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HomeMy WebLinkAboutMiscellaneous - 661 OSGOOD STREET 4/30/2018 I O C� 1 I. F I� I Date..... OR TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION gB�cHU �^ Thiscertifies that ...M............................... ........ ............. .... ......... .......................... has permission for gas-installation . inthe buildings of.................................................................................................................. at�....(ok.0.1....... North Andover, Mass. F6e ... ..... Lic. No. ...\O... rA.\........... ..................................................................... ......... ..... GAS INSPECTOR Check# 9775 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT.TO PERFORM GAS FITTING WORK CITY- -- .��( � MA DATE_ l- —4=/ 5 PERMITS JOBSITE ADDRESS: Z OWNER'S NAME To u F,- ,tn DU4rNER ADDRESS: TEL FAX TI'PE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENT IAL Q-- PR \7 CLEMZLY NEW.® RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMIT TED: YES❑ NO APPLIANCES-. FLOOR--• I Bsmt ( ( 2 3 4 S ( 6 { 7 { 8 9 { (0 11 112 13 J 9 BOILER BOOSTER I I I I ! I I I CONVERSION BURNER I I I I I COOKSTOVE I ( I DIRECT VENT HEATER J I f { ( I I J I DRYER FIREPLACE 1=RYOLATOR ► f i ! 1 L NACENERATORLLERARED HEATt I ( ( I IORATORY COCK ! 1 ! I I I i ! MArcEUPA1R UNrI � { i { I OVEN I I ! I ! I J POOL HEATER ROOM 1 SPACE HEATER I I I I ROOFTOP UNIT TEST ! 1 Ell UNrHEATERUNVENTED Roof HEATERIWATER HEATER 1 I I I I I 1 I 1 i I ! I I l l l i I I I ! I ! I INSURANCE COVERAGE � 3 I have a current Iiabili insurance policy or its substantial equivalentwhich meets the requirements of MGL Ch.142 YES M NO ❑ lfyou have checked YES,please indicate the type of coverage by checking the appropriate box below. �f LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ � ,�J OWNERWS INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the $ N Massachusetts General Lacus,and that my signature on this permit application waives this requirement. CHECK ONE ONLY. OWNER El AGENT F-1SIGNATURE OF OWNER OP.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 m Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Perone provision of the Massachusetts State Plumbing Code and Chapter 14.2 of the General Laws_ PLUIv1BERlGASF1T i ER NAME ,?^.fit'LICENSE# 1— � SIGNATURE COMPANY NAME: ADDRESS: 2 STATE 31�tG Z!P__ �i t Sr l FAX:_ TEL- c- ^ EIuIAIL:_f_ c,L��c=f� :.t� � � r�-�..��r—`• °i,i�'f MASTER'JOURNEYMAN D LP INSTALLER Ci CoRPORATION❑;r PARTNERSHIP❑ LLC❑ �: .� i S � � f►�� �/`� t- I � �� -97 fp).00MMONW LTH OF M � � S CHl3SETTS, ; ` BOARb F I PLUMBERS ANl) rASFIT:TER- ISSUES THE ,FOLLOWING :LrC_EN'SE L10El SEG AS A MASTERPLUMBr t MICh1AfL MARCOUX I y � 108 LAK':ESHOR'E M.A 01826 1008 ` 109�7: 199204 COMMONW ALTH OF MA SAC1i': ITS IVISION OF • • { BC3ARU F PLUMBERS: ,.A...NOASFITTERS IOSSUES THE FOLLOWING 1=1=CENSE:N.:. REGISTERED AS A PLUMBING CORP . M1CHJIFL M MARCOl1X , # P- IWIN°G HEATINr �L ' 108 LAKESHflkE argcU7 rtA o1826-1 31 5 ;. 05/07/ 6 19WO5 '` 9227 Date. TOWN OF NORTH ANDOVER. PERMIT FOR PLUMBING SSACMUS� This certifies that . j0,104"er Awl, has permission to perform plumbing in the buildings of . . .d !? . . . . . . . . . . . . . . . . . at. . .IIIAW.1:5.•. n .-moi '� . . . . . . ., N��ort Andover, Mass. PLUMBING 1 SPECTOR Check # �/bJ AW a� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: D • 42P /Y/�.If ,MA. Date: Permit# ' Building Location: l�Y�/ L��7ir1T.�J,YJ V✓, Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [� New:❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURESUl Lu \ Z tq V ~ a m s WW v U) O = W w O Z g Z p W W w w O ~ F O Z g m O �" a Q W o Ig X w I— W a W w w z g rn x w O� ui Z W Z W >- W m J ~ Q~ m W O Z O ~ I- W l. W O _Wm n a m i�i u> > O O w z Z W a F- V m m W 0 0 x x g O a m P > > > O SUB BSMT. BASEMENT ' -1-FLOOR 2 FLOOR 3mu FLOOR 4m FLOOR 5 FLOOR 6 FLOOR -f-FLOOR 8TH FLOOR f Check One Only Certificate# Installing Company Name:/� f�.C,�L/� i £/� /t�lr!�•,.