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HomeMy WebLinkAboutMiscellaneous - 100 VEST WAY 4/30/2018Date .... 4 —16 — t,-,) '5 ............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ", 0 / .................................................. This certifies that ............... I ........... has permission to perform wiring in the building of ........ at./0-0 ...... ze�' ...... ............... North Andover, Mass. Fee . . .... Lic. No. ................. .......... ECM Check # I"" 0-i `70 10 _, Commonwealth of Massachusetts Official Use Only Permit No. Y/ Department of Fire Services a� Occupancy and Fee Checked �• BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC). 527C MR 2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Old City or Town of. NORTH ANDOVER To the Inspector o Wires: By this application the undersigned gives notice of is or her trite tion to perform the electrical work described below. Location (Street & Number) X �� y6t ttpA Owner or Tenant.P Owner's Address c'1AM { Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building �a7J/1,V r Telephone No. -"' No UV (Check Appropriate Boz) Utility Authorization No. Existing Service Amps / 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: (.(I &C anJ Al.4rm,?Aalo, 7, Completion of the following table maybe waived b the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above El'n-❑ rud. nd. o*o cy i ng Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers po Heat Pump Totals: . umPK e_. To.ns......... ..... o. of Sel - ontaine Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers r3 Heating Appliances KW SecuritySystems:* No. of Devices or Equivalent No. of Water KW o. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors / Total HP elecommunicahons tring: 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: L ;tl,� % CA /I 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 cov rage 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 enalties of perjury, that the information on this application is true and complete FIRM NAME: V t (I d LIC. NO.: p( ((J Licensee: Sly (i7t Signature LIC. NO.: (If applicable, enter "exe pt" in the license nun: er life.) 6 0 Bus. Tel. No.• - - Address: ll t`!eLIFE b©c% / �% Alt. Tel. No.: - /f *Per M.G.L c. 147, s. 57-61, s curity work requires D partment 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 PERMIT FEE. $ 0% Signature Telephone No. Location v (/ (&A'y No. Date TOWN OF NORTH ANDOVER �•7 L s Certificate of Occupancy $ ''<� Buildin /Frame Permit Fee $ '310 s�CHuBuilding/Frame Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6-17 b i 5 7 2 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Vii$ fbr i3ifiCil Use 40..77777 777 BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspect r of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ) ©q D Map Number Parcel Number i 7�k(�cs�J trot. 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R uird Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIUP/AUTHORIZED AGENT 2.1 Owner of Record A4r A.1� /oo VEST ,4V Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 4,ji Licensed Construction Supervisor:y/ / Address Signature Telephone Not Applicable 0 License Number d A9A 0 Eviration Date 3.2 Registered Home Improvement Contractor,,�� cll// e, & flee- %vc,,1ahC`_ otaeAydc Not Applicable ❑ !D 8 11ro Company Name t Registration Number Expiration Date Addres GQ2. Signature Telephone ou M X Z O r . SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s)V1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / / /J / J 7 %�l /Va_, �/GI.G'OL!/I9 4L q ck C_Ax",& s t k,?}Cuid"► 4. W9x40Y14REMOki 111uEllYDo1X91IM1II1119 YC17►[K7.Y1�� Item Estimated Cost (Dollar) to be Completed bv pen -nit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical Z ° ° (b) Estimated Total Cost of Construction 3 3 Plumbing $ C> O Building Permit fee (a) X (b) / O 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b_0WNFR/AU1#0RIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print —4. Si a ure of Owner/A ent Date l MEMENIML MM NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 ND3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS OF GIRDERS flEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Cf) m C m Cl) 0 m CO) 10 CD C Z CD O a r- d d d =. a� .� O o v a� Q =r -� CD O F---- N -. CO) CD O CA d O CA O CA lv C7 CD O rf CD a y CD CA CCD O CCD I F5 C7 V 1 C c?�om 2 .40 CT N EL- a y =tm n � Cl) (o0 -1 m Z "o,*c a = Sm Vi _•i S a •+ a c ao d G y a N N o 0 3E ?!