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HomeMy WebLinkAboutMiscellaneous - 89 MILLPOND 4/30/2018Date....... ............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thi's certifies that ......... ZC--- 61 ........................................................................................................... has permission for gas installatio . . ...................... in the buildings of/. .......................................................................................... at ....... ?.I ..... & ... ..... ... ............ I .......................... North Andover, Mass. Fee....................... Lic. No. ..... ............. ....................................................... GASINSPECTOR Check# � I II -'- 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY � _ _ DATE PERMIT #-O' —MA— JOBSITEADDRESS� _^�`4 ._ OW RVAM t GOWNER ADDRESS L TE -- FAXI� TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL DI RESIDENTIAL PRINT �� jj CLEARLY NEW: nj RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES 0 NOD APPLIANCES'l FLOORS--� BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER —J . _ _ . . -. _ } _ - _ . 11. ---I _. .- __. -.. BOOSTER [- -.-_ - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE _-,=-:1 .�—� — - - I —� .! FRYOLATOR -- FURNACE- GENERATOR GRILLE �- .. _I --! --� - - - - - --_ __...._ — J ------- rl -- INFRARED HEATER LABORATORY COCKS (� _ I<_ _..._ I —J MAKEUP AIR UNIT OVEN -------- --_ ------ POOL HEATER POOL ROOM / SPACE HEATER ROOF TOP UNIT - TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER... OTHER - — z-- — - ---- - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YE-2pNO D IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY D BOND F 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I 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. PLUMBER-GASFITTER NAME _ti.. `� __-_-- _ LICENSE # S 1 P(( SIGNATURE MP MGF D JP D JGF LPGI © CORPORATION 0# PARTNERSHIP ®#=LLC # COMPANY NAME: _ S r S, _ ADDRESS CITY _ --J STATE ZIP TEL 17 FAX L= CELL - _--.EMAIL 1 v 3 199 N ❑ r W ui w LL I N sV�V Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbers. TO BE FILED WITH THE PERM[TTING AUTHORITY. - - ^ »L:^ Name (Business/Oigariizationdudividual): Addxess: LA- G S City/State/Zip: �Q �. Are you an employer? Check the appropriate box: Phone #: 6 11 am a employer with p y _em to ws full and/or part-time). 2 I am a sole proprietor or partnership and have no employees Working £or me in any capacity. [No workers' comp. insurance required.] 3.[] 1 am a homeowner doing all workmyself [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. s. ❑I am a general contractIp i and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its, officers have exercised their right of exemption per MGL c. employees: [No workers' comp. insurance required.] 152 § 1(4) and we have no Type of project (required); 7. ❑ New'construct[on 8. [] R.emodeag 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additions 12. []Plumbing repairs or additions 13•.:J Ro6f repairs 14. [] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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. X am an employer that is providing workers'ompensaion insurance for my employees. Below is the policy and job site information. Insurance Company N, Policy # or Self -ins. Lie. Expiration Date: City/State/Zip: — Job Site Address:— P2 Attach a copy of the workers' compensa ' n policy declaration page (showing the policy number and expiration date . Failure to secure coverage as required under MGL e. 