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Home My WebLink AboutMiscellaneous - 75 MILL ROAD 4/30/2018 (2)i This certifies that has permission to perform ... plumbing in the buildings of.. -7�, at ...... Zlkll ........................ North Andoyer, Mass Fee_ , ti.d ... Lic. NoAS . . Check 4 6'?S— PLUMBING INSPECTQ,'- N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY NORTH ANDOVER MA DATE 8/1811e3 PERMIT # /0/0y JOBSITE ADDRESS 75 MILL RD OWNER'S NAME WEIGOU ZHO I P OWNER ADDRESS I TEL- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES ® NO® FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM EE DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET Mi URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER 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 CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E OTHER TYPE OF INDEMNITY BOND El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a urat to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in liance wi al ertinentprovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MIKE CAPELESS LICENSE # 15851 SIGNAT RE MPEJ JP® CORPORATION®# PARTNERSHIP®# LLC(# COMPANY NAME THE BOILER GUY ADDRESS I 160A PLEASANT ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978 3821017 FAX CELL �Y EMAIL r J a/ Sbbk!CQa- TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. !%1/.��'....�-z1S-% has permission for gas installation ................... . in the buildings of ...�. !/��1..................... . . , North An v r, Mass. Feed: t%c).... Lic. No%S.� . G.f2��........ . GAS INSPECTOO Check # �d 88.25 r Irl��o�lcrn t�19 :J MASSACHUSETTS UNIFORM APPLICATION F611 A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER MA DATE 8/18/13PERMIT # JOBSITE ADDRESS 75 MILL RD �--�� !OWNER'S NAME GOWNER ADDRESS TEL IFAX [�. TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL D PRINT CLEARLY NEW: [j RENOVATION: El REPLACEMENT: El PLANS SUBMITTED: YES El NO APPLIANCES I FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I -- BOOSTER CONVERSION BURNER .wa,�._. �r COOK STOVE DIRECT VENT HEATER DRYER I` FIREPLACE FURNACE GENERATOR GRILLE I INFRARED HEATER LABORATORY COCKS_�� MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT�� TEST i UNIT HEATER .' t UNVENTED ROOM HEATER i. WATER HEATER OTHER I INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES E] NO E] I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E, j OTHER TYPE INDEMNITY [j BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. - CHECK ONE ONLY: OWNER C] AGENT ED SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurat th best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al ertin p vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME MIKE CAPELESS LICENSE # 15851 G MP Q MGF (j JP [j JGF ® LPGI CORPORATION [J# PARTNERSHIP LJ#�� LC [j# COMPANY NAME: THE BOILER GUY ADDRESS 160A PLEASANT ST CITY I NORTH ANDOVER STATE MA ZIP ' 01845 TEL 978 3821017 FAX I CELLI EMAIL :J v 4 e 4 e A`C40R�® v CERTIFICATE OF LIABILITY INSURANCE DATE / Y) 04/18/18!20132013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Matthews Insurance Agency Inc 182 Parker St 9 y CONTACT NAME: PHONE (978) 681-1112 FAX No): (978) 685-3855 MAIL ADDRESS: Lawrence, MA 01843 INSURERS AFFORDING COVERAGE NAIC 1! INSURERA: Atlantic Casualty INSURED Michael Capeless INSURER B: Arbella 105 Tyler St Methuen, MA 01844 INSURER C DAMAGE TO RENTED 100,000 I PREMISES (Ea occurrence) $ INSURER D: INSURER E: INSURER F: 08/07/2012 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DDlYYYY LIMITS GENERAL LIABILITY1,000,000 EACH OCCURRENCE $ DAMAGE TO RENTED 100,000 I PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY 08/07/2012 08/07/2013 CLAIMS -MADE 1-1 OCCUR IL143000684 MED EXP (Any one person) $ 1,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE i $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 I $ POLICY PRO- RO LOC JECT I AUTOMOBILE LIABILITY ANY AUTO I HC357357 08/30/2012 08/30/2013 COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ 300,000 BODILY INJURY (Per accident) S 300,000 ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ 300,000 Per accident NON -OWNED HIRED AUTOS AUTOS S i UMBRELLA LIAB -OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE S 1,000,000 EXCESS LIAB HCLAIMS-MADE XI111463 02/23/2013 02/23/2014 DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A 890911-0937696 11/17/2012 11/17/2013 E.L. EACH ACCIDENT S 100,000 E.L. DISEASE - EA EMPLOYEE S 100,000 E.L. DISEASE - POLICY LIMIT S 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) Heating or combined heating and air conditioning systems or equipment, installation, servicing or repair , plumbing (:tKI lNk;A I t MVLUtK (+AIV(:tLL.A I IVIV Town Of North Andover North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. n 19RR-2nin ACORn CORPORATION. All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD P, COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: MICHAEL N CAPELESS y 105 TYLER ST METHUEN MA 01844-1905 15851 05/01/14 176378 LICENSE O. XpIRATION DATE SERIAL NO. "location � � �'• N —�L-j Date b l NaRTN tTOWN OF NORTH ANDOVER O ot,.° � _. •oma p Certificate of Occupancy $ Building/Frame Permit Fee $ CFoundation Permit Fee $ s4MUSE Other Permit Fees. $ - n .i . Sewer Connection Fee $ `` .Water Connection Fee $ TOTAL $ Building Inspector .A,, .. � a. 78.00 PAID 08.0 -Div. Public Works. ZD m m ' m d ? O O o b 0 m Oil rri y � C d O y O V n � M � CIO � C 0* n a 7 `S nn as7� g g C > G1 V Y r co m M t j z i m > z y r z zz r m m m cn v O C)y z z n O m O zLn z a n m C7 v a m cn m w N z LA O `G14� O IT,oz a Cl) m \' S n 1ril '( o b 0 m Oil :k y � C d O y O V n � M � CIO 0* n X-� O y o IN p � y °z O v� K CJ C �R W m z Ix MKIIYI� o b 0 m Oil v y � C d O y O n � M � CIO 0* X-� O y � � d O v� K CJ C nh rm 0 y C � y CM) n Z y CLO C CO) a� -v 00 CD CL � O cr Ca CD o CD mw a C CD y. �.. CD O y CD v CO) O Z co o � CD 0 CD � s� 0 z O S to ` C fA So OZ .00 y�a0o 0 m =r.� (1_ y � 1.l rrt Sn0.0 n �m Y - m O m y C CO) O =rO m a C) to Z:S 00 O y� C! �l c y r a a o mCL b U2 o s F �/� � m m N C/) m 7 n=: M 'Z y O Q, 10=0 I " c V C12 CA [7 < ' co H y �Y O mm Om ON 2 * * * r O O C') f .« CD .n..,?;� j c � �y .. 3 �- n'o cj o C2 O� v Cn o CC/ z� ° C)7 '�7 w •jJ x�; C) ?7 wOQ jJ �- Z 71 w id x r ?� w n iv �rlw 't7 G7 Cl) ro 'TJ rb x Y y 0 0 c n J) e /to s j f a ' NZ D ' o G � -a z 7 ,� - iv _-� �4 = YL Z - 7r A 'O C, r a ' NZ D ' o G � -a z 7 ,� - iv _-� 85/25/1998 16:17 FROM Corey 8 Donahue, Inc [7 7-7 04 � 0 4'KELLNER .y TO 19786863427 •air. " ,�;,��,,, � gid This plan was not prepared from an instrument survey. Offsets and distances shown. should not be used to establish propgrty, ines. This plan Is Intended for mo lgage.purposes only. I certify that the structure ,. shown on, this Plan: w4.x . in conformance..with the zoning setbacks in effect at .the tine of construction. 1 certify that•the parce[shown is A�g � tocad within a flood hazard area as depicted on FEMA Flood Insurance Rate Maps for Community No: P.e1 Job No. 886649 N MORTGAGE LOAN INSPECTION LOCATION: �s SCALE'.�t� �ar� b DATE: I f REGISTRY' TITLE REFERENCE: 4& PLAN REFERENCE: COREY & DONAHUE. INC. Eugi e-3 &Snrveyoxs i ,� JAB CsmbrWge Road, %basfi,'MA 01$01 TOTRL P.81 m�ML Cn H i 7 to CI n C6 <n ae �o 0 0 In m N rn MK v Cn =a � CO H co 2 T w rn ti.. rn I N CO < N ~• 1 G • �O d � N �O QAJ- . S i ,ro % 5 FORM U -LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *********APPLICANT FILLS OUT THIS SECTION*********�* � PLICANT go rp-� (-PWONE k7 -365 Z LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET -75- m 1 L,L f/ST. NUMBER **** ***************OFFICIAL USE ONLY' ************* TIONS OF CONSERVATION ADMINI$TRA AGENTS: F V r` , DATE APPROVED DATE, REJECTED_ N TOWN PLANNER DATE /APPROVED DATE REJECTED ;h COMMENTS FOOD INSPE TOR -HEALTH DATE APPROVED I DATE REJECTED INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE ................ ....... ... ACORD RTIFI�ATE OF DATE (MMIDDIYY) L1AB1L1TY INSURANC I� D� IROI 3.;....: 05/12/98 PRoOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Landmark Insurance Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198 Massachusetts Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845-4190 COMPANIES AFFORDING COVERAGE Lawrence R. Michaud, CIC COMPANY A Preferred Mutual Insurance Co. Phone No. 978-688-8829 Fax No.978-975-3987 INSURED COMPANY B COMPANY Sirols Woodworking C Jean Guy DBA COMPANY 77 Elm Street PO Box 246 Methuen MA 01844 D CgUERAGES . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MM/DDIYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 2000000 PRODUCTS - COMP/OPAGG $ 2000000 A COMMERCIAL GENERAL LIABILITY 0120526510 03/12/98 03/12/99 PERSONAL &ADV INJURY $ 1000000 CLAIMS MADE OCCUR OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000 FIRE DAMAGE (Any one fire) $ 50000 X BOP MED EXP (Any one person) $ 5000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS ` NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC Y LIMITATU_ OTH TORY LIMITS ER EMPLOYERS' LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE 1 $ OTHER A BOP 0120526510 03/12/98 03/12/99 DESCRIPTION OF OPEF Woodworking Town of North Andover Building Inspector 120 Main Street North Andover MA 01845 ITEMS NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. R. Michaud, CIC TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: `�r",5L) D aCc/1- Est. Cost /Z Address of Work 7S IN /« /Z ex 0 Wo. AA)D0 c%2 Owner Name: 5�,�/ �c,r/�/�xew 1�20 S Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Job under $1,000 _13 -ding not owner -occupied Owner pulling own permit Other (specify) Notice is hereby given that: Pemit No. Date OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date OR: Notwithstanding the above notice, property: _Z6 Date Contractor Name Registration No. I hereby apply for a permit as the owner of the above wner Name i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTlyG/ (Print or Type) ,1 NORTH ANDOVER, Mass. Date 11/27/ 1991 Permit # Building Location 75 Mill Road Owner's Name Murphy r� New U Renovation ❑ Replacement ❑ Type of Occupancy RESIDENTIAL Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-687-11 0 5 Name of Licensed Plumber or Gas Fitter Check one: Certificate # K7 Corporation 64C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes lX No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 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 plumbin-g-work-and-inst Nations performed under the permit issued for this application will be in compliance with all pertinent prov��o� �s o�hefMas�acuusetilts Sr�ate �a��Code and Chapter 142 of theA*e—�2 By ) _ �JJYQ iT " e of License: /�- {{ jl) Plumber Signature of Licensed Plumber or Gas Fitter Title _ 1� 1 __ EGasfitler Master license Number M— 4 2 9 City/Town_ _ i Journeyman _MEN. i oil actal 1 MEN INEENEENESEEN EAM mom 00000=0 Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-687-11 0 5 Name of Licensed Plumber or Gas Fitter Check one: Certificate # K7 Corporation 64C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes lX No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 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 plumbin-g-work-and-inst Nations performed under the permit issued for this application will be in compliance with all pertinent prov��o� �s o�hefMas�acuusetilts Sr�ate �a��Code and Chapter 142 of theA*e—�2 By ) _ �JJYQ iT " e of License: /�- {{ jl) Plumber Signature of Licensed Plumber or Gas Fitter Title _ 1� 1 __ EGasfitler Master license Number M— 4 2 9 City/Town_ _ i Journeyman _MEN. i 7_ O J z O w N w v LL LL O a 0 LL 3 O w m C7 N z� Q h d I- u 0 N I w O m O z Q J O J h J t_ - o v w w a z p C7 ¢ O tl J z LL O O m w LL a CL 0 v � CL 0 CL p a w U w Q 0 i, z J LL N Q d 0 a w m O z J J a J cc O N U w IL N z IAQ C7 f Date. . �...... . N0RT1� TOWN OF NORTH ANDOVER 3� Oy`t t l E b OOL o J AMIT FOR GAS INSTALLATION Rd" �SSACHU5�t 1nR This certifies that ..4 has permission for gas installation ..4m -fl in the buildings of . ,/ev /I . .................... . at►? .,}�{.��..I{.Y. P....... ... , North Andover, Mass. Fee . 45'4� Lic. No./')I'4/-)4 GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File D(�/ N2 2 8 U09 Date ..... /// TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......A-() .. :r ......... -�,e ... A, haspennission to perform .....-.,,4-/q.�e ...... ..................... in the buildinj ...... / .... ... fo WIME, �of .......................................... .................................. /,North Andoypr; Mass. at 7� ...... lb.1 Fee .... . Lic. No.. ........... .... ............. ELECTRICAL IwEcm Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer uommonwealth of Nfassacf;ijser* Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 111991 (lave blank ) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfn„ ed in accordance with the Massachusetts Electrical Code OV ECI 527 CMR 12.00 (PLEASE PRINT INLYK OR TYPE ALL INFORMATION) Date: c N l lei ; u 5OU / City or Town of. 1�) D r A -n1 clove — To the Inspector of Wires: By this application the undersi;ned ;tees notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant r14 ?��,�-� Telephone No. 9 7ff'- 9 7,<—_ R -8-d8' Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Yes ❑ No Ea (Check Appropriate Box) Utility Authorization Na Overhead ❑ Undgrd ❑ Na of Meters Overhead ❑ Und;rd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 3 Lt r q Ci r LXL M Cnnrnintirnr n(tlre (nlln..d s r..his .1,- -a T.. .1. 7_ _ter No. of Recessed Futures INo. of Ceil.-Susp. (Paddle) Fans No. ofy. V "'..,Total r 0, ,r,res. Transformers KVA Na of Lighting Outlets INo, of Hot Tubs Generators KVA No. of Li-htinQ Fu ° ° Futures S11 Above O . n- -immint, Pool b Md. pend. -1a 1Battcry o Emergency ignung Units Na of Receptacle Outlets INo. of Oil Burners FIRE ALARMS INo. of Zones No. of Snitches; INo. of Gas Burners INo. of Detection and Initiating Devices No. of Ranges Na of Air Cond. Total Tons No. of Alerting Devices ° No. of Waste Disposers Heat PumpNumber (Tons IKW Totals: I No. of Self -Contained IDetection/Alertinp Devices No. of Dishwashers SpacelAreaHeating KW. unici al Other Con tion No. of Dryers (Heating Appliances Rey curity vstcnw a evices or Equivalent No. of Waterb,W Heaters No. o a o ISites Ballasts Data nn I g• Na of Dct•ices or Equivalent No. Hydromassage Bathtubs I;v`o. of Motors Total HP Telecommunications Wiring: Na of Devices or Eouivalcnt OTHER Attach additional detail if desired, oras required by the Inspector of if'ires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the lice= provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The urtdersimed certifies that such covera,e is in force, and has exhibited proof of same to the permit issuing office. CITCK ON : INSURANCE ❑ BOND ❑ OTHER ❑ (Specify,:) (Expimuon Date) Estimated Value of E�ec Work al , (When required by municipal.policy.) Work to Start: a/ v - inspections to be requested in accordance with 1vA-"C Rule lo, and upon completion. I cert fi,.under'the.pains pnd penalties,'of perjury, that the information on this�appticcrtian is true and complete FMNI NAME: ADT Security Services 111 Morse Street, Non44 MA 02062 1 LIC. NO.: 1533C Licensee: John S. Basscrt Sienatur LIC. NO.: 1S33C (If applieablc, enter "czcnrp! ' in tlrc license nunrher !i"c) / Bus. Tel. N o.• — 1 1 Address: Alt Tcl. No.:603-594-59L resi OWNER'S INSURANCE WAIVER: 1 am aware that the Lixensee cloes nor hm.-e the liability insurance coverage normally ONLY required by law. By m� signature below. I hereby waive this requirement. 1 am the (check one) ❑ owner oll rler's 2�ert. 011•nerlAricnt Si;naturc Telcfihonc No. PERJ►1IT FEE: S lJ� -�� t.ommonwealth of MassacFls Official Use Only t.7 - - Department of Fire Services Permit No. a C__ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (lea,e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All'work to be perfo„ned in accordance with the Mssachusetts Electrical Code (hECI 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �� a t �cc : u 5 3 oy / City or Town of: CA { Il�4OI,iPIZ To the Inspector of Wires: By this application the undersigrted gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Telephone No. Y 7,y! 55"1_ x'37 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 ❑ Und;rd ❑ Na of 11'Ieters New Service Amps / Volts Overhead ❑ Undbrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 3 u r- g I CL r Avec, m ConiDlenon of the followinz table tnav be waived by the InsDecior of rPires. No. of Recessed Firtures INo. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA Na of Lighting Outlets INo. of Hot Tubs Generators KVA No. of Lighting Fixturesi IS«mmino Pool Above ❑ In- ❑ a o mergency Lighting ornd. prnd. Battery Units No. of Receptacle Outlets INo. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches INo. of Gas Burners INo. of Detection and Initiating Devices No. of Ranges INo. of Air Cond. Total Tons No. of Alerting Devices e No. of Waste Disposers (Heat Pump Number I Tons I KW INo. of Sclf-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KNV . I ,--, Municipat Con tion E1 Other No. of Driers (Heating Appliances Ia'W ,Iste cu a o evices or Eouiti alert / No. of Water 1W Heaters No. o a o I Si Ballasts Data trine• ' "ns Na of D°c,,•ices or Eouivalcnt No. Hydromassage Bathtubsh'o. of Motors Total HP Telecommunications Wiring: Na of Devices or Eouivalcnt OTHER .4twch additional detail iidesired, or as required by the Inspector of IVires. 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 ceniues that such coverage is in force, and has exhibited proof of same to the p,.rntit issuing office. CI-rCK ONHE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electri�l 'o - 02 t rL- (When required by municipal policy.) (ExpirationDate) Work to Start f o2Inspections to be requested in accordance with MEC Rule 10, and upon completion, I certify, under the pains and penalties ofperjury, that the information on th f "aliplicaiion is true and complete FM'I NAIVE: ADT Security Services 111 Morse Street, Non4ocL MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Signatur -// �— LIC. NO.: 1333C (If applicable, enter "ercntpi"in the license tnrndber line•) / Bus. Tet. No.• -1 1 I Address: Alt Tel. No.: 603-594-591 resi OWNER'S INSURANCE WAIVER: 1 am an -are that the Lixensee does nor have the liability insurance coverage normally ONLY reouired by law. By my signature below. I ]rcreby waive this requirement. 1 am the (check onc) ❑ owner ❑ owner 2cent. Owncr/Agent Si_naturc Telephone No. _ PEIZl11IT FEE: 35 N2 3 L 7 2 Date.....} ..d� pORT►f Of 4"to ±e,tiO O 9 SS US TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. U C S x S/ .......................... has permission to perform `�..�/,� wiring in the building of ......... ..-1....L...`f...!.......,..... .....................' .......... : t ..... 5......:2.. r..l `...................................... orth Andover M&W. Pee ... .� Lic. No.' � �3( .........r5-.. ........... ./ � t /�� ELECTRICAL INSPECTOR Check # JL � WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r� � Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Qui 7�- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] leave blank 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 ORT PE L INFORMATION) Date: I City or Town of: a�� To the Inspector Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) rn 1 I Owner or Tenant 4 tI k ff ci dz�(� h Telephone No. -b-<S 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 ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: of Meters No. of Meters Q Completion ofthe following tnhle mnv ho wnivoil by tho rncnort— nPIV;— A No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of otal Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battenr Units No. of Receptacle Outlets No. of Oil Burners FIRE ALAR1IIS No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump 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 ecuritySystems: / No. of Devices` oqquivalent No. of Water Heaters KW No. o No. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: ttach additional detail if desired, or as required by the Inspector of Wires. 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:) Estimated Value of Electrical Work: (Expiration Date) — (When required by municipal policy.) Work to Start: 0) Inspections to be requested in accordance with NEC Rule 10, and upon completion. 1 certify, under th1painh and penalties of perjury, that the information on this application is true and complete FIRM NAME: ADT Security Services, Inc. () ,, LIC. NO.: 1533C Licensee: John S. Bassett (If applicable, enter "exempt "in the license number line.) 1 - Address: 111 Morse Street Norwood, MA 02062 j OWNER'S INSURANCE WAIVER: I am aware that the Lice see does required by law. By m), signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: 1533C Bus. Tel. No.: 781-278-1131 Alt. Tel. No.: 781-278-1725 not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. FPE"ITP-EE.-$�;t)—