Loading...
HomeMy WebLinkAboutMiscellaneous - Lot Empire DriveZIA i Date. . ....... 7 6 -5, 1 � TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION /7 e,� /,&, �51e-j AcH This certifies that ... 62 ........ ........................ has permission for gas installation .6.44:?7. in the buildings of .... 0� -� ................ at ................ North Andover, Mass. Fee. 2�P. Lic. NoJo. ��.K Check# 7�01 � GASINSPECTOR jc�:' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING 9ja City[Town: T4-04�y , MA. Date: 4 j ( 11 Permit# Building Location: C-V'l � v' Owners Name: OrG°"VX u -c Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: J] Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 5!(No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2r, 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner [] Agent ❑ Signature of Owner or Owner's Agent By checking this box ❑; 1 hereby certify that all of the details (or entered) renardina this anolication are true accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: 1 By Bit 'mber C , " � Title ❑ Gas Fitter Signature of L ensed Plumber/Gas Fitter WMaster Cityrrown ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer W LLJ Cn z a =3W W U = = 0 W (J W ~ In z OO Lz W w z H w s( w z m � W 1-- W a H W O t- � W X U) > W W U W N W (9 F0 Q W N O W H X = 1i > V w z 0UJ -� 1 H lz co O z -1 O � W p W W Z W >- U D lX W J a Q m W > O z O Q 0~ H O w z z w H Q h=- O t=i Ca9 u�' _ _ O a rr X 1- > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR --3 'FLOOR 4 FLOOR 5 FLOOR -6 'FLOOR 7Tff FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: GALD150 PLLwALm y. i4cATioG [Corporation 31910 Address: P -O. 50X 1-101 Cityrrown: NAQE(?- tLL. State: fPY1. . El Partnership Business Tel: q'%,g- 37y- liy3 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: STE P N C-0. C. GALL 1051<4 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 5!(No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2r, 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner [] Agent ❑ Signature of Owner or Owner's Agent By checking this box ❑; 1 hereby certify that all of the details (or entered) renardina this anolication are true accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: 1 By Bit 'mber C , " � Title ❑ Gas Fitter Signature of L ensed Plumber/Gas Fitter WMaster Cityrrown ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer z 0 U W a P4 �~ O w C7 E- w D C7 a w O C] � O U W W Q C] O � 3 u. w � � � ❑ Q z 0 F U W x U raZ, � d w 0053 Date ...... 14 ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... �r�.t ... IX ........... .................. has permission to perform ..... .......... ... .. ........ wiring in the building of ...... ........................ ........ A-P�--J ....... .)�e4NorffihAAndover, Mass. Fee.k�:� ........... Lic. No./Y�WP ............. . . ... .. ...... Check # PLEiCrRICAL� INSPE V- R Lon�aonttisa/th o� ///aseac" Official Use Only 2c� c7 Permit No. l Q Q ,parinso o f tiro Ssrvicm Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. lfil7j leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.40 (PLEASE PRINT IN INK OR TYPEALL INFO"TION) Date: I - Z G - // City or Town of:/- fir/ o �,� 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 f7- 33 / - - - /� n ,d, r ` /�ft Owner or Tenant Owner's Address No. Y;0-7 - 3 l - Z Is this permit in conjun7,1,7 with a building permit? Yes ❑ No [�� (Cheek Appropriate Bog) Purpose ofi uiiding vv -e_ _ -Utility Authorization No. /O &/ % [ `' Existing Service ps I Volts Overltewd ❑ New Service / �-el Amps Y� la Volts Overhead ❑ Uadgrd ❑ No. of Meters .�. Uudgrd e- No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Lr�� se - Completion the foltowi»s inblr mnv hn wnivo�l iry rho lr,rnwru.r e.f iVnoe No. of Recessed Luminaires No. of Ceil.-Snap. (Paddle)Fans Transformers Total KVA No. of Luminaire Outlets No. of Hot Tuba Generators KVA Y� No. of %""Wishes No. of Receptacle Outlets Swbnm#ng fool Above r� ' & ❑ No. of Oil Burners L1 INO Bxt- OFie a` L ergencY g FIRE ALARMS No. of Zona No. of Switches No. of Gas Burners o. Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat mp nm r on..........Self-Contained _.._..._..._.__ DDevices No. of Dishwashers Space/Area Heating KW Local ❑ municipal Connection ❑ Odw No. of Dryers Heating Appliances KWSecurity Systems:* No. of Devices or Equivalent No. o ester xW o. o D, D Signs Ballasts Data Wiring: No. of Devices or iflulvalent No. Hydromassage Bathtnln No. of Motors. Total HP a ecomntun ca onsirmgg. No. of -Devices or nivaient OTHER: Attach additional detail ifdesires( or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: y - Z G -/ � 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 fimbdity 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 S BOND ❑ OTHER ❑ (Specify:) I cadft, under the pains and perroNes of ,that the information on this application is true and con plete, p FIRM NAME: iD • S ` �i & LIC. NO.: 14/ / o n? Licensee: SignatureLIC. NO.: l%�I %,6 (i> opph-bie, enter "exempt `may the !gens nwnb"r rine j Bus. Tel. No.:92r-6J-:r--VW Address: / byiT/u nd� /yaF /Ynd:;t,c "t %%� Ol /S Alt. TeL No.: "Per M.G.L. a 147, s. 57-6 , security work requires Department of Public Safety "S" License: Lic. 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) M owner owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: $ W ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL 1. ROUGH INSPECTION: Passed - [ J Failed - [ J Re -inspection required ($50.00) Inspectors' comments: (Inspectors' Signature - no initials) Date 2. FINAL INSPECTION: Passed - Failed - [ J Re -inspection required ($50.00) - [ J Inspectors' comments: (inspectors' Signature - no initials) Date 3. UNDER GROUND INSPECTION: Passed - [ J Failed - [ J Re -inspection required ($50.00) Inspectors' comments: (Inspectors' Signature - no initials) Date 4. INSPECTION - SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed - Failed - [ j Re -inspection required ($50.00) - [ J Inspectors' comments: (Inspectors' Signature - no initials) Date 5. INSPECTION - OTHER: Passed - j I Failed - { J Rse-juspection required (550800)- j i Inspectors' comments: (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF TBE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED.