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Home My WebLink AboutMiscellaneous - 74 HEATH ROAD 4/30/2018AM Date ........ . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..Y.. <t..P ��`e..........................................I........................ "�.......I.. has permission to perform ...........aTGW.�...-E?.UY+OcJ! ............. l+. wiring in the building of......................��..............................//............................... at ......................I... �............................. orth Andover, Mass. a :........................ pp Bb (� 'Pee ......4.. ....... Lic. No. ....... .i�.► ... .......... .... t ELECTRICAL INSPECTOR Check # 1 1 U 273 "' �Y? 411% S,1�4 rr" r+ n Commonwealth of Massachusetts ofsFiao only Permit No. 1 1/ I Department of Fire Services Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave biank 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: �— CA — I q 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) :7t,i j,,f , Owner or Tenant s\C� Lj�df v Telephone No. q?8-660- (()b(� Owner's Address Is this permit in conjunction with a building permit? Yes L. No ❑ (Check Appropriate Box) Purpose of Building V�� I Ce- M0144 Utility Authorization No. Existing Service -,g)u Amps 4O / :�!uOVolts Overhead IS Undgrd ❑ New Service Amps / Volts Overhead Undgrd ❑ Number of Feeders and Ampacity 4 9i) Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wirer. 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 Swimming Pool Above ❑In- EJo. rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number I Tons I KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. 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 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: Cl- (U , I 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 thepains andpenalties of perjury, that the information on this application is true and complete. FIRM NAME:y u `L, L`Cae'. 'rrC - � LIC. NO.: a (43U Licensee: Signature _ LIC. NO.: (Ifapplicable, enter "exempt" in the l'c4nse number line.) r Bus. Tel. No.: 1- ��- 9ci l - %130 Address: Z t For i ✓ Alt. Tel. No.: *Per M.G.L c. 147, s. 57-6il, 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)E] owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ �%� 0 i The Co�2��2oa�l�ear�� a, f 1�lassa��a.�c�'ei�,� Offlee o, ffnesfigafeons 6`00 Washzigton Street -Roston, HA 02111 v m asy.govIdia ��c �x,�' �ompex �tou bsuxance . xc-adt: J n c erg fCo �x°ac ox�l + Zc� re c ansl'Xa bex�, AnpWa>at �nrforn+Won Please, PrzntLew X� Nam '15 dc3xes:_ 1 %�ti j-ve Cz Ylstatelty:_ Ar�� IUI/ . Phon Ci .A -re your aM employer? cheektho appropriatoloox: Typo ofProject (regdred): LEI l am a employerwiih �, [] S am a general coniractox and S � 6. El New c6nsixuctiola employees (dill anaoxpaxt time) T have l itedt�e su1�-contractors 2.E] l am. a sole proprietor Or utner listed on the attached shoot.T 7•Remodeling stip and'7zavena.emplayees These sub• -contractors have 8. Demomon worlang forme in. any' capacity. workers' comp. insurance. 9. Building addition [No workexy comp, insurance 5. We axe a corporation and its 101] Electricalrepairs ox adMom required.] of r,ers have oxerelsad.their 3-E] Z am a homeowner doing allwork right of exemption per MGL 11. -El PIMbinggxepairs or additions myselr. [90worke& comp. c• 152, §1(4), andwehaven.o 12,P RoofxePairs ;r+ ranc�re ed. employees.. [No workers' 13,0 Othex coma. insumncerequired.] rapplicantthac checks box#3 mustalso llauttheseetionbelnwshowingtheirworkars'eompensat[onvolicy Infounation. i Homeowners who submit -g& af9davitindicatingihey 6o doing Aworkandthenhire outside contractors must submit an5w aftidavitiudicaffig such. xCon-hacforstbatcheckfhisbe�mpstaftachedauaddiiionalsheeishowingthenamaofthesui�:contracforsandfheirvaerkers'camp.policyinfozmaiion, am an exnp�`oyet'tlitciz�p�ovic�irig wor�e��' corngetasat�an znsr�rar2cefor ,NY 2W10yees'. Bei'ow isi�ie�ralicy ararija�,s��'e information. i , . 