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Home My WebLink AboutBuilding Permit #382-11 - 76 BOSTON HILL ROAD 11/3/2010 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page '�llP LOCATION 7 Co 4 osZx � Print PROPERTY OWNER Print MAP NO-/67�—PARCEL. ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family [I Addition [I Two or more family 11 Industrial 11 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ^ssessory Bldg L-- ElOthers: ❑ Demolition ❑ Other f f®`Well - ; '®iFloodplain '0 Wetlands. i `0;Watershed�Dstnct, E Septic - 0Wafer/,Sew.er =- rD BE PERFORMED ' � -ESCRIPTION OF WORK TO n � Identification Ple i e, ype or Print Clearly) Phone: C�2� _ 8 ,.7Y'76 OWNER: Name: 1[ Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER C� �,��1 _ Phone: T� 7� Address: 16 �1°i� lt� �r Reg. No. 7 � FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 1�rpoo FEE: $��(h / �3��- Check No.: D Receipt No.: NOTE: Persons 0ntracting with unregistered contractors do not have access to the guaranty fund Signature. of Agent/Owner ., . is - Location -7y Na 2 Date MORT� TOWN OF NORTH ANDOVER F? •. • 4L 9 s i ; Certificate of Occupancy $ s•, MuBuilding/Frame Permit Fee $ � ACs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Z 23651 wilding Inspector 3 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 ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wates'& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i ORTtj ONM Of r 3r; 77 N 0 0- A K E O dower, Mass., COCMICMEWICK V 7d ADRATED 7SS BOARD OF HEALTH Food/Kitchen .PERM IT T D Septic System BUILDING INS ECTOR THIS CERTIFIES THAT has permission to erect..............:......................... buildings on .."" n ..�jir........&4!11�..... ..... . ......2.,�...t... ugh to be occupied as.........3�....�. �...I Chimney .. ... a ?.�.. ... ��16tdilorTno*nfile provided that the person accepting this pet shall in very respect conform to the terms f%Z- 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 PERMIT EXPIRES INe6,ONTHS Final UNLESS CONSTRU S ELECTRICAL INSPECTOR Rough .... ........................................................................................................ Service BUILDING INSPECTOR 16D A� 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. y IMITED TO ITEMS BELOW Ix ILI MIT(COPY OK)..or no inspections t. C7 > OZ 0 x oundation, Frame, Insulation, Final. ci Z 06 columns G ., z` v Ix A O LL Z is filter/cover and outlet connection. LL O )ist W a 5 Dec, etc. Z kring partitions. t rafter cuts. ring at walls. c ections. o ' z ier connections and use"Hurricane Clips"tie to plate. w oo G: al support. ler nails. JER »�* OEg ?o° ..,. c .� c � ing at foundations 2 N oundation pockets. 9U CV s �;, ° ti a� ooh' ,� Beams/LVL's Trusses. O oN" ��° CD Beams etc. w iJ ways, under beams droom above). act to exterior(not in soffit). 11v%.vuv Qirx wvvuu iidmu ui v clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging, clean joints,8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36°high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure s F ORTH Tomm of Andover o 3r; C% r_ L A K E O dover, Mass., ' 3 • � a COCMIC MEW ICK �t ADRATED SS BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INS ECTOR THIS CERTIFIES THAT has permission to erect............ ..... buildings on ...... . to........&4000011....I. ....... ...... .�...�... ugh to be occupied as.........3�....�.1! '..... .. .. ... ... �i�.N....... + .. .....".�r6fjon-To*nf ^... ney Ch' provided that the person accepting this petit shall in very respect conform to the terms ile 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 ONTHS UNLESS CONS TIO S S ELECTRICAL INSPECTOR Rough ........................................................................................................ Service BUILDING INSPECTOR xig�ac A� . Occupancy Permit Required t0 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW t POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVUs Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3' headroom above). Crawl space access. (min. 18x24). ` Bath exhaust fans to have metal duct to exterior(not in soffit). = Firecode S/R wood frame of"0°clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: 1;-h+-nial to 8%of floor area. door. 1 0279 Date......?.. n.Y77&...... f t4ORTH oma TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSE� This certifies that ' 1. ... /.