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HomeMy WebLinkAboutMiscellaneous - 9 SALEM STREET 4/30/2018I r Date............�... �. ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �.....J''...,I.. has permission to perform--.......................�....:::�.h �:4. �?�r�z.,�............................. wising in the building of.......14 Vis,,.: .......1.... J.......... 11 .. ................... at :....9....1.4e v).. Aa... -..i. .. � Nbrth Andover, Mass. Fee............ ........ Lic. Nox-15zq .M..!4r? /....... EL I AL INSPECTOR Check #�- V- 31 Commonwealth of ; amantwelh . Official Use Only Acc /�Permit No.%�'�f partment o� ire Services U BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07]., (leave blank 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 PRINT IN INK OR Y'E A INF R TON) Date: City or Town of: �7To the Inspector of Wires: By this application the undersigned g`ves,;ioticS of tris or her intention to perform the electrical work described below. Location (Street & N Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building pL '."es ❑ No ❑ (Check Appropriate Box) Purpose of Building Existing Service New Service Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool aboveEl In- 1:1o. rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pu P Number ..... _ ...__................................................ Tons K o. o Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other No. of Dryers Heating Appliances KW Sectio oyf Devices or E uivalent No. of Water ICER' No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or Equivalent OTHER: Ar 3 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: G , (When required by municipal policy.) Work to Start: (-J 'Inspections to be requested in accordance with MEC Rule 10, and upon completion. �— INSURANCE t VE G : 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 f 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:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:LIC. NO.: Licensee: c Signature C. NO.: 17S (If applicable, enter "exem t" in the licepse n mbeKI" e. 001BRus. Tel. No.. Address:i W Alt. Tel. No. C *Per M.G.L. c. 147, s. 57-61, security work requires Dep ent of Public Safety "S" License: Lic. No. 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) E] owner ❑ owner's writ. Owner/Agent PERMIT FEE: $ Signature Telephone No.� I The Commonwealth of Massachusetts Department of Industrial Accidents H Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual). Lighting Retrofit Services Address: 234 Ballardvale Street ity/State/Zip: Wilmington, MA 01887 Phone #: 978-988-7800 Are you an employer? Check the appropriate box: 1. 1011 am a employer with 45 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance. 5. ❑ 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): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12..❑ Roof repairs 13.0 Other Lighting Retrofit *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 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 Name: Hartford Insurance Company Policy # or Self -ins. Lie. #: 5B921665 Expiration -Date: 4/13/2016 Job Site Address: �G{.+v��/ J\ City/State/Zip: ���CC�/ {' /l a.., 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. 152 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 DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this 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 Contact Person: Phone #: •QAC R OP ID: MH CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.• THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomementis). PRODUCER 978-975-1300 CONTACT Seyreve & Hall Insur.ASSOC.InC NAME: 305 North Main St. 978-975-7596 PHONE FAX Andover, MA 01810 AIC No Ext : A/C No MAIL E - — Patrick D. Hall ADDRESS: PRODUCER LIGHT -3 CUSTOMER ID #: INSURED Lighting Retrofit Services Inc INSURERIS)AFFORDING COVERAGE NAIC# 234 Ballardvale St, Suite 1, INSURER A:Arbella Protection Ins. Co. 41360 Wilmington, MA 01887 INSURER B: Hartford Ins Co. INSURER C: COVERAGES CFRTIFICeTP w IM91=0 149 KLV1510N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AADW 9M LTR TYPE OF INSURANCE NUMBER EFF POLICPOLICY MM/DDYNYYY MM/LDD/YYrr LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ADDTN'L INSRD. 