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HomeMy WebLinkAboutMiscellaneous - Fernview 5-7Date ..lZ.j�--?z TOWN OF NORTH ANDOVER" 4 PERMIT FOR WIRING 1 This certifies that ........................................... has permission to perform 77- ....5. y. 1... . wiring in the building of ... �� C�/�./ . .............. . /" ry �cJ,Jc a= .......................... "....... orth Andover, Mass. No....... ...?.... . Check # 99 %dam 1120/3 ELECTRICAL INSPECT7104* 1 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, § 3L, the ll� permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall-be limited as to the tim 7-9fongoing construction activity, and maybe_deemed_hy the7nspector_of_Wires abandoned_and_invalid.if-he—.. _ or she has determined that the ::hu:ized work has not commenced or has not prggrossed during tb.e preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. R(,---] ule 8 — Permit/Date Closed: - * Note: Reapply for new permit /'❑ Permit Extension Act — Permit/Date Closed: 44 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS (Please add zip codes & electrician's call contract # & bld permit # if applicable.) Official Use Only Permit No. 1? I . Occupancy and Fee Checked Lev.1/07] (leaveblanlc) APPLICATIOM 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.I.NINK OR TYPE ALL I For TION) Date: A) Citgo or Town of: To the Inspector of Vines: By this application the undersigned gives no ice ft his or her intention to perfq;m the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? In u (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 ' "' "' 'I�Tum—lie`r ofI+'eeders and r�.mgacity Location. and Nature of Proposed Electrical Work: Lu'r-Ltu Completion of the fnl)rnvina tnhla nvny be tiunf„nd h„ rho ho onnMm• of Wivac• No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) pans No. of Total Transformers RVA No. of Luminaire Outlets No. of Hot Tubs Generators RVA No. of Luminaires Swimming Pool Above ❑ In- ❑ nd. r- d. o. o mergency ig ng 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 hitiatinLy Devices No. of Ranges No. of Air Cond. Total Tons No. of Alertin Devices g No. of Waste Disposers Heat PumpNumber Totals: Tons .. ........ KW ...... ' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating I£W1Loca)�_Municipal Co ction ❑ Other No. of Dryers No. of WaterK Heaters Heating AppliancesI�Vt No. of No. of Signs Ballasts ecurity Systems:* o. ofi)eyice' ori uivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of ]Devices or Equivalent OTHER: 3 (�.���/ . /. Attach additional detail if desired, or as required by the Inspector of If"ires. Estimated Value of Electrical Work: - (When required by municipal policy.) WorIc to Start: Cts fes' 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. CIIECK ONE: INSURANCE ❑ BOND ❑ OTHER Y (Specify:) Self Insured I•certify, .miler thepains and penalties ofperjury, that the info..rmatio on this application is true and complete. ]FIRM NAME: ADT LLC DBA. ADT Security LIC. NO.: C-172 Licensee: Thomas J. Leeignature / i�rr, LIC. NO.: C-172 p (If aplicably. enter "exempt” in the 1' ease nam er line.) '� " Bus. Tel. No.: r c ^ C �n Us 3 5�$ Address: 104g' Alt. Tel. No. '*Security System Conu-actor 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 ign ture � Telephone No. PEI?MIT FEE: $ G �LII OI1Z V -Z �mw� T- 12�10 � 1L 11��jk✓kae.e. �t��-� 0 /��` cuor;rio�ad llN Quoit 4��1=0 u Lli lrh 1- --- - — — i4 ��l;F:' ..� �G'I07 , _ 2I/12/LO 3 z1 C k„\\IZ-06DZ0 t1WQOOt1'is 3M;•. _Lqv vQq :p Ill i;09.33.3011:IA08H384's-q 1SSI' , s O;Lovul IOJ W31SAS Cl32�31'SiJ� 1;b, Date.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING nf i o \SACYUSi This certifies that ..4. .` ......................... . has permission to perform . .. !'