HomeMy WebLinkAboutBuilding Permit #442-12 - 70 LOST POND LANE 11/30/2011 BUILDING PERMIT f NORTil `.
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TOWN OF NORTH ANDOVER = 6 ;tr. r r.`6 Y°
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received 4 •���-��• ^'
Date Issued: �'l/
SACHUS
y IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building ne family
Addition Two or more.family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
I�
Demolition
Other_
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1 � DESCRIPTION OF WORK TO BE PREFORMED:
I Identification Please Type or Print Clearly)
OWNER: Name: 4 `rt f� N69 Phone:
Address:
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ARCHITECT/ENGINEER Phone:
Address:
FEE SCHEDULE:BOLDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �
FEE: $_
Check No.:_ 3L N Receipt No.:
NOTE: Persons contracting wit unregistered contractors do not have access to e guaranty.fund
ature�ofcon ractor ,. . _ ��-
4 '
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or..Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
---New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Piot Pian.
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2008
Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
4 .
COMMENTS
CONSERVATION Reviewed on Signature
HEALTH Reviewed on Signature
COMMENTS
I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water $ Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
�3�rEE}PA ,NI �' rD r�;�pser o�tette_ e ti y F no 4 5;
Lvocated-at�l���lain S#ree# `� '' M
IreAlepar r e ;sj r 6rel& a
a
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.s10o-$1000 fine
NOTES and DATA— (For department use
i
p
4
❑ Notified for pickup - Date
i
Doc.Building Permit Revised 2010
Location
Na Date d'
NORTH TOWN OF NORTH ANDOVERAL
-
? �_ • O
Certificate of Occupancy $
;�s""•�''<�, Building/Frame Permit Fee $
S%CHUst
Foundation Permit Fee $ �>
Other Permit Fee $
TOTAL $
Check # t
f
24846 Building Inspector
NpRT#j
T0 0 over .,
No.
C, o , dover, IVlass., •
Q LAKE
If, COCMICHEWICK
"�BSDRATE D P'P�,`��
1 BOARD OF HEALTH
PERMIT T 11 Food/Kitchen
Septic System
BUILDING INSPECTOR
........
...........................................................................
THIS CERTIFIES THAT....... iw'. .... ....
Foundation
Whas permission to erect....... ....................... buildings on .?o.......La '.... a ...... ....... Rough
000
to be occupied as........S.......... ... ...................... ............... ... .. ... ...................................................:.......:
Chimney
provided that the person accepts g this permit shall in every respec nform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
&� PERMIT EXPIRES IN 6 MONTHELECTRICAL INSPECTOR
UNLESS CONSTRUC S S Rough
............................................................ .............. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do- Not Remove Final
No Lathing or Dry wall To Be Done FIREDEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
- Street No.
SEE REVERSE SIDE Smoke Det.
i
I
�lassachusctts: Dclrti imcnt of Public Safeo
Board of Buildin-,j Regulations and Stilndal-d5
Construction Supervisor Specialty License
License: CS SL 99497
Restricted to: RF,WS
MICHAEL CORTNER
16 JONAS ROAD
WESTFORD, MA 01886
2
Expiration: 4/24/2012
Tr=: 99497
�1'Co me�zvores&K i ess ula
e tZ io
� Office o �
=_= HOME IMPROVEMENT CONTRACTOR
Registration: 108126 Type:
-0 Expiration: 8/13/2012 DBA
m L L. CORTNER-EXPRESS ROOFING
Michael Cortner
16 JONAS RD
WESTFORD, MA 01886 Undersecretary
't
I
Pluwnw. VCR 1 Irl.►H 1 C Vr LIADIL1 I T 1NQUr'CHIVL►C 05/13/2011
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
A-Costa Insurance Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
2 Franklin Commons ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Framingham MA 01702-
COMPANIES AFFORDING COVERAGE
COMPANY
A ACE AMERICAN INSURANCE CO
INSURED COMPANY
Jr) CONSTRUCTION B
720 WAVERLY ST APT 1 COMPANY
