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HomeMy WebLinkAboutMiscellaneous - Briarwoodr� 6362 Date..... f-- X6'0 _ 40RT" °t"`° '•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING A SSA US� _ This certifies that .................... f1k'.........'L ............................. has permission to perform ......... ......... µ wiring in the building of . at .............. �..! .................... , North Andover, Mass. Fee.: .. C" ..... Lic. No..:. T Z/f..........� :� �.................. ELECTRICAL INSPECTOR Check # __ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 3 (� Q BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked b [Rev. 11/99] 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 J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 01/24/2006 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) 4 Briarwood Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 �\ Owner's Address 10 Wood Ridge Drive, North Andover MA 01845 %:�xisting this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence p g Utility Authorization No. Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters � New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4 6 Installed gfci in upstairs bathroom Completion of the following table may be waived by the Inspector of 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 Swimming Pool Above ❑ In- ❑ o. of Emergency Lighting rnd. grnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 1 No. of Gas Burners INo. of Detection and No. of Ranges No. of Air Cond. Total Tons 11Ll Lla L..LGYI�;CJ No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons KW......... No. of Self -Contained Totals: Detection/Alerting Devices no. or litsnwasners Space/Area Heating KW Local ❑ 1'lu1J1c1pa1 ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Signs of No. of Data Wiring: Heaters Si ns Ballasts No. of Devices or Eauivalent INo. Hydromassage Bathtubs INo. of Motors Total HP telecommunications Wiring: No. of Devices or F.auivalent Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature LIC. NO.: 9743 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-3828 Address:_ 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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: S 5.00 %2j(�-lt'a 6--f .� r"'4 4 k 041 0 NDERS ELECTRICAL CO.,INC. Wood Ridge Homes ATTN.- Gary 10 Wood Ridge Drive No. Andover, MA 01845 INVOICE October 24, 2005 INVOICE # 050441 09/26/2005 4 Briarwood - RECEIVED oc-f 2 6 2005 Supplied and installed new gfci in upstairs bath Material & Labor: $ 81.41 TOTAL DUE THIS INVOICE: $ 81.41 TERMS: Net Due Upon Receipt of Invoice 2.0% Per Month Finance Charge On Balances Over 30 Days THANK YOU 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL(978)686-3828 FAX (978) 682-1646 a Date.................................. NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING CH This certifies that........... ................................................. has permission to perform ... A 4g TZ C: "'LK .... wiring in the building of ... ................... at ................... ............... ,North Andover, Mass. No.AVIZ = ..'...EECTRICALINSP'EGfbR Check # ­ ...... 7 6924 �L Commonwealth of Massachusetts Official Use Only NEW Department of Fire Services Permit No. �j f BOARD OF FIRE PREVENTIONREGULATIONS Occupancy and Fee Checked y [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: 08/23006 City or Town oh 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) Briarwood Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive North Andover MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remove photoeye from garage lights, install 0narwood light Com letion o the oll t bl b No. of Recessed Fixtures owm No. of Ceil: Susp. (Paddle) Fans a e may a waived b the Ins ector 2L Wires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. arnd. o. of 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. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of Signs Ballasts Security Systems: No. of Devices or Equivalent Data Wiring: 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 Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cert, under the pains and penalties of perjury, that the information on this app ' ation is true and complete. FIRM NAME: Landers Electrical Co. Inc. A LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature LIC. NO.: 9743 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-1828 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 20.00 Date..: ?..��..`�..�0... V' ryQ TOWN OF NORTH ANDOVER G : PERMIT FOR GAS INSTALLATION �� -� . This certifies that :. �...... .�'.......... . has permission for gas installation.... ....` `....... . in the buildings of ......... °..z at�.. .`., North Andover, Mass. Feet .PLic. No�!"- ........ . f�'� .GAS IN PE TOR . V Check # Ti 59 MASSACHUSETTS UNIHORMAPPLICATON FORPERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVERMASSACHUSETTS Permit # Amount $ 2Q 0—' (wrint or type) Check one: Certificate Installing Company Name Ott r ❑ Corp. piddress %fly✓C�^ Partner. .t GC nn 61 of P uslness a ep one ® Firm/Co. Name of Licensed Plumber or Gas Fitter /1 ✓vl t--*, A,& C INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes1Vo� If you have checked yes, please indicat a coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent T hPrPhv n.