. ° :- � F.`.. �:f�./,? Lc �.-.. plumbing in the buildings of . ....................... . at .. - ..�_ �.�? ti. ! . `''- .................. . North Andover, Mass. Fee 1/7 ." .. Lic. No.. �4 31. �........ ......... PLUMBING INSPECTOR Check H 77 1 y 84u3 MASSACHUSETTS UNUORM APPLICATION FOR PERMIT TO DO PLUM13ING (Type or print) NORTH ANDOVER, MASSACHUSEo TIS . `' r G �% V� �� 1 �� �'1 Permit # � �� o I Building Location r '� Owners Name C Y n � r � Amount (/� � /" -Type o£Occupancy New Renovation Replacement Plans Submitted Yes No _ TYTTT1?1W.0 (Print -or type) Chec ne: ertif cate Installing Company NE ame �� "� Corp. 1 Address i pZ � /;8807-1- � ❑� Partner. A VJ ✓n h Business Telephone Firm/Co. Name ofLicensed Plumber: kcA A% ! " A &T11V Insurance Coverage: Indicate the e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity F1 Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one ofthe above three insurance Signature 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 Imowledge and that all plumbing work and installations performed under P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbiq Cede aril Chya "55 f eneral Laws. Title City/Town [APPROVED (oFFIp usF oNLY Ty f Plumbing License v License um er Master Journeyman .. J � • .,I • • _ .CJs i • 1 ..-....-.�-.�......---.- -------.- Wilnure-cm .�-------------Now 00 1i NoONNNo No Now ON .....-om ON NOW .-..-..0- 1 • NONE .................-.. MOWN (Print -or type) Chec ne: ertif cate Installing Company NE ame �� "� Corp. 1 Address i pZ � /;8807-1- � ❑� Partner. A VJ ✓n h Business Telephone Firm/Co. Name ofLicensed Plumber: kcA A% ! " A &T11V Insurance Coverage: Indicate the e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity F1 Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one ofthe above three insurance Signature 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 Imowledge and that all plumbing work and installations performed under P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbiq Cede aril Chya "55 f eneral Laws. Title City/Town [APPROVED (oFFIp usF oNLY Ty f Plumbing License v License um er Master Journeyman V The Commonwealth of Massachusetts DePai invent o f £radush ial Accidents Office of bive&4-, aiions 600 Waslzinbaton Street Boston, 34A 02.11.7 "w.mass-govldia Workers' Compensation insurance Affid-a-vft: Builders/Contractors/ lectricians/Piwnbers Akn Iicant Tnfnrrn"nin . Please print Le�ibl, _ v Name (Business/Orgazuzation/lndividuat): /) � MA &t/ Pfd .rw•v.•• •... Address: City/State/Zip: (,A/ Mf � Ole% 3• Phone •Are � u an employer. Check the appropriate box: 1. I �. , am a employer with 4. ❑ I am a geit eral contractor employees (full and/or part-time).* 2. E3 'I am a sole and I have Lured the sub -contractors proprietor or partner- Misted on the attached sheet t ship and have no employees These sul>-contractors have working for mein any capacity. workers' comp. insurance. (No workers' comp, ina,tranCe 4 �. ❑ We are a corporation and its required.] 3 • am a homeowner doing all work Officers have exercised their .I myself [No workers' comp, of ex emptron per MGL c. 152, § I (4)� and ae have no insurance required.] t L--. employees. jNo . kers' .right comp, insurance required.] ``—uy a"o?icfl Yt f5at ch;U� box IQ M, --t alzo a oe: fbcecd-- C � " eot!• flo�eowners who submit'tius af�da `".."� '—' °•�==�' com^����.. Type of project (required): 6. ❑ Nest, construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑Building addition 10.❑ EIEI ctd al repairs oradditions .11• L v� riumbing repairs or additions 17.❑ Roof repairs 13.❑ Other v1t iadi atutg they mm d +Contractors •fit ch=k thd: uor, a::st ached an additional sheet showi g �¢ Shen hire outside eontxac±ors ct,t ,u'—,.,iC a new affidavit indicating such. the r name of the sub -contractors end theirworkers' -- er is prov uag workers' compensation irzsurance formy etnptUyees Betotit, is the policy andjob site information. Insurance Compiuy Name: Policy # or Self -ins. Lic. #: • Expiration Date: Job Site Address: Attach a copy of the workers' compensation poliCity/State/Zip: cy declaration page (shave ng• the policy number.and expirati Failure to secure coverage as required under Section 25A of MGon date). L c. 152 can lead to the im osition of c fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORM{ ORDER and a fine Of up to $250:00 a day against the violator. Be advised that a copy o f this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjurjI thar the inform ationpro vided above'is true and correct OffZciat use only. Do not write* in chis area, to be completed bJ, city or town officio[ City or Town: • PermitUcense # issuing Autbority (circle one): I. Board of Health 2. Buildiab Department 3. City/T'own Clerk 4. Electrical Inspector S. .PIumbinQ • 6. Other b Inspector Contact Person: Phone'#: Information an- d 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 employeris defined as "an individual, parinefsh ,'association, corporation or other Legal entity, or any two ormom of the foregoing engaged in a joint enterprise, and including t1ae legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association ox- other legal entity, employing employees. However the owner of a dwelling house having not more than three apartmL eats and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainte;:cnce, construction or repair work on such dwelling house or on the grounds or building appur mast thereto shall not because of such. employment be deemed to bean employer." MGL chapter 152, §25C(6) also states that "every state or Io.cal Iicensing*agency shall withhold•the issuance or renewal of a license or permit to operate a' business or to c-- onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 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 itm-t2 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-contractor(s) name(s), address(es) and phone numbers) 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' comp --nation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of ins use coverage. .Also be sxxre to dg)i and date the affidavit. The affidavit should e returned t '-that t 2: i.,_ t_ t er3aTit:3erlt Of b t 3 to she oz�y� or wm �ha� e � ,�caUOU �0� the uer�aifior license is being requestxd,'not the D Industrial A ecidenfs. Should yon have any en�es+don,� regardLg t e la:r or H- you arc rewired to obtain a wort.-ers' compensationpolicy, please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate fine. , City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Deparfnnent has provideda. space at the bottom of the affidavit for you to fill out in the event the Office of lax estigationshas 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 that must submit multiple permitlficense 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 (Le. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would lie to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephoneand.,fagnumber._._ Tb.e Comimonwealh ofMassa.chusetts. Department of fndustri.aI Accidents Office of lnresfiaaf fans ' 600 Washi gt n street Boston, MA 02111 TeL 0 617-7274900 ext 406 or 1-8 "' 7-M.•4S.S:, FF Revised 5-26-05 Fax # 6.17-727-7749 vim,, mass._�ov/dia Date .. V.). �A.......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATU This certifies that (....... 1')'..�.... .......... has permission for, gas installation ........................ in the buildings of ... J- ............................ at .. %. ^.. ... r fN. h !! ........ North Andover, Mass. Fee. ?L.