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. !:do ereby crt ains andpenalties ofperjury that the information provided above 's true correctture: Phone Official use only. Do not write in MIS area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone #: Contact Person: The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 - Boston, HA 02114-2017 www mass.gov/dia N sV�V Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbers. TO BE FILED WITH THE PERM[TTING AUTHORITY. - - ^ »L:^ Name (Business/Oigariizationdudividual): Addxess: LA- G S City/State/Zip: �Q �. Are you an employer? Check the appropriate box: Phone #: 6 11 am a employer with p y _em to ws full and/or part-time). 2 I am a sole proprietor or partnership and have no employees Working £or me in any capacity. [No workers' comp. insurance required.] 3.[] 1 am a homeowner doing all workmyself [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. s. ❑I am a general contractIp i and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its, officers have exercised their right of exemption per MGL c. employees: [No workers' comp. insurance required.] 152 § 1(4) and we have no Type of project (required); 7. ❑ New'construct[on 8. [] R.emodeag 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additions 12. []Plumbing repairs or additions 13•.:J Ro6f repairs 14. [] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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. X am an employer that is providing workers'ompensaion insurance for my employees. Below is the policy and job site information. Insurance Company N, Policy # or Self -ins. Lie. Expiration Date: City/State/Zip: — Job Site Address:— P2 Attach a copy of the workers' compensa ' n policy declaration page (showing the policy number and expiration date . Failure to secure coverage as required under MGL e. 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. !:do ereby crt ains andpenalties ofperjury that the information provided above 's true correctture: Phone Official use only. Do not write in MIS area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone #: Contact Person: 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 receivet'& 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 b6 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 requixed." Additionally, MGL chapter 152, §25C(7) states "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 -'contractors) 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 anLLC or LLP does have employees, a policy is required. B e 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-Accidenis. 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 thai 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-MA.SSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 9609 Date. .......... .. A0Rr#j TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING I This certifies that ............... ql� ........... has permission to perform ... W.ct+c-' .(2F-0('4-CA-v14r ........... plumbing in the buildings of at. . .. FI L ........... North And v rja Fee Lic. No.. � ?P>q� ...... PLUMBING INSPECTOR Check At z3s7o WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date ..1..z..-.�G. r�3... i` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 4-.' C:-- ar_ ............... . µ has permission for gas installation in the buildings of ��`-�? r?�: •.--'fs at ..e. 9.......... .. ,North Andover, Mass. Fee? (.... Lic. No. 1,12';.� :. ..... ........ GA9-1NS� C��R Check # 4571 s °a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY r- V�_ _.._ .... MA DATE _ FV .2 / Z PERMIT # - JOBSITE ADDRESS OWNER'S NAME U n C, ( P OWNER ADDRESS _ _ .. _ _ TEL FAX - TYPE OR OCCUPANCY TYPE COMMERCIAL [ EDUCATIONAL RESIDENTIALE] PRINT CLEARLY NEW: RENOVATION: Q REPLACEMENT: Q PLANS SUBMITTED: YES[] N00 FIXTURES Z FLOOR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB PBSSM CROSS CONNECTION DEVICE �. �! �>� DEDICATED SPECIAL WASTE SYSTEM7 E-77 7-4 DEDICATED GAS/OIUSAND SYSTEM t P DEDICATED GREASE SYSTEM ". , . - . _ - _^� _ . i i ...... r' y _ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM - -=- - _ a.. - • . _ ..;' DISHWASHER DRINKING FOUNTAIN'.9 FOOD DISPOSERr-. -'> - _ --- Al — _' , _ FLOOR / AREA DRAIN n INTERCEPTOR INTERIOR_. _- �- J KITCHEN SINK LAVATORY ROOF DRAIN_ SHOWER STALL # - f ... _ SERVICE/ MOP SINK TOILETf URINAL--,� -s� WASHING MACHINE CONNECTION - � I _. i '. WATER HEATER ALL TYPES - . _ ! -- I''� - - _ __ __b WATER PIPING .. _ _. t t._ __.