�.r/dr � Corporation Addressed 4maw -4150 City/Town: State:ew. f El Partnership Business Tel: f ,F3 Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: Aggic 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. A 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;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 pro 'sion of the Massachusetts State Plumbing Code an Chapter 142 of the General Laws. Ty of License: BY Plumber Title ❑ as Fitter Signature of nsed Plumber/Gas Fitter LillMaster Ci /Town ❑Journeyman APPROVED OFFICE USE ONLY ❑ LP Installer License Number: The Conunonvealth of Massachusetts De&iit�netit oflrillilstrial ccidetlts Office of Investigations 600 Mashingtott Street Boston,MA 02111 •.:.5�'=yam�-' .. I. .. . . -� >'vtvw plass gov/dia Workers' CompensationInsurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeeibIv Name (Business/Organization/Individual): �11d, / ile oole Address: City/State/Zip:,1V,f Phone#: Are you an employer?Check the appropriate box: fr Type of project(required): 1.[j�l am a employer with 1p 4. Q l am a general contractor and 1 employees(full and/or part-time). have hired'thesuh-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheei. 7. ❑ Remodeling = ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9• ❑Building addition required.] 5. [] We area corporation and its . 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.E:] Roof repairs insurance required.]t c. 152,§1(4),and we have noi - employees. [No workers' 13.0 Other comp. insurance.required.] Any applicant that checks box#I 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. %Contractors 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 ani air employer tliat is prot,idiiig tvorA-ers'conrpensatioi insurance for my a/lTployces. Below is thepolicy mfd job site information. �r Insurance Company Name: p wz /���. • Policy#or Self-ins.Lie.#: � O ��o�lp Expiration Date: Job Site Address: City/State/Zip:/1/O- fr •j)/��jt� 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 do hereby certify an the pains and penalties o perjury that the information provided above is trite and correct. Sienature: Date: 1.1-07111 Phone#: Official use only. Do not write in this area,to be completed by chy or totvit official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of.Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Informatio:wandvinstructions r,tct�t�;.�t`,�<t*r� ►.'�� `•.air,;:: ' Massachusetts General Laws chapter 152 requiresiall semployers to provide workers'compensation for their employees. Pursuant to this statute,an entploj ee is defined as" .every person in the service of another under any contract of hire. express or implied,oral or written." (WI +,1r.r_ " it .t'1+ An enzplojwr'.is'defined as"an individual,partnership;'association,corporation?or other legal iintity or any two or more of the foregoing'engaged in p joint enterprise,and including the legal representatives of a deceased employer,or the receiver or truste.6tan individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not_more tlian: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 becai se of such employment be deemed to be an employer." t -- _ - MGL chapter 152,y25C(6)also stats that"every state or local licensing agency shall withhold the issuance or renewal of a License or,permit to operate a business or t0 construct buildings in the commonwealth for any applicant ilio Lias 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 comliliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compcn'sation affidavit completely,Uychecking the boxes that apply to your situation and,if necessarj;'sulipiysub-contractors)name(s),addresses)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 maybe`submitted to the Department of Industrial .Accidents for,confirmation.of insurance:coverage. Also be,suee to sign-and date thea Mdavit. 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. A , d t f!: '. f of t City or Town Ofilcials Please be sure that the affidavit is complete and printed•legibly,`The Departnient-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 pei`mittlicense number which will be used as a reference number._.In addition, an applicant that must submit multiple permittlicense 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 t usiness 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 cooperaiion-and should,.you'have any questions,. - please do not hesitate to give us a call., fr ` The Department's address,telephone and fax number:' _ The Commonwealth of Massachusetts -- _ -- Department-of Industrial,Accidents w Office ofInvestigations y 600 Washington Street Boston;MA 02111 Tel. # 6177727-4900 ext•406.or-1-877-MASSAFE Fax'#617-727-7749 Revised 4-24-07 www.mass.gov/dia - _ f Date .. . ..... .. . NORTH .,.' o? TOWN OF NORTH ANDOVER � F <. PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . .,.. . . . . . . . . . �. . . . f has permission for gas installation el? -�- r- in the buildings of'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . .. Ste. . . . . . . zrtY1ad_,ver Fee. elJ�. Lic. No..W�-�?. . . . �!!iG / �, hh? GAS INSPECTOR Check# � a 7950 r A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: �d' /Y�y�,� MA. Date: / / Permit# Building Location: (Grp �� Cr% Owners Name:';M4WO Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential E New:❑ Alteration:❑ Renovation:❑ Replacement:[Y]/ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED cc 2i SYSTEMS W Z 0 W Y U N 0 z 4A 3E 0 In W H H Q &n J U F"' W C Z C Z W z C Z d' V) Z Q CQ to LU Z N iQ/1 W H G 0 o -j 0 Q UJzH e Q W C oc OC Z H Z C o: LL 0 W oll 3 O Q W W LU 0: Q Q Vf N 0 0 > > 0 _ Q Z SUB BSMT. BASEMENT 1sT FLOOR eD FLOOR 3"D FLOOR 4TH FLOOR STH FLOOR e FLOOR 7T"FLOOR 87 FLOOR Installing Company Name: � Check One Only Certificate# /���i��/�B/N��/7,��17�/��r / ��yj t,�� ,�,,/ Corporation gA Address��X"#A0' D City/Town: i���l� State: ew. ❑Partnership Business Tel:6,27) 3 Fax: 6e5=.5` ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ga/No❑ If you have checked Yes,please indi ate the type of coverage by checking the appropriate box below. A 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 . Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's 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 of7e Mass/a�pu7/tts State Plumbing Code and Chapter 142 o e General Laws. By Type f License: �— Title __,,�mberIV Signature of ' nsed Plumber City/Town Cl'Master License Number: APPROVED OFFICE USE ONLY ❑Journeyman 11 �L A OD GAS FrfM. S' - REGISTERED AS A PLUMBING CORP GEORGE R LAROSE - -ANDOVER PLUMBING 8t HEATING C . 20 AEGEAN DR .__:UNIT 10 METHUEN MA 018.44-1580.- t 2122 05%®1/12 784263: V �: f., =? LICENSEDIAS�A J URN�E1fM�AN�P UM Ik1�D+CsirS7TERS - LICENSED AS-A MASTER.PLUMBER GEORGE .•R LAROSE - GEORGE R LAROSE AR °-:44'ODIL'E .ST ' -44 WILE STREET < :NETHUENMA::01844-4233; ; NETHUEN NA 01844-4233_ 28725 05/01/12 -' _. 784282 . 9983 05/02112 78428 Date.....�..Z...... :..�.1.. t °���``°,•�"° TOWN OF NORTH ANDOVER Fr ' 'PERMIT FOR WIRING SSACMUS� This certifies that ...{. Q2y n� .. 'T7.... . s has permission to perform ....... .................. wiring in the building of........1.! . ......................................:................ t- at t .... ?. ?. .... .t m p.�. ... .... .7 .................. North Andover, ass. Fee....5...... ........ Lic.NoJ6Y,1,,.'7144. f / EL CTRICALINSPECTO Check # r i 0524 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. 7 `� `T Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] leave blank X APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code JME ),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspe for W Wires: By this application the undersign d vesj notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant 1:�X`PY--3--7T e4LJFJ Telephone No.Q�! U Owner's Address S Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd [J No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: O§flD-CR L,-�o✓ C4 A30-v— rvio, J o?o,� Completion of the following table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. E] Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection PP KW No.of Dryers HeatingAppliances Security S stems:" No.of evices or Equivalent No.of Water KW 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 E uivalent 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: J25�� 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 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM LIC.NO.: t 6 Licensee:– Goy Signatu LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.14063 *70/9) , Address: !02 �fC ,1 '� 'y /-� 0�5� Alt.Tel.No.:19��l %3`5>�G *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: 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 Owner/Agent P ERMIT FEE. $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: City/State/Zip:_ Phone #: too,3 fflev �l Are ou an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and 1 ❑ p y 6. New construction mployees(full and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet. * ❑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.❑ Electrical repairs or additions '1 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certder, an es of perjury that the information provided above is true and correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: y Date. . .'. ... .. . .... .. .. f t NORTm TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION h �'ISS ACHUSE�4 This certifies that . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . �r%.-?-. . . . ; ./�-!� -r in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . t . . . .t./. . . . . ! . . . . .. . . . . . , North Andover, Mass. �l Fee.A .u . . Lic. No.et . . . . .,� _! '�� � . . . . . . . . V --GAS INSPE T R Check# �w 3756 E MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTi G � (Print or Type) C NORTH ANDOVER Mass. Date �7 O lhuilding Location (o(o l ()wood S,t`, I Permit # 6 Z�' .� Owners Name Rloan Trro Y ? - New _ Renovation Replacement Plans Submitted D FIXTUP_c W vi Y z s trs cc � S W m ~ = N LU Q m W tsar I � a � � q W z V W W .� Q Y q W W W W d CL •cc W W Cf C z f- z W H a rz 1- w t i- W z d ut a rz m c rr o N y Q W C W 6 G d .4 O O W O 1t1 t- lzx O v z u. n o ..t U > a m a- o SUQ—as'.IT. BASEII!lENT ' IST FLOOR 2NOFLOOR 3R0 FLOOR ' 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR r STH FLOOR (Print or Type) Che k one: Certificate Installing Company Name AnApodr Cc>a-TrV, Corp 2122 Address 2n req '��-. `- ;t1p Partner. Alekb)i,y o (110- ©IS4c1 Firm/Co. Business Telephone: (9 6$s-83} 3 Name of Licensed Plumber or Gas Fitter CeoE .Q Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: t Liability insurance policy F-�,71 Other type of indemnity 0 Bond Insurance Waiver: 1 , 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 17 Agent I hereby certify that ail of the deuils and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing Worst and Installations perforntcd under Permit issued fo: this apptintion will-be in pilanoa with all pettlneat provisions of the Massachusetts State Cas Code and chapter 1i:of the General Laws. .. By TYPE LICENSE: Plumber Title Gasfitter- Signure of Licensed City/Town: Master Plumber or Gasfitter Journeyman 8403 APPROVED (OFFICE USE ONLY) License slumber J 5 5 2- Date. .�. . . ��. . M NgRTh TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION F F s a SACMUSEt This certifies that . ;;.!t fL _. . . . . has permission for gas installation . . -�, . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . .. North Andover, Mass. Feed .... Lic No z` . . . . . . .f,? /` .�`GAS IN P CT�O WHITE:Applicant CANARY: Building Dept. —PINK:Treasurer 02 > Fj MASSA I APPUCATON FOR PERMIT TO DO GFPermit 'y .pAEtCEL �- ��Type or print) DatNORTH ANDOBuilding Locations S v .lS ��. Amount S � � I ( ..' ,YZ�) Owner's Name New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ m L z .. Z ft i n Z C y r rncn 1 - - C t. SU B -BA SE ,M ENT BASEM ENT I ST. F L O O R 2ND . FLOOR 3 R D . F L O O R 4'r 11 FLOG R ST If FLOOR 6T I7 . F1,Q O R 7Tu . FLOOR STIf0 FLOOR (Print`r type) Check one: Certificate Installing Company Name ��� 1 C ��� /< < ® Corp. Address ❑ partner. YL Business TelephoneFirm/Co. -- o a ❑ Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes IQ No❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy (/"M 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 1:1Agent ❑ 1 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 p&formed under P it Issued for this applic n will be i compliance with all pertinent provisions of the Massachusetts Stat apter 142 of the Genera i By, nature of Licensed Plumber Or Gas Fitter Title ❑ Plumber /,�, City/Town ❑ Gas FitterI�iNumoer Nlaster APPROVEDIUFFICF USEONI.Y) ❑ Journeyman Nu 2288 Date.......t J. /�. - . f NORTI� a TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACMUS� This certifies that .... ...... .". C . ..Ic.4... ............. has permission to perform 1�f' t„nJ.......1 �« ` . wiring in the building of....... V J C / C at.... .............................�.........��......�� ' .. ........:..........,North Andover,Mass. Fee...r ...... Lic.No.. ........ f.. —�... ! !�`../. 1�`f/............. p3 / � / �ELECTRICAL NSPEC7'OR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only C� Pett.No.. res�a��a� r�o f ss��,�rssrrs T.p�re«m.e �•tiV[e Shy Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be peifimned in accordance with the MassachusettsElectricai Cade 527 CMR 12:00 (Pieria Print in ink or type all information) Date 9 To the Inspector of Wires: Town of Forth Andover The undersigned applies for a permit to perform the electrical work described below. / e Location(Shed&Number Ze,T Owner or Tenant O Owners Address U is this permit in conjunction with a building permit Yes ,/ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Dl�S3 E�astirt Sennce Amps Volts Overhead ❑ Undgmd ❑ No.of Meters New Service Amps /2 ZL�Volts Overhead 661Undgmd 41 No.of Meters Nu of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lightfing Outlets No:of Hot fuse. No.of Transformers KVA Above ❑ In ❑ No.of Ughtinq Fixtures SwimmiEqPool and ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners BatteryUnits No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Oi No. Pumps Torts KW No.of Sounding Devices NoJ of Self Contained NolfDishwashers Soaee/Area Heating KIN DetectiontSounding Devices C] Municipal El Other No.of Dryers HeatinqDevices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Sailases Wiring No.Hydro Message Tuds No:of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requirements of Massachusetts General Laws r I haveArcuent Liability Insurance Policy irmiuding Completed Operations Coverage or its substantial equival t YES= have submitted valid proof of same to the Office YES= NO = if you have checked YES please indicate the type of coverage by checking the appropriate box Iy�URANCE = BOND- = OTHER (Please.Specify). 1/ (Expiration Date) / Final Estlinated Value of EI l ����( Work to Start -5' Inspectlon.Date Resquested. Rough �/e_ Signed under ViWPonatttes of.pertury: Q� LIC.NO. 4/�7�- FUM NAME J Licensee G J`f Signature / Q /C.N(O�. Address ,� �//`L �� &414 LX/1 BAlt Tel.No. o p r 6 OWNER'S INSURANCE WAIVER: I am aware thatthe Licenses.does not have the insurance.coverage or its substantial equivalent as required by Massachusetts General taws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) PERMIT FEE S i NORT1j 3�Oy "g o I'v ' T I it s TOWN OF NORTH ANDOVER 9SSACHUSt APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY -. S G0n ST DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: ly S? FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND PERMIT SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY DOLLARD $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING CONSERVATION (Jy( 1p l 2"3 PLANNING Ei� 7 DPW - WATER METER NOTE: DPW MUST INDICATE THAT WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW Sianature Date.. . ' Of NO oTM ,ti TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9SSACMUSE�t This certifies that . ./7"�/. ,ter! . . . . .r. . . . . . . . . . . . has permission for gas installation . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at f. . .G �".C., . . . . . . . . . . . .. North Andover, Mass. Fee.. . ? Lic. No.. . . . . . . . .' GASINSPECTOR v Check# / 7 4019 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print �or� ) ,V OR- Name— , Mass. Date 6 - 7 - o a Permit # 0 _ �l l Building LocatioSOwner's Name Type of loccupan y New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ (n N OC X W N N N V Z Q CC N a N a 0 m 0 J N w F z p u f' C _ O h w a m o m rn h ;u W 0 a •s h W Q h 4f 0. W W tWW Z cc J z Q S a a n W h w h s N a " Y W -� h Z �. H W y 0 Z W h J W a — e a — r m o z 0 �n z � W > cc W tl Z. < CG Q < O O W 0 h �} Cr '.7C 0 tl 7C W O 3 C tl -8 V y. Q CL F- O i SUB—BSMT. BASEMENT f 1 ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone .68,7--:1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of Yes K No 11 MGL Ch. 142. If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability Insurance policy P< Other type of Indemnity❑ Bon ❑ 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 Ownersagent Owner❑ Agent❑ I hereby certify that all of the details and information 1 have submitted(or entered)in&7f ation are true and aoc u%te to the best of my knowledge and that all plumbing work and installations performed under the permit application will n mpiiance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge (/ i T of Ucense: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master Ucense Number 3745 City/Town Journeyman O IC S ONL i. BELOW FOR OFFICE USE' ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO ADO OASFITTING c NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE ,r19 GA73 INSPECTOR