- .. Lic. No. S ....... I GAS INSPECTOR Check # /6) ! f 7266 MASSACHUSETI'S UNIFORMAPPLICATON F ORPERMIT TO DO GAS FrrnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations -5— ,�7 fYle'Alyiaw Owner's Name Date � % :;;, •—) G Permit # (->fnount $ 2,p— New L Renovation 0 Replacement Pians Submitted r f4 C', y Leri 0 W V7 L-7 L-1 o 5 z z m y w < a o a oz caa Gw z U 14 w h z o [ C o a > H <. z�, < w a a �C o w > w y t- v ;� W c� .. > o �a < _ ' m z U o z o o W SUB-BASEM ENT .. A a > o O B A S E M ENT f 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR STH. FLOOR t -- 6TH. FLOOR 7TH. FLOOR I 8-TH. FLO O R E Name or type tiy C 1 eck one: Certificate Installing Company -- 1(�l 1 i J U Corp Address'J O (0 a 5—Partner. usmess Telephone _ 9 ,_ g, y.�� 0-Firm/Co. Name of Licensed Plumber or Gas Fitter .) ,V U f 1\- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes c3' No[] If you have checked �, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnityBond 13 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 A—. M. i hereby certify that all of the details and information I have submitted (or entered) in above best of my knowledge and that all plumbing work and in ons perfo ed under Permit compliance with all pertinent provisions of the Massa c �etts tate Gd"d ChV& 1 ICity/fiown APPROVED (OFFiCEUSE ONLY) Signature of l �. Plumber Gas Fitter Master Joumeyman Sed Plumber Or Gas Fitter 99FI�l icense um er n are true and accurate to the this application will be in General Laws. . ti Date.. •r �'< •° :otic TOWN OF NORTH ANDOVER PERMIT FOR PLPMBING 4 r,° •'SSACNUSE� This certifies that .... �t�'. `'.� �..... .�. ..�. �............. has permission to perform ..... ..�-...r................... . plumbing in the buildings of ...to. F.F(-1. T ................ at .j.- . % . r.7.p .h. v. r.r .L .: ........... . North Andover, Mass. Fee eK.. Lic. No.. r 7 .....U �. -'� ......... . PLUMBING INSPE TOR Check # Y `7 86Gc" MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or part) NORTH ANDOVER, MASSACHUSETTS Dam , Y-/'( >lBuil ' Location � ` It / 1 -eee^1 V y a i.li Permit #_Y C 27 Owner -Wr i ^/ t t �y Qe,41T Amount _ _ _ _ New ❑ Renovation Replacement LTJ Plans Submitted -Yes No FIXTURES (Print or type) ;-1 ++ ' Check one: Certificate Installing Name ,Q %o D — I td TT 0 Corp. Address a e c (Cr S u 11 Partner. e fo p �6 Business Telephone 3—� a 9 � � y y� 8---Firm/Co. Name of Licensed Plumber: Insurance Coverage: India Liability insurance policy type of insurance coverage iry�checki Other type of indemnity the appropriate bort Bond Q Insurance Waiver. I, the undersigned, have been made swam that the licensee of this application does not have any one of the above three insurance Owner a ' Agent o I hereby certify that all of the details and information I have submitted (or entered) in abo pp cation are true and accurate to the best of my knowledge and that all plumbing work tions der P Is ' this application will be in compliance with all pertinent provisions of the Mas oh State 1 of the General Laws. ugoa 01 rcm Title Type of Plumbing Li City/town Lr n e um �r Master Journeyman APPROVED (OFFICE USE ONLY Date ... .. ...... . °'tete ,°ary° o� TOWN OF NORTH ANDOVER,,,, - PERMIT FOR GAS INSTALLATION This certifies that . ,� . �� .-... -Y�^:' ............. . has permission for gas installation.. ................ in the buildings of . ........... ............ ..... . at � .. ; ..-:............... Ngrth Andover, Mass. Fee -b,. .. Lic. No..°3ti. `� '?.1 ................ / GAS M&ECTOR Check 6547 AV MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT'To DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 4 To 2 w V ,t, Date vVU Permit # A o -e G SU B-BASEM EN B A S E M ENT Owner's Name mount $ �y 2ND. FLOOR NewRenovation D FLOOR Replacement Q --Plans Submitted D G SU B-BASEM EN 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) Name D` Address S-0 sO k Name of Licensed Plumber'or Gas Fitter _ � y Z • • w d W E• Z H w W Cw7 Name of Licensed Plumber'or Gas Fitter Check one: Certificate Installing g Com an P Y 0 Corp. U-7777 - Partner. to �� 'DSC 2_ • ['Firm/Co. 1A /p 4 6z 4, rz- INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent. Yesck oney If you have checked es please indicate the type coverage by checking the appropriate box. No� Liability insurance policy 0/ Other type of indemnity a Bond 13 Owner's Insurance Waiver: I am aware that the licensee does n_ of have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: er Agent I hereby certify that all of the details and information I have submitted (or enOte ed) in above application 3are3true and accurate best of my knowledge and that all plumbing work ms Ilat'ons performed under Pe it Issued for this application will be in the compliance with all pertinent provisions of the M?sale se Gas Co and Cha ter 142 o General Laws. BY: Signature of Title 'Plumber City/Town: ❑ Gas Fitter Master APPROVED (OFFICE USE ONLY) D Journeyman 4 sed Plumber Or Gas Fitter 36 License NUMDer O • • Check one: Certificate Installing g Com an P Y 0 Corp. U-7777 - Partner. to �� 'DSC 2_ • ['Firm/Co. 1A /p 4 6z 4, rz- INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent. Yesck oney If you have checked es please indicate the type coverage by checking the appropriate box. No� Liability insurance policy 0/ Other type of indemnity a Bond 13 Owner's Insurance Waiver: I am aware that the licensee does n_ of have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: er Agent I hereby certify that all of the details and information I have submitted (or enOte ed) in above application 3are3true and accurate best of my knowledge and that all plumbing work ms Ilat'ons performed under Pe it Issued for this application will be in the compliance with all pertinent provisions of the M?sale se Gas Co and Cha ter 142 o General Laws. BY: Signature of Title 'Plumber City/Town: ❑ Gas Fitter Master APPROVED (OFFICE USE ONLY) D Journeyman 4 sed Plumber Or Gas Fitter 36 License NUMDer O 3229 Date 1."..1' ..S. S....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION --7,17 _ /%/ This certifies thatr�....... ..................... . has permission for gas installation . . : '.". �` ............... �. in the buildings of .,Ile-.'. �r'.r ''..G. %? f at .?...... ...ep.. L l ....................... n,. , N rth Andover, Mass. Fee. ? DI99 i�1No..- % fi081 50•4Q PAID GAS INSPECTOR �% L.., WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ,y �111:16No$j N - /47LO&2,� MASSACHUSETTS UNIFOR rPnnt arT/yp�1 M APPLlCATIOI�d FOR PrRM(T TO DO GASFITTlNG Mass. Date -5 _19 Q Q/ Permit t� � Suddtng t.=Uon io /iP --T-- Ow; ,er's Name_ Type of occupancy`_-- New Q Renavatlan Q Replacement Q Plans Sut:mtted: YesC1 No n C MAPS PARCEL C C Installing Company Nan Addres Susiress Nalsre of Licensed Plumber or Gas Check one: 1%Carp'Oration (I Partnership (1 Fran/Co. Ce:tifcyte fNSUP?{CE COVVtAGE: 1 Rave a currentI bu=n= "icy or is subshrdW equtvalerd wtvch m rets the requirements of }rtta is2, Yes91 No D N you have C-rt=ked ►es, please irate the type coverage by checkingthe -pproprate box A 1Fa�8ity irzsurance.. ICY other type Cf ireemnity Q 8crsd Q OWNER'S INSURANCE WA aR: I am aware tut the licensee does not have the Cpritpter 142 of the Mass. General Ltws, and that my sigrsatu're on V%is, PCM14_wce coverage required by ppliatian naives this requirement. Cheek one: Sis+tiatura of v a OKnar'3 leant Orti-titrQ Anent Q 1 r'wlty msf%* that a7I of the d4t0s and asformaton 1 tuve Submitted 1P �Cge ar C that LI ptumbinp rtrft arrd n'Zit.�llat arts 4or *nsandl rr rs ;�GeaDan atru• to the S tr et vnCmy . faert=+eret ei�s+orts e! :',s 1�{assac.1usetts SYsU teas D+ omkd er the plmsct , a this =AC�rett in mplianu with aCie arc! Cha;to r 1 t2 of !H Gr LtQ s, By T TrW � nature o Lx- Rsea ,urrsaar ac'Z`atc """" C•`tyro,.n a t � Lioris.a Mmbee APPI ( r- H h � � N Y V = Li J NC t O mgr~ cJ t < o C cc C ' W n IC p "+ .� z i c c C +�+ c w C tir r z a < w> s W j= aTC << O O z¢ c s o o s 3 a a v c> i w rt T. FM SASF-MENi T ST FLOOR I I 2!40 FLOOR I I 3 R C FLOOR 4TA FLOOR ' f { STH FLOOR 6TH FLOOR + 7TH,FLOOR STH FLOOR 71 Installing Company Nan Addres Susiress Nalsre of Licensed Plumber or Gas Check one: 1%Carp'Oration (I Partnership (1 Fran/Co. Ce:tifcyte fNSUP?{CE COVVtAGE: 1 Rave a currentI bu=n= "icy or is subshrdW equtvalerd wtvch m rets the requirements of }rtta is2, Yes91 No D N you have C-rt=ked ►es, please irate the type coverage by checkingthe -pproprate box A 1Fa�8ity irzsurance.. ICY other type Cf ireemnity Q 8crsd Q OWNER'S INSURANCE WA aR: I am aware tut the licensee does not have the Cpritpter 142 of the Mass. General Ltws, and that my sigrsatu're on V%is, PCM14_wce coverage required by ppliatian naives this requirement. Cheek one: Sis+tiatura of v a OKnar'3 leant Orti-titrQ Anent Q 1 r'wlty msf%* that a7I of the d4t0s and asformaton 1 tuve Submitted 1P �Cge ar C that LI ptumbinp rtrft arrd n'Zit.�llat arts 4or *nsandl rr rs ;�GeaDan atru• to the S tr et vnCmy . faert=+eret ei�s+orts e! :',s 1�{assac.1usetts SYsU teas D+ omkd er the plmsct , a this =AC�rett in mplianu with aCie arc! Cha;to r 1 t2 of !H Gr LtQ s, By T TrW � nature o Lx- Rsea ,urrsaar ac'Z`atc """" C•`tyro,.n a t � Lioris.a Mmbee APPI ( r- q %r 4% Date ....:f �. �/ :.. HORT/� °f'"`°:•1"a TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................... .........1,/!.......%............................................ has permission to perform ................!. .� ..'/....'.......................................... , wiring in the building of .............................................................. i /r at.............:......L...:::.1...`..'..:::.................. ....`.............�, WorthrAn�doa+e S. Fee. ...... Lic. No .�.....J!.. {.. :... �........................ GLECTRICAL INSPECTOR Check # / J t �rlx Commonwealth of Massachusetts = Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Perin it No. 3 D Occupancy and Fee Checked [Rev. 11/991 (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: City or Town of: %fO PF/- io�/I)0 12 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) 5' a u V t L^ �,�j iJo Owner or Tenant�� �� ��� Telephone No.9 6© Owner's Address .3�-)/>7i� Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building �/� St �>_:N j j�L Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the In ector - 'Wires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. Elrnd. ❑ 0.0 mergency Lighting 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 Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pum Number Tons KW No. of Self -Contained TotalsJ. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Kms, No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 6Vires. 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: Estimated Value of Electrical Work: Work to Start: (Expiration Date) (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains acid penalties of perjury, that the information on this application is true and complete. FIRM NAME: Express Electric Unlimited Licensee: Yan Kener Signature LIC. NO.: A 12757 LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 877-263-2500 Address: PO Box 1 169 Everett, MA 02149-1169 Alt. Tel. 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: $ /5 -p g2