- . OTHER - - € r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYE] OTHER TYPE OF INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER: l 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 0 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of py knowledge and that all plumbing work and installations performed under the permit issued for this application will be in pliance II Pertinent pro ' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I. Richard Martinez LICENSE # f 32096 GNATURE MP[] JP RT CORPORATIONPARTNERSHIP# LLCE,#�• COMPANY NAME I RM Plumbing & Drains ADDRESS I 198 Mishawum Road CITY Wobum jSTATEF,.MA ZIP 01801 TEL 781-760-6610 FAX 1 78143376439 CELL EMAIL I 6chiem1229@yahoo,com 0 I CONTROL # H 3 916 3 4 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. j This license is subject to the provisions of the General Laws I as amended. It is b personal privilege, and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. t� MASSACHUSETTS UNIFORM APPUCATON FOR PERMff TO DO GAS WrING (Type or print) NORTH ANDOVER, /M A %SSACHUSETTS Building Locations �y / J �'���al fy / i C/OyE own New Renovation ❑ Replacement Date /�s Permit # Amount $ Plans Submitted (Print or type j Name ;s A -4 - Address -�? A" fe g-5 Name of Licensed Plumber or Gas Fitter 1ok Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Firm/Co. INSURANCE COVERAGE Check one I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked Les, pleas mdi he 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 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 Pe d for this application will be in compliance with all pertinent provisions of the Massachu/ y�tat� Cclde and Ch er f the Gee Laws. tle APPROVED (OFFICE USE ONLY) Signature of Licensed Yrumber Or Gas Fitter ❑ Plumber ZZ5 „ ED Ga Fitter License Number aster ❑ Journeyman x w U O a H a W a CIDW OF Pa .F 'S. a Q C4 O w W d W� x z FCnp p N p z p WV F z F z W W C7 > W EW. U °o z W'C W WW¢ a z Q o o w w O x w O SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type j Name ;s A -4 - Address -�? A" fe g-5 Name of Licensed Plumber or Gas Fitter 1ok Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Firm/Co. INSURANCE COVERAGE Check one I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked Les, pleas mdi he 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 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 Pe d for this application will be in compliance with all pertinent provisions of the Massachu/ y�tat� Cclde and Ch er f the Gee Laws. tle APPROVED (OFFICE USE ONLY) Signature of Licensed Yrumber Or Gas Fitter ❑ Plumber ZZ5 „ ED Ga Fitter License Number aster ❑ Journeyman 4a Date - / Z- -02P •' N° 4222 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING �SACMUsc- �1 This certifies that ............... has permission to perform !.'`' ......... . plumbing in the buildings of ........ at .�.�....... , North Andover, Mass. Fee7��...... Lic. NoJ.. -3.... ... `k ..... .. .c..�......... . PLUMB11N INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 9J 0 Replacement FUCTURES Permit * yZ�v t5� DC ti 11 r1r Submitted: Yes O No O Installing Company Name_ f�C�c�T ti �,�►m,y►ATA�i� Check One: Certificate Address__ _ A(-` 0— RC H MAAj s. a.1 .0 Corporation _ 171 E i N r'_ n) - Al Ay 1 1JL/ p Partnership Business Telephone 2-0i;n/Co. E Name of Ucensed Plumber �n e,3 FeT 4. .SAMMr4 rt-qlO-c - - INSURANCE COVERAGE: I have a es CO policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesN If you have checked y.W, please indicate the type coverage by checking the appropriate box A liability Insurance policy Other type Of indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent O I hereby certify that all of the detafs and information i have submitted (or entered) in above application aro We and accurate to the gest of my knowledge and that all plumbing work and installations under the perm for this application will be in compliance with all pertinent provisions of the Massachusetts State A e and of the Laws. BY �l um Tito Type of License: Master % mmwmih ❑ /Town License Number_ l34-; z z z e, le < H z W OS Y N as < W C i Q v = y H z O_= v N C 4 V M !- � W = S < W M y= � < ; ~ C W O O W < to ¢ < W O J= C C a .. a' _< s 3 3 0 i i arc o. p r< is < W U. Y la <" < S < < O < J < sus—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name_ f�C�c�T ti �,�►m,y►ATA�i� Check One: Certificate Address__ _ A(-` 0— RC H MAAj s. a.1 .0 Corporation _ 171 E i N r'_ n) - Al Ay 1 1JL/ p Partnership Business Telephone 2-0i;n/Co. E Name of Ucensed Plumber �n e,3 FeT 4. .SAMMr4 rt-qlO-c - - INSURANCE COVERAGE: I have a es CO policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesN If you have checked y.W, please indicate the type coverage by checking the appropriate box A liability Insurance policy Other type Of indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent O I hereby certify that all of the detafs and information i have submitted (or entered) in above application aro We and accurate to the gest of my knowledge and that all plumbing work and installations under the perm for this application will be in compliance with all pertinent provisions of the Massachusetts State A e and of the Laws. BY �l um Tito Type of License: Master % mmwmih ❑ /Town License Number_ l34-; W W IFA Q Z m d O a 0 r � v z = � � v OW. a G m o 0 d O _ z r t O ti a H Rte, i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) UV O.ANDOVER , MA Mass. Date 1gj_ permit Building Locatlonjl? MILLPOND Owner's Name_ NO . ANDOVER , MA Type of Occupancy RES New ® Renovation ❑ Replacement Q Plans Submitted: Yes❑ ' No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate � Address 91 B LMONT STREET 13 Corporation NO . ANDOVER , MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Licensed 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 R7 No ❑ ' If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy El Other type of Indemnity O Bond CI OWNER'S INSURANCE WAIVER: I am aware that the ficensee 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 ove app6catlon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this applicatl will b In pliance with ail pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law ey T e of Ucense: tuber gnatur o c nse um a or Gas Fitter Title stiller aster License Number M-3440 ArY O . Journeyman N N ¢ T N N N Y V G in a: N R O = N W J N W O U m 1— = 7f < s m of w f K7 s o > F- W = Z O �' H 2 0 _ W .• ¢ of m o N SUS—aSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR (J I I 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate � Address 91 B LMONT STREET 13 Corporation NO . ANDOVER , MA . 01845 ❑ Partnership Business Telephone 508-689-9233 ❑ Firm/Co. Name of Licensed 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 R7 No ❑ ' If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy El Other type of Indemnity O Bond CI OWNER'S INSURANCE WAIVER: I am aware that the ficensee 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 ove app6catlon are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit sued for this applicatl will b In pliance with ail pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the neral Law ey T e of Ucense: tuber gnatur o c nse um a or Gas Fitter Title stiller aster License Number M-3440 ArY O . Journeyman f, Asa 2064 Date.! ,....... J � 4 HOR►„ TOWN OF NORTH ANDOVER of ti =' Fr 2` co PERMIT FOR GAS INSTALLATION �9SSACMUSEt - .. This.certifies that .C: ... .....10. has permission for gas installation ............ K in the buildings of ..,4z-� ./3c..�. . at ......... , North Andover, MaB <: Fee. ? t .. Lic. No. .�' Y.10 .... .. � . . /GAS INSPECTOR' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: I'Se MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTIAIG (Print or Type) t NORTH ANDOVER Mass. Date j;�,n /9 ql' iiuilding Location /,, -4� Y Permit it Owners Name Ae i7,11 C_ 'I New Z.:: Renovation Replacement D Plans Submitted �� F1X�LIfl_C (Print or Type) % Check one: Certificate Installing Company Name// 111✓ /0 eo-1 ✓ Q Corp. Address %off Y-7— Partner. _�,✓� tY+� �) 14, %ry h.fl r OI D O�� Firm/Co. Business Telephone: i Name of Licensed Plumber or GasFitter '4C_ '4C_ -- Insurance Coverace: Indica-_e ; e ;ype o; insurance coverage by checking the appropriate box: Liability insurance policy � O_her type of indemnity 0 Bond Insurance Waiver: I, the undersicne4, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature or owner/agent of property Owner = Agent Q I hereby ee:tiry that sil ar the dctsihs and informat:oa I have submitted (Cr tittered) in &Love appiiation are true and accurate to the best or my itaowtedge and that au phumbin; work and IasnL'atiorts -e=faraed urdC ftrr.-A !aced ra: this spruation wihl be in compliance with ad pezthacat Provisions or the btarsachuaetts Slate Car Code Ind b.spte Is. cf tso Geieai Lara. ., By TYPE LICCNS= { P 2. Umber Title I Gasfitter Signature of Li ensed City/Tcwn: { Master Plymber or Gasf1tter Journeyman APPROVED (OFFICE USE ONLY) License 14faniper as t C Cf pf C a! {{ C - pF- W us m .'� t O V Gl trs t- C UA s m W� W �_ W a C W > 4 m C m O V _W 07 ul < G r Q W r7 F- .i f t•• Lu O ? W h- LLI 0 U3 oc0i�c�y a BASERdEMT I I I I I I I I I I I I I I I ( I f I j'IST FLOOR I i I i I 1 I t►► i{ f 1` I I I A I f l j 2`IO FLOOR 13RM FLOOR 4TH FLOOR STH FLOOR 67H FLOOR TTI{ FLOOR ( I I I I I I ( I I I I I I I I ( I I I 8TH FLOOR I I ( I I I I I (Print or Type) % Check one: Certificate Installing Company Name// 111✓ /0 eo-1 ✓ Q Corp. Address %off Y-7— Partner. _�,✓� tY+� �) 14, %ry h.fl r OI D O�� Firm/Co. Business Telephone: i Name of Licensed Plumber or GasFitter '4C_ '4C_ -- Insurance Coverace: Indica-_e ; e ;ype o; insurance coverage by checking the appropriate box: Liability insurance policy � O_her type of indemnity 0 Bond Insurance Waiver: I, the undersicne4, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature or owner/agent of property Owner = Agent Q I hereby ee:tiry that sil ar the dctsihs and informat:oa I have submitted (Cr tittered) in &Love appiiation are true and accurate to the best or my itaowtedge and that au phumbin; work and IasnL'atiorts -e=faraed urdC ftrr.-A !aced ra: this spruation wihl be in compliance with ad pezthacat Provisions or the btarsachuaetts Slate Car Code Ind b.spte Is. cf tso Geieai Lara. ., By TYPE LICCNS= { P 2. Umber Title I Gasfitter Signature of Li ensed City/Tcwn: { Master Plymber or Gasf1tter Journeyman APPROVED (OFFICE USE ONLY) License 14faniper a....::+t�G�.L':�.,bwh'�""�,'�rai'^"�"`'._^.,� ., _. ,� ,,.,.. �„�.� �,. _ •�...•.,�,ycr..-n`D++a+"+r"' "8'�. ,31:ianvE,,... 2069 Oate.. . .�. . TOWN OF NORTH ANDOVER F PERMIT FOR GAS INSTALLATION 9SSA�u El p %� CU This certifies that ... 11� .. ... . • • . • . has permission for gas Mallation .... .! -r---� . in the buildings of ........................ at ... yq. ''. // ......I North Andover, Mass. Fee..,?. .... Lic. �iO l f 5 � GAS INSPECTOR WHITE: Applicant �.