+rr;f., Thor mil ..F 41,e .1.,a..:1.. __.1 :—P----`'--- (V1 MUCreal - Dove appucatlon are true and accurate to the best of my knowledge and that all plumbing work and installations "erfol YRUer ermit Issued for this a catu*ov will be in compliance with all pertinent provisions of the Massachusetts StateG. o Cha 14 aw . By: Signature of Licensed Ply er Or Gas Fitter Title Plumber f City/Town Gas F' License um er aster APPROVED (OFFICE USE ONLY) ❑ Journeyman C�lV W x a � H � o w aah z O z p F z a H h w a w x z C) o w � � >� � � m � x w z< a< Q o o w a s o a > A 4 p SUB -BA SEM ENT BASEMENT 1ST. FLOOR 2 N D. F L O O R 3RD. F L 0 0 R 4TH, FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. F L 0 0 R 8TH. •FLOOR (wrint or type) Check one: Certificate Installing Company Name Ott r ❑ Corp. piddress %fly✓C�^ Partner. .t GC nn 61 of P uslness a ep one ® Firm/Co. Name of Licensed Plumber or Gas Fitter /1 ✓vl t--*, A,& C INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes1Vo� If you have checked yes, please indicat a coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent T hPrPhv n.+rr;f., Thor mil ..F 41,e .1.,a..:1.. __.1 :—P----`'--- (V1 MUCreal - Dove appucatlon are true and accurate to the best of my knowledge and that all plumbing work and installations "erfol YRUer ermit Issued for this a catu*ov will be in compliance with all pertinent provisions of the Massachusetts StateG. o Cha 14 aw . By: Signature of Licensed Ply er Or Gas Fitter Title Plumber f City/Town Gas F' License um er aster APPROVED (OFFICE USE ONLY) ❑ Journeyman C�lV M The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations Uf 600 K ashington Street Boston, AL 4 02111 www.massgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole have hired the sub -contractors listed proprietor or partner- on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [Ivo workers' comp. insurance 5• ❑ We are a corporation and its required] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t 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 I I.7 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other COmpeII6at10II pobC}` :II{0.'.1pII. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractocs that check this box must attached an additional sheet showing the. name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 ofcriminal penalties of aER and a fine fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORD of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Of ERce a 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 Signature: Date.: Phone #: Ficial 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 #: Information as 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 employer is defined as "an individual, partnership, association,. corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrnents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §35C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co=mpliance 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 until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If 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 insurance coverage. Also be sure to sign and. date, the affidavit. The affidavit should be returned to the city or town that the application for the perruit or license LS being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' " compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference member. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank youin advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Mee of Invesfigations 600 Washmgton Street Boston, MA 02111 Tel. # 617-72.7-4900 ext406 or 1-877-MASSAFF- Revised. 5-26-05 Fax # 617-72.7-7749 vry vv.mass_�ov/dia I -w Date.................. VjOR TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING S CHUS This certifies that ..... ...................................................................................... has permission to perform ................................................. wiring in the building of ..... ............... A'--) .............cuav-................................ at ...... �7 ...... ............. dell .... ...... Feel� .. . . ........ Lic. No.9,P North Andover, Mass. -C-� ELECTRICAL (T Check# YIJA- 6459 J W t\- Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 1 � BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] 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: 01/30/2006 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) 7 Briarwood Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive, North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: Replaced bad switch in upstairs bedroom Cmlvtinn nithe fn/lnwina tnhlo -- ho ""A-1 h., fh� r„—,...—1 rar, No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Tolft-tal Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 1 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals: Number "'"" Tons I................... KW ..................... No. of Self -Contained 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 E uivalent No. of Water KW Heaters No. of No. of Si ns Ballasts Data Wiring: 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 Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature LIC. NO.: 9743 (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-3828 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 20.00 6346 5 Date ........ (.— .. 2. . IP . —d . 4 . ... ... .... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING j 4 This certifies that ............ ........ /--ce .;. Pr ................. .... ................. . ... . ... .......... . ..... has permission to perform ..... ................. wiring in the building of ..... .............. I — 6.e1 !4 at .....................................f. W..C217 ....................... . North Andover, Mass. Fee .... -�..-��..'.."".." Lic. No. 5Y .11........ .. ............. ELEc-mcAL INSPitTOR14 Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ✓ L( BOARD OF FIRE PREVENTION REGULATIONS 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: 01/24/2006 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) 1 Briarwood Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive, North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replaced buttons at door No. of Meters No. of Meters Completion of the following table may be waived hv the Inspector of 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 Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency tg ing 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. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW ........... """ No. of Self -Contained 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 KW Heaters No. of No. of Si ns Ballasts Data Wiring: 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 Wires. 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 X BOND ❑ OTHER ❑ (Specify:) (Expiration Date) 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. I certify, under the pains and penalties of perjury, that the information on this a lic 'on is true and complete. FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature LIC. NO.: 9743 (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-3828 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally i required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ 5.00 Signature Telephone No. eNDERS TRICAL CO.,INC. Wood Ridge Homes ATTN: Gary 10 Wood Ridge Drive No. Andover, MA 01845 June 30, 2005 INVOICE # 050222 I i INVOICE 06/09/05 Checked light, replaced lamp, office walkway, Checked intercom, 1 Briarwood, replaced buttons at door. Material & Labor: $ 291.25 TOTAL DUE THIS INVOICE: $ 291.25 TERMS: Net Due Upon Receipt of Invoice 2.0% Per Month Finance Charge On Balances Over 30 Days THANK YOU 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL (978) 686-3828 FAX (978) 682-1646 03 U Date...... . 7. -7- 6-.0-4 This certifies that ............ ................................................................................ has permission to perform .... I ............ wiring in the building of ... u-jo ...... 51 .......... at .... ... 69 .......................... . North Andover, Mass. Fee .... r .... Lic. No. ........ ELECTRICAL MpEcrOR . ChecL-# TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ............ ................................................................................ has permission to perform .... I ............ wiring in the building of ... u-jo ...... 51 .......... at .... ... 69 .......................... . North Andover, Mass. Fee .... r .... Lic. No. ........ ELECTRICAL MpEcrOR . ChecL-# -C-\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. G� 3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked r [Rev. 11/99] 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: 01/24/2006 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) 1D Briarwood, 16 Ardmore Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive, North Andover, MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑. No. of Meters New Service Amps 1 Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Repaired bad splice, checked outlet Co totionnftho fnllnwino tnhln m „ ho ,.,,i 4 k„ fl— 1.,...,,.,,.-- -rru:- - - _ ..... ... , No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans 1Y -- 1!j ww, No. of otal Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No, of Alerting Devices g No. of Waste Disposers Heat PumpNumber Totals: ""' Tons """' KW No. of SelVContained Detection/Alertin2 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 KW Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the informatio on this application is true and complete. l FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signature,/ 'LIC. NO.: 9743 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-686-3828 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.. `978-686-3829 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 5.00 GANDERS 0 ELECTRICAL CO.,INC. Wood Ridge Homes ATTN-. Gary 10 Wood Ridge Drive No. Andover, MA 01845 INVOICE August 12, 2005 INVOICE # 050295 07/13/2005 Repaired Bad Splice on Receptacle at 1 D Briarwood Checked Outlet in Kitchen at 16 Ardmore Service Call Labor: $ 65.00 TOTAL DUE THIS INVOICE: $ 65.00 TERMS: Net Due Upon Receipt of Invoice 2.0% Per Month Finance Charge On Balances Over 30 Days THANK YOU .000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL (978) 686-3828 FAX (978) 682-1646 Date ... /..... z .. d' .. . . 6 .. 6 .. I ... . ... ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING / This certifies that y1/6 & / 5 �.