The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 79 MILLPOND 4/30/2018G Date ....... 6-117-211.5 .I.1.5 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that..........:.......................................................................... has permission for gas installation ......................... in the buildings ofjj... . .......... .....-.................................................. at ..: ...... .1.... !?'................................... . North Andover, Mass. ... Fee..........'...... Lic. No.... .............................:............................................. GASINSPECTOR Check # 10026 mV4 A (P Ik )�� va-amu G'91 "Val-Vt. 'ri MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY /VGr rh And oi/e( MA DATE -3� S PERMIT `=sem' 11 JOBSITE ADDRESS !� , I t 120/1'd Ra OWNER'S NAMEr- GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:k PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE I GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER, ROOF TOP UNIT a TEST -. UNIT HEATER UNVENTED ROOM HEATER -WA-T1ER HEATER OTHER i INSURANCE COVERAGE I have a current liabilft nsurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES 0 ❑ / ' I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE -BOX BELOW LIABILITY INSURANCE POLICY l OTHER TYPE INDEMNITY ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information 1 have submitted or entered regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME . �dQ�?zx/S LICENSE # f " ' SIGNATURE MP q MGF❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION 0 # PARTNERSHIP # LLC'[]COMPANY NAME '. G- rJ99111LI14.1 /Id ADDRESS' CITY � E' Z -v' -s 2 STAT �P " ZIP rl— -- VA2 TEL FAX CELL EMAIL (P Ik )�� va-amu G'91 "Val-Vt. 'ri S� - - 1 i i � ♦ 1 .• �.� ... i\ ��P•�.-�.�..__.-�..v�+•.•.-,e+._�-�-�T.zx—=maces-•v.... ,ter.. .�..s-r'n M% f i w 0 z o� F w M z a d z w CN o Elz z }❑ o w F W oz W 3 Wu r- w o a a o 3 W 0 zo a W ~ � U J CL CL 4d S2 iii = W H LL rAW 0 z 0 w a CAz z W4a 0 P4 v 0 a . 1 i �..—..fti ....,r ..,.. »..... _ _.». ........ .r ..__ _ '. ..._.....-....... _. _ ..... «.._ ... ..... y -♦ .. _-..e+. > +f w � x. 10 1 ` l .� _- --_" _. .. _._ _ _._.-__--._. __._._.___ .--._____..._..•._._ .. ._._ _,1 F�"�!i1 1 .:fit %' I c O J G v 'r, .......... - - - y - i .. p, . i ...� . ... A EDWARD J MATHEWS III (PL) 24 WEST WOODCREST DR MELROSE MA 02176-3414 IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): ./ V 14 9 e ti-, Address: ;.4 City/State/Zip: A* �1, SQ Phone #: /, / 7 ' g9- I ..?9/ s - Are you an employer? Check the appropriate box: 1.0al am a employer with �, 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.I 6. ❑ 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.] Type of project (required): 7. ❑ New• construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infonnation. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors 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 C.2 Policy # or Self -ins. Lic. #: C -7,?-3 iS Expiration Date: lA 7 �� Job Site Address: / 1 /�l 11.eUn City/State/Zip: r 6ration � Attach a copy of the workers' compensat on policy declaration page (showing the policy number and expdate). 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 DIA for insurance coverage verification. I do hereby certify under the pains..andpenalties_of perjury that the information provided above is true and correct. Phone #: 12, a/ , S! ! %S Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # U 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 #: 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 chanter 152, §25C(7) stats."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-contractor(s) 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 Date.j 4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......e..,f .......... ............. has permission to perform ... t . f ........ wiring in the building of ...... ......................... at.,4e . ........... !�..d ........... . North Andov I has Fee ...,.1.5........... Lic. ..... 7!�E�ICAL 14 PECTO Check # 0597 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the l permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed4`N1 �u 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 meceding,l2-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 puipose 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 August008 and extending"through August 15, 2012. '649ule 8 — Permit/Date Closed: *** Note: Reapply for new per 0 Permit Extension Act — Permit/Date Closed: �-r � � �ruusaffho��%asiactuste�{3 BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 7 Occupancy and Fee Checked [Rev. 11071 (Icav a blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfermed in accordance with the Missaehusctts Electrical Coale (AtEC). 527 CvfR 12.00 (PLF-4 SE PR7hTW INK OR TYPE -4LL BWORMARO) Date: 1/17/11 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice ofhis or her intention to perform the electrical work described below. I -cation (Street & Number) 79 MILL POND ROAD Owner or Tenon JUDY BARTON Telephone No. 978-794-9794 Owner's Address SAME Is this permit in conjunction with a building permit? Yes ❑ No x (Cheek Appropriate Boa) Purpose of Building DWELLING Utility A_. irixation No. Existing Senice200 fps 120 /240 Volts OverheadFl Undgrd ❑ No. of Meters 1 New Service Amps 1 Volts Overhead ❑ iindgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical War&: ONE NEW RECEPTACLE IN 6AS FIREPLACE WIRED IN METAL CLAD CABLE f n...,.lorin....rshP "Ir-3no tehlo mm- AP toaitwd by the luneewr of Wires. No. of Recessed Luminaires No. of CeilrSosp. (Paddle) Fans of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators K'VA No. of Luminaires S41mmin Pool a Above ❑ ❑ g d. cod. o. o Units g Butte Units No. of Receptacle Outlets 1 No. of Oil Burners FIRE ALARMS No, of Zones Nof Switches No. of Cas Burners o• I Detection and lnitistin Devices No. of Ranges tl No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Totals Num er 'ons_ -- Det ction/Alernt,'n Devices No. of Dishwashers Space/Area Heating KW LOCIl ❑ Connection ❑ Other No. of Dr yers Heating Appliances KW runty Systems:* Na of Devices or Equivalent No. of aterkW Heaters a o o. o SiLms Ballads Data Wiring: No. of Devices or E uivalent No. Hvdromassa g a Bathtubs No. of Motors Total UP a ecommu � ons arum No. of Devices or E uivaenE OTHER: .quaea aaauronae aerau q aesrreu, or us regwrrW ay vM i,.a1 c -J r,1— Estimated Value of Electrical Nook: (%Vhen required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10. and upon comptetion. LVSURANCE COVERAGE: finless waived by the owner, no permit for the performance of electrical work may issue unless r the licensee provides proofof 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 C] BOND ❑ OTHER ❑ (Speciff•:) I certify; under Are pains and penaltiesofperjury, that the tnformadOn o this application is true and complete. FIRM NA.IfE: LANCE M A CI . Zil ELECTRIC SIC. NO. --37455E Licensee: LANCE MACINNIS Signature LIC. NO.: (lfopplicable, enter "exenwir - in the license number line)Bas, Tel. No.15087260802 Address: 12 LOCUST STREET MIDDLETON MA 01949 6141 All. Tel. Na• *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safely "S" License: Lir. No. OWNER'S INSURANCE WAIVER: i am aware that the Licensee does not Aave the liability insurance coverage normally required by fay. By my signature below, l hereby waive this requirement. i am the (check one) El owner ❑ owner's agent. Owner/Agent P,ER]►�IT FEE: S S S Signature Telephone 1No. Date ... ....... &ORTN TOWN OF NORTH ANDOVER PERMIT FOR` OAS INSTALLATION This certifies that . )' ........... ... has permission for gas installation .. in the buildings of at ... n ,wl. A ..... 'North Andover,, Mass. Fee. %At -P. Lic. No.6 o.e4 �.e r � 7 GAS INSPECTOR Check# 8014 W M4* 6-3 -!off o-111, FIYTI IRFS W Lu WrA MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING Cityrrown: MA. Date: ` Permit# Building Location: I J �p.