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HomeMy WebLinkAboutMiscellaneous - 75 JOHNSON CIRCLE 4/30/20181160 9- 7 Date.AIA.S.Its ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING his certifies that".J.60,.on.-mM..E1-Ne4<-N-C .................................. as permission to pprfon-n- -...(5). plumbing in the buildings of...... ...................................................... ... at ....... ..... ............... North Andover, Mass. Fe4�5T� ..... Lic. No. Q.71t.� . .................... PLU . M . Bi .............. N G IN SP ............ E C T 0 . R .................... Check #2ql!S I i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) /�'"� r `� 1 rTh �7��t1✓� ,Mass. Date iZ 20 15 Permit # Building Location.� 5 3 o SG n CI' rC i f Owner's Name TL. C4wd Owner Tel# C)'l - (D G — GZ GG Type of Occupancy S i ', New ❑ Renovation 0"" Replacement ❑ Plan Submitted: Yes ❑ No ❑ FIXTURES Installing Company NameV-= Y1\\ Address 126 P-� �c S +- Business Telephone # -i -q — a2 bC4 it C11 4 4iq- s gZZ 6 ti _ Name of Licensed Plumber f,�1p4 (A Check one: Certificate ❑ Corporation Q Partnership Q Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes e' No Q If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy �f Other type of indemnity Q Bond Q NV MDQ-kFMRfQaWBD V @,UD09H' I 'v are 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. Rf rri St cO ne Nv miq nq Nv rrdq-k @ dm; Check one: Owner Q Agent Q - ---- -- -­. - k— ­­) - nuuvc appucauon 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 wil com lianc i h II City/Town APPROVED (OFFICE USE ONLY) p t a pertinent provisions of Chapter 142 of the General La C Signature of Licensed P er Type of License: Master Journeyman Q License Number ME■■■EM■■■■■■■■■■■■■■■■■■■■ ®E©■MEE■■■■■■■■■■■■■■■■■■■ .. • ■ENNNOMMOEEE■■■■■■■■■■■■■■ • •.• ■MN■MMNM■■■■■■■■■■■■■■■■■■ .. • ■MMMOMMOMMME■■■■■■■■■■■■■■ • • • ■EMMONMENNNO■■■■■■■■■■■■■■ • • • NOMMEN■■■■■■■■■■■■■■■■■■■■ ..•■MEM■M■M■EE■■■N■ENEEENNEEM •••■EEEOMMEM■ME■■MEMO■MEMEEE■ I Me ON ENEEMENNEEMENEEMEN Installing Company NameV-= Y1\\ Address 126 P-� �c S +- Business Telephone # -i -q — a2 bC4 it C11 4 4iq- s gZZ 6 ti _ Name of Licensed Plumber f,�1p4 (A Check one: Certificate ❑ Corporation Q Partnership Q Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes e' No Q If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy �f Other type of indemnity Q Bond Q NV MDQ-kFMRfQaWBD V @,UD09H' I 'v are 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. Rf rri St cO ne Nv miq nq Nv rrdq-k @ dm; Check one: Owner Q Agent Q - ---- -- -­. - k— ­­) - nuuvc appucauon 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 wil com lianc i h II City/Town APPROVED (OFFICE USE ONLY) p t a pertinent provisions of Chapter 142 of the General La C Signature of Licensed P er Type of License: Master Journeyman Q License Number t The Commonwealth of Massachusetts 17epartat2ent oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 4 www mass.gov/dia s. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMTTING AUTHORITY. Name (Business/Organization/Individual): Address: r -L 6 City/State/Zip: /A/• X-eACy- 611 Are you an employer? Check the appropriate box: ,19 /) -e- r )i e, M Gi Phone #: -/ �(� �/ oz (► t 1.l] I am a employer with employees (full and/or part-time).* 2.0<am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.I] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its officers have exercised their right of 'exemption per MGL c. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] I? . Type of project (required): 7. [] New construction 8. remodeling 9. ❑ Demolition 10 [❑ Building addition ILFJ Electrical repairs or additions 12. F1 Plumbing repairs or additions 13. E] Roof repairs 14.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such TContractors 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 am an employer that is pr aviding workers' compensation insurance for• my employees.' Below is tine policy and jolt site information. Insurance Company N Policy # or Self -ins, Lia. #: L S 3 $3 570,40 4 Expiration Date: /011 //t lob Site Address: -7� 0� ti son Cr'!'C be City/State/Zip-&, /ai►�y-(- /'fir Attach a copy of the workers' compepsation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by 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. A, copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do lzer eby cefiffyynder• the p� and Phone #: 4-79- �'(Y-rz�p that the information provided aboveras true and correct. 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 #: We r31 S 3s3 sa46 1� t/ k 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 liire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth .for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill -out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractoi(s) name(s), address(es) and -phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The'affidavit'should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if yo'u'are required to obtain a workers' compensation. policy, please call the Department at the number listed below. Self insured companies should'enter-their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of TndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ow PLUMB ERS",�*..:W:'D'A a SF;[T.T-.RS IL .. Date .... ...... S ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING C� -P 1. �. r.►.. r .L........ ..�- ................ This certifies that .................................... has permission to perform ..... ... GSC iAe n-� ................................. � � j �o o ,\ ............................ wiring in the building of ......., ...1 N T ........................................................................................... at.......L......4�h...5.4........).c..� r .................... . Nort Andover, Mass. Fee.AI.0... _'............. Lic. NA 2012 I . �..... %. ... /�v'j....... .... .... _ ......................... ELECTRICAL INSPECTOR Check # ,X �+ ' � L� ►-i ti 5\1- Commonwealth of Massachusetts Department of Fire Services 'aM BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (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 ININK OR TYPE ALL INFORMATION) Date: l ab I l l b - 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) g S J v �\v\S un C� (,r, k z Owner or Tenant Owner's Address \,nc A, _3_eI^P- Q 1m � Is this permit in conjunction with a building permit? Purpose of Building - Existing Service Amps . / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. Yes I9- No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: !T QIVy4f 176JPr►0111J ITS A r.,ion�- iit Completion 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 Swimming Pool Above ❑ In- Elo. 