-.0 . -................... z.... .............. has permission to perform ....... .......... wiring in the building of ......... P. q).. F . ...... "OA&.5 ... at ....... ....... 7 North Andover, Mass. ................. im Fee —4�..�7':=.. Lic. No. ............ i � CTRICAL INSPECTOR Check # Q Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. l9b yBOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] 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: 01/24/2006 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) 4 Briarwood Court Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address _10 Wood Ridge Drive, North Andover MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Troubleshoot for tripping breakers and fuses .AP Attach additional detail if desired, or as required by the Inspector of Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) +.Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the informationon this 1' ation is true and complete. FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signatur LIC. NO.: 9743 (Ifapplicable, enter "exempt" in the license number line.)Bus. Tel. No.: 978-686- 8 8 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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: $ 5.00 = ice,, -win euute mu oe waivea o the !ns ector o 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 Swimming Pool Above ❑In- —1o. o mergency Lighting rnd. rnd. Batte ry 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 of Ranges Totallo. No. of Air Cond. onsl No. of Alerting Devices No. of Waste Disposers Heat Pum s Number - Tons KW No. of Self -Contained Total Detection/Alertin gil Devices No. of Dishwashers Space/Area Heating KW Local ❑Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Water No.KW No. of No. of No. of Devices or Equivalent Signs Ballasts Data Wiring: No. of Devices or E uivalent 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 Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) +.Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the informationon this 1' ation is true and complete. FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signatur LIC. NO.: 9743 (Ifapplicable, enter "exempt" in the license number line.)Bus. Tel. No.: 978-686- 8 8 Address: 1000 Osgood Street, North Andover, MA 01845 Alt. Tel. No.: 978-686-3829 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: $ 5.00 <_ LANDERS ELECTRICAL CO., INC. 1000 OSGOOD STREET— P.Q. BOX 783 —NORTH ANDOVER, MA 01845 Phone 978-686-3828 — Fax 978-682-1646 Woodridge Homes ATTN: Gary Webster RECEIVED 10 Woodridge Road No. Andover, MA 01845 -_P 2 4 2005 INVOICE February 18, 2005 INVOICE # 050024 01/19/2005 #4 Briarwood Court RE: lights keeps blowing fuses Upon entering unit, there were no tripped breakers or fuses within the panelboard. Did a physical walk-thru, turning on every lighting luminaire, switches, and lamps. Found no breakers and/or fuses tripping when doing so. Labor: $ 65.00 TOTAL DUE THIS INVOICE: $ 65.00 TERMS: Net Due Upon Receipt of Invoice 2.0 % Per Month Finance Charge 1:0b 2.0 Balances Over 30 Days THANK YOU A6361 Date ..../.'. 2-.'. .-.. '.p 4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... Lxi?kA�.e'e ......... . .7 ................. has permission to perform .......... -TD lu fe/;L ................... F ........ ............... wiring in the building of ....... ............ ........ at .... 7,6 Andover, Mass. k ..................... ... Lic. No. ................ t/) -A L C! `7 ic �e�sp�c:r� Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancyand Fee Checked JUIF I [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 01/24/2006 City or Town of. North Andover To the Inspector of Wires: `p By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 9 Briarwood, 1 l Devon Court i Owner or Tenant Wood Ridge Homes Telephone No. 978-423-7867 Owner's Address 10 Wood Ridge Drive, North Andover MA 01845 N Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters .� Number of Feeders and Ampacity © Location and Nature of Proposed Electrical Work: Installed new outside lights 1 CO No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans ,ua,e m"y ue wuaveu Vy ane fns ecror of wires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ Fn- - ❑ o. o Emergency Lighting 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 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 Totals Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Water No. of No. of No. of Devices or Equivalent Heaters K`,1, Signs Ballasts Dat Data Wiring: 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 Wires. 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this tion is true and complete. lic FIRM NAME: Landers Electrical Co., Inc. LIC. NO.: A5912 Licensee: Terrence J. Landers, Vice -President Signatur LIC. NO.: 9743 (Ifapplicable, enter "exempt" in the license number line) Bus. Tel. No.: 978-686-3828 Address: 1000 Osgood Street, North Andover MA 01845 Alt. Tel. No.: 978-686-3829 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 5.00 NDERS pELECTRICAL CO.,INC. k Wood Ridge Homes ATTN: Gary 10 Wood Ridge Drive No. Andover, MA 01845 INVOICE RECEIVED OCT 2 6 2005 By .. —r.