�/,t7 Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [ in O W W V to New: ❑✓Alteration. ❑ Renovation: Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIYTI IRFS W Lu WrA U3 I-- < < MW in O W W V to 3- O 1 S Lu � H in w Ix z N W - W W m t. n. W r- a W a ; W r rn v W W Wz Lu W Z 0 o F- _ o n, u. > L% Z W H h O Z �- tr fn J Q d CO W O Z it O~ W W z- o 0 U � a W W d>0 o .O uL S 7C J O o_ 0 (7 t9 °� =� o SUB BSMT. BASEMENT 75T FLOOR 2 FLOOR -Ya FLOOR 4TH FLOOR 5 FLOOR WH FLOOR VH FLOOR �> _ 81HFLOOR ,, `... �% p �L-/�3 C' l��a rl J'N `�C`L T i' ��% C Check One Only . ,Certificate #, Installing Company Name:' 1 /1� T El4orporation Address:7'-t J , ! "�!.%% �' ( Cityrrown: 1 ra)LClo_ 0 State: M ❑ Partnership Business Tel: '77<K 7?q _ 162 c i Fax: 177 -77 7 —26 . Firm/Company �j Name of Licensed Plumber/Gas Fitter: G- lJ/[ d)Crkm /� INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch.142 Yes L'J No ❑ li y ,u haveiFb .;Cou tJ pjaasz iijdlcata the type of cove aga by chacning tha appropi-iata box iF isiuw. A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coveragerequired by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ By checking this box ; I hereby certify that all of the details and information i have submitted (or entered) regarding this application are true ano accurate to the best of my Knowledge and that all plumbing work and Installations erformed undor a ertnit Issued for this application will be In compliance with all Peril lit vision of the Massachusetts: State Plumbing da lid Chapter U of th General Laws. 'Ile v Type of License: By4 ❑ Plumber �, ,�l r c _• r L.�-� " T1tle , > . _ ❑ Gs Fiter Sig attire of Licensed . m , luber/Gas Fitter ' 0M . aiter QJOurneyman f' cityfrown w License Number: 50 --5 , •1 _ _ APPROVED OFFICE USE ONLY ❑ LP Installer _ ESTIMATED CAST OF JOB 0 -73 6 3S n L a The Commonwealth of MassachuSetts Pruitt Form Department of Industrial Accidents Offke, of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers - ♦. ♦. t _. it. l_u dr NaMe (Busif V r Eness/Organization/Individual): i ' "/q C ` —1 N �_,6 '1 0 * -PI L Address:—i ij O tJ -rl4 I N City/5tatelZip: t D r,3 _L='i Q1' % o 1914f'l Phone #: (7 -7 �) -7 7 Ll — 1 � 6L J Are you an employer? Check the appropriate box: Type of project (required): 1. am a employer with' ❑ I am a general contractor and I 6. ❑ 'Ne constn*-tton employees (full and/or part-time).` 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7, Remodeling ❑ g ship and have pr employees These sub -contractors have g. ❑ Demolition working forme in any capacity. employees and have workers, ❑ Building addition [No worker's' comp. insurance comp. comp. a corporation 5. ❑ We are a corporation and its 10.❑ .Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work off cern have exercised their 11. ❑Plumbing repairs or additions myself. [No workers' comp. insurance required.] t right. of exemption per MGL c. 152, 1(4), and have no 12.❑ Roof repairs Q'Other ;SAS U Ir'ft> �o or employees.lNa workers' 13 d In 6•- P1 PPi 4 P NCl coma. insurance required.] elli� tN - ;'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name ofthe 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 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. • Insurance Company Name: W rpi t!�-�. APS D j-� t2.+ ((3-; 5 � S d Rnpic t p6 - u ; i f �'4?—O � �c Policy# or Self -ins. Lic. �-tN IKQ #: Gid d- M U3 Expiration Date: %� N/ �-� Ci AA 'h d Lit. e— In Job Site Address: 0 City/State/Zip- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1S2 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI�Ar insurance coverage verification. Ido hereby cernfy ru der 4pains ar d aejj!liig 2Leqrjqry that the information provided ab ve is true and correct. Signature- - C. _ _Date: A O Phone #' -�—"—� L t X c�_ L. Djflcial use only. Do not write in this area, to be. completed by city or tome ajfflcial City or'Towin: Permit/License #........ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #:__ j Date. r TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� ?� This certifies that ...'r.. has_permilsion to perform ....�:� i,�................... plumbing in the buildings of .... at ....�1..��?�� l.l../.�G ................. North Andover, Mass. Fee.,-! Lic. No.. ? f.'