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HomeMy WebLinkAboutMiscellaneous - 100 CORTLAND DRIVE 4/30/20180 C "'rf 0-RTk ACHU541� CERTIFICATE OF USE & OCCUPANCY t' Building Permit Number 533 (2/10/2006) Date: Julv 25, 2005 THIS CERTIFIES THAT THE BUILDING LOCATED ON 100 Cortland Drive Unite 039_ MAY BE OCCUPIED AS Single Family Dwellin IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meeting House Common 121 Carterfield Road North Andover MA 01845 Buildin�spector D O b 404 E Z I a O y p � C I CC3, O•— COD p� 'E m m a� o as = O� R O �. �a _C! O =IC d Co cc OI ci Iy � C cc d H Q E Cos C O h y cm 3 m � z y C WCA� W ag _O mo nv a CD y m � Z.,t. O C Cf C o a :. t m � Z m ca �Z m ` o m a N F=- +O� «. O m yO, F� m W .y Q Q W E CL=., o « ca 0 Z o v0 �;y0 a � in Co C F=- .. ems..tto 5 E Z I a O y p � C I CC3, O•— COD p� 'E m m a� o as = O� R O �. �a _C! O =IC d Co cc OI ci Iy � C cc d H Q II ra � I t r CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 533 (2/10/2006) Date: July 25, 20 THIS CERTIFIES THAT THE BUILDING LOCATED ON 100 Cortland Drive Unite (#39) MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetins House Common 121 Carter6eldRoad North Andover -MA 01845 Building Inspector i#. APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: Parcel SUBDIVISION Buildlin-g Permit # 33 I oco { t Y� if - Lot � Lot Number 92,, DATE REQUESTED FILED READY FOR INSPECTION /Z CLOSING DATE ON PROPERTY: -712 I?a4 I i FIVE (51 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE Cl INSPECTION FEE OF TWENTY DOLLARS DOES NOT MEET ALL APPLICABLE CODE SIGNED CONSERVATION PLANNING ROUTING DPW - WATER METER M7* SEWERIWATER CONNECTION F:J� NOTE 1 WITHIN THIS TIME FRAME. A BE- LL BE CHARGFIS IF THE STRUCTURE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST A r Signature )rm revised 2006 Date.. � C/ .0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . /`z�. .rr �a �.�... ...1 .S ................. has permission to perform ... k-: . ......... • . • . plumbing in the buildings of ...4. 14 e'.'V.... ............. at. ..........„ North Andover, Mass. Fee. G�.. Lic. No. �. .. `.: ... T- PLUMBING INSPECTOR Check # GDo ( 7 6937 i I II I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO',PLUMBING (Type or print) I I f! NORTH ANDOVER, MASSACHUSETTS / Date tiding Location &/6 Ll,-I—&14d— mud— Permit #' —+ / Amount Owner 1c�/'3"�l�Ll/2/�Q/h[-.-L .'/ New Renovation Replacement Plans Submitted Yes No I I FIXTURES (Print or type) I Check one: Certificate Installing Company Name Awvvn CdS � D Corp. Addressr►JA Partner. MAI G/�-y 5 - Business Telephone Flo &�,1SG, Firm/Co. I Name of Licensed Plumber: I Insurance Coverage: Indicate L,,iype of insurance coverage by checking the appropriate box: Liability insurance policy © Other type of indemnity D Bond D I I I Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance I Signature Owner I Agent I I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massaa Plyxnbin!� Chapter 142 of the General Laws.By Ztt.LStte ig ure o censea Plumuer Type of Plumbing License Title City/Town � � rcense um er Master I D Journeyman APPROVED (OFFICE USE ONLY I I Date ...Y. /?. ���. �..... Fj ` �p TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION r aa �9SSACNUSEtty �'- This certifies that . !.............. has permission for gas installation ... ....... in the buildings of .. !rte !k. G3 ... f ! .5 .. .................. at . 1. o cl ...... North Andover, Mass. c Fee/°.�.... Lic. No. GAS INSPECTOR r Check # !i a C 5538 uA%ACHGSE M UNIFORM APPUCAMN FOR PERM TO DO GAS FWMG (Type or print) Date d2� /6& NORTH ANDOVER, MASSACHUSETTS Building Locations Permit # Amount $ I lU0 ,- Owner's Name New Renovation Replacement Plans Submitted :1 11 0 (Print or type) J P/vm 6 t Cts one: Certificate Installing Company Name// LiCorp. Address —I � �1J4t Partner. M d/C/L/"" --2 Firm/Co. usiness a ep one 77(7 Name of Licensed Plumber or Gas Fitter/ l� -j i7TH. FLOOR (Print or type) J P/vm 6 t Cts one: Certificate Installing Company Name// LiCorp. Address —I � �1J4t Partner. M d/C/L/"" --2 Firm/Co. usiness a ep one 77(7 Name of Licensed Plumber or Gas Fitter/ l� -j INSURANCE COVERAGE - Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes one No C] If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 13-1, Other type of indemnity 13 Bond 13 Ow per's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of 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 , 11VIC y %cnuy u,ua uu v, u,c u�,a„O u„uIII ,vu„uuUlf a 1"Yc — IIUaaw w, Uuu.wu) u, du VU at/Fnuauvn aic uuc auu accuiuM w nuc best of my knowledge and that all plumbing :cork and installations performed under Permit Issued for this application will be -in compliance with all pertinent provisions of the Massachusetts State Gas Code an C a 142 of the General Laws. le I,\PPRU`vrED,(-,FFICE USE GNLY) Signature of Licensed Plumber Or Gas Fitter I Plumber J6 �j )- Gas Fittertc� se Number "faster Journeyman j 1 Location No. 6�_3 3 Date (7 d-6�6 NORTN TOWN OF NORTH ANDOVER "ISO" 9 \+ Certificate of Occupancy $ sACMus Building/Frame Permit Fee $ ? /0 1� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -sS• Check # 141,96 18976 Building Inspector M X 3 Z O TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING gg q ._... *1�.-. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �o Cd rtb 6�A 1r96) /def 3 1 Map Number Parcel Number ` `Information: J� 1.33ZZoning 1.4 Property Dimensions: 5Fb CA -A-00 NNf ) -30-7-q(. 7.5' Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide ReqtAired Provided R red Provided 1.7 Water Supply M.G.L.CAO. M) 1.5. Flood Zone Information: ZOne 1.8 Sewerage Disposal System: Public X Private ❑ , Outside Flood Zone Municipal X On Site Disposal System ❑ SECT, N 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: es No 2.10 er of Record pe LLC Cu rfoA 1;71-cAdyer M V4 Name (Print) / Address for Service Sig re Telephone 2. weer of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: - Not Applicable ❑ Licensed Construction Supervisor: License Number Address14 7 —7 6.35 Expiration Date 101-A S' tore Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Adlduess Expiration Date Signature Telephone M X 3 Z O t f - O U w O O F=4 O OQ 40. N V) a w a q � mm v 0 CD ~� a W I a W W C e_v D o o a a vs¢ o I i w W pq cn cn h • m 0 C- C O C c s o� x> y E a o o C D o Q r N ^�a „ o E c o� m �If `Nc �Q' cc CL E h ce 3 Om m y c c -m 'O N CD 0 cm CLU CD O O y - y O ID C: Z Ocm CD cm O= o&C-L o_c O y O C C Z o CLju CO2 a 01-- CD ' W c •� � _Go nz 5 z cco "r m ti O �O COD O F- �C O.t.. m ? �a a I I I O Q E mm OI 0 CD ~� �3 I C e_v D o o a a vs¢ o L O o Z c m C.2y ' O Z c p_ C40) Q c Q I CODO y CM ■� -0 O Q E mm CLCD 0 CD ~� �3 C e_v D o o a a vs¢ o c � c CL o Z c m C.2y c O c I C40) Q W U) U) W 19 W U) i � a I FORM U - LOT RELEASE FORM I INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does hot relieve the applicant and/or landowner from compliance with any applicable or requirements_ *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT M 1 k CzrrNp?1S LLC PHONE 1,78-�57 LOCATION: -Assessor's Map Number PARCEL 3 r' SUBDIVISION LOT (S) 3q STREET .vim -`ft Cvt �n 5T. NUMBER USE ONLY******** ******** RECOO�nENDATIONS OF T-QWN AGENTS: CO ERVATION ADMi COMM TOWN PLANNER COMMENTS 0) . FOO SEPTIC COMMENT DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED EALTH DATE APPROVED j DATE REJECTED UR -HEALTH OIC IS'EW E DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DR1VEW&Y PERMIT FIRE DEPARTMENT LE ENTER, I o VIA_ RECEIVED BY BUILDING INSPECTOR Revised 9197 jm The Commonwealth of Massachusetts Department of Industrial Accidents I fi 1, Al ,t„ Office of Investigations 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address City/State/Zip: Phone #: 7 `��� 7�Z�✓ 0 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 2.'R(employees (full and/or part-time).