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 No. of Waste Disposers HeatPump Totals: Number ............................. Tons " KW """'' "'"'" No. of Self -Contained 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 Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP 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: 000, G(- (When required by municipal policy.) Work to Start: J'X) \ 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 cover e ism 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 ofperjury, that the information on this application is true and complete. FIRM NAME:. n f� if 6 f' It "� n C LIC. NO.: 90 t a Licensee: �7 C� � eS f i ✓ t Signature LTC. NO.: JC_0 a05 (If applicable, enter "exempt" in the license number line) Bus. Tel. No. Address: C "? , F17r1 jys/r e4v4 Z,.W k/t to oxe L/ Alt. Tel. No.: 4 71- 17 R- to bl *Per M.G.L c. 147, s. 7-61, security work requires bepartment 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: $ /I d ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass R Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INECTION: Pass 0 V Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ly % FINAL INSPE TION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 44, Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 021142017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information I - Please Print Legibl /Iny Name (Business/Organizationdividual):� %� 1 -:*Ie 14C Address: t�,; qf in 4 vQ City/State/Zip: L!111,1 114A O tq u q Phone Are you an employer? Check the appropriate box: 1. LIQ ""' a employer with (9—. employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 6.FJ We are a corporation and its office rs have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. E] New construction 8. E] Remodeling 9. ❑ Demolition 10E] Building addition l l.EZ[yleetrical repairs or additions 12.0 Plumbing repairs or additions 13. E] Roof repairs 14.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: fl A r' Policy # or Self -ins. Lie. #: - 14 W rz & VV 7 �\ Expiration Date: 3/01116 Job Site Address: S -SU V\ASU^ C �'cC� City/State/Zip: Al Joy i /L►/7- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify under the pains and penalties of peijufy that the information provided above is true and correct. c Phone #: q u -,799- 9 (0� 3 Official use only. Do riot 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 Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia . +1 �s OF N1pSSACNUSE `` I •1.TVA �- cpMMpNWEA • ` • • • �lANS EI CENSE ` ES THE FOE MA EEEGTRI G � AH•.\ I Sp REG JOURNEY ( `� AS 1, y E PIKE t t u I GEOF FRE `. Na AVE SpFt1NGV 25}4 67 MA 01904 50520 r yNN E 50209 E T, (� COMMONWEALTHOF MASSACHUSETTS BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A I REGISTERED MASTER ELECTRICIAN` Q GEOFFREY L PIKE 't 67 SPR I NGVALE AVE LYNNMA O1 04-2 9 51�+ 20121 A 07/31./16.:. 50519 (U 0 01 ► S C A I41 1� L1 L L I i '` LA U 1 ~ M 1 M1@ T 67 (U I` I I G u ce H W J O O � O O J ( LA W u O _ O N C l65 Jg<i� In C', 'C C L© 'O n__ C n Z O 6T N fn � d Ln1U I i 611 10 � Z ny N O 4 O m T-4 �( N b-4 N o C f 11 -j :moi N ul 4J dj L 61 W 0U d a� a� v J A w''0O IC60 O jp C W L1 L L I i '` N N° 33-,3 Date ... . ... :...................... t HORTO TOWN OF NORTH ANDOVER J PERMIT FOR WIRING This certifies that ....... ......................................................................... •s has permission to perform wiring in the building of ............................................. -' .. ..r ............... at......,r:.................................................................. ,North Andover, Mass. Fee.`—�..�.5............ Lic. No`'. . f.(4�:;':.. �. ..................