. ..... ..... /� (, PLUMBING INSPECT R Check !1 22 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) � �d N�fnLQbV�1(" Mass. Date 0 Permit # Z� C Building Location�G 'I'OfP�� Owner's Name �l d& cI::LLcT()4 Type of Occupancy RESIDENTIAL IN New Cl Renovation ❑ Replacement �.1 Plans Submitted: Yes ❑ No ❑ EMERGENCY RENTAL WATER FIXTURES HPATPR . RP.PT.AC`F'MP.NT Installing Company Name WELCH BROTHERS CO. I NC Address 148A TANNER ST LOWELL NIA 01852 Business Telephone 9 7 8 4 5 3— 210 0 Name of Licensed Plumber THOMAS F. CAREY Check one: Certificate J Corporation 1-501—C L.] 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 n No ( 1 If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy i-. 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: 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 plumbing work and installations performed yn9 a permit issued this plication will be in compliance with all' , pertinent provisions of the Massachusetts State Plumbing Code and Cha 142 of the G r a BY _ A Title Signature o L' umber _ � _ Type of Ucense Master F3 Journeyman 0 City/Town APPROVED NLY) OFFIC USE Olicense Number 8481 ■ �� neuo� o��r�u Installing Company Name WELCH BROTHERS CO. I NC Address 148A TANNER ST LOWELL NIA 01852 Business Telephone 9 7 8 4 5 3— 210 0 Name of Licensed Plumber THOMAS F. CAREY Check one: Certificate J Corporation 1-501—C L.] 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 n No ( 1 If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy i-. 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: 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 plumbing work and installations performed yn9 a permit issued this plication will be in compliance with all' , pertinent provisions of the Massachusetts State Plumbing Code and Cha 142 of the G r a BY _ A Title Signature o L' umber _ � _ Type of Ucense Master F3 Journeyman 0 City/Town APPROVED NLY) OFFIC USE Olicense Number 8481 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG (Print or Type) a .y G NO.ANDOVER , MA , Mass. Date f `t ___19 Permit Building Location a7 MILLPOND Owner's Namei�� NO . ANDOVER , MA Type of Occupancy ' RES New ® Renovation ❑ Replacement ❑ . Plans Submitted: Yes❑ • No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: CertlfTcate r Address 91 RE ,MONT STREET 13 Corporation NO . ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q No ❑ ' It you have checked yes, please indicate the type coverage by checking the appropriate box. A Itabfllty insurance policy KI 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: Owner -0 Agent C1Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In Ove for are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the Permit sued for this applicau wil;Gas;i;(ter- Title pflance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law BY T e of Ucense: 14 - Plumber Plumber gnalur o c nse um a or Gasriller Master Ucense Number M-3440 City/Tcwn Jcutneyman N N 2 W N V) N Y U tt V7 In W ¢ WV1 of R O of F J W j. d m N tu F- Ujj lu G a C d r 01 ¢Yl ¢ W 2 U < W _ N _ W ~ < H G Q �.. C F., W W q •• F— T J J F' < .. l W ¢ W C G O 'aL > U. W H U W J H ¢ W l N O _. O o a J 0 c > a a !- O SUB—BS MT. BASEMENT , I 1ST FLOOR (� 2ND FLOOR 3RD FLOOR _ I I �Y 4TH FLOOR STH FLOOR I 6TH FLOOR I 7TH FLOOR STH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: CertlfTcate r Address 91 RE ,MONT STREET 13 Corporation NO . ANDOVER, MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter JOSEPH KEVIN CALLAHAN INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q No ❑ ' It you have checked yes, please indicate the type coverage by checking the appropriate box. A Itabfllty insurance policy KI 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: Owner -0 Agent C1Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In Ove for are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the Permit sued for this applicau wil;Gas;i;(ter- Title pflance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law BY T e of Ucense: 14 - Plumber Plumber gnalur o c nse um a or Gasriller Master Ucense Number M-3440 City/Tcwn Jcutneyman ACHU This certifies that has permission for gas inst tion !../.:' . . in the buildings of ...... L j 'Olin ...................... a at ... .�% . .. , North Andover, Mass. Fee;�j .... of/Li . No.�-3. &0 25,40 [Aj[GAS INSPECTOR WHITE: Ap cant ',CANARY: Building Dept. PINK: Treasurer GOLD: File y Date..d.� .jn 2028 .. NORTH TOWN OF NORTH ANDOVER F , p PERMIT FOR GAS INSTALLATION t ACHU This certifies that has permission for gas inst tion !../.:' . . in the buildings of ...... L j 'Olin ...................... a at ... .�% . .. , North Andover, Mass. Fee;�j .... of/Li . No.�-3. &0 25,40 [Aj[GAS INSPECTOR WHITE: Ap cant ',CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIPIG (Print or Type) c NORTH ANDOVER Mass. Date . . /,— -� tuilding Location % 7 C, I/ Owners i I - New Renovation D Replacement II Plat S F#X—Clop: C! Permit Name.Tz/�vl �Gr,T s Submitted/ 10 (Print or Type) Check one: Certificate Installing Company Name /.��yy,�� ,�',.9 Q Corp. Address z6M° - -s , Partner. /t/, /.�, r •,C %a An 279f,1 0AFep -2 i�:71 Firm/Co. Business Telephone: Name of Licensed Plumber or Cas Fitter Insurance Coverace: indica--E: !,"-e of insurance coverage by checking the appropriate box: Liability insurance policy C O:^er type of indemnity Q Bond Insurance Waiver: 1, the undersicned, have been made aware that the licensee of this application does not have an. one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I hereby certify that all of the dctails and information I haeme submitted (or entered) in *tote appiieation are true and accurate to the best of my k -W -ledge and that aLL plumbing work and InstAdatioas ;*folate d under ftrrnit i=zd for this application will -be in comptiattea with all pest =t provisions of the Massachusetts State Cas trade and Csapte :t_ t„ =0 t,caCai LAWL .. TYP'E' L I C Z N S G% i # P? uirtber Title_ „�� a -r l Gasfitter Signature of Licensee Master Plumber or asfi.tter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number � W y Y G y - U1us t- C uA c ` s w w_ w t0 C > t - 4 - us to Z I. :r W O C T u. us LuO 0] a ,u > SASEMEXT I -IST FLOOR j =X0 FLOOR 3R❑ FLOOR 4TH FLOOR I I I ' I! f ! I I I I I I ! ( ( I I- {{ 1 - ..' 5TH FLOOR 6TH FLOOR I I I I I I I I I I ( I I( I I I I I I I I I T TK FLOOR 8TH FLOOR I I I E I I I I ( I ( I I t I I I E I I I I I I (Print or Type) Check one: Certificate Installing Company Name /.��yy,�� ,�',.9 Q Corp. Address z6M° - -s , Partner. /t/, /.�, r •,C %a An 279f,1 0AFep -2 i�:71 Firm/Co. Business Telephone: Name of Licensed Plumber or Cas Fitter Insurance Coverace: indica--E: !,"-e of insurance coverage by checking the appropriate box: Liability insurance policy C O:^er type of indemnity Q Bond Insurance Waiver: 1, the undersicned, have been made aware that the licensee of this application does not have an. one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I hereby certify that all of the dctails and information I haeme submitted (or entered) in *tote appiieation are true and accurate to the best of my k -W -ledge and that aLL plumbing work and InstAdatioas ;*folate d under ftrrnit i=zd for this application will -be in comptiattea with all pest =t provisions of the Massachusetts State Cas trade and Csapte :t_ t„ =0 t,caCai LAWL .. TYP'E' L I C Z N S G% i # P? uirtber Title_ „�� a -r l Gasfitter Signature of Licensee Master Plumber or asfi.tter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Number +�F'.�s"^dfi;':�•�'^i"='64w...'"2+�4- ,�s^.-- :��•A+t�+-L•-s '^.t.c.,,.-.�-..:i;�. Date.., 1�,Ta 2059 This certifies that.. �...... ✓� :.r! . ... •. m has permission for gas installation .. G R!i A <.,r ........... in the buildings ofiq .. . at ... f . : p �� ... .. No Andover, Mass. Fee.�.�•.'.. Lic. No./LSL. .. ,,.. AS INSPECTOR' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File A TOWN OF NORTH ANDOVER nI. �PERMIT FOR GAS INSTALLATION M This certifies that.. �...... ✓� :.r! . ... •. m has permission for gas installation .. G R!i A <.,r ........... in the buildings ofiq .. . at ... f . : p �� ... .. No Andover, Mass. Fee.�.�•.'.. Lic. No./LSL. .. ,,.. AS INSPECTOR' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File