� _?L...... . ................... has permission to perform ....... ' ' ....... .................................................... wiring in the building of...... ucture. at "' "A-7.5/-m- "' . .. North Andover .......... ./�............. _ ass. Fee..................... LECTRIc NSP OR Check # ' Dimension I 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.$10041000 fine NOTES and DATA— For department use I I f i Notified for pickup - Date Doc:.Building Permit Revised 2008 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 Plot Plan ❑ 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building permit Revised 2008mi L J Date.....1..`..�? ...... ,10RTM °ft "° TOWN OF NORTH ANDOVER = PERMIT FOR WIRING : � - �SS�cHUSE� This certifies that ................ . .4 ...... ......................... has permission to perform .......!! •• .......................................... wiring in the building of L.-V.1. U.,!..5 t at................ �??r..n.�«...�L ........ALEC.T.RCArtNSP Andover ass. Fee..................... Lic.No.x.10............... . ........ R Check # Z'6 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. / Z`7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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: 7— 7— 11 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) t'v /3 D b 10 M i Owner or Tenant Geri e uo i ii 1 S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Cy 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: ,^ e (2 CA_;t/1 Gqll i Completion of the ollowing table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd, rnd. 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. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: 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 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 ifdesired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 12-00 ----(When required by municipal policy.) . Work to Start: -=2,G , ,( Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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:) I certify,under the ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ' t J , P LIC.NO.: Licensee: rw( 4, b1f4 Signature eLa LIC. NO.: (If applicable, enter "exempt"in the license number line. Q I^A Bus.Tel.No.•?7 5'6 g6'��`7((q y Address: `� T_ t /l f a Vyl Alt.Tel.No.: *Per M.G.L c. 147,s. 57-6T,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) ❑ owner ❑owner's Owner/Agent Signature Telephone No. PERMIT FEE: $ Eugene P.Willis P.E. 76 Boston Hill Rd. i North Andover MA. r November 17,2010 North Andover Building Inspector 1600 Osgood Landing North Andover, MA. Re:garage construction 76 Boston Hill Rd. Dear Building Inspector: This letter is to certify that the garage constructed at 76 Boston Hill Rd. has been built in accordith the plans submitted and conforms with the MA State Building code. OF 4Assq r L � CIVIL ` 1 c�'10NAL�� pRTFy F o p ove r Town - _ 3r; =y LAKE `O dover, Mass., �' 3 • O COC MIC MEwiCK 7d ADRATED `SS BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • • BUILDING INSPECTOR THIS CERTIFIES THAT .. 0L.�.LI....�....................E.Y.k .............. Foundation has permission to erect........................................ buildings on . ..?1a !s �t�... �.�. Rough �1......... r... to be occupied as.........3�....�. rils�-ip-e--rsld ... ... �i A.......MA..�.....f%Z- ... . ..��... Chimney h'provided that the personaccepting tshall in very respect conform to the terms 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 ONTHS ELECTRICAL INSPECTOR � UNLESS CONS TRU TIO S S Rough Service BUILDING INSPECTOR Final - I Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE J1 Smoke Det. ORTH Tovm of _: o Andover No. 3r ~ __ _ - -_- a o�vl/ MW' _ - - �- 4t _ LAKE O dover, Mass., • COCMICMEwICK V �d ADRATED PP�t�C. `SS ` BOARD OF HEALTH Food/Kitchen Septic System .PERM IT T D BUILDING INSPECTOR THIS CERTIFIES THATI..�.I.f....�....... .............F.Y.�4. �.............. ............................... .................................. Foundation has permission to erect..............:......................... buildings on ...... .L�........ ►s.d'�...�.......... ...•... Rough to be occupied as.........3�....�. ..... .. .. ... ... ....... .0%.......�.�..�.....