� _ > OG y C7 Ath >t n S -OCD ca ao CL Z 5 a:.: co o CD CD m N = � C C d Ca N N CS E Q C C o O � � � a Nr.7 N co CD N tvCD .d—► N MCD o: Ci Er CD 0 O68 �� 0 Oka C=Dr N ♦ 03 o S; m'o c.'o C7 m C C3 C/) d U) o to 'ty a'- 'jd oFa -X p'- C/) ",l7 QQ Ci7 n r O 7d 71 w- 'Jd , r � w a� a a. C7� C w � ^ CL x o x 1 ft Omni 0 9 0 c CD ol North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) re of Hermit Applicant uate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name City 115 Phone # 22,6 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Address /D Z /4c4� s City A/101 �z cx Phone 2Aa Company name: Address City Phone * Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment.aswell_as_cbAI.penaftiesinsheinnn-d-a STOP WORK.ORDPR..aW-a fine of.t.$1-00m)ajday. Gainstme I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u5""pains and pen f of perjury that the information provided above a true and correct. Cinn��arc „/// �� Date / 9-2 Print name 1� U� �� /7`� Phone ,# S294' W Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept El Check if immediate response is required E] Licensing Board p Selectman's Office Contact person: Phone #: Health Department Ei Other 4 11,19 , Date.. r OR 14 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... 4/1 G. ..... �±4C� 0 ..... .... 6) ............................. hal. permission to perform ...... ().Ll ....... ............................. %l ng in the building of .......... 4 .................................................. at ........ U......(. (, ... ............. . . North Andovppmass. Fee 6 .. Lic. No. ......... Z ' E EL CrRICA eN�S�PECTOR LEmic Check # 3" Carnnionwaallh o` l�adda77c�cudat'� ..LJsParinunt o`�trs JarViCad BOARD OF FIRE PREVENTION REGULATIONS Offs ' I Use Ona%�� Permit No: Occupancy and Fee Checked Rev, 11/99) loave blank) APPLICATION FOR PERMIT TO PERFORM'ELECTRICAL WORK All work to be perfornud in accordancc with the Massachusetts Eluctricnl Code (MCC), 527 CNIR 12.00 (PL EIISE PRINT IN INK OR TYPE;ILLIYFP •1170N) Date: % ©� Z/ .2— U City or Town of: tf N_ 1/tG To the Inspector of Wires: lay this application the undcrsigned gives notice of his or her intention to perform the electrical work described below. Locatlun (Street & Number) , ®D VES ` L,_J - Otvner or Tenant jrrvtyFT��2L tsiyC. Telephone No. Owner's Address S Prrnti4 r Is this permit In conjunction with n bullding pernill? Yes ❑ No- '❑'— (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Servicc Amps / Volts Overhead ❑ Vadgrd ❑ No. of Meters • New Service Amps / Volts Ovethgad ❑ rJ Und g ❑ No. of Meters•. Number of Feeders and Ampacily Locations and Nature of Proposed Electrical Work: i Completion o_(rhe following table may be iralml br llle /n,,aector of lVires. No; of Recessed Fixtures No. of Cell.-Susp. (Paddle) Fates f Tal 'transformers KVA No.1of Lighting Outlets No. of blot Tubs Cenerators KAVA No, of Lighting Fixtures ove n- Swimming Pool rein. grnd. ❑ No. _61 mergency L g i ug Battery Units No. of Receptacle Outlets No, of Oil Burners FIRE ALARIYIS No. of Zones N-675TITetection an Initiating Devices No. of Switches No. of Gas Burners No. of Ranges Total No. of Air Cont. Tons No. of Alerting Devices \o. of Waste llis ogees P eat Fu nip Totals: unr er ons o. o c - onta nc Ve(ectloill(Alertlng Devices - `tu. of Dishwashers Space/Area Heatlitg KNY Local ❑tyl-ullicipal ❑ Other Connection No. of Dryers Heating Appliances W SecuritySystems: No. of Devices or Equivalent a u. o r NVatero. Healers K�V o t o. o Sl„tts Ballasts Datn Wiriug: No. of llevices or E uivalent No. Hydromassage Bathtubs No. of Motors Total lip a ecommun cat ons r ng: No. of Devices or E uivalent OTHER: , Arrach additional derail tfdesired, or as regnired by the inspector of Wires INSUR-kNCE COVERACE: Unless waived by the o}vncr, no permit for the performance of electrical work htay issue unless the licensee provides proof of liability insurah.ce including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof ofsame to the permit issuing office. CHECK ONE: INSURANCE OND CrOTHER ❑ (Specify:) k�)gPf�CNN�dio %Z �) Q Z l (Expiration Daie) Estinmted Value of Electrical Work l (When required by municipal policy.) Work to Start: / Ll) / o Z---ltupectiotu to be requested 'ui accordance with MEC Rule 10, and upon completion. / certifj•, ander the /rains nnrl penalties of perjury, Nutl the Information on this applicallon Is trite and complete. FI101 NAN-IE: '%C A N �� � �a LIC. No. Licensee:yS(fP/,/ /� , 'j /l frr►w@ Gv4 ;r Signature 67j7JAY41. LIC. NO.: D, a (tf opplicable. enter '•C.renrpt "ill the licence number idle.) As. Tel. No. - Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nol have the liability huurance coverage normally required by law. B,• my signature below, l hereby waive this requirement. 