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HomeMy WebLinkAboutMiscellaneous - 95 UNION STREET 4/30/2018 (2)�' 1 N M �� Ir �,� 14- D -, This certifies that ........................................... has permission to perform ...... �....... i ... . 5yS. �. ...... wiring in the building of at V Fee. Lic. No. '('heck # 0177 10958 ....... . , orth Andover, Mass. 172, ELECTRICAL INSPECTO Kat Cn 40. '" .5 N b m o ' U o2 �ti a ci��o� w �,'� a ° k N N V7 0 O s��m -1 9 N v[b'c w� p p NCN •� w Gk N 'ice O � �• O tom. •� � `#�� N O •p � � �a ''� •U v cd v o � q O ` w .Yq.. W O O L Y cd N0 0 U P+ y Co y b � q: � a� g� pp q U O 04 d m cf (V arT1 ,�� r ,r�yb 0h o u NM o Co o b ca •� q ��' o O '� N �A v ani bbD Ci w ami $ a 'p 0 N w O � bA .p p� 0 H �c•' p as w ani a°"i b9 '� U U ti �,•• U GL ,y it p .d MR T •.. 7i .y o n p o d 0190m,U, p GLU � 0 U U:Gf•O _ 'UG i-� a w• U w N •S Gd do N -.1s o RS U U O Ro cd cd ..U. U U 0. b ++ c-, d to � w U roa�yrl: � o � '5.q r[ P, .o A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS (Please add zip codes & electrician's cell #; contract # & bid permit # if applicable.) Official Use Only Permit No. Q�/' 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 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: j // - City or Town of: �/7/_� To the Inspector of Wires: By this application the undersigned gives notice of his or her' tention to pe fo the electrical work described below. Location (Street &,N ur►yber), Al �/ T Owner or Tenant � GJK-,rA✓1 ,_A n�� i.— Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters umber of Feeders and Ampacity Location and Nature of Proposed EIectrical Work: Siem No. of Recessed Luminaires . .. .. r .,«✓vs --x No. of Ceil.-Susp. (Paddle) Fans cuuie rauy ue waivea oy me inspector oy {vires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ o. o mergicy lig ng rnd. rnd. 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 Devices No. of Ranges TotaInitiating No. of Air Cond. Ton sl No. of Alerting Devices No. of Waste Disposers Heat Pum Number ........................ Tons KW No. of Self -Contained Totals Detection/Alertin3, Devices No. of Dishwashers Space/Area Heating KW --1 ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems:, ) No. of Water No. No. No. of Devices or Equivalent / Heaters KW as Signs Ballasts Si Data Wiring: No. of Devices or E guivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 7� /:� nuuurc uuumunai aerau yaestreq or as required by the Inspector of If res. 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 X (Specify:) Self Insured Icertify, under thepains andpenalties ofperjury, that the infgrinatioz on this application is true and complete. FIRM NAME: ADT LLC DBA ADT Security LIC. NO.: C-172 Licensee: Thomas J. Lee ignature LIC. NO.: C-172 (If applicable. enter "exempt" in the 1-ense number line.) t + �l�' � n \Vs, fy 1-F (S C14� Bus. Tel. Na _(Lo )3 S q4 r�-ia8 Address: � (�' CLin � ,r Alt. Tel. No.:_ „Security System Contractor License required for this work; if applicable enter the license number here: 001779 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. $ _Z15 COMMONWInAL I=1 OF / iASS Gi4USE d o S.. . ELECTRICIANS `A`. REGISTERED SYSTEM CONTRACTO ISSUES. i HE ABOVE LICENSE i0i `y APT LLC. DBA ADT SECURITY, l\\,-. `THOMAS J LEE. n"rN 41D .U'N.IVERSITY AVE.Aico WEST_WOOD MA 02090 '231 172 C 07/31/13 201934 =56g,-Ki Fold, fh n Detach Along All Pedoiations t tN Date ...7--/.7, /Z- .... b This certifies that .............. 4 has permission to perform ... sec "4 - wiring in the buildingof ...... ("' e�F-< (A/ ............. at .... ......... 6'4'.'?7t6orth Andover, Mass. Fee. Lie. No.. ELECTRICAL INSPE �TR Check y I , - 10955 00 � l0 A rte+, p� `yrJ Kj rpt y p••� Q �pp � O cj O[ U q0„ ai b C'7 •,�� � o a� O C1 y � c 4B q �•�' a�N o 0 C .5 0, U o 0 y 03 0b Cd O a N CJ Nt-� Ci ' W ^� O LOlw++ o b cn o 0 Nbz :Q iii H �U po, � U C7 p N ca 0 a U W o c.) N 00 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS (Please add zip codes & electrician's cell #; contract # & bid permit # if applicable.) Official Use Only Permit No. Occupancy and Fee Checked ,ev.