Loading...
HomeMy WebLinkAboutMiscellaneous - 90 MILLPOND 4/30/2018N O O (O CT c) DC) C> O r 9 o O Z O v O O 0 i � � 1 N O O (O CT c) DC) C> O r 9 o O Z O v O O 0 Date TOWN OF NORTH ANDOVER q�Yti. PERMIT FOR WIRING This certifies that .. yr ......I has permission to perform ..... %, wiring in the building to�ftjjp-rJ.........over........ . at .........�f Q ...'.. /.�..��'1./9........ , No And, Mass. Pte � .. Lic. No.'6?6v. '".. /�40 ..... �� ELECTRICAL INSPECTO Check # 11143 lfommonwea& of /t'/addac"tb Official Use Oni 2 cc�� cc�� Permit No. epartrnenj o1.}ire Saruicaa Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C,j027 CMR 12.00 (PLEASE PRINTW INK OR TY,P/EALL INFORMATION) Date��z�iz- D - /l— xv12 City or Town of. /itn> %yPptrFrL To the Inspec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) %O 77zc %i;o1,-P Owner or Tenant �J/ ci/<fEz_ „a 41 Telephone No. 9'7(f-2017fS'— Owner's Address S,Q d7 Is this _permit in conjunction with a building permit? Yes ❑ Nop (Check Appropriate Box) Purpose of BuildingI�cvECGiX0 r�'oN, , ) Utility Authorization No. Existing Service uIA Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service J14 Amps ! Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity All Location and Nature of Proposed Electrical Work: t'i1% F i%I hG�l v /ciQi%YYi'iD��iY /1�9/fiyY�� Completion o the ollrnvin table ma be waived b the Ins ector o 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 Above n- Swimming Pool nd. grud. ❑ . No. o Emergency Lighting Ba Units No, of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: _.._um_ er ons -­ * " '' -7- -- o7 oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems:' No. of Devices or Equivalent No. o aterI o. of o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Tel No ofDeviuilat ons it ng: No. of evfces or E uivalent OTHER: - Attach additional detail if desired, or as required by the Inspector of lVires. Estimated Value ofyle trical Work: 4e7-5® (When required by municipal policy.) Work to Start: 9 h/ �oi2 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 Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application Is true and complete. FIRM NAME: J.P. McCurdyElectrical Services Inc. LIC. NO.: 20172 A Licensee: Ms f& cc f. fg( -- Signature _ LIC. NO.:MWS'E (If applicable, enter exempt" in the license number line.) Bus. Tel. No..• 781-595-7074 Address: 17 Walnut Road, Swampscott, MA 01907 Alt. Tel. No.: 781-595-2431 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. SS CO 000914 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 El owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: r y X44~��-��•.a���._Ls`J'w.,J`9'� ' � t ':!. T K` '{ Ir v • n ..�-.Y '_w -���� .♦•- a «• _. _^ - �. �.�. _ �..� _,...� +-_...+w�+..+�. �.,._. ..ter _ S-�ui �`- t i ��� ;s�t:kfi,J1! `t�`�i� ��,.'•'}':`r...nt� '.:t'��� �''•: �. ..�- ,_ - _. - _= __ _.._ __ _._ __ _ .� a1 •,, �'//�� Y' .1 yi lS/ � . Ni - l_ •� i f >.il�? L :r` . :1 __ •t7 ! _ .} �L. iJ : i:. -,Iq1 }y 4 . w.'i • .. �) a � i�',� I....-.'� `. ��l ' • ..-. Tl,. ._— ..J • ... .. I. T i ' 'e _iJ+.J } . . # ' i .. .i • i -.L a . f `:.+ � 1 L _ ,t 1:��, I1_.. �',« r L N^�J rLl al• . 1 . .. ~ , i . 1 .., � I �i � �. _ .a,.. , . -- � i ..�)'•� is • .�'' •i'; _,-_ i:.. ±-T •t�, '. pp ^ _._, ...j,: ':' �;i.a'a ' �. ___ ., _ • f.' .� era : �•.;,•^ ..y.... � _ • � `vt i .J �_.}- .•~!� _.a r `l ♦,- t'r 1. '�r�f 1pl�.'3 .. -4j �.hT.r.�� .. Lf} 'R ,fn. .� . .Il'TI . R.- ♦J •. R. 1!. ^, ai3 � '� .._. y Li ., '4'd4. . Ej�± .���• _t• a. la; rte.. r y �. t tt i Date. N° 4447 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ;ar This certifies that .... .` ..... has permission to perform ...... P: ?y r y ........ plumbing in the buildings of . f ..................... North Andover, Mass. Fee.'