� CANARY: Building Dept. PINK: Treasurer GOLD: File v milt office usse�0AIr llepartrrktnt of Public Sr(fety Pe,nJt No.POW BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy a Fao Chocked ;)117-1s- 3/90 (leave blank) �T APPLICATION FOR PERMIT TO PERFORM rELEC'.;TRICAL WORK APPS , All work to be perlomted in accordance whh the Mascat:huswts EI«l i a C (PLEASE PRINT IN INK OR TYPE All City or Tvwn of The undersigned. aPplles TION) To the Inspector of Wires> Location (Street &Number) Owner or Owret's Address _.._...—__�--� ---------_�'`'''__�'[—...—_._._�r........� ._..._�...._. Yes L..J No L�1� (Check Appropriate 80.9) Is this perroit in conjunction with a building tmrmit' - d.�� ..__ Utility Authorization No. Purpose of Building �_ 1� [ �_Q Amps �_��-� Volts Crvurhead Q Undgrd No. of Meters Existing Service ((�'' / Volts Overhead D LlndKrd Nn. nf Meters __----_ New Service y -------nnips hturnber of Fepders and Ain vcit Location and Nature of Proposed Electrical Work Nu. of tier Tubs No. of lr; No, of Li Frtin Uullels _ �%C6ove n %wimminrt Puul Bend, end. G-rrnerar r of No. of of No. of Dishwashers No. of Dfyers _ -__J—T Beat = 'Jo. of Water Heaters Nn. Hydru Massage T OTHER: o. L nG C-6 r -- gancy Lighting OCT 2 3 19�'*' INSURANCE (OVERAGE: Pursuant to the requirements of K`130ac:husttes General Laws Liability Insurance Policy Including Completed Operations Coverage Lir icy substantial equlvalant, YES Cl NO la 1 have submitted valid pmol ( have a current ERA of same to this office. YES (J NU LJ If you have checked YES, please Indicate the type of coverage by checking the appropriate bo -� — INSURANCE Lld'BONp 0 OTHER❑ (Please Specify) -- (Explration Date) Estimated Value of Electrical Work $ _-- 1tion [late Requested: Rough Final - Work to Start —--••---- nsPec Signed under the penalties of perjury: LIC. NO. FIRM NA EIC. NO. Licensee Signature � I 1k -5��- Bus. Tel. No. sw Address 1 x Att. Tel. No .._..._ � lent OWNER'S INSURANCE WAIVER: I am aware that the licensee does i estth sathe ruqu rentent.cOwnergC Lir iAgceurestantia`pleaseacl ecksone) Ired�y Mateachuseus General taws, and that my signature on this permit APPhcatlan waives d PERMIT FEE $-47—W-- Telephone 47--.�--••�-W- — Telephone Nv.-- I _ (Signature of Owner or AS01`11) 3p. Ballet Uiiib FIRE ALARMS No. of Zones olal No. of Detection and Tons Initiatinx Devices 'Tota No. of Sounding Devices. - KW No. of Self Contained -- — -- " oetertion/Snunding Devices KWMunicipal ---�--�-- ❑Other local❑• Connection OCT 2 3 19�'*' INSURANCE (OVERAGE: Pursuant to the requirements of K`130ac:husttes General Laws Liability Insurance Policy Including Completed Operations Coverage Lir icy substantial equlvalant, YES Cl NO la 1 have submitted valid pmol ( have a current ERA of same to this office. YES (J NU LJ If you have checked YES, please Indicate the type of coverage by checking the appropriate bo -� — INSURANCE Lld'BONp 0 OTHER❑ (Please Specify) -- (Explration Date) Estimated Value of Electrical Work $ _-- 1tion [late Requested: Rough Final - Work to Start —--••---- nsPec Signed under the penalties of perjury: LIC. NO. FIRM NA EIC. NO. Licensee Signature � I 1k -5��- Bus. Tel. No. sw Address 1 x Att. Tel. No .._..._ � lent OWNER'S INSURANCE WAIVER: I am aware that the licensee does i estth sathe ruqu rentent.cOwnergC Lir iAgceurestantia`pleaseacl ecksone) Ired�y Mateachuseus General taws, and that my signature on this permit APPhcatlan waives d PERMIT FEE $-47—W-- Telephone 47--.�--••�-W- — Telephone Nv.-- I _ (Signature of Owner or AS01`11) 3p. i 2633 k FO A ik •e'.Ai�O��`� SACMUSE� Date....1.4...."......� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..: .... ....... ........................ has permission to perform, ll ... . wiring in the building of .........., % ...'.......................... .4 at.... `" ""�'.............. . . .. .. . . .. .................. , North Andover, Mass. Fee ..30 j 0. Lic.�. ....................................... ea � 3 ELECTRICAL INSPECTOR `` 9 /0-0/24/95 12:57 30.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File