* I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. N New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I .❑ Plumbing repairs or additions 12.❑ Roof repairs I 13.❑ Other I. *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy, information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. I Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: I Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expi I I ration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveragp-vprification. I do hereby certify under th ains and pe /alties f perjury that the information provided Si nature: Date: 2- 4 Phone #:� F ` Z Y7—W " Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 6. Other Contact Person: Phone #: is true and correct. I I 5. Plumbing Inspector I T a �ip ze v� oon�nonu�ea�i o���a�%iuoe�Q BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS' 055417 Birthdate:- 04/05!1960 Expires; 04105/2006 Tr. no: 21033 Restricted: 00 THOMAS D ZAHORUIKO 121 CARTERFIELD RD ' N ANDOVER, MA 01845 ActingC mis oner Permit Number MECcheck Compliance Report Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename: Untitled TITLE: The Nantucket at Meetinghouse Commons CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 02/07/06 DATE OF PLANS: 2/07/06 PROJECT INFORMATION: Meetinghouse Commons North Andover, MA 01845 COMPANY INFORMATION: Meetinghouse Commons LLC COMPLIANCE: Passes Maximum UA = 477 Your Home = 447 6.3% Better Than Code The heating load for this building, and the cooling load if Design Conditions found in the Code. Abe HVAC equipr than 125% of the design load as spqeWed in Sections 789 �riate, has been determined using the applicable Standard -lected to heat or cool the building shall be no greater 1310 and J4.4. Zl I Date ��� Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1628 0.0 30.0 50 I' Wall 1: Wood Frame, 16" o.c. 2356 0.0 13.0 186 Window 1: Vinyl Frame, Double Pane with Low -E 379 0.340 129 '. Door 1: Solid 35 0.340 12 Floor 1: All -Wood Joist/Truss, Over Unconditioned Space 1628 0.0 19.0 70 Furnace 1: Forced Hot Air, 90 AFUE Air Conditioner 1: Electric Central Air, 10 SEER COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been desiined to meet the Massachusetts Energy Code requirements in MECchec Version 3.3 Release lb and to comply with the I mandatory requirements listed in the MECcheck Inspection C c ist. I The heating load for this building, and the cooling load if Design Conditions found in the Code. Abe HVAC equipr than 125% of the design load as spqeWed in Sections 789 �riate, has been determined using the applicable Standard -lected to heat or cool the building shall be no greater 1310 and J4.4. Zl I Date ��� 1 4 MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lb DATE: 02/07/06 TITLE: The Nantucket at Meetinghouse Commons Bldg. Dept. Use Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 continuous insulation Comments: Above -Grade Walls: 1. Wall l: Wood Frame, 16" o.c., R-13.0 continuous insulation Comments: Windows: 1. Window 1: Vinyl Frame, Double Pane with Low -E, U -factor: 0.340 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ I Comments: Doors: 1. Door 1: Solid, U -factor: 0.340 Comments: ] No Floors: 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R-19.0 continuous insulation Comments: Heating and Cooling Equipment: [ ] J 1. Furnace 1: Forced Hot Air, 90 AFUE or higher Make and Model Number [ ] 2. Air Conditioner 1: Electric Central Air, 10 SEER or higher Make and Model Number Air Leakage: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 clip (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: [ ] Materials' and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked oh the building plans or specifications. I Duct Insulation: ; [ ] ( Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. J Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as j specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runouts Circulating Mains and Runouts Tem erature ( F) Unto 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. NOTES TO FIELD (Building Department Use Only) Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 1 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) IJ1 I C 0 E E 0 0 on 4: L 1 In Oo 0 L o C Q ..G t 0 N bpop Q Q ip z ... 