1 am the (check onc) ❑ owner ❑ owner's Owncu/A�cnl 513RHIT FEE: ,S Si;nanure '1'cicphuucNu. ROUGH MUL Location �� �' q "T8 Date No. q� r NORTq TOWN OF NORTH ANDOVER F?O• t, `•D I•,hO 9 Certificate of Occupancy $ . Building/Frame Permit Fee $ • o� � ,? a ��'°'••� '��' Foundation Permit Fee $ sS cMust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ � ` J Building Inspector 2 � / � 7 �$1/02/98 09:02 117.40 �" ' � Div. Public Works Location No. Date ' - ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ - Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 117 .: f . r ter.! i. Building Inspector Div. Public Works _ s SIS LA n r 7 ti 0 0 I L a Z ,.. rt, _ to rr > _ z .; V ? ✓ 7 _ 7 c N Z r t av O I O\ Z a Q � r� Z Y sZ VZ., z z _ � N 0 'L w n z IA ✓. LA n r 7 ti 0 0 I L a Z ,.. rt, _ to rr > _ z .; V ? ✓ 7 _ 7 c D N r Z r t av O I 2 Z � Z Y sZ VZ., z z _ � N 'L w n z IA ✓. 0 7 r, r �I i �i - z r LA n r 7 ti 0 0 I L a Z ,.. rt, _ to rr > _ z .; V ? ✓ 7 _ 7 c D N r Z r t av O I 2 Z I I Z VZ., z z r N 'L w n z IA ✓. 0 �I �i n �I x N n 77 I N W rrAA V' I t 1/v .i CO) � z CD O ar CMCLd O � �• a� O av CL Q CD O CZ O to CD O COP) 'v CD O 0 CO) n� C O C CA Er Cl) CDO •f CD CD y� CD CA CCD O CCD 0 P 007 C w� m 0 C �� O d �. y O Q y aO�m .0 N� aO m n y0aC , m M= g.O y -1 °' �: CD y a?d o_ m CA C* o C. o,a_� 0 O y, ='nG1 0 CL Y-446 O =r CD m H w 1, CA CL Ap y C W a �m C � m y -9 CD G = CD W O o CD ,..: X0:7 aCD 3 CD y o_ W d m CL= C.) j� o: c."9 o o: o = CD' m r cn 3 0 p cn tt-DD rt M 7 d rfl z 7. °= a OGC a w W' o pGp ir7 n ?'_. o pip n? (� o C O d 'b N o O %C r r yo.. a Ct A) 0=3 0 0 c I i _ _ . .. .. l _. __. _ .. i . 'rr 1Y1�1,� f-i0C1�jN %. "I -,.- -;4 J u i Date ..Z.. �... .. ... r .... . ,NORTH TOWN OF NORTH ANDOVER pba a° Ie,nL p PERMIT FOR GAS INSTALLATION This certifies that X ::.:` ...... T......r ....... ....... . has permission for gas installation ....r.. - ......................... in the buildings of .:..... ............................. at............. North Andover, Mass. Feer :....... Lic. No�� :,I,s .... .... '.................... . 12/10/98 13:45 15.00GAMgPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION -FOR PERMIT T DO GASFITTING (Print or Type) A�©/�-L� , Mass. City, Town Building ����� (1� AT: Location Date t./2 _ L? 19 Permit # Owner's Name-P,���iN J✓U/�� Type of Occupancy: Y/I/S)Al New❑ Renovation Replacement 11 FIXTURES Plans Submitted Yes ❑ No kp (Print or Type) Installing Company Nam Address (1 1 L_ Check One: Certificate Corp. D Partnership 0 Firm/Company Business Telephone d_ Name of Licensed Plumbgr or asfitter I hereby certify that all of the detail 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 Massachusetts State Gas Code and Chapter 142 of the General'Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have current liability insurance policy to include completed operations coverage. 1:1 master ❑Journeyman AGasfitter Signature of Licensed Plumber or Gasfitter License Number ■■■■■■■■■■■■■■■■■■■■■■■■■ (Print or Type) Installing Company Nam Address (1 1 L_ Check One: Certificate Corp. D Partnership 0 Firm/Company Business Telephone d_ Name of Licensed Plumbgr or asfitter I hereby certify that all of the detail 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 Massachusetts State Gas Code and Chapter 142 of the General'Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have current liability insurance policy to include completed operations coverage. 1:1 master ❑Journeyman AGasfitter Signature of Licensed Plumber or Gasfitter License Number No 0 0 Date.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING D./I z C ............................ This certifies that ..... I ...... has permission to perform ....... .............................. wiringin the building of ................................................................................... ,#at .... ......iX ..................... . North Andover, Mass. ( . ............................................................... 'Fee .... ?,I� .. ...... Lic. No..L.....5. / ) /-/ ELECTRICAL INSPECTOR 11/24/98 08:40 35-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ii Rough Service Final I, 014r (fam 1 unwralt4 Of MBBBSthII us Office Use Only MEOW 7 Department of Public Safety Permit No.