C
FRAMINGHAM MA 01702-
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
L DATE(MM/ODJYY) DATE(MM/DD/YY)
GENERAL LIABILITY BODILY INJURY OCC $
COMPREHENSIVE FORM I / / / / BODILY INJURY AGG $
PREMISES/OPERATIONS PROPERTY DAMAGE OCC $
UNDERGROUND I / / / /
EXPLOSION&COLLAPSE HAZARD PROPERTY DAMAGE AGG $
PRODUCTS/COMPLETED OPER 81&PD COMBINED OCC $
Y CONTRACTUAL / / / / 81&PO COMBINED AGG S
INDEPENDENT CONTRACTORS PERSONAL INJURY AGG S
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
AUTOMOBILE LIABILITY BODILY INJURY
ANY AUTO (Per person) v S
ALL OWNED AUTOS(Private Paw / / / / BODILY INJURY
ALL OWNED AUTOS j S
(Other than Private Passengers f (Per
HIRED AUTOS / / / /
PROPERTY DAMAGE $
NON-OWNED AUTOS
GARAGE LIABILITY BODILY INJURY&
PROPERTY DAMAGE S
COMBINED
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM / / / / AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND — 0967816 05/12/2011 05/12/2012 TORY LIMITLIMITS ER
STATU-
0TH
EMPLOYERS'LIABILITY C
EL EACH ACCIDENT $ 100,000
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 500,000
PARTNERS/EXECUTIVE
OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE S 100,000
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATONSA/EHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEROF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
EXPRESS ROOFING 10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMP tTSAGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-N(1/95) ACORD CORPORATION 1988
I Iii
LOOK Fax:978-251-2907 O�ce:978-256-2333
PROPOSAL DATE OF PROPOSAL 10/2112011
www.expressroofer.com mike0exoressroofer.com
HOME IMPROVEMENT CONTRACTORS LICENSE#108126 P.O.Box 542,Chelmsford,INA 01824
CONSTRUCTION SUPERVISOR LICENCE#99497
••• PROPOSAL SUBMITTED TO: • • WORK TO BE PERFORMED AT:
NAME CATHERINE BARTLETT "°°"Ess 70 LOST POND LN
AOOREss 70 LOST POND LN INORTH ANDOVER
NORTH ANDOVER
PRONE' 978 2081306
We hereby propose to furnish materials and perform the labor necessary for the completion of.
STRIP ALL SHINGLES OFF HOUSE ROOF CLEAN UP AND HAUL AWAY
TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE AND LAWN AREA
COMPLETELY DE-NAIL ROOF AND RE-NAIL ROOFING BOARDS AS NEEDED
ALL WALL FLASHING WILL BE INSPECTED AND REPLACED AS NEEDED
Install: GAF Weather Watch 6' up from the bottom eves and cover back low pitch roofs
GAF Weather Watch around vent pipes
GAF Weather Watch in valleys
GAF Weather Watch on roof where roof meets house
GAF Weather Watch under chimney lead and Y down on roof
Felt paper over roof boards
GAF Starter strip on all roof decking edges
GAF Timberline HD Architectural shingles 130 Mile wind warranty
GAF Cobra ridge vent along all ridge surfaces
GAF Timber Tex caps
8"drip edge along all roof edges White
New pipe flange's over vent pipes
All shingles will be fastened using 1 '/:'-1 '/2"roofing nails
ROLL MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP
:• -•• Rill Ell qZMAROUNIM04asTel a 10 rem
INCLUDES:ALL LABOR AND MATERIALS FOR THE ABOVE AND ROOFING PERMIT
10 YEAR WORKMENSHIP LIMITED AND LIMITED LIFE TIME GAF SHINGLE WARRANTY
CLEAN UP AND HAUL AWAY ALL SHINGLES
Note:No warranty on problems and/or damaged caused by ice backups No Warranty on old skylights
All material is guaranteed to be as specified,and the work to be performed in accordance with the drawings and specifications
submitted for above work and completed in a substantial workmanlike manner for the sum of. Co.'s
$NO MONEY DOWN$ PAYMENT IN FULL AT COMPLETION OF JOB WITH CASH OR BANK CHECK Q�ZII�( by
MADE OUT IN THE NAME OF f W\\LC
+ Michael L.Cortner \\ p►��\
Call Toll Free Respectfully submitted &:2/
BBB. 1-888-210-ROOF ••• Note-This proposal maybe withdrawn by us if not accepted by:
10/28/2011
All workers fully insured
ACCEPTANCE OF PROPOSAL _
The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized _
to do the work as specified.Payments will be made as outlined above.Any additional work than the above will be
an extra charge.
