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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .......................... ........
has permission to perform
wiring in the buildingiof
.................................
at ..... e? ... North Andover Mass.
..............................................
Fie -5....'' ........ Lic. 4.
. .....
EL CfAlCAL INSPECTOR
Check # 14911S�
9272
14
r't
Commonwealth of Massachusetts official Use Only
Department of Fire Services Pernut No. 9,? 2,;L -
Occupancy and Fee Checked
'
BOARD OF FIRE PREVENTION REGULATIONS Occupancy
1/07
L (leave hlanlrl
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 PRINTININK OR TYPE ALL INFORMATION) ]Date:
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her in ntion to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant ,L!Q, -54C 4e14
Telephone No.
Owner's Address SOB Gres P - 12
Is this permit in conjunction with a building permit? Yes ❑ No
Purpose of Building (Check Appro Hate Box)
Utility Authorization No.
Existing Service ,200 Amps Jap / ,�2y p Volts Overhead � Und d
!n ❑ No, of Meters
New Service Amps / _Volts Overhead
❑ Undgrd ❑ No, of Meters
Number of Feeders and.Ampacity
Location and Nature of Proposed Electrical Work:
/S 'I/"Ar / r,'L- -AA ,:-11 . _ 0_ _i
No. of Recessed Luminaires
Com [etion o theollowin table may be waived b the Ins ector
No. of Ceil.-Susp. (Paddle) Fans
NO. of Total
No. of Luminaire Outlets
No. of Hot Tubs
Transformers IIVA
Generators KVA
No. of Luminaires
Swimming Pool Above in
d. ❑
o. o mergency ig g
❑
No. of Receptacle Outlets
d.
No. of Oil BurnersFIRE
Batte Units
�RlvIS N
ALo of Zones
No. of Switches
No. of Gas Burners
No..of Detection and
No, of Ranges
No. of Air Cond. Total
Wtiating Devices
Tons
No. of Alerting Devices
No. of Waste Disposers
eat PSP Number Tons _ KW
Totals: """-'-"
_ No, of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/AleDevices
Local Ej Municipal
No. of Dryers
Heating Appliances KW
Connection 0 Other
Security Systems:*
No. of Water
KW
No. of No. of
No. of Devices or E ...valent
Heaters
Signs Ballasts.
Data Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
Telecommunications Wiring.
r1T13-L• 'n .
No. of Devices or Eauivalent
Attach additional detail if desired, or as required by the Inspector of
� Wires.
Estimated Value of Electrical Work: Q,
(When required by municipal policy.)
Work to Start 03103. D Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
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 W BOND ❑ OTHER ❑ (Specify:)
I certify, under the rains and penal"�''f ofperjury, that the information on this application is true and complete.
FIRM NAME: -Les�prgd-jt7,-
LIC. NO.:
Licensee: Wali � Signature �V 3
((If applicable, en er "exempJt " in th :cense n be line.) LIC. NO.:
Address: R T�. i� 3 Bus. Tel. No.:7 1-a ' 1663 -Cell
*Per M.G.L c. 147, s. 57-61, security work requires D artrnent of Public Safety "S" License: Alt. Licl. No.
_3 S d6
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: $ �_
V 4939
Date ...Y-,-"-72- q/
..........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
N4s �-So'
This certifies that .................
has permission to perform ................ -�7
plumbing in the buildings of . ....
North Andover, Mass.
at -No --- - ---
Fee'?'��. Lic. No. .. .............. ... ..........
INS A3ECTO�R
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
a (Print or Type)WVY t
/- Mass. Date Permit # �v
Building Owner's Name
Type of Occupancy
by
New Renovation ❑- Replacement ❑ Plans Submitted: Yes ❑ No,/
[I-
V
Installing
B . P . # S EWER# FIXTURES SEPTIC#
a
Business Telephone
Name of Licensed Plumber
Check one: Certificate #
❑ Corporation
❑ 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 k, 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 w4ives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Aaent
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 rfo ed a permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum m and Ch er 142 of the General Laws.
By
SR&MrVof Ucens Plumber
Title
Type of License: Master Journeyman ❑
City/Town
APPFiONED 0 FI US ONLY License Number
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SUB-BSMT.
BASEMENT
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1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
a
Business Telephone
Name of Licensed Plumber
Check one: Certificate #
❑ Corporation
❑ 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 k, 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 w4ives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Aaent
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 rfo ed a permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum m and Ch er 142 of the General Laws.
By
SR&MrVof Ucens Plumber
Title
Type of License: Master Journeyman ❑
City/Town
APPFiONED 0 FI US ONLY License Number
0
i_ocation
R�}o.4EJ Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $�
Building/Frame Permit Fee $""—�
Foundation Permit -,Fee $
Other P rmi Fe $
Sewer Connection Fee $ ----`�
Water Connection Fee $ --'sy
sy
TOTAL $
Building Inspector .
-17
" Div. Public Works
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OFFICES OF:
APPEALS .�., NORTH ANDOVER
BUILDINGt +.: »y�r
DIVISION OF
CONSERVATION
HEALTH
PUNNING PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
t 1u matn Sacci
North Andover.
Massachusetts o 1845
(617) 685=4775 .
In accordance with the provisions of MGI. c 40, S 54, a condition of Building Permit
Number '/ SIT is that the dcbris resulting from this work shall be
disposed of in a prcperiv liccnscd solid waste disposal facility as defined by MGI., c 111, S
150A.
The debris will be disposed of in:
u tvC�
ion of Facility)
Signature of P , s-ppiicant
V;(` 9V
Date
NOTE-: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the 3ui1ding Inspector.
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Date.. c�..1. `'..-.. 1
4
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .... ..........
has permission to perform ..... ........................
plumbing in the buildings of ....................
at .. U �....0 < ` ................. North Andover, Mass.
Fee. Lic. No.. C ..... ........ftp ... .. C_.c �...... .
PLUMBING INSPECTOR
Check #
5224
MASSACHUSETTS UNIFORM APFLM"ATION FOR PERMIT TO DO PLUME3ING
fPrint or T ) 1
,moi �r Mass. Date Permit #
Building Location / % Owner's Name
(�
Type of Occupancy - r^QP5
New ❑ Renovation C Replacement ❑ ,,,;,Plans Submitted: Yes ❑ No ❑
FIXTURES''���
B.P.m SEWER# SEPTIC#
0
Name of Licensed Plumber (/P10/141 LZ (_.Oa/'(/
Check one:
❑ Corporation
❑ Partnership
❑ Firm/Co.
Certificate n
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes A!!�, 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 C3
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 installatio s rm -urVer the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plu bi a and Chapter 142 of the General Laws.
re of Licensed Plumber
Title
Type of License: Maste�-C Journeyman ❑
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4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
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Name of Licensed Plumber (/P10/141 LZ (_.Oa/'(/
Check one:
❑ Corporation
❑ Partnership
❑ Firm/Co.
Certificate n
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes A!!�, 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 C3
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 installatio s rm -urVer the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plu bi a and Chapter 142 of the General Laws.
re of Licensed Plumber
Title
Type of License: Maste�-C Journeyman ❑
City/Town
APPS OFF! USc ONLY) License Number