�� .. ��... Chimney e provided that the person accepting this per it shall in very respect conform 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 Ir60NTHS ELECTRICAL INSPECTOR UNLESS CONSTRU 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. NORTH Town of No. s3 _ = - }� �. - 0 dover, Mass., Y Q LAKE ' A�ACOCMICHEWICK V -/ DRATE D17 '9% E BOARD OF HEALTH Food/Kitchen Septic.:SystemT T PERMI I 'BLL ING WSPEC TOR THISCERTIFIES THAT.........I...... :.................................................................................................. , ......................... Foundatio'/�=VC11, � � � � ; .. has permission to erect........................................ buildings on } ....: .:..:........ ::'.:................................ Rough .............. tobe occupied as.................:.:............ :...:.`.`...:..1.::. '........:.... '......:..............,.......... `n' " ..................................................... Chimney provided that the person accepting this permit shall in every respect conform 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 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTION STARTS 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 FIRE DEPARTMENT` Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i ON NIL 3.6' 60ST �5 W N EXISTING GARAGE FOUNDATION 32.7' 0 #76 BOSTON HILL ROAD EXISTING DWELLING NOFN g cp = MICHAEL 9Oy F-1 N � SERGI m v No.33191 y A�OFESS10aPP ��SLIRV�O 1 RTI THAT THE I YSTR ` TURES CONFORMS GARAGE L OCA TION TO ` TAL S L INELFEC NTSOF TR .E l YIN EFFECT SNC TELA. {HtS CER'llFCA RON DOES NOT CONSIDER ANYOTHER RESM107XWS SUCHAS COVENANTS,WE TLANDS,&WMENTS, ORDERS OF 138 S. )THE?DAWAG SHALL NOT BE usF,D SYTHE camrFoRANY PuRposE orHER N rm4 r TlNED A CEPT T I N. PERMISSION OF ALCOR TIA SEROII FUR R EISD IS THIS CERTIFICATION IS MADEAND LIMITED TO THE ABOVE CL/ENT INECOPYRIGHTED PROPERTYOFCHR&qTIAAfSENASERC41NC. ANDANY US4UTHORIZED .ElS „tI8lTED.CHRIS SEN& LOCA TION:NO.ANDO VER,MA. SEAG4 TAKES NO RESMMISILITYT THE LMUTHOR12W USE OF THIS DR4MMG OR ANY INFOR-MA TRW C` TAIKEDHEREON DATE: 5/12/10 SCALE.-1"=40' PROFESSIONAL ENGINEERS& LAND SURVEYORS CHRIS TIANSEN & SERGI, INC. 160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830 WWW CSI-ENGR.COM TEL. 978-373-0310 FAX 978-372-3960 D WG.NO.:94019.001.004 Date./.?......3.°........ .1.... i kORTij ;�'.°-:6."-°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHUS� This certifies that .........5'�..:...�.�........... c: ��..`. '............................ has permission to perform ......!`�".r . // 'f� f r 1................................................. wiring in the building of........ ......... ................................. at.. r. �......./ 6 ... ,North Andover,Mass. Fee,T(2��'.. ..... Lic.Nok.�f,9.:Y ............. ...z .................. ELECTRICAWNSPE�R Check # �f 9167 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. q f7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: /2 - 3- - eff City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned&Jves notice of his or her intention to perform t1welectrical work described below. Location(Street&Number)_MX/11.5 rv17 /f• /� �� Owner or Tenant �1 Q l Telephone No. Owner's Address ,� c Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building l Utility Authorization No. Existing Service /U 0 Amps 12-1 / z yAolts Overhead 2' 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: L Completion of the ollowin table ma be waived by the Ins ector of Wires. ' No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool bove ❑ n- ❑ 1VOK-01 Emergency OK-01E Lighting rnd. grnd. Battery Units No.of Receptacle Outlets f p No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches L No.of Gas Burners o.of etechon and Initiating Devices No.of Ranges No.of Air Cond. TotalNo,of Alerting Devices Tonsnsg No.of Waste Disposers eat Pump Number Tons KW No.of SeIT-47ontained Totals: 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW ecuritySystems:* No.of Devices or Equivalent No.o Water No.o o.o Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP 7 elecommunicationsWiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /2-3 c, _ r,f 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. CHECK ONE: INSURANCE U9�OND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: /l LIC.NO.: 9153-3 Licensee: Ize Signature zG _ LIC.NO.: 9 9 3 3 (f applicable,e 6 r "exempt J n the license number line.) Bus.Tel.No.: �?-2 LG Address: Alt.Tel. No.: *Per M.G.L c. 147,s. 51-61,security work requires Departm 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)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $