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Home My WebLink AboutMiscellaneous - 81 MILLPOND 4/30/2018N O O co D 0 0 0 0 0 0 0 f 3 b �. 0 Date .. d ) a r..,l.... .. ,.. f NORTH " TOWN OF NORTH ANDOVER PERMIT FOR WIRING s a -I�(11(' y..S I............This certifies that ......................................... ..............' has permission to perform' %G 1 { s� ... wiring in the building of 4 G /� X17 ..................................................................... at ....... ("-./ ..... fl.:.! (... .w;.�.............� ............. ,North Andover, x Fee ..................... Lic. No. � ...f /. ............... ... �!� ✓ .,!1.................... EL RICAL INSPECTOR Check # i Commonwealth of Massachusetts Official Use Only Permit No. (? ( �—o Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 27 CM 12.00 (PLEASE PRINT IN INK OR T P LIN ORMATION) Date: Ci or Town of: City ��y�- To the Inspec or of fres: By this application the 4undersigned Ives notice of is or r in ion to perform the electrical work described below. 9. Location (Street & N her) Owner or Tenant Teleph Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No R"� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps i Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system// Cmmnletinn nfthe fnll—d— tnhlo ., , he .. -a A- rL- rw ..tur...__ No. of Recessed Fixtures _____._ _ _.._ �........ No. of Ceil: Susp. (Paddle) Fans .»..... ...» v.. ..».....»V a.ac a.... cl.aV/ V II tI GJ. No. of Total 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 Ba4e Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones / No. of Switches No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number I Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal F-1Other Connection No. of Dryers Heating Appliances KW SecuritycS Devices Sysor E uivalentems: No. QA No. o Water Kit Heaters No. o No. o Signs Ballasts Data Wiring• No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach 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:) (Expiration Date) Estimated Value of El ctrical Work: (When required by municipal policy.) Work to Start: ,r Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the ins a :. penalties of perjury, that the information on this application is true and completes FIRM NAME: my-HollisLIC. NO.: I r Licensee: John S. Bassett Signature LIC. NO.: 1533C (Ifapplicable, enter "exempt" in the.license number line.) Bus. Tel. No.: 603 594 592$ Address: r Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid, see 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: $ 3 2 2 3 Date . 7.—.,--2 S..�.. . A , ,aORTM TOWN OF NORTH ANDOVER a �`4ao ,e,ti00L p PERMIT FOR GAS INSTALLATIONR This certifies that . .{. .V. _.�-.�� . • has permission for gas installation ........... . cc in the buildings of ......................... . at ............ North Andover, Mass. Fee. .. Lic. No.,-. . 0.u2 J.. .. ....... . /GAS INSPECTO WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4, . l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) _ A G C MAP PARCEI.:� # 2 2-- 3 _ Type of Occupancy New ❑ Renovation ❑ ReplacementA Plans Submitted: Yes❑ No t] Installing Company Check one: Certificate Address % A). O!WL£_ :5^r— 1 Corporation t MA C'� 19,0 9 ❑ Partnership Business Telephone '%g / ?j�?3 92 SEE` C3Firm/Co. Name of Licensed Plumber or Gas Fitter , / ! A-rk ..S�Irr72 S 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 F 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 ❑ Signature of Owner or Owner s Agent / I hereby certify that all of the details and information I have submitted (or entered) in abo4applition a tr and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issueapp io wl be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gener Ely T=e o nse: I umber Signatilre of cen d Plumber or Gas Fitter Title B 6 astitter MMaster License N tuber City/Town ,Journeyman APPP VED IC US NL ME MEN11 rmff�MEIEEMEMENEM son, =MEMOS] WWI - SIM rMEMEREMEMOSSINEE son SEENESSEENEEMIN SO IN FEE SEEMEN Installing Company Check one: Certificate Address % A). O!WL£_ :5^r— 1 Corporation t MA C'� 19,0 9 ❑ Partnership Business Telephone '%g / ?j�?3 92 SEE` C3Firm/Co. Name of Licensed Plumber or Gas Fitter , / ! A-rk ..S�Irr72 S 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 F 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 ❑ Signature of Owner or Owner s Agent / I hereby certify that all of the details and information I have submitted (or entered) in abo4applition a tr and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issueapp io wl be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gener Ely T=e o nse: I umber Signatilre of cen d Plumber or Gas Fitter Title B 6 astitter MMaster License N tuber City/Town ,Journeyman APPP VED IC US NL �,��t ;�! �x '� ��': .-�`"�; `� .r'T'` .. � r� `y� � /' �.t� j