1nsmance CommpanyName: �N ®f �� Policy' # or Sex in.s..,ic. g• Expiration Date l (- 13- /q, rob;site.A.ddxew, :"\ ��w � rC� CiiylSia%lip. IU- v r C /`/��; cne;2.S .A.iEach a copy C'Me workers, comp ensatlon policy iieclaration page (showing.t)ae poSicy number and eviration. date). Failure to seciixo coverage as reclu7xedundereciion 25A ofMGL c, 152 can lead to the imposiiien of eximinalenalties oz a Erne up to $1,5D 0.00 andlox ane�yeax impxisoxnn ent, as well as civilpenalties in the foam of aSTOPLWORK ORDER and a %tte ,of -up to $250.00 ,% day against the :vlolator. Be advised that a copy oftlb stateinentmay be foxwardedto the Ofdco of Investigations ofthe DIA. fox ibsuran.ce coverage vexaficaiian. ado Hereby cerizfy uricter'tiie_&Ng anrlvenaltles o, vex,�xry Miatilie infonmation provided above & Irue and eort'eez; W. offlewuse oily, Do notwwte in tries area, to be completed by city or'town official ryPermitlLicense =K� ty or awn. Nuing.A ntharity (circle one): 1. Board. of Health. I Buildingl)epartment I CHNIT- om Cleric 4. Electrical Inspector 5. Plumbing bspector f. Wher - - hformation and instructions., Massachusetts General Laws chapter 152 xecVi es all employers to provide workers' compensation for their employees. Pursuant to Ibis statute, art erawfoyee is defined as ",.,evexp person iu the service of another under any contract oXaa; ' express onimplied, oral orwxiften." Aa eftTloye N defined as "an individual, partnership, association, coxporatioxt or, otherkgal entity, a -r anyiwo oxmoxe of theioxegoingengaged inajointenterpxise, and includingthelegalzepxesentativesofa'deceasedemp, ex,.orthe receiver onf�e of an iadividuat partnership, association or other legal enfity, employing employees. Lowevex the ownexofadwe7lingltousehavivgnofxrtoxetha�zihtee apartments andwhoxeszdestihexeiu, ortho occupantofthe. dwelliughcuse of another who employs persons to do maintenance, contraction oxrepakwo* on. such dweilinghouse or onthegrounds orbuift appurtenant thereto sh.allnotbecause, of such employmeutbe deemedtobe an employer" MUL chapter 152, §25C(6) also states that "every state or local lic�azsiug agency shall withhold the issuanco or renewal of a license or permit to op exate a busuaess or to construct buildings fa the contmonwealth for any applient who has not produced -acceptable evidence of compliance, WRh the insurance coverage requfeed;' Additionally, MGL chapter 152, §25C(7) stafes "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublie woxkuntil acceptable evidence of compliance with the insurance xequixements of this chapter havebaonpies entedto. theconiractmgauthorify.,, Applicants Please fill out the workers, comp ensailon affidavit completely, by checking the bores that apply to your situation and, if necessary, supply sub-contxactox(s) name (s), addresses) and phone numb 01(s) along With.theix cexiificate(s) of insurance, LimifedUabilityCompanies (LLC) orLimMLiabVityPatinexships (LU)withno employees otliexthanthe members orpariners, arenotxequireclfo caxxyworkers' compensai%oninsuxan, Lan LLC oxLLp doeshave employees, apolicy is xequixed. De advised that" affxdavitmay be submiffedto theDepatiment of Industrial Accidents for con nation of insurance covexaio..Also be sure co sign, and date the affZdavii 11e affidavit should b e xetomed to the city or town That the applicatign for fhepexudt or license is being requested, xtot the Department of Wastrial Acoidenfs, Shouldyou have any questions regarding the law or if you at xequixed to obtain aworltexs' comp