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HomeMy WebLinkAboutMiscellaneous - 71 MARBLERIDGE ROAD 4/30/2018I Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ , .. ......................................... C'--** has permission to perform fia"an.. To�w ......... wiring in the building of ..................... 2FS-4".; ................ .... . .. ... ......... 7/ at ...................... ................. , North Andover, Mass. ......... ......... Fee3-'r-!Z&�. Lic. No.S."TM .................. . I ........... ........... 1, ELECTRICAL. INSPECTOR Check # 7625 lfommonweahh of Ma-macLe Official Use Only 2cc /�Permit No. epad.d of gim Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE 4LL 0 TION) Date: d-? City or Town of: M6 To the Inspec or of Wires: By this application the undersigned gives no 'ce of his r h:Z;�2 the electrical work described below. Location (Street & Number) 1 � Owner or Tenant IM77�, ��() Q� Ls1�`(} Telephone No. Owner's Address Is this permit in conjunction with a building pe it? Yes ElNo (Check Appropriate Box) Purpose of Building J C Utility Authorization No. Existing Service Amps / Volts verhead ❑ 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: Q� ✓LS - y4 t �� Comnletion ofthe following table may be waived by the Inspector of 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 No. of Luminaires Swimmin Pool Above ❑ In- ❑ g nd. rnd. o. oEmergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection nd Initiating Devices No. of Ran es g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p eat Pump Totals: um_._er _..._ ._...._....'..._ ons ................_._._.__..... o. of elf-Contame Detection/Alerting Devices No. of Dishwashers S ace/Area Beating KW p g Local ❑ Municipal ❑ Other Cyonnection No. of Dryers Heating Appliances KW uri SecNo of Devices 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 Equivalent OTHER: Attach additional detail y aestrea, or as requtrea by the inspector ql mires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: �"� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability i ance including "completed operation" coverage or its substantial equivalent. The undersigned -certifies that such cover a is in force, -and -has -exhibited -pro -of -of sotto De p�issuing o ice. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and peN 'es o erjury, th the in o tion on this application is true and complete 3FIRM NAME: �� /1l � LIC. NO.:� Licensee: LST?- -e-yn Blvdz Signature LIC. NO.: (If applicable, engem t" in I'cense n tuber line.) Bus. Tel. No.' Address: Alt. Tel. No.. *Per M.G.L. c. 147, s. 57-61, security work requi es Department of Public Safety "S" License: Lic. No. �' r OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. TOWN OF ANDOVER ELECTRICAL PERMIT FEEs (Effective March 12, 2003) r7 � 400 NO SE CABLE ON OUTSIDE OF BUILDING Air Conditioners: $40.00 each Alarm Systems Security: (for fire systems see smoke/heat detectors) Residential: $40.00 Commercial: up to 10 Devices $60.00 additional devices over 10- $1.00 each Carnival Equipment: $50.00 each Ceiling Fans: $1.00 each Commercial New Construction or Alterations: $100.00 per 1;000 -Sq: Ft. of Construction Space Commercial Service Change/ Repair: Must have Utility Authorization Number $100 (first 100 amperes or fraction, one meter) a) each additional 100 amperes capacity or fraction. $30.00 b each additional meter $25.00 Commercial Temporary Service: $100.00 Must have Utilih, Authorization Dumber Commercial Repair and/or Maintenance Permit: (Blanket Permit) up to 2 Electricians $150.00 per pair of Electricians over 2 $50.00 Data/Telecommunication: Residential: $1.00 per port Commercial: $30.00 up to 10 devices over 10 - $1.00 each Dishwashers & Disposals: $5.00 Each Dryers: $15.00 Each Emergency Lighting (Battery Units) $ 1.00 each -unit - Feeders or Sub -feeders: each 100 amp capacity of fraction thereof Residential: $5.00 each Commercial: $15.00 each Gas/Oil Burners: Residential: $20.00 each Commercial $20.00 each Generators Residential & Commercial: a) including photovoltaic & generating Equip Per KVA $1.00 b) un -interruptible power systems, per KVA $1.00 c) batteries over 100 amp. hours, per cell $1.00 Heat Devices: $1.00 each Heat Pumps: $40.00 each Hydro -Massage Bathtubs/ Hot Tubs: $20.00 each Lightixig Fixtures $1.00 each Lighting Outlets: $1.00 each Major Appliances: (not listed) $20 each Motors: (per hp or fractional part thereo $2.00 Oil /Gas Burners: Residential $20.00 each Commercial $20.00 each -- Office Furnishings: per circuit $10 elocatable Partitions/Cubicles) Outlets & Fixture: $1.00 each Ovens Built in/Counter Top Units: $10.00 each Panel Change/Circuit Breaker: Residential: $20.00 Commercial: $25.00 Phone Jacks: See datahelecommunications Ranges $15.00 each Receptacle Outlets: $1.00 each Recessed Fixtures: $1.00 each Re -inspection Fee: $25.00 Repair to Service Residential: $20.00 Residential New Construction (Dwelling): $220.00 (with service up to 200 amps) Must have Utility Authorization Number for services over 200 ams see below a) for each 100 amps capacity or fraction add $20.00 b) each additional meter $10.00 c) -each -additional panel/sub panel $25.00 Residential Additions/Alterations: $220.00 maximum Residential Service Change or Underground Service: $40.00 Must have Utility Authorization Number a) one meter, up to 100 amp capacity $40.00 b) each additional 100 amp capacity or fraction $20.00 c) each additional meter ..$10.00 Sewer Ejection Pump: $25.00 Signs: $25.00 each ballast Smoke & Heat Detectors & Initiating.Devices: Residential: $1.00 each Commercial: $60.00 up to 10 devices over 10 - $1.00 each Space Heaters: area heating $1.00 each Sub -Panel: $25.00 Swimming Pools: Residential: Above Ground: $25.00 Inground: $50.00 Commercial Pool: $100.00 Switches: $1.00 each Temporary Service: Must have Utilit Authorization Number Residential $25.00 Commercial $100.00 Transformers. a) capacitors, Per KVA $1.00 b) ducts, conduit & conductors (Associated w/ Padmount Transformers) $25 c) each manhole $10.00 d) each handhold $5.00 e) per KVA $1.00 f) primary feeders, $25.00 each (over 600 volts, non-utility owned) vaults and equip. $25.00 each Washers: $15.00 each Waste Disposals: $5.00 each Water Heaters: $30.00 each *For Multi -Family & 47\Large Commercial Project see Wiring Inspector for pricing: Paul Kennedy (978) 623-8306 (Office Hours 8 ani to 10 am) _ *Inspection Schedule: .1 ROUGH 1 FINAL I TRENCH (if applicable) ADDITIONAL INSPECTIONS *$25.00 (if applicable) (revised 07/05) t t ti Date ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ;............... / ....... ...... ...... ............................. has permission to perform wiring in the building of ....... ................................. ............................ at .... 7/ ...... ....... ...... ���-:..4�:,i,.---a--).,,Northn.,Andover,Mass. Fee.............. Lic. No... 6sv . .. .... ......... ... ....... . . .. . . .. . ....... ELECTRICAL INSPECTOR Check 0 7835 ;`. VV111111v1/Wt!d1En OT massaCl1[ISettS Official Use Only Department of Fire Services Permit No. 2P 3S BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked — I ZV Rev. 1/07] eaveblank 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 W INK OR TYPE ALL INFORMATION) Date: 111Z �10 ,7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) I (,e1/ f e r S-7 Owner or Tenant /t1 a I'7 lo Owner's Address 17 ( /Y-10 eb e Telephone No. Is this permit in conjunction with a building permit? Yes ff No ❑ (Check Appropriate Boz) P urpose of Building T(t 7"',e ✓\ Utility Authorization No. Existing Service 709 Amps (!moi / Volts Overhead ❑ Und rd g j�] No. of Meters / New Service I Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: kr, SSI a�w