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Home My WebLink AboutMiscellaneous - 7 STACY DRIVE 4/30/2018 7 STACY DRIVE 210/091.0-0032-0000.0 Date....y� `�. ..`�.�... N°RT$l °f� °:•�"a TOWN OF NORTH ANDOVER 3a �•.r °c F p PERMIT FOR WIRING ,SSACMUSE� � F G This certifies that " 1.� ....................:.... .`.` has permission to perform--"-' -�--- ....................................................... wiring in the building of. `-r.�.. .................................................................................. at....7.: - �-�� ............ ... ... No Andove ,Mass. Fee�d...� ....... Lic.Noly.A.I� :............ :. ELECTRICAL INSPE Rif c Check # 7 � J la�N (f0owionweaIg o/Massaeh.eesatfs Of Use Only tt�� cc77 Permit No. �3 .1JeParinwnf of iro Servicas Occupancy and Fee Checkedcl_fL-- BOARD OF FIRE PREVENTION REGULATIONS (Rev, 1/07j leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK . All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: Ah>R,'Y To theIn pec o of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) 5 a c. 4Q Owner or Tenant /r t=om 7 t/�� '�j,/ Telephone No.,o Owner's Address 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table ma be waived b),the Inspector of I-Vires. No.of Recessed LuminairesNo,of Cell.-Susp.(Paddle)Fans °.° otal Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Lumidaires Swimming Pool A ove ❑ n- ❑ o.o Emergency Lighting rnd. rnd. Ba"ery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No,of Gas Burners o,of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat ump 'um er ,ons. o,oSelf-Contained Totals: " """ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ un a pal ❑ Other Connection No. of Dryers Heating Appliances KSecurity ystems:*KW No.of Devices or Equivalent t No.of WaterKWo. o o. of Data Wiring: Heaters Signs ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required bti•the Inspector of{Vires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stan: 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 cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (T OND ❑ OTHER ❑ (Specify:) certify, under the pains and penalties of perjury,that the information on is apptic ion is true and complete. FIRM NAME: DAVID E(E1CTr4i CAI- cot4rOCTt � LIC. NO.: )q%3A Licensee: DAV 1 D µA6rot*IZ Signature LIC.NO.: (If applicable,en�gr .exe�mpt"in the license number line.) Bus. Tel.No.: �1 t��-b.�d 2 Address: ? 13tLVndNT ST Nt7RM AN��CR Alt.Tel.No.:q 7Y 325-673y *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic. No. OWNER'S INSURANCE WAIVER: 1 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 0-e Signature Telephone No. PERMIT FEE: Date. `1. `Y . . .�. . . NaRTM,ti TOWN OF NORTH ANDOVER , PERMIT FOR PLUMBING ,SSACMUS� f .1 G This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform ;.. . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of : ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , North Andover, Mass. No:. i, . �'�. ' . . . . . . . . . . . // PLUMBING INSPECTOR � f Check # .-� /� 80L,o s MASSACHUSETTS UNIFORM ,AppL (Type or print) ICATION FOR PERMIT TO DO PLUMBING . NORTH ANDOVER,MASSACHUSETTS Building Location 2 Owners Name �P� Date Penna# -� T e of Occu anc S ,,/,, Amount New Renovation E Replacement 'V Plans Submitted Yes �"( No ❑ FIA'TURES L.1 _ q U 15T FLOOR 3 D FLOOR 3RD FLOOR 41H FLOOR SME 61HEL03R 9M (Print or type) Installing Company Name �� /. Check one: Certificate Address r/e Elgod - Corp. Partner. usmess e}ephone Name of Licensed Plumber ej 0._ Insurance Coveraue: Indicate the type of insumnede coverage by checking the appropriate box: Liability insurance policy Otherof indA types yM33ity 0 Bond El Insurance Waiver I, the undersigned,have been made aware that the hcense-of this application does not have any one of the a Rime insurance Bove Signature ❑ Owner Agent ❑ I hereby certify that all of the details and information I have submitted best of m}�lrnowledge and that all plumbing work and installations (017 entered)m�OVe application are true and accurate to the compliance with all pertinent provisions of the Massachusetts ormed under P sued for this application will be in lambing Code an ter l42 By: of the General Laws. Signa, of l rcens umoer Title Type.of P umbirng License �;PROVE70PFUCE /Town l USE ota Y cense lvumeer Master ❑ Journeyman 1SLC urr.rretircwealth of Massachusetts Department o 1, � /� .f Industrial Accidents. Office of jnveVfi ;i riy a atlt)nS ".