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 ININK OR TYPE ALL INF RMATION) Date: "%9// City or Town of: I V1 To the Inspector of Wires: By this application the undersigned Ives notice of his or her ' to ion to pe form h�ectrical work described below. Location (Street & Num er) Owner or Tenant (� G , Telephone No. — Owner's Address S�/�l- Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts r dm er of Feeders and'Ampacity Location and Nature of Proposed EIectrical Work: Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ �S�ti"CC ltfvl No. of Meters No. of Meters SQS Tel rV1 No. of Recessed Luminaires r -.1 �w—x No. of Ceil.-Susp. (Paddle) Fans <uu<e may oe waivea oy the trzrpeetor of wires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o mergenc., ig ng rnd. rnd. Batter 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 Initiatin Devices No. of Ranges No. of Air Cond. TotaTons l No. of Alerting Devices No. of Waste Disposers Heat Pum Number ­-- ...................................................... Tons KW No. of Self -Contained Totals ti j, Devices No. of Dishwashers Space/Area Heating KW Local Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. No. of Water No.KW No. No. of Devices or Equivalent Ballasts Signs Ballas Si Data Wiring: No. of Devices or E quivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 3 V (' Y& --ri uuumunui aeaaa rJ aesu•ea, or as required by the Inspector of N"ires. 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. CL-IECK ONE: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured Icertify, under thepains andpenalties ofperjury, that the infgrszuatior on this applicatiozz is true azzd cozzzplele. FIRM NAME: ADT LLC DBA ADT Security LIC. NO.: C-172 Licensee: Thomas J. Lee Qyianature LIC. NO.: C-172 (Ifapplicably. enter "exempt" in the A ' l' ense number line.)) ,� � Bus. Tel. No. .-(Lo3 `_> 4 4 S -w Address: < <' CLIn:E,n ', fO k -E ().!jSO4` Alt. Tel. No.: "Security System Contractor License required for this work; if applicable,•enter the license number here: 001779 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. FERMIT FEE: $ G I d y 100110MONWEAL s H OF MASSACHUSETTS S ELECTRICIANS ~� A'.REGISTERED SYSTEM CONTRACTO ISSUES THE ABOVE LICENSE T0: "A,D7".` L'LC. SBA AD1' SECUR,ZTY, 1 HOMA.S J LEE �s 410 .U`N,IVERSITY AVE WESTWOOD MA 02090-231 _172 G 07/31/13 20193 iJ[J 1 X14' (i�7dC7 "PoU then Detach Altong NII Peiiamflons J Ia K 4b This certifies that .................................... r has permission to perform ...G�!%�!./'. wiring in the building of at . ✓� �Ll/!o s -t/ ST' ..... U' :! C North Andover, Mass. o Fee ?�-,�. �.�... Lic. No. 172, ..... ......... . . ELECTRICAL INSPECT OR heck # i 0957 i ca�1 .oMW b" ,5 N y� N coy `a' a� iC ci o y *,b�A, U'�oR o v o o 'd '00 O G cd 'U'• .� CJ a� Go A, m � •�, c O ' l 'g C'i O 'O vNy .o O�. •� N y aai oda ^�00 O p W cd O p a� N a`3 q N G jai � Ry �•o c o ~ o ii G W O �+ N G N b •d cn O, G m h o2s�y 4ccn`ag�cac ORO N .p.. •O G U s., ti G y .o LL spyy+ y o U G W api U •� v k O O •� a-. IN(1 p O O TJ M N O y� •0p C ;9 G- p 0 y W +�• 2 + y+ W ay y .� 4i 'O �.� 0- O 2 iC vi O bU p .�.-1' ..Gr �...O i7 p U N y W a• W 3 y cn p •N O b ltt p N U t+ al VzJaoa�°°' " Ei.c 0�yWotjS �' 3 o�nn ,N L� cry . O ,H,_ yy p O tti G O U U ol � G,d y �-�•q�y��e� � H � y,Go., cd o•n jy i WN�axi b it N ti r1 cC N +' W U Ir -1 cG t� o y •" o •�^ p •O 4>5 U -• N U .�.. 4J U U N 4 N 9 0 W L a go IH i r I Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS (Please add zip codes & electrician's cell #; contract # & bld permit # if applicable.) Official Use Only Permit No. 109 7 - Occupancy Occupancy and Fee Checked :ev.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 PRINTININK OR TYPE AL INF RMATION) Date: City or Town of: To the Inspector of Fires: By this application the undersigned gives noti e of his or heel nt ntion to perform the electrical work described below. Location (Street & Number) ' Owner or Tenant - l Telephone No.�%97 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 Overhead ❑ Undgrd ❑ New Service No. of Meters Amps / volts Overhead ❑ Undgrd ❑ No. of Meters Num—ber of Feeders and Ampacity Location and Nature of Proposed Electrical Work:�����`� t o� el STenrn No. of Recessed Luminaires r... .. ___�,�__� •___� No. of Ceil.