8500045964 $250,000 01/03/14 01/03/15 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL 8 ADV INJURY $ 1,000,00 X Equip Rental Cov GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PROI POLICY X ECT LOG PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 1020015640 03/15/14 03/15/15 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A B UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE NIA I IE.L. 4600045965 58921665 01/03/14 04/13/14 01/03/15 04/13/15 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I $ WC STATU- OTH- XT RY LIMI S ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CFRTIFICeTC L r%l nco Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 ACORD 25 (2009/09) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 04z— v r aoo-cvva At+UKU t.UKrUKA I IUN. All rights reserved. The ACORD name and logo are registered marks of ACORD y Town of North Andover FIRE STATION #2 k,.2-Aug-2014 09:40:06 Current Scope of Work Page 1 Qty Qty Ref see Floor Room Ref # ECO # Var Sury Done done COR B OFFICE OPEN MAIN 2043 4L4128W LO-8'RLR 1 2 2 Y B OFFICE FILES 2044 4L4128W LO-8'RLR 1 2 2 Y B BEDROOM 1 2045 2L4128W LO RLRB 1 1 1 Y B OFFICE OPEN BEDS 2046 2L4128W LO RLRB 1 4 4 Y B KITCHEN 2047 NO RETRO 1 0 0 Y B BATH BY BEDS 2048 4L4128W LO-81RLR 1 1 1 Y B BATH BY BEDS 2049 NO RETRO 1 0 0 Y B STORAGE LOCKERS 2050 2L4128W LO RLRB 1 1 1 Y B LOUNGE 2051 4L4128W LO-81RLR 1 2 2 Y B LOUNGE 2052 2L4128W LO RLRB 1 1 1 Y B SHOP TRUCKS 2053 4L4128W LO-8'RLR 1 20 20 Y B SHOP TRUCKS 2054 2L4128W LO RLRB 1 2 0 Y 369 B STORAGE TO BASEMENT 2055 NO RETRO 1 0 0 Y B STORAGE TO BASEMENT 2056 2X 13W DRUM 1 1 0 Y 370 B BEDROOM WORKOUT BIKES 2057 2L4128W LO RLRB 1 2 2 Y 368 B BEDROOM WORKOUT BIKES 2057 A 2L4128W LO RLRB 1 1 1 Y B STORAGE BASEMENT 2058 NO RETRO 1 0 0 Y B STORAGE BASEMENT 2059 2L4128W LO RLRB 1 1 0 Y 371 B STORAGE BASEMENT 2060 2L3121W LO RLRB 1 1 0 Y 372 B MECHANICAL BOILER 2061 NO RETRO 1 0 0 Y 1 EXTERIOR BLDG MT. 2062 11W COMPACT SI-E 1 4 4 Y 1 EXTERIOR BLDG MT. 2063 50W METAL HALIDE 1 1 0 Y 373 1 EXTERIOR BLDG MT. 2064 71W LED/NEW-EXT 1 1 1 Y 1 EXTERIOR BLDG MT. 2065 71W LED/NEW-EXT 1 1 1 Y 1 LIFT FEE 2065 A LIFT-FS2 1 1 1 Y 1 RECYCLING FEES 2065 B RECYCLING-FS2 1 1 1 Y 1 WASTE DISPOSAL 2065 C TRASH-FS2 1 1 1 Y Copyright (c) 2014 - Lighting Retrofit Services r F��. - � II �c� of-, rell& HORT11 pf ��ao ,a 1tiQ ,SSAGMUS� Date..f .Z....2.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatf�� �EC .................................... ........................... ...................... has permission to perform5',alr�ce�� ............................................................................... wiring in the building of��ST.�T/off ................................................................................... at.......... f/ ...........54 ................ T ?- ZLECrRICAL , North Andover, Mass. Fee... ... Lic. No A �/ 0/ INSP Check # J& Uq o X908 • t.011 Commonwealth of Massachusetts Department of Fire Services r` BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �9e Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR7107 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ' Z. Z City or Town of: NORTH ANDOVER To the Inspector of Wires By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) J 1; ` k`OA 5 �- Owner or Tenant` it �-�cti t 1'vv1 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service zgQ_ Amps /,Z2 /;�16 Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd B2�— No. of Meters l Location �and �Nature /oof�Proposed [{Electrical Work: R E— t- EE b ��1/EL Serv1FC-e _�{-.Y! 7 7'C.Y y ^ ! �G ZdV �pY' ���/�i 1 �iVf `I i.