� / T) . BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy d Fee Checked 3/90 cleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed to accordance with the Massachusetts Electrical Code, 527 CMR 12:00 7 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oat- G City or Town of &10017v Aim Lec To the Inspector of Wires) The undersigned, applies for a permit to perform the electrical work described below. Location (Street & Number) IdVo ej� G" � Owner or Tenant Owner's Address Is this permit in conjunction with a but ding permit: Yes No (Check Appropriate Box) Purpose of Building �_ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters flew Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work E6Y4TGLt!C�GbM OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO ❑ 1 have submitted valid proof of same to this office. YES U NO [J If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work ,$ Work to Start � Z� �a Inspection Date Requested: Signed under the penalties of perjury: FIRM NAME ---- OP/JD. Rough //- '?C/— //— — Final LIC. NO. / Licensee Signature � LIC. NO. Address _ _ a�� Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware thatthe Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures A ve In - Swimming Pool grnd. 11rnd. ❑ Generators KVA No. of Receptacle Outlets t!// No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets / No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Conditioners Tons Initiating Devices of Sounding Devices. Heat Total TotalNo. No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices Municipal Local❑. Connection ❑Other +y No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. or No. of Low Voltage No. of Water Heaters KW Signs Ballasts J Wiring No. Hydro Massage Tubs No of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO ❑ 1 have submitted valid proof of same to this office. YES U NO [J If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work ,$ Work to Start � Z� �a Inspection Date Requested: Signed under the penalties of perjury: FIRM NAME ---- OP/JD. Rough //- '?C/— //— — Final LIC. NO. / Licensee Signature � LIC. NO. Address _ _ a�� Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware thatthe Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that........ ........ .f..6 ..................... as permission to perform .......................... .......... �K 3Yiring in the building of ........ . ....................................................... at ......1 AP ..... North .7A ;dovass. Fee... Lic. No4.13.. .. .i.......................... 7�ELECTRI�AL ;PECrOR Check # � TBE COMMONYVEALTHOFMASSACHUSETTS Office Use only DEPAR7MEAToFPUBIICS4FElY Permit No. BOARD OFFIREPREVEMONRBGULAHONS527CM12W — ? Occupancy & Fees Checked APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS 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 described below. Location (Street & Number) /00Owner or Tenant PFj Owner's Address V U Alo Is this permit in conjunction with a building permit. Yes No (Check Appropriate Box) Purpose of Building �`� [ll, Utility Authorization No. Existing Service Amp �Volts Overhead Underground � -- �' No. of Meters New Service Amps / Volts Overhead Under mound --�-- g No. of Meters Number of Feeders and Ampacity Locatiorend Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs I No. of Transformers otal No. of Ligltiting Fixtures -^ Swimming Pool Above Below KVA v Generators KVA round round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS Tons No. of ZonesL�4 No. of Disposals No. of Heat Total Tota! Ne. of Detection and , Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices i• No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal � Other----�� No. of Wath A{o. of No. of Heaters K Connections ns Bailasis No. Hydro Massage Tubs / No. of Motors Total HP OTHER• imuarloeCowraW Rust utttodyere�trirartays�GenaalLaws haw aomentLiablltlyhmlrarePbhcymchAgCornp wWOrris s"Wrilalequivalait YES © NO havesubrmt�dvafidproofofsarnetotheOlhM ITS ED�� FyouhawcheclDdYES,plea9ein�ethe ofmverageby heIgttte ' box %URANCE BOND OrIBM ftaTSpmi1y) F rl�en ibtkto Start hq0c6onD&RaVeqod gned under'& Fbiakes ofpaW RMNAMF EshrrWdValueo()~bmcalWork $ Rough /f 0;70A) Final 1 01- Ed M01 ATUE'SINSURANCEWAIVER;Iamaw&ethattheLiotsedoesUba, IdWmysignahueondmpaMapphcahttrisrt�gtl mrnt lease check one) Owner Agent 0 Signature of Owner or gen Alt Tel No. go �. I. WIN _ Telephone No. PERMIT FEE i