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HomeMy WebLinkAboutMiscellaneous - 10 LACY STREET 4/30/2018 (5)7 - NORTH .ANDOVER BUILDING DEPARTMENT 1600 Osgood Street North Andover Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORMFOR TOWN CLEWK DATE: Z(� NAME: ADDRESS: I L ZONINGDISTRIOT: : TYPE OF BUSINESSLIU BUILDING LAYOUT PROVIDED:_ YES NO AVAULAYJ EPARK.II GSPAOES: ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE BUSINESS FORM FOR TOWN CLERK 2.40 Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use- of the building for luring put -poses. Home occupations shall include, "but not limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehiclerepairs, beauty= parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods, which impacts flue residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the oWnier of the home occupation and residing in said diwft, b. The use is carried on strictly within the principal building; c. More shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; - d. Not more than. twenty=-five (25) percent of the existing gross floor area of :the dwelling unit. so used, not to exceed one thousand (1000) square feet, is devoted to'such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; C. There will be no display of goods or wares visible from the street; £ The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, dishubance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customary in buildings for residential use. Signature Date North Andover MIMAP March 26, 2014 . ....... ... ....... .... . .. .......... Wr .. ... ...... w& ... .... .... Mw —4, :7' ...... ... .......... ... Aw. A ... . . te 1w. M M' .... ..... ... .... . . . . . . . . . . aL Aw. Q, AC d., W\ mw 7. rest Street . . .... .... ... d.- 'kl et :d � . .. .... ... AW At& .7" ssbo 7 e Rail Line Wetlands Zoning Interstates 0 Exempt Lands f : Bu:in' I District 1 0 Busine a 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, SIR IC3 Busine S 3 District Meters Data Sources: The data for this map was produced by Merrimack M Busine! s 4 District Valley Planning Commission (MVPC) using data provided by the Town of Roads ©Genera Business District Ci Easements a Plann Commercial Dev ,So le North Andover. Additional data ph by the Executive Office of e, Environmental Affams/MassGIS. The information depicted on this map is 0 Comd, Development Dist C3 MVPC Boundary a Corri 0 for planning purposes only. It may not be adequate for legal boundary do Development Dist 0 to definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER E3 Municipal Boundary 0 Corldc Development Dist III. S Zoning Overlay I :ndu:�� :� I District MAKE NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING GAdul[Ente Entertainment 0 nd. 2 District . 'wwwww THE ACCURACY, It - I" COMPLETENESS, RELIABILITY, OR SUITABILITY 10 :ndustr il 3 District ve lay District Downtown OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT E3 el� �- -, , 0 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ®Historic District 93 ndustr il S District E3 Water Protection Reside ce I District01 "llo THIS INFORMATION 13 Parcels C�- Reside ce 2 Distdc 4CHU 0 Hydrographic Features JM.P—ide ce 3 District a 1c. 4 District -- streams 582 ft de ce 5 District YY de ce 6 District { a Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 VMarch 25, 2011 There is a small, red house on the property of the old %ipporwill Farm on Lacy Street. John and Stephanie O'Mahoney, who live on the same side of the road and contiguous to the'old farm, recently purchased that property and are now doing extensive renovations to the house. I do not see any building permits and would like you to check into that. Also, the house behind me, 10 Lacy Street, has an unfinished addition going on 5 years now. I also don't see a building permit for that project and would like you to check into that. Dianne McGarvey, Esq. 90 Lacy Street North Andover, MA 01845 drmlaw@earthlink.net 6 5 Ei Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 ch 25, 2011 There is a small, red house on the property of the old Whipporwill Farm on Lacy Street. John and Stephanie O'Mahoney, who live on the same side of the road and contiguous to the old farm, recently purchased