�- / � � LL L���•�� Com letion nf the ollowin table m b ' d b h A, No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans warve t e—spectorol Wtres. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- E] rnd. rnd. No. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number ""' Tons ''' ` "" ' ' W ''"""""........... No. ofSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. o Water Heaters KW o. of No. of 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:' G V Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: . 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information o on this application is true and complete. FIRM NAME: /Var ©he - e'lrGI rico t e.�c/Ytj` LIC. NO.: j Licensee: 6t-e.ahPyx_--J NGy &,, SignatureA4e;A,,,.t% .g2OKAIL_LIC.NO.:�� Bus. (If applicable, enter "exempt" in the license numbg r line.) 7 Tel. No.*. WI-J2zaU7 Address: _IO W rir ��. SPS Alt. Tel. No.:.,,'/Y/— 6 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 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: $ %�/ �M�ri q a3 -off �i 7456 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that G%4/ !.L° .. has -permission for gas installation .. .. ........... in the buildings of ...N-.�...�� ? . 7`^- . at . 1 ..��!�? .. ST ............... North Andover, Mass. Fee. . r . Lic. No.. �%U �� 3 ...................... GASINSPECTOR Check # /j N14SSAa SMS LNbRIMAPPUCATONFOR PERIMTO DO GAS FfrU NG (Type or print) Date //// d l% d NORTH ANIInVUD yj kSSACHUSET TS -- Building Locations ./ 4 Il✓ / a AIN Uri �,/ New � Renovation El Permit # '---Amount $ Owner's Name / w Replacement ❑ Plans Submitted ❑ (Print or Name_ 1 4-40 A- I Relgl G Vv14 /4-A Check one: Certificate Installing Company Corp. Partner.. rl Firm/Co.- Name irm/Co:;Mame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No o If you have checked yes, please inAicate the type coverage by checking the appropriate. box. Liability insurance policyEzr Other type of indemnity Bond Owner's Insurance Waiver: Tani aware that the licensee does not have the Insurance coverage required by Chapter 112 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 --j —uu Y uml. It vi uip ucLaus uuu iuwuuuuvu 1 nave suomnteu (or enterea) in above application are true and accurate to the. best of m} knowledge and that all plumbing work and installations perfornir..d under Pisrnit Issued for this application will be in compliance with all pertinent provisions of the vfassac use s State CJ4 CndY,<1?l Chapv642 of the General Laws. By: Title CityiTown 1 APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitt r Plumber 02-10`7 Gas Fitter license N umber n ter in/oUrneyman U z M �. L7 x° O U w [-4 ' x O pA�+ C7 M H OG]T+ z O J a f�WCz4G O pH O W A` 0 q 0 HF SUB -BASEMENT B A S E M ENT 1ST. FLOOR r 2ND. FLOOR 3RD. FLOOR 4T 1I. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR -4 (Print or Name_ 1 4-40 A- I Relgl G Vv14 /4-A Check one: Certificate Installing Company Corp. Partner.. rl Firm/Co.- Name irm/Co:;Mame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No o If you have checked yes, please inAicate the type coverage by checking the appropriate. box. Liability insurance policyEzr Other type of indemnity Bond Owner's Insurance Waiver: Tani aware that the licensee does not have the Insurance coverage required by Chapter 112 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 --j —uu Y uml. It vi uip ucLaus uuu iuwuuuuvu 1 nave suomnteu (or enterea) in above application are true and accurate to the. best of m} knowledge and that all plumbing work and installations perfornir..d under Pisrnit Issued for this application will be in compliance with all pertinent provisions of the vfassac use s State CJ4 CndY,<1?l Chapv642 of the General Laws. By: Title CityiTown 1 APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitt r Plumber 02-10`7 Gas Fitter license N umber n ter in/oUrneyman Date. ���... ..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ! ?' 4--"!� .. ....../ ...... . has permission for gas installation in the buildings of ... k. A4 -.<-.t.:% ! ...�!C' at . � .. f �a l2 .................... �. North Andover, Mass. Fee.. 6.... Lic. No....7::.... .'...� .-:.. ^... . GAS INSPECTOR Check # 5636 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /� j IjOkY Ak1Doijcx. , Mass. Date 6,126 oZ004, Permit # �� Building Location 9 SPL rt 37 Owner's Name 70td,(/ OF ND- AI JOQV64 "" NO T H tJDl�UC)Z Type of Occupancy. P/RC SlArlD JJ New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone q 7 !B- 6 8,7-'l 10 5 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # )❑ Corporation 1862 ❑ 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 J( 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 El I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accur,4te to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n " mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. Lj r By T e of License: Plumber Signature of censed Plumber or Gas Title Gasfitter Master License Number 3 74'5 City/Town Journeyman APPROVED O FIC SE O • • • • n • • mom •• ■����������������■ �r�■ mom MENEM ■v■ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone q 7 !B- 6 8,7-'l 10 5 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # )❑ Corporation 1862 ❑ 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 J( 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 El I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accur,4te to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n " mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. Lj r By T e of License: Plumber Signature of censed Plumber or Gas Title Gasfitter Master License Number 3 74'5 City/Town Journeyman APPROVED O FIC SE O z 0 w 0 w U LL LL O a O LL 3 0 w w NI W z Ud a[ O Z_ f - H LL N S n 0 a O H a O w z a a O LL 2 O Q 0 J a a Q W w LL a[ No 2490 Date ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41' This certifies that ...... — ----- .......... .......... ............ ............ ............... ... has permission to perform ... ..................... . .... ................ ........ '-d T", .... wiring in the building of ....... ............................................ .......S./...................................... . North Andover, Mass. ......... Lic. NA ... ......................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TRE COWON] LO MAg'4CWJSOffice Use only DEPARTADDiTOFPUBLIC&IFM Permit No. -41 f1 BOARD OFMEPREVElMONRF_GUMTIOAS5270IR12DO Occupancy & Fees Checked AA PPL.It.ATION FOR PERAff TO PEUORM E,E=CAL WORK ALL WORK TO BE PERFORMED rN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date P U Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ® No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. �® Existing Service o2(9D AmpsZ/ /22�OVolts Overhead Underground ® No. of Meters New Service Amps / Volts Overhead ® Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 274 r S' No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:1round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices Wo. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal® Other No. of Dryers Heating Devices KW i ® Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER lnsw&reCaaage RnLat1DthetagtmanenlsofMasmchw&GmrALaws lhasea=atLiabkh>,stra=PblicyarJ-xiagCa> e C�dwcr#ss�rtaig.,,lea,t YES ® NO Iharest.bmittedvt6dproofafsmm1ot te0� YES F7NO ® IfjauhmduJodYES,pleasemdi*theNxcfoaeaEpbyd=drnC#r bcx WS[1RAl`K� ® BOND ® OTHER ® (PIeweSpeaf') o. EstimWed ValuedElecincal Waik $ Work IDSWn 241 h�D*Ra pewd Rough Final FIRMNAME 1.:40 Ltoa> 1l I ..�v Sime �o Lioa>SeNo / S -� L2 id 67 1 BtsnssTel. Nct Adless •�® G'— c ` ®.� Alt Td Na OWNER'SWSURANCEWAIVER;1.amawaetbatheLi =domro oo�eageorassulz tc>tiale,>tascegtmedbyMassa�aselcsCeleralLaws andtbatmysa�taern�lspe�.ollwai�this tac�Iaena�. (Please check one) Owner ® Agent Telephone No. PERMIT FEE $ /� i