� 600 W ashinfon Street Eosto n, AIA 02111 r wwrv.rriass.a Idia Workers, Compensafiou Insurance.Affidavit: guiders/Contra.ctors/E Aa Iicant Information jectridians/plumbers Please Print Legibly Name (BusineSs/Organization/individual): Address: City/State/Zig: Phone#:_ !' 7� ��-�1?�=' Are you an employer?Check the appropriate box; 1.❑ I an a employer with 4. ❑ I am a o F7. e of project(required): �erieral contractor and I em es(fill and/or part-time).* have hired the sub-contractors New construction am a sole proprietor or par tner- Iistvd oxi the attached sheet I Remodeling ship and have no employees These subcontractors have worl`-ing for me in any capacity. work=, 8. ❑ Demolition [No workers' comp. insurance 5. ❑ We are a comp. insurance. corporation and its 9 ❑ Building addition 3.❑ required_) officers have exercised.their 10: I am a homeowner doing all work right of ex ❑ Elegy i.cal repairs or additions myself. [No workers' camp, c 15� exemption per MGL I I: Plumbing repairs or additions insurance required.] t 'employees.' 1(4),and we have no [No workers' 12.❑ Roof repairs comp. insurance required.] 13•❑ Other *Any appiicant_that checks box#1.must also fill out the section below showing their workers'coin .rssation ofi t g rlomeowners wlio submit.ilits aiudavit inriicerittg L`iei erc deice !is+;:r; ._ the p' tContraetors that check this box musi attached an additional sheet showi p iniomiation. n hi ouiae convaciors rnuit sabmil a new amtiavit irdirg s ch. n the name of t e ;b_Do;, tors and their I am an enw1over that&n+rn,,;n`-_ t_ woricers'comp.pol icy information. r ,e workem'compensation insurance infnrmatio2 .for ml'employees. Below is the poficy and job site Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: .lob Site Address: Attach a copy of the workers' compen ation otic decla Cit}'/State/Zip:ddf� .�.0 P ration pace(showincr g the policy number and expiration date). Failure to secure coverage as required under Section 25A of fine up to$1,500.00 and/or one-year imprisonment, as well as civi)penalties in ad to Orme imposition a STOP WOR criminal penalties of a of up to 5250.00 a day against the violator. Be advised that a copy of this statement or , o K ORDER and a fine Investigations of.the DIA for insurance coverage verification. ) b forwarded to the Office of I do hereby certify eF4he paimv es o er u jP ! rJ that the information provided above is true and correct Sic-mature- Dates; Q Phone#: Official use onlp. Do not write in this area, to be completed h3;city or town official Citj,or Town: Issuing Authority(circle one): Permit/License 4 1. Board of Health 2. Building Department 3. City/Town 6.Other Clerk 4. Electrical Inspector 5. PFumbin� b Inspector Contact Per-sort: Phone Date. . ... . ... . .. . . HORTM Of o� TOWN OF NORTH ANDOVER f � A PERMIT FOR GAS INSTALLATION �,SSACHUSEtt This certifies that . . . . . . . . . . . . . . has permission for gas installation A? in the buildings of . . .Jr .. � '. . . . . . at . .- . . . . .-�.-� f�!� . . . . . ... . . , North Andover, Mass. Fee. . 7. . L>.c. No.. . . . . . . . . . _ . . ,c-. . . . . . . . . . GAS INSPECG Check# 6762 MASSACHUSETTS UNIFORM APPUCA'TON FOR PERMIT TO DO GAS FLING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building LNations Permit# Owner's Name Amount$ New D Renovation Replacement Ej-- Plans Submitted Ed w U a� a w a a o = x F Z o a I ° W F w U F z F C x a W eC G Ems• z m W a w v w 'o a _Z d ' �° z' o c SUB -BASEM ENT 3 C `� z > c a F 0 BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . FLOOR ' 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Name ef , 9 P5441— Check one: Certificate Installing Company a Corp. Address �h U� d �^ Co �c Partner. usmess 'e ep one _ irm/Co. _ Name of.Licensed Plumber'or Gas Fitter 110( 1001 INSURANCE COVERAGE I have a current liability Insurance policy or it's substantial equivalent Check one: If you have checked es,please indi stype coverage by checking the appropriate box.Yes No� Liability insurance policy Other type of indemnity D 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 Check one: er Agent 13 hereby certify that all of the details and information I have submitted(or enOte ed)in i1 application are true and accurate best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in the compliance with all pertinent provisions of the Massachusetts a¢Code an h er.142 of the General Laws. BY Si ature of Licensed Plumber Or Gas Fitter Title Plumber City/Town•. ✓ 0 Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ourneyman 3