Signature
VAC
Date �Q , SHINGLE COLOR C v1 C Q0.
Homeowner is responsible for protecting and cleaning content of attic from possible dust and debris during your roofing project.
—Note any plywood replacement will be an extra $60.00 per 4x8 sheet-labor&materials included
GAF SYSTEM PLUS WARRANTY PROVIDING 50 YEARS 100%LABOR AND MATERIALS AGAINST MANUFACTURING DEFECTS ON
ALL GAF PRODUCTS(TRANSFERABLE)EXTRA$295.00
We recommend rubber roofing on back low pitch roofs
We recommend new chimney lead with all new roofs for an extra charge of$295.00
Massachusetts Home Impl"ovement Sample Contract
This Form satisfies all basic requirements of the state's Home Improvement Contractor Law(MOL chapter 142A),but does not include sthndard
language to protect homeowners. Seek legal advice if necessary. Any person planning]tome improvements should first obtain a copy of"a ;
Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8797 or 1=888-283-3757.
Homeowner Information Contractor Information
arae ^� omp,any Name
Street'Address(do not use a Post Office Box ad ess) Contractor/Salesperson/Owner Name
`l6 LOST �� G `r NIEi►2-
City)Town State Zip Code Pusiness Address(must include a street address)
Am
S C4 �-
Daytime Phone Evening Phone .ity/Town State Zip Code
(� 33
Mailing Address(It different from above) usioess Phn qederal Employer ID or S.S.Number
Law regmres that most heme ho- Items pmvement Contractor Res.Number Expiration date
pmvrmeat don n tan have■ I ' O
slid mgiatratioo mncbc
The CJ.ontractor agrees to do the following work for the Hornell ner: 8-0101C
m e ocompleteg e e, r e mff rd.as To 156 We n ace
J(o DF—
Required.1'ermits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and Will be secured by the contractor as the homeowner's agent, be adhered to unless cir ces beyond the contractor's control arise
(owners who secure their own permits will be
exelkided from,the Guaranty Fund provisions of ate whe ctor r n contracted work.
MGL chapter 142A.)',j yy'bEC C 1 NAL
j ' abate when contra to ork will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: d (*)
Payments will be made according to the following schedule:
$ upon signing contract(not to exceed 1/3 of the'total contract price or the cost of special order items,whichever is greater)
$ 13y or upon completion of
by _/_/_noupon completion of
i
S
I upon completion of the contract (Law forbids demanding fall payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ 10 be p
ordered before the contracted work*begins in order 5
to meet the completion schedule.(**)
NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may
not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made
which must be special ordered advance to meet the material
sP � e completion schedule,
Express Warranty.Is an express warri ity h Ine provided b- tate contractor _No Yes (al!terms of the warrauty must be attached to hn rontract)
Subcontractors-ncMontractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear.
' Make sort the contractor has a valid Home Improvement Contractor R.egisrtration The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by;writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or
1-800-223-0933.
• Does the contractor have insurance? Check to see that your contractor is properly insured.
• Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancer this agreement if it has been signed at a place other than the contracts.normal place of business,provided you notify the
conitactor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following.the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF T114ERE ARE ANY BLANK SPACESM
Two identicat copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should,be kept by the contractor.
Ho owner's Signature ntractor's Signature
1 �
Da to zz'
Date &/z/z/z
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(asan .
alternative to-court action)if they have a dispute with a contractor. The same right is not automatically affordeqI to a
contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute
concerning this contract, the contractor may submit the dispute to a private arbitration ficin which has been approved.by
the Secretary.of the Executive Office.of Consumer Affairs and Business Regulation and the consumer shall.be required
to mklto such arbitration as provided In Massachusetts General Laws,chapter 142A.
Homeowner's Signature Contractor's Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties.to alternative dispute resolution
initiated by the contractor. The homeowner may initiate alternative dispute re
p solution even where separatelysigned b the -- _ ere this section is not
g Y parties.
