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HomeMy WebLinkAboutMiscellaneous - Exception (701)0 CO CL cQ CD Z m z r m v caa m T O o_o m v ..« , p O o OD N 0 CA O o N 0 Eff rt cu m x o n N 5 5. a �• cQ N 3 to a N O cQ' - C. 3 L° c 91) N m 510 m 3 vp a a( o c �. U �. ? .. o m N a (D 3 3 m cn o � m o o 3 a o. m 0 m 0 0 �a am o w .-► ID � _= y m !C_ D m m a z FA O N C- O o m -4 O "v 70 m N oCD y > N 0 0 NC- c groo'M• I a z to m z 3 a .� z v O m X O z to O G) z z O "v 70 m -a m z 3 a .� z v O m X Location �F� r C- t e-, « /?vi. No. ��Es��-�% Date TOWN OF NORTH ANDOVER \ f � • 09 Certificate of Occupancy $ �'�'''•••°''<� SJ�cwusE Building/Frame /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee SI iT� $ 3 TOTAL $ Check # 24-33 22744 Building Inspector 1 v ri h] 3 E 1A ST I a, O z LI 3 R 4 to ~O•� N N O 'L7cn O Cab > a�"a00.o0ca ° ,= ,== - gb .2 CC p :r � CM CCS ° Cd0 °'�''3 ca 0 ca,` 13.0 z cd U tb O U O Q .sr � O bO c� a 42Cn a, O z LI 3 R 4 m 3 a I c CL Iu o �e f v lug Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked tev. 1/07] (,__,,,., 1A APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEUCMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORM4TION) Date: City or Town of: NORTH ANDOVER By this application the undersi ed To .the Inspe for of Wires: gn gives notice of his or her ' tention to perform electrical work described below. Location (Street/ umber) �� (2 I C � � ^� Owner or Tenant /,IQ Owner's Address Telephone No. Is this permit in conjun on with a building permit? Yes Purpose of Building ' l C l- No ❑ (Check Appropriate Boa) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / _Volts Overhead ❑ Undgrd E] No, of Meters Date ... -;�i..-..�...ZD . - 3 TOWN OF NORTH ANDOVER O p PERMIT FOR WI • -� � • RING ss,CHUS This certifies\ that ............................... """"""' has permission to perform ........................................... wrong in the building of ........................ at/ ........ .... ...................... `• ............. .. . North Andover ..................... ,Mass. Fee /�",, Check # ` --� LECTRICAL INSPECTOR 9269 l� 4tle !may he waived by the Inspector of Wires. xr-ansiormers 17W Generators KVA Units ALARMS No. of Zones o. Of Alerting Devices of Self -Contained tecf*on/Alertin Devices :al 0Municipal Connection ❑ Other urity Systems: No. of Devices or Equivalent 'a Wiring: No. of Devices or Equivalent communications Wiring: No. of Devices or Ennivah-n* if desired, or as required by the Inspector of Wires. Work to Startnicipal policy.) Inspections to be requested in accoraance will, MEC Rule 10, and upon completion INSURANCEtUVEGGE. Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee. provides proof of liability ' ce including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove a is in force, and has exhibited proof of s toA;petis office. CHECK ONE: IIVSLTI2ANCE BOND❑ OTHER I certify, under the ❑ (Specify.) %'%/S� ia, �� paiks d pen ,gsof erjury, that the in o C anon on t is application is true and complX�ai FIRM NAME: � �/ � /J �%(,��t( Licensee:s] J LIC. NO.: e L bA Signature (If applicable, enter -exemp " in the 1i nse -number lin . LIC. NO - Address: vt l 11� �j Bus. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work uires Department of Public Safety S" License: AIL L ci No.. ,1 / 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" Date. . Z 7! �� . ....... o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. �.� . �:..�'�,�< .. «7. r ..................... has permission for gas installation ..� f .. 1. ! a/' ........... in the buildings of ... ) — �.A... � l: A ........................ at ...5 .b d . { ti < H It , North Andover, Mass. Fee .. )Y C—. . Lic. No.Jcc ? C ... ...... L�.�-,..... . GA�INSPECTOR v Check # SL- 78 MASSACHUSErIS UNIFORM APPIKATON FOR PERNIlT TO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations eAP2 L't.k"C'A Owner's Name New [3 Renovation ❑ Replacement ❑ GAS FITTING 3 /zt/M Permit # Amount $ kc— Plans LPlans Submitted ❑ (Print or type)_4e_ Chec one: Certificate Installing Company Name�� r I Il --Q / f'�� 11 Corp. Address 131-m �d ` Y� ❑ Partner. usmess Telephone — �3 �"Firm/Co. Name of Licensed Plumber or Gas Fitter (9 5,W -/e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type 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 ❑ I hereby certify that all of the details and mtormatton i nave suormu.eu tur cinc►cu) in auvvc at,t,u%,auu„ aic .,.. a..., a.. ,..��. best of my knowledge and that all plumbing work and installations performed under Pe •t Issuieo for this application will be in compliance with all pertinent provisions of the Massachusetts to as Te and Cha er 14 f the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ©lumber ❑ Gas Fitter License Number 0--Pdlaster ❑ Journeyman • 3RD. FL -06-R won �7TH. FLOOR i8TH. FLOOR (Print or type)_4e_ Chec one: Certificate Installing Company Name�� r I Il --Q / f'�� 11 Corp. Address 131-m �d ` Y� ❑ Partner. usmess Telephone — �3 �"Firm/Co. Name of Licensed Plumber or Gas Fitter (9 5,W -/e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type 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 ❑ I hereby certify that all of the details and mtormatton i nave suormu.eu tur cinc►cu) in auvvc at,t,u%,auu„ aic .,.. a..., a.. ,..��. best of my knowledge and that all plumbing work and installations performed under Pe •t Issuieo for this application will be in compliance with all pertinent provisions of the Massachusetts to as Te and Cha er 14 f the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ©lumber ❑ Gas Fitter License Number 0--Pdlaster ❑ Journeyman NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: j� z,0 A sl NAME: iG4— cull c✓ �r � c✓C� CIOQ� ADDRESS: i(�(��iny�� / ��71�G'✓� ZONING DISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: ?' S ZONING BY LAW USAGE: YES NO 4do� Ob A� BUILDING INSPECTOR SIGNATURE Revived 11.5.04 BUSMV FORM FOR TOWN CLERK