Estimated Value of lectriAttach additional detail if desired, or as required by the Inspector of Wires. f al Work: 660, (� ® (When required by municipal policy.) Work to Start: f ^,/d 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 A 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 1 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains an4 penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: �ZD ",.,?j Licensee: l'n �� a P,;*. Signature LIC. NO.: (If applicable, enter "ezem t' in the license umber line.) Address: _203 0 '„ee ' .A� ©`IL1Bus. Tel. No.:i�� Alt. Tel. No.: *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 agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ No. of Recessed Luminaires No. of Luminaire Outlets Completion o the ollowin No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs table may be waived by the Ins ector o Wires. o. of Total Transformers KVA Generators KVA No. of Luminaires No. of Receptacle Outlets 6 Swimming Pool Above ❑ ln- ❑ rnd, rnd. No. of Oil Burners o. o mergency ig g Batte Units FIRE ALARMS No. of Zones No. of Switches 3 No. of Ranges No. of Gas Burners No. of Air Cond. otal Tons i No. of Detection and Initiatin Devices No. of Alerting Devices No. of Waste Disposers No. of Dishwashers No. of Dryers No. of WaterNo Heaters KW No. Hydromassage Bathtubs OTHER: eat Pump Number Tons KW Totals: _._........._ ...................._. _. Space/Area HeatingKW Heating Appliances KW . of of Ballasts No. of Motors Total HP No. of Se -Contained Detection/Alerting Devices Municipal Local ❑ Connection E] Other Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Equivalent Estimated Value of lectriAttach additional detail if desired, or as required by the Inspector of Wires. f al Work: 660, (� ® (When required by municipal policy.) Work to Start: f ^,/d 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 A 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 1 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains an4 penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: �ZD ",.,?j Licensee: l'n �� a P,;*. Signature LIC. NO.: (If applicable, enter "ezem t' in the license umber line.) Address: _203 0 '„ee ' .A� ©`IL1Bus. Tel. No.:i�� Alt. Tel. No.: *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 agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ FCvt al © CZ The Commonwealth of Massachuse& Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 C-1 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information PleasePrint Le�My Name (Business/OrganizatiorAndinvidual); t" A a / Address: 90-3 , 4 Cdr /� / City/State/Zip:`e 7� �er'1 M,4 0 S qt( Phone 9 7,g � �% �' �l/ Are you an employer? Check the appropriate box: I . ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors UI 2am .a.sole proprietor or partner- listed on the attached sheet f ship and have no employees These su&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 MOL myself. [No•workers' comp, c. 152, § I (4),•and we have no insurance required.]l employees. [No workers' comp. insurance required-] *Any applicant that checks bol # I must also fai out th t' bei h Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. C7 Demolition 9. ❑ Building addition. 10.0 Electrical repairs or additions I l.❑ Plumbing repairs or additions 12.❑ Roof repairs 1,3:❑ Other e sec ron Ow s owing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all walk and then hire outside contractors must submit a new affidavit indicating such. - 4contractors that check this box mustattaehed an additional sheat showing the name of the sub-contraccoes and their workers' comp. policy infnmuition. I am -an employer that is. provrdutg:workers' compensation insurance for my employees Below is the information. policy and job site 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 againstthe.