ensationpolicy,Please call theDepartment atftnumbexlistedbelow Selfinsuzedcompaniessbouldenfertheir self insurance license number On the appxopxiafe Eno. . ' I pity OrTown OfUcials �'leasebesuxethatthea�izdavitiscompXeteandpxinfedZegibly. TheDapartm.enthaspxovidedaspaceattbeboftom oxthe a E&-V1tforyouto fill out in the event the Office oflnvestigafionshas to contactyouxegardingthe appR,cant Please be -sure to 0 inthepermiMIcensenumbex w%icb will be used as a xeftencenumber, In, addition, an applicant that:(�ustsubmitmultiplepexmifJlicenseapplicationsiaany givenyear, need onlysubmitoneaffidavitindicatingciurnt p olicy in oxmation (Ifnecessaty) and under "rob Site .A ftess" the applicant sh,ouldwxife "all locations in (city or towh.)" copyoftlieaffidavitthathasbeell offzciallyst4edormarkedbythecityortow.nmay bapxovidedtothe, applicant is Anew Az<ewazddavitxalisibef{Iled'onteaclt year al venture (x,e, a dog license orpennitto burn leaves eto.) saidperson is NOT xegahad to eomplem this aff(davzt, The Office aInvestigations would like to thank you in advance for your cooperation and shguld you have any gtresiions, please do=Vaasita%to give us a call. The Department's address, telephone a:UA fax number; AbeQ 9x�Wean ofMumgv,-Awoft-qi D pax e QfJhdWAVaI Accldmta Offlea QV~in VUtfgaVoY .4 Q(k asW--Rgt - 8-�ceQt Qa 11, 02111 Tell 017.7-27-4900 W A06 ax x-877 WqM P.evised 5 26-115`l� ' l "MO.; 3y i oo ;0"".n m c . +, U4E L;DIIIII1 mealth )If 9iz55zjr4usP.tS t'ermlt a u.eOYtty9 7 8tpartinent of public emfttg ' Oacupaftty i Fie —=—. BOARD OF FIRJ4E PREVENTION REGULATIONS 527 C �� 12:00 W90 I� � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be d ( P accordance with the Massacnusetts Electrical Code, 527 CIWA 12.'W (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate t*-.o�QQ r Town of NORTH ANDOVER To the Inspector at Wires. The uderiiQnad applies for a permit to perform the electrical work described below. Location (Street & Number) iZo a d - Nn A� _ t, A r�,, Owner or Tenant Owner's Address '14 en` k 'R oad yo_ Arid 0v r M✓ t, of �,atS 13,this permit in Conjunction with a building permit: Yes No (Check Appropriate Sox) Purpose of Building R P t('i d n n4j,a Utility Authorization No. Existing Service Amps _J Volts Overhead Und rnd 9 CD No. of Meters .r�,� • New Service Amps _� Vous Overnead Unagrno [ No. of Meters Number of Feeders and Ampactty Location and Nature of Proposed Electrical W01'K No. of ugnting Outlets I No. of yal No. of Transformers Toto KVA No. of Ugnung Futuna i Swtmm.ng P_c;, �ocve-- ;n- r— ,rro _ Srno ._ I Generators KVA No. of Receotacte Outlets I No. of Ott Ear ars No. at Emergency Llgnpnq j ®artery Units FIRE ALARMS NO. Of zones No. of Swticn Outlets I No. or Gas=::rrers NO. of Ranges I No. Cf Aa Ccr.c. 'O1a' 'Cris No. of Ost•ctian and Initiating O.wcee No. of &Soosals I No.of Meat -0c31 -oiaI ?tire cs ons -(W No. of SOunaing O.vIC" NO, of Oianwasners $OaCerArea 4eattro No. of Sett Contalnea Oel•ctlowSounang O.wus No. of Dryers I Heating Cev,ces KW Local '— Munlciou ..�Glher Cann.ctlon No. of Waist Heaters KW No. 01 S.gns °a.tas:s Low Voltage Wiring No. Hyaro Massage Tuoa I No. of -Mol .otat HP OTHER. k INSURANCE CCVERAGE. Pursuant :o the reautrements a'•.lass:crLsers ;ensrat Laws.. 1 nave a currant Ltaotbty Insurance Policy tnctuang Gcmc etec Ccerauons Covetage or its suostanaal *Q010"JM. V63 � NO nave suarntnea valid proof of same la Ina Office. YES - t�0 - If 1 you nave cnecs•a YES. pleas. trtalcate tit. hp. of Cow %o o onesxnp-tri roonaa box. INSURANC _.. _ aONO = OTHER' -(Please % (t'saglrtwon pets . Eu atlm.a value of E!sctncal Work S � ' Wont t0 Stan 3� Insoec:ton Oats ;�ac..as:sc. Rougn Final Signed unser trio Penalties of perjury. FIRM NAME /� 4%Zs tic. No. Ss8 c. No. Bus. Tel. No. Adarus d�15 LOGLe�/LiX/ �y1%�i All. Tel. No. t OWNER'$ INSURANCE WAIVER: 1 am aware trial trio L:cnnsee ^.cos not nave tri• insurance coverage or its suaatanuef "units" � auuea DY Misaaacnusella General Laws, ano trial my ItSnature on ^.ts :ermu aopttcatton waives Inti reaWrem.lq. Osent r (Plea" cnecs ones' iteonone No. l7q_-Ii�I PERMIT FEB i tee "I - lS.gnalure al Owner or Agents -P N, 14 91 Date .................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... X ................................... ......... ....... has permission to perform ✓................. wiring in the building of .............................. ................ Xp .. ......... over. Mass.:: at ..... 11.�Z .... zi Z ... n.— .............. . North And e-- - p Fee............ Lic. No.< ... : ........ ........................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ,\ Office Use 991 i ,'I (� - �Ir �umm�nwettl 1itt�tttulrr� Permit No. i3eva tmient of Public *nfPtg Occupancy A Fee Checked ' - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank) �4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date...a �- �7 (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to erform� (the electri al work described below. Location (Street & Number) (� `t e `� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) c-� Purpose of Building Uti lit y Authorization No. Existing Service 2CY-0 Amp �J Overhead LJ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity 3 Location and Nature of Proposed Electrical Work r�'n A GD OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO _ I have submitted valid oof of same to the Office. YES -' NO _ If you have ch ec ed YES, please indicate the type of coverage by checking the appr nate box. INSURANCE BOND ` OTHER _ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S �� - -ro Work to Start Inspection Date Requested: Signed under the Ppalties of p rjury: FIRM NAME q t 14 0 Final LIC. NO. � LIC. NO. Licensee Signature j��'/ Bus. Tel. No. Address Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the License does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Ownel Agent (Please (Please check one) � � iy 1 Telephone No. PERMIT FEES (Signature of Owner or Agent) x•6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures I Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges 9 No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained Disposals No. of Dis p No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Local [:] Connection ❑Other I No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO _ I have submitted valid oof of same to the Office. YES -' NO _ If you have ch ec ed YES, please indicate the type of coverage by checking the appr nate box. INSURANCE BOND ` OTHER _ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S �� - -ro Work to Start Inspection Date Requested: Signed under the Ppalties of p rjury: FIRM NAME q t 14 0 Final LIC. NO. � LIC. NO. Licensee Signature j��'/ Bus. Tel. No. Address Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the License does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Ownel Agent (Please (Please check one) � � iy 1 Telephone No. PERMIT FEES (Signature of Owner or Agent) x•6565 Date../."W....7 �12 1085 I 07 TOWN OF NORTH ANDOVER 0. 0 PERMIT FOR WIRING This certifies that ... .......... 4.... ......... has permission to perform .... ...................I...e e..." I ............. 5r .......... wiring in the building of .. ... ...... ... ..... r. at ..........4 ......... ...... ,North Andover, Mass. . ....... FeeLic. No. .......................................................... ELECTRICAL INSPECTOR 7W' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC t (Print or Type) NORTH ANDOVER Mass. Date Building Location -Iq 1•; afh 'Rd - Ynrih And n vPT Permit # 1Z • Owners Name kRpin nnf.r. �- New 77 Renovation D Replacement Plans Submitted FIXTURE:5 (Print or Type) Installing Company Name Address -5 hPeril,hinQ Plnce- (StQhe hn.,nn� lqA 09120 Check one: Certificate 0 Corp. Partner. Firm/Co. Business Telephone: bi j_ �k3 k>,_ 4142 Name of Licensed Plumber or Gas Fitter Frank 'Fi end,a_ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q 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 th.r}e�e, insurance coverages. Sig6`nature of owner/agent of property Owner J` Agent 1 iteteby certify that all of the details and information 1 have submitted (or entered) in above` application are true and accurate to the best of my knowledge and that aU plumbing work and Installations performed under Permit issued for this application will -be to compliance with all patinent arovisions of the Missaehueetts Stite Gas Code and C}unter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE:_ Plumber Gasfitter ignature of Licensed Master Pllmbe or Gasfitter Journeyman License Number .� 2578 Date.��? �;/.�� ...... � A M ,.pRTH TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION. M d This certifies that I ... has permission for gas installation ............. in the buildings of .. e. /,,4f.c �'......................... at ...7:5'! R. ��. ,�? . ....... No Andover, Mass. Fee.. , . Lic. No.../. /1. 33. 1 , ... . A Is PECTO WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATIOWFOR PERMIT -:--O Q , pLV�g�ry� (Type or Print) '. , .. ... • ' :.' • • •, , , .; • • � NORTH ANDOVER ,Mass. -: ` •. Qate:' , •�S' "" la ,' � mBuilding Location Permit G 414i _ Owners ame tiro ; New '0 Renovation E]' Replacement Plans Sybmitted FIXTURESi► • (Print or Type) ,! Check one: Certificate Installing Company Name �� ,��sc� r �i�� _ _ _ _ (� Corp. Address. �� P r sh in n'Pi a v e Partner. - 610 artner._61ehPh�.n�)AA 0 iin C'j Firm/Co.� Business Telephone 7g1- - 414k Name of Licensed Plumber: `Fra nl'i nnri Insurance Coverage: Indicate the type of insurance 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 J. this application does not have any one of the above three insurance coverages. • Signature of owner/agent of property Owner Agent\� .;. I kmbr eerlifr dial all of lie delails and infornulion t have subiniticd lot enlesed) in shove applicalioe ire Irse stW ersralt to dW bed of of knowiedge and dul all plumbing walk and inslallations I1crfnrnicd under rcrmeit iuued for this applicaliors will be i11k so ONtbl a NM•jj tike" of lbs Musadiusells State Plumbing Code and Cl►aplcr 142 of lite Qnaal UWL ,W By Title. City/Town: Signature,,of'Licensed Plumber Typ of Plumbing License ry l� M 11 Y < . .. 4n 03 0 V< ~ W w le z t» J P.T• a: ac :C t- N z o d z a cc a .� O W W l ¢ W ca in k Y z k. K.W< ¢F_ Z' a: � W <-jz pZ'r-sr.. a � ka�c H rwO ] 3r a 0. Jr- l <W� • i V } O Nz NV fO =a Q e X W O VN Y Y .J O O 0 O J 3r= (- N W O O O < 'W a O SUB—,BSMT. BASEMEHT IST FLOOR I 2HO FLOOR 3RD FLOOR 4TH FLOOR GTH FLOOR 6TH FLOOR 7TH FLOOR ' STH FLOOR r • (Print or Type) ,! Check one: Certificate Installing Company Name �� ,��sc� r �i�� _ _ _ _ (� Corp. Address. �� P r sh in n'Pi a v e Partner. - 610 artner._61ehPh�.n�)AA 0 iin C'j Firm/Co.� Business Telephone 7g1- - 414k Name of Licensed Plumber: `Fra nl'i nnri Insurance Coverage: Indicate the type of insurance 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 J. this application does not have any one of the above three insurance coverages. • Signature of owner/agent of property Owner Agent\� .;. I kmbr eerlifr dial all of lie delails and infornulion t have subiniticd lot enlesed) in shove applicalioe ire Irse stW ersralt to dW bed of of knowiedge and dul all plumbing walk and inslallations I1crfnrnicd under rcrmeit iuued for this applicaliors will be i11k so ONtbl a NM•jj tike" of lbs Musadiusells State Plumbing Code and Cl►aplcr 142 of lite Qnaal UWL ,W By Title. City/Town: Signature,,of'Licensed Plumber Typ of Plumbing License ry l� M 11 -3644 Date. .... . F TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �' D This certifies that .. 1..�kC� Via... !.. ! UNG Q .. .......... . has permission to perform TS -lie :. IIq .e ....... plumbing in the build in s of G%n.................. . at . .. �. ... %1 .......... , North Andover, Mass. Fel,;L d �. Lic. No.,�' Q03 ............................. . PLUMBING INSPECTOR C k # 17 Lk, WHITE: Applicant 03/16/98 09;50 CANARY: Building Dept. 25.00 PAID PINK: Treasurer �'. -• �.+ -raorvr7M Mr r'LA%oAi&un f Vit iC21M11 /u uv ('L-usyruusv .. (Print Of Tvoe1 NORTH ANDOVER, . Masa. Oats Building Locatlon74 14eai-h ]Ron ri New ❑ Renovation ❑ Replacement FIXTURES Permit * • .3 7 4' L- Owner's Name Re I c -n n P, r 'l�( ►� +- 5� n n ❑ Plana Submitted: Yes ❑ No. ❑ Check one: Certificate Installing Company Name ❑ Corp. Address�� ►� r�h i n n'P f g y e ❑ Partnership �Sf ryn-e h ti nn JAI ,A n fl Sr 0 ❑Firm/Co. Business Telephone j,l`T_ i Name of licensed Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or Its substantial equivalent. Yea A No ❑ If you have checked y", please Indicate the type coverage by checking the appropriate box A liability Insurance policy A • Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ilcenaee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on thla permit application waives this requirement. 7j�� r,! C eek one: Sknatuts of Owner or Ovnsr a Agent Owner Agent ❑ I= carlity that AN of the details and Informailon I have submitted for entersdl in above application are trw and accurate to the best of my krwwledpe and that allplumbing wak and Installations performed under the p rrrA Issued for this application will be in comp8ance with an Wlnent provisions of the Massachusetts State Plumbing Code and Chapter 1412 of Vw QerWall Laws. AfTnOVED (OFFICE USE ONLY) gna un of f censod Plumber License Number P y a Type of Plumbing License: Master ❑ Journeyman 0 Emu En NONE Check one: Certificate Installing Company Name ❑ Corp. Address�� ►� r�h i n n'P f g y e ❑ Partnership �Sf ryn-e h ti nn JAI ,A n fl Sr 0 ❑Firm/Co. Business Telephone j,l`T_ i Name of licensed Plumber INSURANCE COVERAGE: Check one I have a current liability Insurance policy or Its substantial equivalent. Yea A No ❑ If you have checked y", please Indicate the type coverage by checking the appropriate box A liability Insurance policy A • Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ilcenaee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on thla permit application waives this requirement. 7j�� r,! C eek one: Sknatuts of Owner or Ovnsr a Agent Owner Agent ❑ I= carlity that AN of the details and Informailon I have submitted for entersdl in above application are trw and accurate to the best of my krwwledpe and that allplumbing wak and Installations performed under the p rrrA Issued for this application will be in comp8ance with an Wlnent provisions of the Massachusetts State Plumbing Code and Chapter 1412 of Vw QerWall Laws. AfTnOVED (OFFICE USE ONLY) gna un of f censod Plumber License Number P y a Type of Plumbing License: Master ❑ Journeyman 0 -11' 3382 Date 7-. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING, This certifies that .................. has permission to perform . .............................. plumbing in the buildings of ... 13c c -7-4 A .................. at .. ? y.. �� .'.13."d..... .... Norah Andover, Mass. Fee ... Lic. No./ ....... PLUMBINeINSPECTOR 06/24/97 08:43 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer