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Home My WebLink AboutMiscellaneous - 90A PLEASANT STREET 4/30/2018Date l-Jp..—.03 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ::.I! ... D .1-0.4 ............................ ( ............................................ has permission to perform...... h-4. La.�n ........... o wiring in'the building of ...... T.U�n ........ sa./v o ............................................... at .......... ?1 .......... a North Ando !r, ../ ......... 5.0 CA-) Fee ... ........ Lic. No,/I—/>.'// ......... .. . ............ LECTRICAL Check # >6�� INSPECTOR 4583 No.. Date In""'. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT C' w `ten X94°�.*. 0,11y h . Building/Frame Permit Fee $ SSACHUS� Foundation Permit Fee $ � _ I , ,� t : (rt",'�., 4�,- Other Permit Fee $ ,�-y / /a Building Inspeator Official Use Only Permit No. %�f$ eti�lZlyl6'l27�1/c�f.C'?�f t� nL1g.S.S1 fC?�I.SG�77S Defeat o6 �udue Sasettry Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 //�� (Please Print in ink or type all information) Date ACS --g To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. —` Location (Street & Number Owner's Address J /`}/'v% Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building �/� i�� Utility Authorization No. e Existing Service_ Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Newer Amps Volts Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 03�-,o"a/e, I',' e- , /"C/, �ozlv_- '�P` 1--e /o ,, '* r3- - fl INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includin mpleted Operations Coverage or its substantial equivale ES NO = d valid proof of same to the Offi NO = If you have checked YES please indicate the overage by checking the appropriate box INSURANCE = OND = OTHER = (Please Specify) 4e^„_ (Expiration Date) / Estimated Value of Work to Start Signed under th FIRM NAME i / Inspection Date LIC. NO. 1<:4e % Z2 X? NO.. -',v' 70 /oV .0 IA- c ''T <- S /Bus. Tel No. Address / e<, /�/' Gar�� Alt Tel. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITfEE $ 'C Qom - (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. -of Ranges ,. No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwas;}ers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includin mpleted Operations Coverage or its substantial equivale ES NO = d valid proof of same to the Offi NO = If you have checked YES please indicate the overage by checking the appropriate box INSURANCE = OND = OTHER = (Please Specify) 4e^„_ (Expiration Date) / Estimated Value of Work to Start Signed under th FIRM NAME i / Inspection Date LIC. NO. 1<:4e % Z2 X? NO.. -',v' 70 /oV .0 IA- c ''T <- S /Bus. Tel No. Address / e<, /�/' Gar�� Alt Tel. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITfEE $ 'C Qom - (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City - _ Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name. - Address k. City Phone # Insurance. Co. Policy # m Company name: Address City Phone # Faikwe to secure coverage as required. under Section 25A or MGL 152can lead to -the imposition of criminal penal of,a fine W to $1,5M and/or one rears' imprisonments well.as_civil-penabas-oSholem-daSTDPYAK)W-ORDFR and afine-ofA3t110-OD)-a-day me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ta. ! do hereby certify under the pains and penalties of peuiffy that the information p wid+ed above is true and correct. Signature Date Print name Pbme-# Official use only do not write in this area to be completed by city or town dfiiciar City or Town PermM icensina. D Building Dept E]Cheak d immediate response is regu "red . Licensing Board E] Selectman's Office Contact person: Phone #. Ej Health Department Ei Other Date ...`: � ...0 .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION i This certifies that�. .... ` � -� °—�...... . has permission for gas installation -.4 .5. �. !.. . in the buildings o........`:....?.:... ........................ at �,...`!-H.: ... , North Andover, Mass. Fed-:.:;??...... Lic. NoZ'??6!. e/` z.-�<......... . l GAS INSCTOR Check # / �`� ?+61 MASSACHUSETTS UNUMM APPUCATON FOR PERNffr TO DO GAS FU NG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations r Owner's Name New ❑ Renovation ❑ Replacement Date ,J a �--/6 Plans Submitted ❑ Permit # �71,V Amount $ C;k ,i (Print or type) Name,�� ddress U_eS Name of Licensed Plumber or Gas Fitter Check o Certificate Installing Company ❑ Partner. QFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please 'ndicate the type coverage by checking the appropriate box. ❑ 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 p Agent ❑ I hereby certify that all of the details and mrormanon i nave suuimucu kVA UJIMICu),i, auwvc aY11ii L-11 ai a. — U— aa.a. — w L— best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S azure of Licensed Plum4er Or gas Fitter Plumber j WGFitter =eNumber .�Nlaster Journeyman ",s x w z a vi - Cn rA U W W C4 W � N z O W 0 p D p z CW. W 6F' WC¢F W O F En a. G E rA z cn O F rxC�Yi rA pC O xz A C7 O .� U0W a � A F O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. F L O O R 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type) Name,�� ddress U_eS Name of Licensed Plumber or Gas Fitter Check o Certificate Installing Company ❑ Partner. QFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please 'ndicate the type coverage by checking the appropriate box. ❑ 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 p Agent ❑ I hereby certify that all of the details and mrormanon i nave suuimucu kVA UJIMICu),i, auwvc aY11ii L-11 ai a. — U— aa.a. — w L— best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S azure of Licensed Plum4er Or gas Fitter Plumber j WGFitter =eNumber .�Nlaster Journeyman ",s ° TOWN 0' NORTH ANDOVER f PERMIT FOR GAS INSTALLATION /► i This certifies that / � �. ........ 6... ................ . has permission for gas installation . S7V-qf�-' ................ in the buildings of ./. vh at.T '` T ,North Andover, Mass. Fee LJ. v : S Lic. No... t ................. ..... Check # o GAS INSPECTOR 6S8 4 !z MASSACHUSETTS UNIFORMAPPUCATONFOR PERNIlT TO DO GAS FTr11NG (Type or print) Date (� �% Q NORTH ANDOVER, MASSACHUSETTS a d )�1�vev C4W 7Z- ci� ` Dnr,.,;t if Dullull1s L.va.uuvu� Owner's Name New ❑ Renovation ❑ Replacement i Plans Submitted ❑ Amount $ (Print or type) 1,-,0"Ah 4 M Address Name of Licensed Plumber or Gas Fitter Checo Certificate t ng Company orp. ❑ Partner. ❑ Firm/Co INSURANCE COVERAGE Check one: . I have a current liability Insurance policy or it's substantial equivalent. Yes r] No ❑ If you have checked yes, please m ate the type coverage by checking the appropriate box. ❑ 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 ❑ �n „f the Ai tnac anri infnrmatinn 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts #(e Gas Code ar d Chapter 142 of the General Laws. By: Title City/ Town APPROVED (OFFICE USE ONLY) // Signature of Licensed Plumber Or Gas Fitter Plumber 4�u/% Gas Fitter License Number Master Journeyman w a w a c U O W @ p � p z w ` z c a w w a w z w w Fw+ C4 a p A c7 UO a > A a H O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4THFLOOR LO5TH. F O R 6TH. FLOOR LO7TO R SHL O O R TH . (Print or type) 1,-,0"Ah 4 M Address Name of Licensed Plumber or Gas Fitter Checo Certificate t ng Company orp. ❑ Partner. ❑ Firm/Co INSURANCE COVERAGE Check one: . I have a current liability Insurance policy or it's substantial equivalent. Yes r] No ❑ If you have checked yes, please m ate the type coverage by checking the appropriate box. ❑ 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 ❑ �n „f the Ai tnac anri infnrmatinn 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts #(e Gas Code ar d Chapter 142 of the General Laws. By: Title City/ Town APPROVED (OFFICE USE ONLY) // Signature of Licensed Plumber Or Gas Fitter Plumber 4�u/% Gas Fitter License Number Master Journeyman Date. .P..'.� 9�... J TOWN OF NORTH ANDOVER s l/ PERMIT FOR GAS INSTALLATION G✓/� �! This certifies that .... rl'I.l.� h�1. �.,. f : ........ .......... has permission for gas installation .. . in the buildings of ........... at . l.V ..6�-f!" ?. sT—, , North Andover, S. Fee.) -.� . Lic. NoJ —.) c?. ... Check # � t S 3C ,690- 3 GASINSPECTOR MASSACHUSEIM UNH ORMAPPUCATONFORPERNUrTODO GAS FrrfLNG f z (Type or print) Date NORTH ANDOVER, MASSA Building Locations A41%01/ (,t/ Owner's Name New ❑ Renovation ❑ Replacement Permit # ,phi t/,Z�/t � Plans Submitted ❑ (Print or type) C ec ne: Certificate stalling Company Name �� v ' -- orp. �d /� JJ"❑fit" Partner. Address Business Telephone ElFirm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance polic r it's substantial equivalent. Yes D No ❑ If you have checked Les, please ind� a the type coverage by checking the appropriate box. ❑ 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 nave suurmueu tur cntcmu) nx auuvc aFFnuauvxx axx. — ax— ax.x.uxaxc xu uxc best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusettsState fJas Code an"apter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Pignature of Licensed Plumber Or Gjaj Fitter lumber /v) Gas Fitter Icense m e Master Journeyman x a cn Cn rn U H o W @¢� R'' OG ] O z F zO F Z FWW+ z H W C7 O CW7 EW, OU Ox w ;ZD A C7 .�� a > A a FW0 SUB-BASEM ENT BASEMENT LOOR LOOR FLOOR L O O R L O O R FLOOR LOOR OOR (Print or type) C ec ne: Certificate stalling Company Name �� v ' -- orp. �d /� JJ"❑fit" Partner. Address Business Telephone ElFirm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance polic r it's substantial equivalent. Yes D No ❑ If you have checked Les, please ind� a the type coverage by checking the appropriate box. ❑ 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 nave suurmueu tur cntcmu) nx auuvc aFFnuauvxx axx. — ax— ax.x.uxaxc xu uxc best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusettsState fJas Code an"apter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Pignature of Licensed Plumber Or Gjaj Fitter lumber /v) Gas Fitter Icense m e Master Journeyman