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 cert f) underthe ai n n of perjury that the information provided above a a and carred Signature:c2�%Xzt Phone #: 974f d /%z 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 S. 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 that 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 oot produced acceptable evidence.of compliance with the insurance eoverage 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 -contractors) name(s), address(es),and phone numbers) along with their certificates) 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 requued. 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 appiication for the permit or license is being requested, notthe 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 permit1license 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 ofthe 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 bum 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. # 617-7274900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ��d — MASSACHUSETTS UNIFORM APPLICA T ION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date - �uilding Location Permit %%%%Q�/� ,�'t Permit Owners Name�j�,E$ # ? Y New —7. Renovation Replacement TEr/ Plans Submitted D (Print or Type) Check one: Certificate Installing Company Name /5?A)/D-1/,� ��i//�/Bi/r/��.�/� irk, %C [ Corp.— Address 57g / s� - dwi;wa4 ; Partner. Firm/Co. Business Telephone: (514F) Name of Licensed Plumber or Gas Fitter � Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Z Other type of indemnity 0 Bond Ej 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 17 Agent El I hereby certify that all of the details and information I hare submitted (or entered) in above application are true and accurate to the best of mY knowtedgc and Mat aU plumbing work and Installations performeId under Pumit issued for this appEieation will -be in compilanea with all pestlaent provisions of tho Massachusetts State Cas Cade and t-apter I4: of the C.enerai Laws. By - -- -- 77.. _ YPE LICENSE: �— Plumber --�4 Title AIR I j ��_ , Gasfitter Sig ature of Licensed City/Town:Master Plumber or Gasfitter �3 Journeyman APPROVED (OFFICE USE ONLY) License Number N � W N w art v a t` a m a s o°= ct: H W< tw- W = W F- to a Crz n W y tW- 4 O N a z V w :- 4 Q O f- C W U1 W at 1 e w W a Q a? w W W r v= W t7 F- c W z d W < a •.• 1 4 >- 0 m' v Z It O trs z Q u y C W � G 4 Q O O W cc O W !- t= Z O cs U. � d C� . c U ct > C2 a F- O Slim -B S &1T. BASEMEXT IST FLOOR 2ND FLOOR 31311 FLOOR ` I 4TH FLOOR STH FLOOR 6TH FLOOR ` 7TK FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name /5?A)/D-1/,� ��i//�/Bi/r/��.�/� irk, %C [ Corp.— Address 57g / s� - dwi;wa4 ; Partner. Firm/Co. Business Telephone: (514F) Name of Licensed Plumber or Gas Fitter � Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Z Other type of indemnity 0 Bond Ej 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 17 Agent El I hereby certify that all of the details and information I hare submitted (or entered) in above application are true and accurate to the best of mY knowtedgc and Mat aU plumbing work and Installations performeId under Pumit issued for this appEieation will -be in compilanea with all pestlaent provisions of tho Massachusetts State Cas Cade and t-apter I4: of the C.enerai Laws. By - -- -- 77.. _ YPE LICENSE: �— Plumber --�4 Title AIR I j ��_ , Gasfitter Sig ature of Licensed City/Town:Master Plumber or Gasfitter �3 Journeyman APPROVED (OFFICE USE ONLY) License Number \a t�fi 5 Date ..Y.-. /� - `? ......... d, N0RTI, - TOWN OF NORTH ANDOVER Qf ,fD •HQ A 3? O ' f PERMIT FOR GAS. INSTALLATION :� 9 s 9e - '• a This certifies that .. A. n c.r? a? t-/ n M has permission for gas installation G.Aj,.C!-c .............. in the buildings of ..A.^ -.P.. %-4.X. D. e.. , , . , at :s........... No b Andover, MasA Fee. < !1.'.. Lic. No. �`x 3 . 1-4 . G S INSPECTOR " WHITE: Applicant, CANARY: Building Dept. NK: Treasurer GOLD: File 6 Date.``z........ NORTH TOWN OF NORTH ANDOVER py ao ,s�hpL p PERMIT FOR GAS INSTALLATION . This certifies that . . has permission for gas -installation ....... + - ............. . in the buildings of . . at, '. �%(..'-%?-� ...... ......� .. , orth� Andover, Mass. Fee.:.��...: Lic. No.......... :.:.... ,/� .......... 'GAS-IN�SISEGTOR z� PINK: Treasurer WHITE: Applicant CANARY: Building Dept. > K. MASSACHUSETTS UVIFORM APPUCATON FOR PERMIT TO DO GAS G \l., �lType or print) ate NORTH ANDOVER, MASSACHUSETTS Building Locations r h i e- d iY Owner's Name =} Lindsa Renu ebC � Renovation ❑ Replacement Plans Su bmfitted❑ - ?nnC r Npe) Checkone: Ccruncite installing Company Mme Andover Plb4. & Ht4. Co.. Inc. ©"Corp. eartss 20 Agean Dr. , Unit -10 ❑ Partner. Methuen. Ma. 01844 Business Telephone(978) 685-8383 ❑ Firm/Co me of Licensed Plumber or G: s Fitter Georae I aRnte 'NSLi AivCECOvERAGE Check one: nave a currenr liability Insurance policy or it's substantial equivalent. Yes NoE "vou have checked ves, please indicate the type coverage by checking the appropriate box. '`'•. ueiiin insurance policy Other type of indemnity ❑ Bond ❑'.', :.) ner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage requited by -Choler 142 of the -lass. General Laws, and that my signature on this permit application waives this requirement Check one: S'anarure of Owner or Owner's Agent Owner —1 Agent. ❑« •' 7i:-cbv certifv that all of the details and information I have submitted (or entered) in above application oi'my knowledge and that all plumbing work and installations performed under Permit Issued for t :ompiiance with all pertinent provisions of the iNlassachusetts State Gas CoSWfand Chapter I�i�%tw �--C4 L' y- TiIle (:'rv,Town UPRUV EDIUFf ICF:IJIEONI,Y) [PIgnature of Licens d Plumber Or Gas Fitter v: lumber 9983 ❑ as Fitter License I umoer u lvlasier ❑ Journeyman I accurate; to the ion will be in 0 v, z n N V C Z pCG = _ Z, L — Z '! 96 C r: fi y _ of n C C ti Z -t Z :sl "t tom"' .t 1r i. it r it i V Vl .^n ' i 1ra.tt:�SEYI ENT SE.M ENT 'NU. FLOUR (<: ) R 0. F L U O R 5 r5 FLOO K 6T 11 F L U O K 7T II FLUO K7 7, 77 .4 F 1. O O R r•' ?nnC r Npe) Checkone: Ccruncite installing Company Mme Andover Plb4. & Ht4. Co.. Inc. ©"Corp. eartss 20 Agean Dr. , Unit -10 ❑ Partner. Methuen. Ma. 01844 Business Telephone(978) 685-8383 ❑ Firm/Co me of Licensed Plumber or G: s Fitter Georae I aRnte 'NSLi AivCECOvERAGE Check one: nave a currenr liability Insurance policy or it's substantial equivalent. Yes NoE "vou have checked ves, please indicate the type coverage by checking the appropriate box. '`'•. ueiiin insurance policy Other type of indemnity ❑ Bond ❑'.', :.) ner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage requited by -Choler 142 of the -lass. General Laws, and that my signature on this permit application waives this requirement Check one: S'anarure of Owner or Owner's Agent Owner —1 Agent. ❑« •' 7i:-cbv certifv that all of the details and information I have submitted (or entered) in above application oi'my knowledge and that all plumbing work and installations performed under Permit Issued for t :ompiiance with all pertinent provisions of the iNlassachusetts State Gas CoSWfand Chapter I�i�%tw �--C4 L' y- TiIle (:'rv,Town UPRUV EDIUFf ICF:IJIEONI,Y) [PIgnature of Licens d Plumber Or Gas Fitter v: lumber 9983 ❑ as Fitter License I umoer u lvlasier ❑ Journeyman I accurate; to the ion will be in 0 9 Date. 4P. - _ v ?......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. f4.t.(.lit. ,!? :....................... has permission for gas installation . r4 /I tl En. s .n ............ in the buildings of C. Ir. ....................... v at .. j..��7,w .�f,�t ! t ......... , North Andover, Mass, Fee.. . Lic. No...3Y A .. .. �Ui.�.A4a-. � ... . T S INSPECTOR Check # l 0� 5019