i- � � - �G` d ��� ILI dl el b ❑ Partner. Business Telephone q'7 — e175_ g� Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above annlication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Std Coded _Cha�2 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber �$y� Gas Fitter License Number ® Master ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION I -OR PERMIT TO DO GASFI'TTIt1G '1 (Print or Type) NORTH ANDOVER Mass. Date kuilding Location ��-'X Permit 3 W/O •� Owners Name New '-1 Renovation [] Replacement Plans Submitted D FIY.TI.IRr:7. (Print or Type) // Check one: Certificate Installing Company Name (d 1, ��'1tr� (_] Corp. Address 7 e -e, -r Partner. Firm/Co. Business Telephone: ��� Name of Licensed Plumber or Gas Fitter �a�„� s��e ,,uC ;`'v Insurance Coverage: Indicate the type of insurance coverage by checkin4 the / appropriate box: Liability insurance policy F --j Other type of indemnityF—] Bond Insurance Waiver: I, the undersigned, have been made aware that the Licensee of this plication doe ve an r of the above three insurance coverages.. ignature o gen 7oproperty Owner Agent 1 heteby eertif at all oC t7r' euils and information l have submitted (or cntcrcd) in above application are true and accurate to the best of my knowledge and that ali plumbing work and installations performed under f etmit iueed for this application will be in compliance w(th all pertlnent provisions of tho hUssachusetts State Gas Cade and Chaptet 142 of tho Genual Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE:2ek5----- Plumber - - Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman _'z5 -v License Number Y • ■■■■■■rr r�rra� ■ ■ ■■ ■ ■■■■■rr■r MEN ■■r■■■■■ ... ■■■■■r■■r■n ■ r■■r r■sr■■ .. .. - r■■■■r■■r ■■101 NONE MEN NEN .. ■■�rrrr r ■ ■■ . Ion■■ ■ ... ■■■■rrrn■N r ■r■■■■■ ■■ ... 01000000001 ■ (Print or Type) // Check one: Certificate Installing Company Name (d 1, ��'1tr� (_] Corp. Address 7 e -e, -r Partner. Firm/Co. Business Telephone: ��� Name of Licensed Plumber or Gas Fitter �a�„� s��e ,,uC ;`'v Insurance Coverage: Indicate the type of insurance coverage by checkin4 the / appropriate box: Liability insurance policy F --j Other type of indemnityF—] Bond Insurance Waiver: I, the undersigned, have been made aware that the Licensee of this plication doe ve an r of the above three insurance coverages.. ignature o gen 7oproperty Owner Agent 1 heteby eertif at all oC t7r' euils and information l have submitted (or cntcrcd) in above application are true and accurate to the best of my knowledge and that ali plumbing work and installations performed under f etmit iueed for this application will be in compliance w(th all pertlnent provisions of tho hUssachusetts State Gas Cade and Chaptet 142 of tho Genual Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE:2ek5----- Plumber - - Gasfitter Signature of Licensed Master Plumber or Gasfitter Journeyman _'z5 -v License Number 0 u. z D N v m n Ip. z N m -1 n x m N m m m D �o v r_ C1 D m m Z 71 '71 0 0 x � v z o 7p m 3 n � m � c O N m v O o z G� r a � N Z Date.. �fi;/.:� / ..... i . F HORT#1 q RImw— i+� T0WN OF�NORTH ANDOVER. f 2 y° • �.. _ Oz. PERMITiMR GAS INSTALLATION c , gg ,y . ��9SSACNUSE��ya Kj. A jviai U This certifies that .... r . ;... ✓fX i ....... has permission for gas installation) in the buildings of. at . 16,..1 .. l�lf �... d �....... ,North Andover; Mass. Fee. ,E'.. U . Lic. No...... I...... r ,: f a z ASI SPEC OR , � 3 WHITE: Applicant- CANARY: Building Dept. PINK: Treasurer GOLD: File 'i iViA ACtiUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITT111(3 $Pirint or Type) NORTH ANDOVER Mass. Date l Z E uilding Location 4:�p-S- Permit # `�y� • - Owners Name C2.�c9Qe�Q , New I. `Renovation Replacement f•�Plans Submitted (� FIX 1 1 yrs c .:(Print or Installing Address Type) Company Na 14r/ ��14/3 - M Check one: Certificate (-1 Corp. Partner. Firm/Co. u car N o x tri m a a ar m a a o o V a w t_ x rn, p µ�j t' W Q Uj x O , O p N W cc N M O N W f d, w x w O 0. O ct W y t 4 N w [C w m 4u d yt x a GI tt '. 0 OX a Q w �" a w F' W x 0 tz W' O ? k t•- w ..t tr W z Q W . z a o o W v O a z y CC O rn z Q' x o 1�,. a ca o a H o SUBi—QSP.1T. BASEMENT 1sTFLOOR 2ND FLOOR 3RD FLOOR — — — — — — — 4TH FLOOR ''5TH FLOOR 6TH FLOOR TTHFLOOR "8TH FLOOR .:(Print or Installing Address Type) Company Na 14r/ ��14/3 - M Check one: Certificate (-1 Corp. Partner. Firm/Co. Business Telephone: ad,2,p- .3c/,2 r ^ Name of Licensed Plumber or Gas Fitter ;'Irisurance Coverage: Indicate the type of i:isurance 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 coverages. 'Signature of owner/agent of property Owner Agent 1 hereby certify that all of the dcuils and information l have submitted (or entcred) In above application aro true and ■ccusate to the best of my knowledge and that ad plumbing work and (nstxlladons perfomicd under rcrnsit issued to: this application wW be In eompl%anoo with all pciUnent pra'ions of rho Massachusetts Slate Gas Code and Chaptct 142 of tho Genual LAws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE Plumber aSfitter Signature of Licensed Master Plumber or Gasfitter ourneywan .J / 3 - License IJuwl;)er i' Date. ....� .. . s 40RTH TOWN OF -NORTH. ANDOVER - - Oi,�«ao PERMIT FOR d S INSTAL ION. SSACHUSES/- , r This certifies that .. .. �� .. !.t.- ........... . ll has permission for gas installation s �� t>�a in the buildings of ! ( . ....�. t�/ 1 ....Y ......... I.... at��:... ,North Andover, Mass. Fee.. -""' Lic. Noy. .. ........ f GAS INSPECTOR"'. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File r f 1 Date...4.!.... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... f 3. -.. . ��.. s..... .. ................ . has permission for gas installation ....1.� . ............ . in the buildings of .. 47e. < ; , /X .................. . at . ' t4 ./-i /< e! .. ? . / . North Andover, Mass. Fee..).O. ' .. Lic. No. ......... GAS INSPECTOR Check # 4 r} G 3 3640 V ASSACHUSETTS UNIFORM APPLICATON FOR PER 11T TO DO or print) MiKirl ANDOVER, MASSACHUSETTS Building Locations t � ` w la" I rilrl 31 AM 6.), f Permit # Amount S 0, Owner's Name New ❑ Renovation ❑ Replacement n Plans Submitted ❑ (Print or type) ' )� Name— Address U Business Telephone Name of Licensed Plumber or Gas Fine - FAM /1 % N a Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Ell Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifvou have checked ves_ please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owners 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 herebv certifv that all of the details and information I have submitted for entered) in above appi)carron are true aria accurate to the best o(my knowledge and that all plumbing work and install I'rtormed under Permit Issued For this application will be in compliance with all pertinent provisions ofthe Massachusettas Code and Chat r 142 ofthe General Laws. By: Title Ciry/Town i APPROVED It)FPIC:? uSE f I,Y) Sianvuture of Licc:gWd Plumber Or Ga--5:?-iacr ER Plumber 0L do IQGas Fitter Icense wumot, IVl'asle. Journeyman r }V s'.. (Print or type) ' )� Name— Address U Business Telephone Name of Licensed Plumber or Gas Fine - FAM /1 % N a Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Ell Firm/Co. INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifvou have checked ves_ please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owners 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 herebv certifv that all of the details and information I have submitted for entered) in above appi)carron are true aria accurate to the best o(my knowledge and that all plumbing work and install I'rtormed under Permit Issued For this application will be in compliance with all pertinent provisions ofthe Massachusettas Code and Chat r 142 ofthe General Laws. By: Title Ciry/Town i APPROVED It)FPIC:? uSE f I,Y) Sianvuture of Licc:gWd Plumber Or Ga--5:?-iacr ER Plumber 0L do IQGas Fitter Icense wumot, IVl'asle. Journeyman