� October 24, 2005 INVOICE # 050447 09/13/2005 9 Briarwood 11 Devon Removed Old Outside Lights, Supplied and Installed New Outside Lights Material & Labor: $ 225.38 TOTAL DUE THIS INVOICE: $ 225.38 TERMS: Net Due Upon Receipt of Invoice ' 2.0% Per Month Finance Charge On Balances Over 30 Days THANK YOU 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL (978) 686-3828 FAX (978) 682_1646 Of pORTp 1h F D • o i °•,r•° •F`th ,SSACMUSE� Date. .34 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...1:� (. (�S....................... has permission to perform ....%..{....................... . plumbing in the buildings of ..4 .< s�. !? !.'�. {..`�.............. at .. S...I�%�. ?" . ............... , North Andover, Mass. Fee. Lie. No../ ........ ........ PLUMBING INSPECTOR Check # >^l 6892 M MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TOW PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date � D p Building Location S ri !.r C Owners Name d 'c 4n1_5Permit # Type of Occupancy Amount 4-r" New Renovation o / Replacement �Plans Submitted Yes � Cl No ❑ FIX(((TURES w0 z a w U z U � Q� z w SBM a A A A F r a tQ.7 A¢ a as &�41V)HIYT MHJOOR i MHDCR 3W HAOM HBM SIH MOOR %lam FLOOR 9M H lOOR (Print or type) Check one: Installing Company Name /(jrn Certificate �� ❑ Address Corp. 4c -k", ]nti a� Partner. Business Telephone ( Firm/Co. Name of Licensed Plumber: � kD L, {-� w� 1 Insurance Coverage• Indicate h type of insurance co erage by checking the appropriate box: Liability insurance policy 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 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 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 Massachusetts State Chapter 142 of the General Laws. By. ign re (cense um er Title ype of Plu ing License, Cit RO is nse umr Master ❑ APPROVED �oFi;tcE USE ONLYP"loumeyman Date .. ?/�./I! '. �........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION J This certifies that _. . (. 1 ...................... has permission for gas installation ......tf.................. ,� in the buildings of,... %.f'�.�.:� ...................... . at ................... . North Andover, Mass. Fee... .)..:. Lic. No.. S S. .....�`` :d.!.-c>'.�..... G�1S INSPECTOR Check # f a - i t - 5494 MASSACHUSETTS UNIFORNI APP'LICATON FOR PERMIT TO DO GAS FITTING (T)pe or print) Date 4J WNORTH ANDOVER, MASSACHUSETTS Building Locations S \ �f �' ! ``�- l�� t},�� P Permit # J^Y� Y Amount S Owner's Name New ❑ Renovation ❑ Replacement Plans Submitted (Print or type j�f r t4t) ,) W 01Vl Y Address Name— XP "� y� �� Name of Licensed Plumber or Gas Fitter C one: Certificate Installing Company Corp. Partner. Ftn Co. LNSURANCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes iffNo0 If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy rM 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 13 t 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 pe o ed under Permit Issued for this application will -be in compliance with all pertinent provisions of the Massachusetts St s1111hapter 42 of the General Laws. Signature of Licensed Plumber Or Gas Filter Title By. Plumber J Z 7 Z2 Cit)/Town Gas FittertcL �ense Nurnref Master APPROVED,CMCE oSE ?SLY) Journeyman �������������������� ray• ;3RD. FLOOR Must (Print or type j�f r t4t) ,) W 01Vl Y Address Name— XP "� y� �� Name of Licensed Plumber or Gas Fitter C one: Certificate Installing Company Corp. Partner. Ftn Co. LNSURANCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes iffNo0 If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy rM 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 13 t 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 pe o ed under Permit Issued for this application will -be in compliance with all pertinent provisions of the Massachusetts St s1111hapter 42 of the General Laws. Signature of Licensed Plumber Or Gas Filter Title By. Plumber J Z 7 Z2 Cit)/Town Gas FittertcL �ense Nurnref Master APPROVED,CMCE oSE ?SLY) Journeyman Of `NORTH ,M ° a � F p SS HUS Date./1,7.4/ d & TOWN OF NORTM'ANDOVER PERMIT FOR PLUMBING This certifies that •,-�?-�!i'. \tJj�[7 ..t .............. . has permission to perform`"" ........ / ...... . ................ plumbing in the buildings of .. ............ at .. . 4 .-. _ .................:. .. , orth Andover, Mass. Fee-3,� Lic. No. cP G.S (... P. . . G� ING INSPECTOR Check # / (` 7'38 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location �' Date - o Cv, , vners Name Permit # _ 3 Type of Occupancy Amount 2 Acy New ❑ Renovation Replacement Plans Submitted Yes ❑ No ❑ LTVTiinr. C, or type) Instal i/ Installing Company Name ,y�jS 9 ,{.IJ Check one: Certificate ❑ Corp. Address v rl ( jcrill ❑ Partner. Business a ep one t rm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of in .urance coverage by checking the appropriate box: Liability insurance policy � 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 Signature I Owner ❑ I hereby certify that ;SII of the details and information I have submitted (or entered ucst of my knowiedge and that all plumbing work and installations Pei -fu ed d _ompliance with ;ill pertinent provisions of the Massachuscas State PI g Co By: — . igna urc Ot M7;nse um Type of Plumbing License Title //�� 53 CityiT own L►!�(Q-1 umer Master APP ROVED (i)FFIC6 t;SE ONLY tcense ,Agent ❑ bovc application ;Ire and accurate to the ` ernnit Issued r t application will he in General Laws, ® Iournc.vman