that property and are now doing extensive renovations to the house. I do not see any building permits and would like you to check into that. Also, the house behind me, 10 Lacy Street, has an unfinished addition going on 5 years now. I also don't see a building permit for that project and would like you to check into that. / ' Dianne McGarvey, Esq. 90 Lacy Street North Andover, MA 01845 drmlaw@earthlink.net n S ( j^4 �- 1 USA FIRST -Q,: ER 1� L ilk i•% Commonwealth of Massachusetts Department of Fire Services. BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and F=ee Checked [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All xAork to be performed in accordance lvith the Massachusetts F,lectricai Code (MEC). 527 CMR 12.00 (PI. EASL'' PRINT IN iNK. OR TYPE ALL INMRHATION) Date: /� _ 2,- City or Town of: /// To the Inspector of Wines: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 11-2 �L Owner or Tenant k %/ Telephone No. Owner's Address r /-r e - Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Existing Service Amps t zye Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Utility Authorization No. Overhead ❑ Undgrd No, of Meters Overhead ❑ Undgrd ❑ No. of Meters ('onr tletiotro f tt it /- lei 4,;P` Illach additional delail if -desired. or as I*equired hr the Inspector al'►i ires., Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start/,// -2- —fi .7 Inspections to be requested in accordance with MEC Rule IQ. and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no pen -nit 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 covers« . 'n force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certi0, under the /wins and penallies of perjury, that the information on this applicalion is true and complete. FiRM NAME: - /Z LIC. NO.: Licensee: v . s / _ S�� ! / Signat LiC. NO.: 1�j X 3 3 {ll applicable, crr rr ' c1.vempt' in the license triunher line.) _ r Address: 4 No.: Alt. Tel, No.: *Security'System ystem Contractor License required for this work, if applicable, enter the license number here: 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, t hereby waive this requirement. I am the (check one) ❑ owner[] ❑owner's agent. Signature Telephone No. PER1VtIT FEE: $ - t - /tt inwtrt tauu., JIM l%oe 1Vaffect Py, file fits)echlr Ul Wires, No. of Recessed Luminaires No, of Ceil.-Susp. (Paddle) Fans No. ofTotal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- Elo. o mergency rg rng rod, rod. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches No. of Gas Burners o. of Detec—tion an InitiatingDevices No. of Ranges No. of Air Cond. Tons) No. of Alerting Devices No. of Waste Disposers eatump Totals: um er I ons o. o e - .ontame Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unlelpa ❑ Other Connection No. of Dryers Heating Appliances KW _ Securityystems: ° ° ° ° No. of Devices or Equivalent Heaters KW °' ° Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunFcationsrang;: No. of Devices or E uivalent OTHER: Illach additional delail if -desired. or as I*equired hr the Inspector al'►i ires., Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start/,// -2- —fi .7 Inspections to be requested in accordance with MEC Rule IQ. and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no pen -nit 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 covers« . 'n force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certi0, under the /wins and penallies of perjury, that the information on this applicalion is true and complete. FiRM NAME: - /Z LIC. NO.: Licensee: v . s / _ S�� ! / Signat LiC. NO.: 1�j X 3 3 {ll applicable, crr rr ' c1.vempt' in the license triunher line.) _ r Address: 4 No.: Alt. Tel, No.: *Security'System ystem Contractor License required for this work, if applicable, enter the license number here: 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, t hereby waive this requirement. I am the (check one) ❑ owner[] ❑owner's agent. Signature Telephone No. PER1VtIT FEE: $ ®/--( /2,a° -d7 M i Page 1 of 2 H3MLS - Report for MLS 110441056 Aaron Stephenson From: h3@n1spin_com Sent: Tuesday, February 06, 2007 10:34 AM To: arstephenson@cfgmtg.com Remarks NLS # 70441056 - Active .and - Residential D Villaoe Dr. List Price: $1,900,000 Middleton, MA 01949 Essex County Grade School: Middle School: High School: Directions: Located across street from Sheraton Ferncroft overlooking Ferncroft Country Club This site overlooks Ferncroft C.C., the 4th hole and across the front 9. The site is in Middleton and Danvers and consists of io units, approx 3000st each with Z000 sf 1st level and 1000 additional. Design calls for 2 car garage, lots of glass overlooking the golf course and the site has considerable privacy. The process continues for final permits but a buyer has the opportunity to work with the seller in finalizing layout, facades, and construction specifics that work best for them. Property Information Total Approx. Acres: 6 (261360 sq. ft.) No. of Approved Lots: 10 Approx. Street Frontage:500 ft Features Area Amenities: Public Transportation, Shopping, Swimming Pool, Tennis Court, Walk/3og Trails, Golf Course, Medical Facility Beach: No Cable Available: Yes Documents: Legal Description, Subdivision Approval, Land Survey, Topographical Map, Order of Conditions Electric: At Street Gas: At Street Land Description: Easements, Rolling, Elevated, Sloping, Wooded, Golf Course Frontage Road Type: Private, Paved, Publicly Maint. Sewer: Public, At Street Sewage District: essex Water: Public, At Street Waterfront: No Zone Usage: Condo/Co-Op Cultivation Acres: Home Own Assn: No Pasture Acres: Assn Req: No "timber Acres: HOA Fee : $ Other ProDerty Info Adult Community: Yes DEQE/DEP#: Disclosure Declaration: No Disclosures: owners are finalizing town approvals for 10 units and buyer may participate in design and specifics. Perc Test: No Tax Information Pin #: Assessed: $555,400 Tax: $5426.26 Tax Year: 2006 Book: 7533 Page: 424 Cert: Zoning Code: res Map: 21 Block: 0 Lot: 15 Market Information Listing Date: 8/15/2006 Listing Market Time: MLS# has been on for 175 day(s) Days on Market: Property has been on the market for a total of 175 Office Market Time: Office has listed this property for 175 2/6/2007 H3MLS - Report for MLS # 70441056 Page 2 of 2 At day(s) day(s) Expiration Date: Original Price: $1,900,000 Off Market Date: Sale Date: The information in this listing was gathered from third party sources including the seller and public records. MLS Property Information Network and its subscribers disclaim any and all representations or warranties as to the accuracy of this information. Content 02007 MLS Property Information Network, Inc. MLS * 70496144 - Active Land - Commercial 163r North Main Street List Price: $1,350,000 Middleton, MA 01949 Essex County Grade School: Middle School: High School: Directions: Route 114 across from Real Macoy Restaurant Remarks Property consists of two single family houses and wooded land. Land is zoned M 1 Light Industrail. A great use for this property would be new industrial contractor bays,etc. Seller will accept offers contingent on buyer getting approvals. Call for more details.. Property Information Total Approx. Acres: 6.42 (280090 sq. ft.) Cultivation Acres: Home Own Assn: No No. of Approved Lots: Pasture Acres: Assn Req: No Approx. Street Frontage: 119 ft Timber Acres: HOA Fee: $ Features Beach: No Cable Available: Yes Electric: On -Site Gas: Other (See Remarks) Land Description: Rolling, Elevated, Wooded Road Type: Public, Paved, Publicly Maint. Sewer: Private Water: Private Waterfront: No Zone Usage: Other (See Remarks) Market Information Listing Date: 12/3/2006 Days on Market: Property has been on the market for a total of 65 day(s) Expiration Date: Original Price: $1,350,000 Off Market Date: Sale Date: Other Proaerty Info Adult Community: No DEQE/DEP#: Disclosure Declaration: No Disclosures: Perc Test: Tax Information Pin #: Assessed: $0 Tax: $0 Tax Year: 2006 Book: 0 Page: 0 Cert: Zoning Code: M1 Map: Block: Lot: Listing Market Time: MLS# has been on for 65 day(s) Office Market Time: Office has listed this property for 65 day(s) The information in this listing was gathered from third party sources including the seller and public records. MLS Property Information Network and its subscribers disclaim any and all representations or warranties as to the accuracy of this information. Content 02007 MLS Property Information Network, Inc. 2/6/2007 H3MLS - Report for MLS # 704410S6 Aaron Stephenson Page 1 of 2 From: h3@mispin.com Sent: Tuesday, February 06, 2007 10:34 AM To: arstephenson@cfgmtg.com Remarks MLS # 70441056 - Active Land - Residential 0 Village Dr. List Price: $1,900,000 Middleton, MA 01949 Essex County Grade School: Middle School: High School: Directions: Located across street from Sheraton Ferncroft overlooking Ferncroft Country Club This site overlooks Ferncroft C.C., the 4th hole and across the front 9. The site is in Middleton and Danvers and consists of 10 units, approx 3000sf each with 2000 sf 1st level and 1000 additional. Design calls for 2 car garage, lots of glass overlooking the golf course and the site has considerable privacy. The process continues for final permits but a buyer has the opportunity to work with the seller in finalizing layout, facades, and construction specifics that work best for them. Proaerty Information Total Approx. Acres: 6 (261360 sq. ft.) Cultivation Acres: Home Own Assn: No No. of Approved Lots: 10 Pasture Acres: Assn Req: No Approx. Street Frontage: 500 ft Timber Acres: HOA Fee: $ Features Other Property Info Area Amenities: Public Transportation, Shopping, Swimming Adult Community: Yes Pool, Tennis Court, Walk/3og Traits, Golf Course, Medical DEQEJDEP#: Facility Disclosure Declaration: No Beach: No Disclosures: owners are finalizing town approvals for 10 Cable Available: Yes units and buyer may participate in design and specifics. Documents: Legal Description, Subdivision Approval, Land Perc Test: No Survey, Topographical Map, Order of Conditions Electric: At Street Tax Information Gas: At Street Pin #: Land Description: Easements, Rolling, Elevated, Sloping, Assessed: $555,400 Wooded, Golf Course Frontage Tax: $5426.26 Tax Year: 2006 Road Type: Private, Paved, Publicly Maint. Book: 7533 Page: 424 Sewer: Public, At Street Cert: Sewage District: essex Zoning Code: res Water: Public, At Street Map: 21 Block: 0 Lot: 15 Waterfront: No Zone Usage: Condo/Co-Op Market Information Listing Date: 8/15/2006 Listing Market Time: MLS# has been on for 175 day(s) Days on Market: Property has been on the market for a total of 175 Office Market Time: Office has listed this property for 175 2/6/2007 MMLS - Report for MLS # 70441056 Page 2 of 2 day(s) day(s) Expiration Date: Original Price: $1,900,000 Off Market Date: Sale Date: The information in this listing was gathered from third party sources including the setter and public records. MLS Property Information Network and its subscribers disclaim any and all representations or warranties as to the accuracy of this information. Content @2007 MLS Property Information Network, Inc. MLS # 70496144 - Active Land - Commercial 163r North Main Street List Price: $1,350,000 Middleton, MA 01949 Essex County Grade School: Middle School: High School: Directions: Route 114 across from Real Macoy Restaurant Remarks Property consists of two single family houses and wooded land. Land is zoned M 1 Light Industrail. A great use for this property would be new industrial contractor bays,etc. Seller will accept offers contingent on buyer getting approvals. Call for more details.. Propertv Information Total Approx. Acres: 6.42 (280090 sq. ft.) Cultivation Acres: Home Own Assn: No No. of Approved Lots: Pasture Acres: Assn Req: No Approx. Street Frontage: 119 ft Timber Acres: HOA Fee : $ Features Other Property Info Beach: No Adult Community: No Cable Available: Yes DEQE/DEP#: Electric: On -Site Disclosure Declaration: No Gas: Other (See Remarks) Disclosures: Land Description: Rolling, Elevated, Wooded Perc Test: Road Type: Public, Paved, Publicly Maint. Sewer: Private Tax Information Water: Private Pin #: Waterfront: No Assessed: $0 Zone Usage: Other (See Remarks) Tax: $0 Tax Year: 2006Book: 0 Page: 0 Cert: Zoning Code: M1 Map: Block: Lot: Market Information Listing Date: 12/3/2006 Listing Market Time: MLS# has been on for 65 day(s) Days on Market: Property has been on the market for a total of 65 Office Market Time: Office has listed this property for 65 day(s) day(s) Expiration Date: Original Price: $1,350,000 Off Market Date: Sale Date: The information in this listing was gathered from third party sources including the seller and public records. MLS Property Information Network and its subscribers disclaim any and all representations or warranties as to the accuracy of this information. Content @2007 MLS Property Information Network, Inc. 2/6/2007 NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street North Andover �7k 3 76 - 4 Tel: 978-688-9545 Fax: 978-688-9542 BUSEMSS FORM FOR ToWN CLERK DATE: 3 NAME: L I2�!)e�1(1 0(7101( - ADDRESS: (C) ZONING DISTRICT: I ` TYPE OF BUSINESS: � wS+V'cc�laVi BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: ZONING BYLAW USAGE: YES NO INSPECTOR SIGNATURE BUSINESS FORM FOR TOWN CLERK 2.40 . Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use- of the building. for living purposes. Home occupations shall include, "but not limited to the following uses; personal services such as funushed by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of the home occupation and residing in said dwelling; b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; d. Not more than twenty-five (25) percent of the existing gross floor area of the dwelling unit so used, not to exceed one thousand (1000) square feet, is devoted to such use. hi connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customary in buildings for residential use. Signature 3 14 II Date 2.40 . Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use- of the* -building. for living piuposes. Home occupations shall include, "but not limited to the following uses; personal services such as funushed by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multifamily district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the of vner of the home occupation and residing in said divel ing; b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; d. Not more. than twenty-five (25) percent of the existing gross floor area of the dwelling unit . so used, not to exceed one thousand (1000) square feet, is devoted to ' such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customary in buildings for residential use. " Ji 1,,,, CrA4^ SignatureDate a Tz Date.... ....................... kORTN TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..................... ........................................................... has permission to perform ......... .................................................. wiring in the building of ... ....................................................... ............ .. North Andover, Mass. Fee ..... Lic. No . .... .... . ... .......... ELEcrRICAL 114§PE Check # j & V 7346 Commonwealth of Massachusetts official Use only " -tunDevarttnent of Fire Services Permit No. 73,10 BOARD OF FIRE PREVENTION REGULATIONSpancy Occu and Fee Checked cpc�s_ [Rev. 1]/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: Cityor Town of: & 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) A0 Owner or Tenant /tj/ G L/ A7M p U !r Owner's Address l_ _n+ ,- i-=- v P' 2 Telephone No. Is this permit in conjunction with a buil 'ng permit? Yes No ❑ (Check Appropriate Boz) Purpose of Puilding k4_ Utility Authorization No. Existing Service New Service., Amps / Volts Amps / Volts Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Cell.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- E] rnd. grnd. No. of Emergency Lighting BatteEX Units No. of Receptacle Outlets No. of Oil Burners ---- FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Rangcs No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat um Number F --` ` Tons - KW - '-' '--'- o. of Self -Contained Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑unicipal ❑ 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 TelecommunicationsWiring: No. of Devices or E uivalent 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 cove ge is in forceand has exhibited roof of same to the p permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: QD e) (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 application is true and complete FIRM NAME: I.14, c— I LIC. NO.: Licensee:L%1t,66&-;1 j�J %' It//GL7iG%j1� Signature �����e 5 LIC. NO.:,4 (Ifopplicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: IZ 33 AA1, j- S)�- 1`& Z"ol'.S i vet /%�,�1 G a- Alt. Tel. No.: ; Z -fr P o� OWNER'S INSURANCE WAIVER: I am aware that the Licen a 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. $ ���