` . � . Lic. NoA) 7/... \. g --� n ......... . PLUMB .N�tNSPECTOR 3c, 91 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS APPLICA ON FOR PERMIT TO DO PLUMBING ` Date Building Location 9� Zl�J ?6 %-69AZ � Owners Name iC�j�CI eil/c�V Permit ,�Md/Amount? . G% Type of Occupancy New Renovation Replacement Plans Submitted Yes No El VTXTTTRF..R _ Check one: Certificate (Print or type) / , `� Installing Company Name 01 a'f 2 / � Corp. 11 Address ��� �� Q /� 'U s L� AUC Partner. M Firm/Co. Name of Licensed Plumber. e7 i3a1�� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy 12 -Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Mass3chusou Statehlunbi 3 CV apd Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License iaa2l ►censeum er Master Er Journeyman ❑ • • • J 1 1 mom IN---- ---EINE M115114-6 mom 101010001 01 -.--W-------------- WNWININIEWWWWWWWWO • 1 10.-- W' ----IMEW W W ----------- --m i •9' ON INWOMMINEMINOWIN _ Check one: Certificate (Print or type) / , `� Installing Company Name 01 a'f 2 / � Corp. 11 Address ��� �� Q /� 'U s L� AUC Partner. M Firm/Co. Name of Licensed Plumber. e7 i3a1�� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy 12 -Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance ignature 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Mass3chusou Statehlunbi 3 CV apd Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License iaa2l ►censeum er Master Er Journeyman ❑ I THE C0MM0NWE4L7H0FMAMCHVSE77S office Use only DLFARTA NTOFPUBLICS4= Permit No. BOARDOFMEPREVEMONREGM770AS-WCMR12.00 Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORMELECTTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the nspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address !�141nE Is this permit in conjunction with a building permit: Yes M No F-1 (Check Appropriate Box) Purpose of Building D110 L (V-. Utility Authorization No. Existing Service Amps / Volts 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 INS7AAt(. d�*—✓fCE1— No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures / Swimming Pool Above Below Generators KVA groundg1:1round 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 Rangese Xfsr��G� No. of Air Cond. Total Tons No. of Detection and No. of Disposals ECIs No. of Heat Total Total ' r''tl� Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW t k t S'7—, rt)& No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of SiRrs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• 1 C(�—, rD& /)7(CIQ.0c.JAUf /Navd FAAI-- htwar=Ca►etaga P==1othem*z=aZdMmmdws=GermWLa%s Iha,.eata mtLiabtkhstra=Pcbcyerl mhVCartl *eOLA&mCo.mwcrilsst egmalat YES NO IhmesthmodvalidpodofsatnetotheOf m YES U NO F-1 If}whmedxckedYES, pi=eQlr5=drrM eefi:owWbyd=ktgthe INS'C1RAI r7l BOND F7 oTf-I m M err may) Er /Ut` CG ! L.; ,m ,.�) ►.L L C e4 l f� Bs im&d Valuecf�k Wodc$ Wcik osw 2/a -?/,0 h pe=D&R4xsted Rough _ Fall FIRM NAME �� F/4 N1- IJ- & c� R •X f C/d LioaWNa �o� b U Licatsae S,4M 6- Sigmm // Blsirxss Td. Na Alt Tei 1 Uff e l-�3 k=�= OWNER'S)NSURANMWAfVMiammvmthattcL ffwdo�e mt_themst==aowag"silbMrtiale*=iatasm*zedbyX4mmdtseltsCZ=a1Laws and that my sigttatirem this pentlit �:plicatiQt wanes this tagtmeirlatL (Please check one) Owner Agent Telephone No. PERMIT FEE $ � i: r N U a; Q 613� 6s 64 6 Jm o = � LL o cCD 1 _ CL O ELL ti o E a Z aD= ,_ LL c O �� cc a ` O ~ �-�c �Q U m LL O O H gtfR �♦ O O Q r� Y C 0 r 0 M04 Z TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: %3A071®� SIGNATURE: Building Commissioner/InELWor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 416 /L .N - �" nj 0 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) I.S. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �LhA� L &5NID104-MAY4 qD MAI �iud Nam, Name (Print) Address for Service : A - r�-P�ffiLAA_� — � � 5-- C Signature Telephone 2..2 Owner of Record: Name Prin %Address for Service: c Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ?A !,l E T t -g Opjv `T 14-,-) Licens9d Construction Supervisor: Z, I3 D y License Number t D M E y-�tu+ N S r- 2 l�[ �7 M A D 1 �Z 4 Address /—ZO—ZBDZ ySy - 2 Expiration Date Signaturco Telephone 3.2 Registered Home Improvement Contractor 'PAV 5 Not Applicable ❑II `r���r�vS'r, C. D 1011 �N 1 � MR 720 Compahy Name /116 � � u�N S7- DP 4Z.t47, M o r Registration Number - LeU1Lrii Address D Iz: j 9 7 ySY • SZ Expiration Date St nature Telephone SECTION 4 - WORKERS COMPENSATION (N.G.L. C 152 & 25c(6) 'Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......X No ....... ❑ . SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) J0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: � kPI A01/ E AND K9 ✓I1i4LA lii tL /itnr LfA�11NG?'S� l�z I7,4Th FL to le/i O.fll f/ ke Mo ✓E 4,y D Oe 92M69 AAJed 9M G - A/a e tLl IV y .4A/1t/ &AJ 9 J11AD d 4r6 H4 - A J I fn[ Fi'21T Floo y- se e a/.4. -y c SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ©FFICIUSE ONl(.Y , 1. Building _3111Q , IFy (a) BuildingPermitFee Multi Tier 2 Electrical ZSOD . (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC N 5 Fire Protection MIA 6 Total 1+2+3+4+5 3 , ?X I Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS OR CONTRACTOR APPLIES FOR BUILDING PERMIT AGENT I, 4,E Z '�22,10 L4 /1�j,¢d/ as Owner/Authorized Agent of subject property Hereby authorize to act on My beha i all tters=tto rkauthorized by this building permit application. 91-t-1 25 Z Z Signature of Owner Dat— e SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, R l' e—h ri,�� ,yd be lti A l) as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N Si ature of Owner/A ent NO. OF STORIES Date' SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 3RD SPAN DEMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT O FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U -LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all :n/cessary approvals/permits from- - Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. , *-**********APPLICANT FILLS OUT THIS SBC T IONy"�`** APPLICANT �lj2r1 gq PHONE 97- -e I -- LOCATION: Assessors Map Number O9s - PARCEL6� 90 SUBDIVISIIO/lN LOT (S) STREET !! Mill �ON�I �y��JMf7Ui GfM �_ ST. NUMBER ****** OFFiC1AL USE ONLY RECOMMENDA T IONS OF TOWN AGENTS: CONS RVATION ADMINISTRATOR COMMENTS � S1 lzu, )i t,< DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH . COMMENTS DATE. APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED SY BUILDING iNSPECTOR Revised 519' jm q. DATE 0 ENOORS----- This endorsement, effective 12:01 AM 10/08/1999 Forms a part of policy no.: WC 102-43-02 Issued to: PAYETTE CONSTRUCT ONCO By:GRANITE STATE INSURANCE COMPANY LOC NO. NAME AND ADDRESS SCHEDULE FEIN 0001 PAYETTE CONSTRUCTIONCO 042196192 1110 METHUEN JT DRACUT. MA 01 26-0000 Issue Date: 10/07/99 Authorized Representative WC990610 (Ed. 1-97) UI # ' STANDARD WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY EXTENSION FORM we 1b2-43-02 Policy Prefix & No. ------------------------ 013-82-1099-00. MASSACHUSETTS Schedule PAYETTE CONSTRUCTIONCO INTRA/Independent State Rlsk ID Item 4. Clessificitlon gf Operations Premiklm oasis Entries In this item, except as specifically provided elsewhere in this policy, I Code Estimated Total Per $100 of Estimated do not modify any of the other provisions of this policy. No. Annual Remuneration Remuneration Annual Premiums RATING GROUP: 0001-01 CARPENTRY - DWELLINGS - THREE STORIES 5651 18, ocic 8.29 1,492 OR LESS STATE OF MASSACHUSETTS TOTALS TOTAL CLASSIFICATION PREMIUM 1,492 TOTAL UNMODIFIED PREMIUM 1,492 MODIFIED STANDARD PREMIUM 1,492 UNDISCOUNTED PREMIUM 1,492 DISCOUNTED PREMIUM 1,492 EXPENSE CONSTANT 0900 214 TOTAL ESTIMATED PREMIUM 1,706 MACHWC (SURCHARGE) 4-ool 1116 80 TOTAL DUE 1,786 WC 7754 (Ed. 4-81) See Name and Address Schedule - WC990610 The Commonwealth of Massachusetts Department of /ndustrial.Sccidents Cf; ice of Investigations Boston, Mass. 02111 Workers' Compensation Insur-ance .4fflidavit dame Ple2se Print pAVLt=,E-- blame" D G 12 Lccaticn" -I (I D �E U GNU S Cit./l) (Z 14 Lyt� i4- Phone 12m a hcmeawner performing all work myself. aI 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. Comoanv name: �i� V r✓7�/ �U Address Cihi" T-) P h c n e r `% 7 S2 d - Insurance Co. 12 ffyi! 'J Pclic•i # U)0 I Comcanv name: Address Citi' Phone' - Insurance Co. Palic,/ t Failure to secure coverage as recuirac under Section 25A or VIGL 152 can lead to the imposition cr c:imiral penalties of a rine up to 51.500.00 and/or one years' imprisonment as •.veil as c:vii penalties in the form cf a STCP'NCRK ORCER and a Rne cf (5100.00) a day against me. I understand that a ccay of .his statement may be fcrvarced to the Office cf Investigations cf the GIA for coverage verification. 1 do hereby cer dy unc wins ant;es or perjury that the information provided accve is :rue and correct. Signature Qate D Print name tiIT Oak L Phone 7k1 q`f Sat orfic:al use oniy do not NrTte in this area to be ccmcleted by city cr town crfic:ai C`ty or Tc.vn P=rmitlUcensine ❑Check .fi immediate res.ccrse is required Contact person: Phcre T, Building Dept Licensing Board ❑ Se!eCtman'S OffiCe health Department ❑ Other Cl) m M m VJ U) 0 CO) CD n Z 0 0 CL r o d o � CL _. a� Cl -v o p CL Q CD o CO) 'C CD O CO) O O CO) -o c 0 c CO) n CD O r► CD cD y� CD CO) 0 O CD O CD C C c �MqC d 2 O �• N C Q CO) d O � m N mn m Cl) C H n a O CD Z�'C N s = -:m oCA =r o _a i d = COD m C m y O .W p O cp �' O fi O Z C' nCA ' ray .�• O O i y r a = 0m dc CO //�^� 0 ? A m b C/) R ok St co Ap a 3 : t 0�1 Vycr • `. V 6c ►n E7 CD � C N ^ c m r•• • (J) S C45 ,z o Cqe CD ^ /� f ' m y \� CAD C 0 �CD 0 y V m �. _ m (�. C CD CD '• o m r: d•, � C. _ � s '� '• c C o=: w r C/) ^y C �z O COD C/) 00 T GO GO O ;;Cl OS 00 � CGy Oo cn � C/) a r N N O OO x o O M 0 c I Mar 20 00 04s28p March 20, 2000 Essex Manae To: Roger Payette, Payette From: Torn Tierney, EMG Subj.: Gendlerman project, 90 Roger, event Group Cin (978) 521-5520 P.1 M G Essex Management Group Permission for constructitm on the irlterior of unit 990 Millpond has been granted. We appreciate your professionalism and look forward to the fixiished product. Also, be advised that dumpsters are tot allowed to be left on the property. Please Ret me know how long fnis may be require4 to see if an exception can be made. Thomas J. Tierney MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFITTIU' G t (Print or Type) NORTH ANDOVER Mass. Date 1$uilding Location jos'/� y,� Permit # Owners Name o` � G e- -e^X4 New Renovation II Replacement Plans Submitted IN (Print or Type) Check one: Certificate Installing Company Name ,,�,� �� �.o/ Q Corp. Address����� Partner. LZ __ Firm/Co. Business Telephone: Name of Licensed Plumber or Cas Fitter 'e� // %hs G r•'��'1 Insurance Coverage: Indica--e ,-e :ape of insurance cove: -age by checking the aporooriate box: Liability insurance policy CE, Ot^er type o' indemnity Q Bond Insurance Waiver: 1, the undersicned, have been made aware that the licensee of this appiication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I huchy ec:tiry that all or the dcuils sad irdormation I haeme submitted (or entered) in &Love appiiation are true and accnuate to the Dost of my iciowtcdse and Mat ad plumbing wort and tnsaltadoos p,= or=cd und= f'_r=it issied ro: this appiiation will be in compii:ttoa with ad pertinent provisions of Lho Massachusetts State Cas Cade and Gupta Is.:: Ire CcnC=i Laws. i3v T`_'PE* LICTEVS=' Title ( Gasfitter Signature of ensed City/Tcwn: I Master Plum/be or Gas -fitter journeyman APPROVED (OFFICE USE ONLY? .Lerase 1-jum-151EIr m c W tri Vs Tf Ila U � ►� a; F to us I C{ i O t� = of Z O ws 6 C C Q a t tss + mrr7 r to u, o— t- r, a u`, t- j 4 to v < c o > }" LU U4 97 ua W r U -4 C2 F- C us `a d tat c G C — }' < y- t? a — o O = O rn — > w _ < < o u, o CL SJA-3S7.tT. E ! 1 ! ! I i i i ! I i i ! I I 1 I •I !ii i3ASEhSEMT -t ST FLOOR j ZMD FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR TTI{ FLOOR 6TH FLOOR (Print or Type) Check one: Certificate Installing Company Name ,,�,� �� �.o/ Q Corp. Address����� Partner. LZ __ Firm/Co. Business Telephone: Name of Licensed Plumber or Cas Fitter 'e� // %hs G r•'��'1 Insurance Coverage: Indica--e ,-e :ape of insurance cove: -age by checking the aporooriate box: Liability insurance policy CE, Ot^er type o' indemnity Q Bond Insurance Waiver: 1, the undersicned, have been made aware that the licensee of this appiication does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner = Agent Q I huchy ec:tiry that all or the dcuils sad irdormation I haeme submitted (or entered) in &Love appiiation are true and accnuate to the Dost of my iciowtcdse and Mat ad plumbing wort and tnsaltadoos p,= or=cd und= f'_r=it issied ro: this appiiation will be in compii:ttoa with ad pertinent provisions of Lho Massachusetts State Cas Cade and Gupta Is.:: Ire CcnC=i Laws. i3v T`_'PE* LICTEVS=' Title ( Gasfitter Signature of ensed City/Tcwn: I Master Plum/be or Gas -fitter journeyman APPROVED (OFFICE USE ONLY? .Lerase 1-jum-151EIr TO 206 NORT1y 3r a+ + OL 0 9 s • 09 a Date.... /. ! 1;-.. 'b... ,a TOWN OF NORTH ANDOVER $ PERMIT FOR GAS INSTALLATION; ..r ..a ..... This certifies that ..... ........ o has permission for gas install tion in the buildings of . .4e4. -'.... , .... . at .. ' a . ........... , North Andover, Mass. Fee.. S`. w Lic. No..� . ........................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File 4. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print air Type) NO.ANDOVER , MA , Mass. Date "� - - 19 �. Pe/r�mit #.� Off% --- a Building Location W MILLPOND Owner's Name NO . ANDOVER MA Type of Occupancy ' RES G New ® Renovation ❑ Replacement ❑ • Plans Submitted: Yes❑ ' No ❑ Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate ' Address 91 B . ,MONT STREET ❑ 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 RJ No ❑ ' If you have checked Les, 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 permft'application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent C1 1 hereby certify that all of the details and information I have submitted (or entered) In ove appficatlon are true and accurate to the best of my kncwiedge and that all plumbing work and Installations performed under the permit sued for this applicaa Will b In pliance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the neral LawY. BY Type of Ucense: umber gnatur o c nse um a or Gas titer Title sritter Master Ucensa Number M-3440 �Y Journeyrnan O N W N N N Y U � ' to V3 Q rn cc O N W W = OU in t = n 2 -1N °m `r d u v ur tri ¢ N r7 V W = N = < y = O C W W S r.J W 2 < �' W p !- t- S W WUj > = U. O W O < W Ts W 7 MU O O W p ►1 r - x'= O c7 � 3 o O J U c > G a 1- O SUB—aSMT. BASEMENT ' I ST FLOOR Y 2ND FLOOR ORD FLOOR 4TH FLOOR STH FLOOR 8TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name CALLAHAN AIR CONDITIONING Check one: Certificate ' Address 91 B . ,MONT STREET ❑ 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 RJ No ❑ ' If you have checked Les, 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 permft'application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent C1 1 hereby certify that all of the details and information I have submitted (or entered) In ove appficatlon are true and accurate to the best of my kncwiedge and that all plumbing work and Installations performed under the permit sued for this applicaa Will b In pliance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the neral LawY. BY Type of Ucense: umber gnatur o c nse um a or Gas titer Title sritter Master Ucensa Number M-3440 �Y Journeyrnan O 2081 Date-/ V-; ...... TOWN OF NORTH ANDOVER' PERMIT FOR GAS INSTALLATION This certifies that e ............... has permission for gas installation ............... in the buildings of ... ,0............... C" at F( ........... North Andover, Mass. o Fee. 2 A', Lic. No..2Y. r.<.. ...... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer, GOLD: File