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer (torn onweaCth o� r�>/Ja99ac�irr�e:�t r OClicial USC Ort!v -' �a�arEmenf a Pcr:. it No. C� servcczj y BOARD OF FIRE PREVENTION REGULATIONS Occupancy a(td 1 ee Checked— [ Rev. I l r 99 ] --=-- (leave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO All work to be performed in accordance whit the :blasszchusclfs Gcctrical Cock (.MEC), 527 CtIR 12.00, `K (PLEASE PRINT 11V ItVK 01? TY'L- ALL IrVFOI/ bL 11'10!0 lla tc: City or Town of: dbvr°r To the! Inspector 0 1•Yu•es: By t(tis application the umiersi�ned �,ives notice of his or her iutentioft to perform the electrical wort described celo:v. Location (Street �C Nuutber) ^]� c �n�n✓�Cn,n �i r - Owner or Tenant Owner's Address T c I e p I i o n e No. LN01. Is this permit ill conjurtction witll a buildinb p� nlit? Yes No (Citcck Appropriate Box) Purpose of tiuildina �,•Q Q .)z Utiiity -Authorization No. Existin" Service Amps / Volts Overhead ❑ Und rel No. of Jlctcrs New Service Amps Volts O\critcd r i i L- [ ndgrd No. of:lleters Number of Feeders and Antpacity Location and Nature of Proposed Electrical Work: jLNO- of Recessed Fixtures No. of Ccil.-Susp. (Paddle) Fasts I ` I No. Of Li-htins Outlets I;No. of Ilot Tubs ::No. of Lighting Fi ;tures Swintniina Pool Above E, IT'- ❑ arnci. arnd. No. of Receptacle Outlets No. of Oil Burners " No. of Switches INo. of Gas Burners I No. of RangesNo. of fir Cond. total Tons :\o. of Waste Disposers bleat Yuntp ' Number (Tons Totals: -. ............. !�1� ! v. of UISMYUsners INo. of Dryers I:tio. of `Vater Heaters K'tV No. c Hcdr)Tnassa"-e 13athtubs "` OTHER: jSpacc!Area Heatin, KW Heating Appliances INO. of Si;`ts I.'U. O1 ,,(OtOrS KV. I-'0. °f Ballasts Total IiP fable ruav be waited bv!Irc lnsoCc:or of fill •es. No. of Iota! Transforutcrs KV.1 ! Ge.^.crator-s KVA i [YO of uteroency' lailttne Battery Units FIRE ALARI•IS INo. of Zones `+o. of llctectiort and Initiating Devices No. Of Alerting Devices i IND. oC Selt'-Contained Detectiom'Alertina Devices ' Local (Municipal Connection L Other N"o. of Dec 2 So- E U 1'�.cCvlili:IliiiICaUO(1S `\'1I•IIi�: No. of Deviccs or Enui:^:'Fnt I:tccir aGdi!ior.ci :ti'SUR-ViNCE COZ Gr - . or I EIZ-\ (�n�CSo .val`.ed by the o ' � no � ... ,. llle licensee CrOVldts XcOf of zbl;' - JriiianCe C ICai '.11Suraticc inn udln g "Comoic' ^^�^';CII _ r LL nl:de C Ca cry C :IS Substantia! _ -. _.... rSi�% Certifies that such COVerag� IS Ill fort.^, ]tld has e=dit ite b d proofot to tl:e _ergot iruin-, OC" C;:EC` 0\ INSL'Z .\CE EO`'D OTiILR ❑ (Specify:) - Estimated Vaiuc of E;cctrical W (E.:.ircric, .c) or:.: ("When required :,•::;tuaicipal polies.) tor!: to Start: Insoections to be reauestc'Li in accordaltcz .:itl: MEC io E 0, apo ccn cc ple::Cn. gertrf , !order• fireI)airr.t' nrrrl perraltics of pe:jrrr�, !/:at t/re irrforrcation ort t/upli s apcation is true and conroiete. IrIIZ�[ iN.\,NiL: u. f itL Ll Q. NO.: i. 5yL Licensee: � C41f1 �.rt;I,�.�\>w.�( Si�natur LIC. NO.: 6DI I t �1 ill :ire 1iCCrr.t� rttunbdr :'ur C.l .. Address: tSS vac) SF S+ "-AC - � 11 Bus. Tel. 0\NNER'S I;` SU(:_ -\NCE 1` :\I�'tli: all,, awardliar the ] V u 1�� .-alt. Tel. L:c.—nsze does ;rc: c;e the iiabilil lits J rccuircu 'Dv law. by ji,' ,atlllC below, ! (lC1 0�' ova till$ re^ll:rCTC::t aiC C urarice co�'era'!e Or ;alt`/ ltcc`.:Or,cl ❑Octner IJ' O\`.....y-_.tl. Si -nature I e!cr,hor.c \'o. PI�R.lIIT TE E: S 1,12 3951 Date 1 A? -x' * ' . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS.�cMusE� '�CThis certifies that ..... .............. . has permission to perform .. ..�.-fr. . .. ..�r! plumbing in the buildings of .................. at .. .. ............ , North Andover, Mass. FeEr 7 ...... Lic. No..&?�3aP' . ` . f , ...... . . PLU 02/23194 10:.55 27.40 PAID WHITE: Applicant CANARY: Building -Dept. PINK: Treasurer -0 C)71 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) 4108jb .