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter.142A)and other consumer
protection laws(i.e.MGL chapter 93A).may not be waived in any way,.even by agreement. However;homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law:
Homeowners who secure their own building permits are'automatically excluded from all Guaranty.Fund provisions of
the Home Improvement Contractor Law. The contractorls responsible for completing the work as described,in a
timely and workmanlike manner. Homeowners may be entitled to other specific regal rights if the contractor guarantees
or provides an express warranty for workmanship or rtiaterials.'In addition to guarantees or warranties provided;by the
contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular
purpose.' An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the
terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about
Your consumer/homeowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract �.
The contract must be executed in dupl
documents have been.attached. Parties are icate and should not be signed until•a copy of all exhibits and referenced
-also advised not to sign the document until all blank sections have been
filled in or marked as"void,deleted,or not applicable. One original signed copy of the contract with attachments is to
be given to the owner,"' the other kept by the contractor. Any modification to the original contract must be in writing
and agreed to by both parties. Contracted work may not begin until both parties have received a Pully-executed co
the contract,and the three day recission period has expired. py of
Accelerated Payinents
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself
to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow
account as a prerequisite to continuing the contracted worlr- Withdrawal of funds from said acc
signatures of both parties. ount would require the
Additional Information
If you have genera] questions or need additional information.about the Home Improvement Contractor Law or other
consumer rights,ortf you wish to obtain a free copy.of "A Cons
Law,"contact: umer Guide.to the Home Improvement Contractor
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation.
.10 Park Plaza,Room 5170,Boston,.MA 02116
(6I7)973-8787 or 1-(888)2833757
If you want to verify the registration of a contractor or if you have questions Or need additional info
about the Contractor registration component of the Home Improvement Contractor Law,contact: rt1]3tlOn specifically
Director of Home Improvement Contractor Registration
Bureau of Building Regulations and Standards
One-Ashburton Place, Room 1301,Boston,MA 02108
(617)727-3200 or 1-800-223-0933
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General '
(617) 727-8400
AND/OR
Better Business Bureau
(508)652-4800
.(508)755-2548
(413)7.34-3114
Date.....
NoarM
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
'4U5
/V
This certifies that(I;wgze-s
...................... .................................
has permission to perform ....... ... .......
. g je,�e-
........................
............. ...
wiring in the building of..... ....... .......................
at.............70......1-6
............70 1-657 44,fll, 40AICI
................ ......... ...Z..................... North Andover,Mass.
. .......... ..... ................
Fe// Lic.No.............. ....pv�v -/'o
Check # 7 2- ELEcrRICAL INSPECM
5566
L11L C VM[V1VlV WL9/:Lti Vl'MAJ, 1(,1I UJL;11 J �Office Use only
DFPAR7AfEW0FPUX1CSAFM Permit No.
BOARDOFFREPREMMONREG E47YONSM7 Ml2W
Occupancy&Fees Checked
APPLICATION FOR PERMIT TO PERF RMELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHU TS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work de c d below.
Location(Street&Number) �G �, ,`���2
Owner or Tenant ,
Owner's Address
Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box)
Purpose of Building -5//t/6/f r14 A-1/411 /�/.�/T t� l�!'iv 6— Utility Authorization No.
Existing ServiceAmps G/ Volts Overhead Underground ®' No.of Meters r
New Service Amps / Volts Overhead Underground No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
round eround
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
N ^f Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
_ Tons
of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices 1466 KW Local Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Si s Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER'
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IhaNeaa>aaYLi?N ylrs>=toePb yi kxirgCmnplMCDmr,gperitsa>bstarrialmphulat YES NO
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INSURANCE BOND [� DIRER
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Liaer�ae �1l`�b'/�S Signahae Lica>seNo _ _210
pry :,2Z� !� /J/,7�J• l �"�a'�t�1—�(UGG�/� Bt>SnSsTd.No.
Alt.TdNo.
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ardthatmyagnahneondmpwnitq#cabcnwar4sttristegtr¢mn t � � �'�Gala�lLaws
(Please check.one) Owner 1:3 Agent
Telephone No. PERMIT FEE$
Signature of Uwner or Agent