0 E 0 .G U C--� j C Q II \ N 0 O j Z u �Z;�� t Iro u - s -. I 0 i I I �Q o u. �s > I C c O � M N � � O m N I O 0 JL � c N al � c 0 b�J � Q— �_. N u u 0 I � I Q ; a- � N 0 0 i I I �Q o u. �s > I C c O � N � � O m N I O 0 JL � c � 0 � al � c 0 b�J � 21- �_. t zln� u u LQ) 0 L E I l v� Q L 0 E r 1 eo # C `� 0 64 \ Q r t 0 7 0 u � O l C 0 ro .0 u j 0 Q IE O I� II la0 \ 0 v w 0 �bt � z� j z I� G 41- O -h i 0-01 ' 4-h ' 6 , n -z,2 0 + � G 0 EO E U ]410 � Q 0 0 S + co o 0 �N z �oQo �Q +� 0 E 0 � V j (� 43 L O II W N C z 2 -C 0 �-z�� -Z UM QU V) O -h i 0-01 ' 4-h ' 6 , n -z,2 � fol [\ d M M �p Ln `n `n `n �C Ln � cc00 00 p0 CA Q00 V M© N 0,0 CO Cil 11 �G C� M O c rl �o r� �n Crl `(�+ ' p 0 c� 'v 3 cin Ati O 4-J G OD ° cn n nn nbD �� o 0 0 0 o 0 0 0 0cn Ln i i 111,Q L o 4� � o '- C 0 -a 0 0 E 0 Q r 1 �= C O \ 1 o z 0 bo d- o u o Q C o Q E0 o 0 al \ i vi 0 C ro Q NO uu Z s �.ZUj� 1-0r pr 10 J., h.)p 0 E E 0 4.3 41 n. 01) -1— a -qt S i 0 0 NQ 4� L 'fin 0 N � i o= C \ 0 Z �bjJ i Q � 0 C < � s c4 Z s C u U �I t Z 0 U 0 Date ..... 7 .. / . . 0, . ... ... .. . ... ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. has permission to perform ..... /Y&.w. ...... . ............................. wiring in the building ofj . .... '. , . ..... ...... ....... AIR ...... North Andover Mass. ...... Lic. No . ...... . ...... ELEcrRicAL INSPECibi ` -Check # d 1� Commonwealth of Massachusetts 1 -`^ OI'lic��i! lase Unly r.- 1 I Department of Fire Services Permit No. z A Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS i[Rev.9,05] Heave blank-) APPLICIATIOl N\ol-kto fNI `F�ORnlied � PERMIT TO PERFORM ELECTRICAL WORK ll e ith the-lassachusetts I:IeCUie tl Cudc (. IEC). 527 (AIR I2.00 (PLE,LSE PRIAT LV NK OR TYPE, ILL LVFOR.ILITION) Date: City or Town of: ( &�A-� t-3 -_ To the kip 'lot' a/ 6i�i� cis: E3y this application the undersigned gives notice of his or her intention to pertilrnl the electricalwork describ d below. Location (Street & Number) Owner or Tenant aA &�l f � � 7•t --� �'t'l�� gTelep hone No.6k Owner's Address ["� sj ✓� f?� l rpt!-rr�r�„�� l Is this permit in conjunction with a it? building permYes No ^� ❑ (Check Appropriate1Box) Purpose of Building Utility Authorization No. Gj j ZZ� Existing Service ;knips / Volts Overhead ❑ Undgrd ❑ No. of Meters, New Service Amps 1e)J `2 r -%Volts Overhead ElUndgrd E:9,1**�N0. of Meters' Number of Feeders and Ampacity — j Location and Nature of Proposed Electrical Work: WL No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers Heaters KW No. Hydromassage Bathtubs OTHER: Completion o/!hc frdluuint; !able Mov he waived by Ihe /nsneetotr o/, 6f?res No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool 'kbove ❑In- ❑ grnd. vrnd. No. of Oil Burners No. of Gas Burners No. of Air Cond. I otat Tons Heat Pump Number Tons 1 ............................... . ota s .................... Space/Area Heating KW Heating Appliances KW No. of No. of Signs Ballasts No. of Motors Total HP Transformers KVA Generators KVA iw- ut r.mergency Ligntnng Battery Units FIRE ALARMS No. of Zones r4o. of vetecnon and Initiating Devices No. of Alerting Devices �No. of Self -Contained Detection/Alerting Devices Local ❑ Nlunicipal ❑ Other Connection No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Equivalent �(/� Uluclt tciclitiotaui dhvail i/•clesireal• of as required ht thr Insyicclvr 0/ ll "irr:r Estimated Value of Electrical Work: (When required by municipal policy.) \kork to Start: 1,t (t Inspections to be requested in accordance with )vIEC 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 operaton” coverage or its substantial equivalent. T•he undersigned certifies that such cover141 's m force, and has exhibited prooforsanic to the permit is,:uin�J office CIiECK ONE: INSURANCE BOND ❑ OTF{[:.R ❑ (Spccily:) 1 cerlifj, under the pains and pentillies g1'perjuty, tont the infurnnrliun un tlri.� ftp/�licnliurr iv Irrsr nnrl rurtt/�lrle•. FIRM NAME: ,� LIC. I`O.:Mp�_ Licensee: /AA's�'��A—ice ;Signature /,t r;l;Itli, ,able. _t ter "cc;entJ l in !hr Grc n; rntrtbrr sine. Bus. Tel. No.: ¢Z--Zaq Address: �_(, (.d,[� vcJa+ S�►�t,� f�7 �� . Ait. Tel. No.:_)k 3% OSrG7� VSecurity System Contractor Lice se required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nal have the liability insurance covcra`ae normally required by haw. By my signature below, I hereby waive this requirement. t and the (check one) ❑ owner ❑ owner':; auyent. Owner/Agent ;signature TelephoneNo._ PF'R.ivtlTFF,.F. 4 &u2, Commonwealth of Massachusetts Department of Fire Services I Permit No. 011-1cial Ilse Only BOARD OF FIRE PREVENTION REGULATIONS 1[Rev-C 9pos)y �'tta,F�t b I: ked APPLICATION `ATION1 F�rnied rORPERMIT ll aCCOI'LlallCe I TO the ;` PERFORM ELECTRICAL WORK cats Llectical Code (: IEC). 527 C'\,111 12.00 lPLE; ISE PRINT IN LVK OR TYPE .ILL MoR.1 L ITIO),Vj Date: �j Z, IJ 104, City or Town of: � A10J 4 - — To the hr,vp to ��J l6'irc�s: By this application the undersigned gives notice of his or her ill to pertorm the electrical work described below. Location (Street & Number) Inn C n 1.1►, N �,Nd Owner or Tenant Owner's Add Telephone No. 6���j Is this permit in conjunction with a building permit? Yes LJ No ❑ (Check Appropriate Box) Purpose of Building kl�-5 t fd-CA- Utility Authorization No.�0a' Z, Existing Service Amps ! Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps t'��Volts Overhead ❑ Undgrd Q�o. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cum leliun u/'llte bllrnrin > I rhl No. of Recessed Luminaires " No. of Ceil.-Susp. (Paddle) Fans c e ntu,, e uuricc ?v 11e 14 ods No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA 1 ! No. of Luminaires Swimming Pool AboveElIn- ❑ o. o Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners -- --_' FIRE ALARMS I No. of Zones' No. of Switches No. of Gas Burners No. of Detection and i Devices No. of Ranges --Initiating No. of Air Cond. TotaTonal No, of Alerting Devices No. of Waste Disposers Heat Pump Number ............................................................... Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW � Security Systems:* i No. of Water ' No. of No. of No. of Devices or E uivalent Heaters KW: Signs Ballasts Data Wiring: No. of Devices or Equivalent . No. Hydromassage Bathtubs No. of Motors Total 1-1P Telecommunications Wiring: '� No. of Devices or Equivalent I OTHER: 43 . I nueh 1111dili0w( <Irlail ifclesirecl. or as required /W rlre losl;c•clor ul' II'ircc:; Estimated Value of Electrical Work: / `�dc- ( When required by municipal policy.) Work to Start: ti,�� Inspections to be requested in accordance with ;VI EC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner. no permit for theperlormance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivillent. I'llc• undersigned certifies that such CO% T'lly 's m force, and has exhibited proofoF:ame to thepermit issuin; office. HECK ONE: INSI..'RANC'E 110ND ❑ OFHER ❑ (Spccily:) I c•ertgjl, mider the pains rand penalties qf'perjrmy, that the inforlrruliun un this application is true and complete. FIRM NAME:6^-LCA. LIC. NO -:M 6496 Licensee:;cif;nature LIC..NO.:'� Z? YC u rl,�' n;l;liccrl.lc..rhr "e.:eml%I' in Nre tiro;: monhrriine.i Bus. Tel. No.: Address: _ � (,d,(1� vL1 5�-�i cG /�7 .t i� �'� t3iJE >�-�( Alt. Tel. "Security System Contractor Lice se required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nol have the liability insurance covcra�ae normally_ required by law. Bay my signature below, I hereby waive this requircnunt. I am the (check one) ❑ owner ❑ owner's agent. 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