(� Mass. Date o2 // 1999 Permit s Building Location �% �Y��j S(�/i/ C� �R Owner's Narne 2 i mmerl"o9nJ Type of Occupancy Residen al New ❑ Renovation ❑ Replacement N Plans Submittedj.,X s ❑ No ❑ FIXTURES Installing Company Name Heritage Htg. &Pig. CO. Inc. Check one: Certificate Address35 Pleasant Street EX Corporation 714 Stoneham, Ma 02180 C7 Partnership Business Telephone , 781 —438-7776 f l Firm/Co. Name of Licensed Plumber Gordon Switzer 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 coverage by checking the appropriate box. A liability insurance policy IN 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 Aaent Owner ❑ Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbin ode and Chapter 42 of the General Laws, By Title gna ure of Licensed ber City/Town Type of License: Master Journeyman ❑ APPROVED OFFICE USE ON— Lam— License Number 8 3 2 2 z_ o z > N O C7 W 'i3 a¢ }a ?u -It CC 3: -, Ln _(n N x Q U W N a a U. — _a — 3 x U=O 7 ¢ N W ¢ Q Ny - Q Q (R Z ¢ LL S ¢Cr '�' x '►Z"i I W W x a r 3 3 o z i 3 x a o H a X w x w r a v> a a o x z a m a y a r- 0 z a o J o Ln a ? a¢ z W LZ H o Q x. Q o ++�� Sa o � ri 3 Y J m x J a} 3 -P h Q p J 3 N y LL Ll C] a ¢ N o rd 3 SUB—BSMT. BASEMENT IST FLOOR W 2ND FLOOR N A 3RD FLOOR D T 4TH FLOOR I T STH FLOOR R S 6TH FLOOR E 7TH FLOOR C-±[± 9 8TH FLOOR T D Installing Company Name Heritage Htg. &Pig. CO. Inc. Check one: Certificate Address35 Pleasant Street EX Corporation 714 Stoneham, Ma 02180 C7 Partnership Business Telephone , 781 —438-7776 f l Firm/Co. Name of Licensed Plumber Gordon Switzer 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 coverage by checking the appropriate box. A liability insurance policy IN 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 Aaent Owner ❑ Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbin ode and Chapter 42 of the General Laws, By Title gna ure of Licensed ber City/Town Type of License: Master Journeyman ❑ APPROVED OFFICE USE ON— Lam— License Number 8 3 2 2 J z O w N a w U LL LL O ,Q c LL O J w w N z O F- U w a N z 4 XJ n w w LL a z C7 D J = � o LL O m w LL a O F a y� Oz w M V O 1 z J a :—.4-06 04:38vm 'From -AIG -. = Hickey Insurance Agency Inc Po Box 427 .-:43 Main St Milford, MA 01757-0427 .;uan Domingo Allsico 28 Front Stre®r A,pt 41 m ei!crl, MA 01757-0000 4973 331 8599 T-720 P.002/002 c-690 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIUr ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANY A GRANITE STATE INSURANCE COMPANY ' +IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR --E =OLICY PERIOD INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER C'; CUMEN7 WiTh RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED THE 01' -'CIES DESCRIBED HEREIN IS SUBJECT TO Al: THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN t•:.,� IiAVE BEEN REDUCED BY PAID CLAIMS. 'TYPE OF INSURANCE POUCY NUMBER I POLICY BFFRCTNE DATE POLICY EXPRATION DATt WORKERS COMPENSATION � AND'IPLOY=RF LA816ITY I LIMITS ",E aftOPRIETOR �ARTNER97EXECLMYE ClFiCEREARE I IATUrORYLi1AR9 .� :: � C 8738578 I 2/14/2006 2/14/2007 CTMER �—,crop* A=hffS 10'AA 000=0M Only. CH ACCIDENT �'sWE POLICY LIMIT CERTIFICATE HOLDER !CANCELLATION S'JF:DY HOME IMPROVEMENTS! SHOULD ANY OF THE ABOvEDESCRIBEDPOUCrESBECANCEu�DGWORETME EXPIRATION DATE THEREOF, TME issues + COMPANY WILL ENDEAVOR TO MNL 12 34 FRONT ST DAYS WWffEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TME LE". BUT S PRI NGMELD. MA 01151 F&XURE Yo MAIL SUCM NCYICE SHAD IMPOSE MO OMJGATION OR LMTUT- of ANY KIND UPON T)f COMPANY, ITS AGENTS OR REPRESENTAWILS Al1THORIZED REPRESENTATIVE C 0 i s ,aaood $ soc.aoa. S 1 OG.Ood