-Susp. (Paddle) Fans cu�ic muy ue wuiveu oy me lnspeecor of mires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o, o mergency ig ng rnd. rnd. Batter 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 Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No.KW No. of No. No. of Devices or E uivalent Ballasts Si ns Ballas Data Wiring: No, of Devices or Eq uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 3�l � �� niauca uuuaeiunui aeaau it aesuea, or as required by the Inspector of !fires. 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. CL-IECK ONE: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured Icertify, under theepains andpenalties ofperjury, that the informatiaf on this application is true and complete. FIRM NAME: ADT LLC DBA ADT Security % LIC. NO.:—C- 172 Licensee: Thomas J. Lee (4-- C nature �f LIC. NO.: C-172 g .�'� .!� .moi (If applicably. enter "exempt" in the l' ense number 1ine.) "" � " �/' � Bus. Tel. No. ()� `> t� S�%`�' Address: _ t°�' CL_ (nJL, '�r � a \���, fJ 1 F ©30 Alt. Tel. No.: *Security System Commetor License required for this work; if applicable, enter the license number here: i 001779 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: $ J I } ELECTRICIANS A'"REGIS.TERED SYSTEM CONTRALTO ISSUES THE ABOVE LICENSE TO: "s A.DTLLC bBA AD- T SECURITY, \ '� "`THOMAS J LEE. tj'', 410 :U'N,IVERSITY AVE. WEST.WOOD MA 02090-231 172 C 07/31/13_ 201034 fJf���.��i �yFold, Then Detach Along All Fe of ions , � \ Office Use OnIY&r _ 014t \.i11II mi ntutalth of Musaoustm Permit No. Mepa tmeHt of Buhl-tt $ufetg Occupancy & Fee Checked X61—�0 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 390 (leave blank) M-9-4 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 Qty* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) I,L41zl:� 0A Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Purpose of Building Existing Service _>nz 6-a Amps Volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes �❑i No ISG (Check Appropriate Box) Utility Authorization No. Overhead � Undgrnd ❑ No. of Meters Overhead ❑ Undgrnd ❑ No. of Meters Total No. of Lighting Outlets I No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Arno i Abover— In- n- ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets i No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Air Conc. No. of Ranges I I tons Initiating Devices No. of Disposals I No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers ! Space/Area Heating KW Detection/Sounding Devices No. of Dryers I Heating Devices KW Local Municipal ❑ Other —ii Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: ®Z INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws r%, I have a current Liability Insurance Policy including Comeieted Operations Coverage or its substantia! equivalent. YES = NO ' have suomitted valid proof of same to the Office. YES = NO = If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND —_ OTHER = (Please Specify) � (Expiration Date) Estimated Value of E!ectrical Work S // x �'� (/_ 9 C Work to Start�p Inspection Date Recuestea: Rough Final Signed under the Penaities of perjury: ! LIC. NO. FIRM NAME '� Licensee LVI - AAA J. DA,eGdj Signature LIC. NO. 18900 � c/1rc�°Y Bus. Tel. No. /U Address %1=/ [ 10 n AJ �>� d o , 4,17 Alt. Tel. No. - OWNER'S &INRANCE WAIVER: I a aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- gwred b us General a aat m permit application waives this requirement. Owner Agent (Ple ce I Teleohone No. — ERMIT FEE 5 (Signature of caner or Agent) x-5565 �f' 2526 NORTH of a otic 4$ Date ........: J. . ��,�..... TOWN OF NORTH ANDOVER A PERMIT FOR WIRING 0 SSAcHUS� ~ �v.. �' This certifies that ...................:............................................ has permission to perform ... .... ....... s��...!. ... .D wiring in the building of �t - ♦ °' .............. ........... . .. r�-L�........... P at ...'n.......Gr[liY�/.... ..%Z. ,.............�LEI�I�A-�-i�S� North Andover, Mass. S r Fee..../.Ap.. Lic. No./j.��t................................... CTOR Cry �r�q WHITE: Applicant CANARY: uilding Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,f NORTH ANDOVER Mass. Date lJil i kuilding Location `Q) Permit # Owners Name��<atleS New 77 Renovation D Replacement Plans Submitted FIXTURES (Print or Type) Check one: Certificate Installing Company Name 4 -S ��er, �„'c�4 Corp. Address t�f� ,(��/��= s7` Partner.-/,-' %l! Firm/Co. Business Telephone: 1? 25- 7l ?,C Name of Licensed Plumber or Gas Fitter ;C fj,)1 V A/o Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy —Other type of indemnity 0 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 coverages. Signature of owner/agent of property Owner 1-1 Agent U 1 hereby certify that all of the decsils and information 1 have submitted (or entered) in above application are true and accurate to the txst of my knowledge and that all plumbing work and installations performed under Permit issLed for this application will be in compliance with all pertinent provisions of tho Massachusetts Slate Gas Code and Chapter 142 of the Genual Laws. . By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber GasfitterSignature o/Licensed Master Plum er or Gasfitter Journeyman 1I 3 �/_ License Number Y • r■■■■■■ r ■r■■■ ■ ■ ■ ■■o ■ ■o■■UNN ■ ■mNr■■ ■■■■r■INNso .. ■■■■IN■■■r■■■■■■■■■■■■■i■ .. ... monsoon ■s■■■r■■■m�o■sor■ ... on 00100■■■■■■■no ARE NONE ■ ... ■o■■■oor■ ■■■■■■■■■■■■s■ (Print or Type) Check one: Certificate Installing Company Name 4 -S ��er, �„'c�4 Corp. Address t�f� ,(��/��= s7` Partner.-/,-' %l! Firm/Co. Business Telephone: 1? 25- 7l ?,C Name of Licensed Plumber or Gas Fitter ;C fj,)1 V A/o Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy —Other type of indemnity 0 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 coverages. Signature of owner/agent of property Owner 1-1 Agent U 1 hereby certify that all of the decsils and information 1 have submitted (or entered) in above application are true and accurate to the txst of my knowledge and that all plumbing work and installations performed under Permit issLed for this application will be in compliance with all pertinent provisions of tho Massachusetts Slate Gas Code and Chapter 142 of the Genual Laws. . By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber GasfitterSignature o/Licensed Master Plum er or Gasfitter Journeyman 1I 3 �/_ License Number a r z N V m, A 0 z 0 0 m. N CA z N v . m A -a 0 z N A m A x •m N m m m ' 0 0 m. N CA z N v . m A -a 0 z ZDate.. ................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION A This certifies that . I- .. ,J ............ ...................... has permission for gas installation ........................... . in the buildings of ......................................... ....:............. North Andover, Mass. Fee.. .... Lic. No............ ' r•.. . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File -� MA SAL;HUSETTS UNIFORM APPLIC ATI (Print or Type) ON FOR PERMIT TO DO QASFITTINQ NORTH ANDOVER ,Maas.Date /% Bullding Permit Location # % (.1 s'��' �, L1Lp 0, 6b) Owner's Name ��� �� 5 �c�Sse1 New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No 0 ffla ax a O w jK ar+ d r= � H e o« f 0 M J Im IM F .hi W L !W V- X j i o d u ao°e y s o V SUB—®s{NT. •ASEMENT ittT FLOOR =ND FLOOR SAO FLOOR 4TH FLOOR STH FLOOR ! STH FLOOR ► 7TH FLOOR j STH FLOOR I I I I I I I I �,� Check one: Installing Company Name //�� P f Corp. Address d Partnership Cg-Ftrfn/Co. Business Telephone Name of Licensed Plumber or Das Fitter INSURANCE COVERAGE: Check one 1 have a current Itablifty Insurance policy or its substantial equivalent. Yes Cly No ❑ K you have checked yes, please Indlcate the type coverage by checking the appropriate box. i Certificate A liability Insurance policy U—� 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: %nature of Owner or Owner's ent Owner ❑ Agent ❑ 1 hereby certify that ah 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 an plumbing work and Installations performed under the permH l ued this appikal on will be In compliance with all pertinent provisions of the Massachusetts State oas Code and Chapter 142 of the Type of License: Title mbar a ure o nae um er or as er assfilter Cfty/Town IJoumeyman Ucense Number AP1110YED (OFFICE USE ONLY) e r rn 0o = > m lob v m b to t = r • 1 � � p p 2 • r rn rn m lob v b to -1 r O p 2 O O a x O � n -1 m -� c o .N m o O O , z Q r > � N •z , O � At NORTH q41 L D ° f s Date ........... 1.. �....�.� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....� . + ..� .'..:,.;:.'! jtf �� r r.F l.�.,•... ; .. � �. r" has permission for gas installation ...... ...::., ........... in the buildings of ... .. c::.; . E'%._. ,-:........ . at . , North Andover, Mass. Fee. `-.--�—Lic. No....! .;�. GAS INSPECTOR WHITE: Applicant- CANARY: Building Dept. PINK: Treasurer GOLD: File