The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 1010 JOHNSON STREET 4/30/2018 (2), Location No. -/J Date TOWN OF NORTH ANDOVER s Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 5 `� 16;0 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING uls Or tl►ii>I; Use C1tisl BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioneffl for of Buildings Date / SECTION 1- SITE INFORMATION 1.1 Property Addr s: 0 1.2 Assessors Map and Parcel Number: iv-7 - P- 01 Map Number Parcel Number 1.3 Zoning Information: Zonis District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided ReWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record i ,. KA 0,,,_ Name (Print) Address for Service: 1-5000 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: U VC"-S� Licensed Construction Supervisor: —P O C� / ?> -7 fL, a Address �C -1 6 Yom` 7 S Signature Telephone Not Applicable ❑ Q5-6 License Number /U Expiration Date 3.2 Registered Home 1% rovement Contractor Not Applicable ❑ / v �C:2 <0 Company Name e' G / 3:�2 Registration Number Add s Expiration Date _ t nature Telephone T M X Z O v n m c 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 altapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s)Addition ❑ Accessory Bldg. [IDemolition ❑ Other ElSpecify ` Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I .L. Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICW USE ONLY.. 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) Y (b) c,1 7 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, C W , as Owner/Authorized Agent of subject property Hereby authorize bosu ' to act on My behalf, in all matters relative to work authoriz by s building permit application. IS 13,10 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, u � 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 V`]>,.r Print me T Signature of Owner/Agent Date 1! 1 1111111;l I NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 RD SPAN DINIENSIONS OF SILLS DINIENSIONS OF POSTS DIN ENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 NOTICE EMPLOYEES NOTICE m EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES ------------------------------------------------------------------ NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD,- CT 06183 ----------------------------------------------------------------- ADDRESS OF INSURANCE COMPANY (7PJUB-73OK535-4-02) 02-17-02 TO 02-17-03 ------------------------------------------------------------------ POLICYNUMBER EFFECTIVE DATES ARGEROS INS AGCY INC 360 MAIN STREET READING MA 01867 -------------------------------------------------------------------- NAME OF INSURANCE AGENT ADDRESS PH0NE DUVAL, KENNETH P DBA 420 IPSWICH RD DUVAL ROOFING BOXFORD MA 01921 EMPLOYER ----------------------------ADDRESS------------------------- ------------------------------------------------------------------ EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the ----------- ---------- NAME OF HOSPITAL AD ---..--..------ — ----D--- RESS ——— — — —.-. -- -- •--- ---•-- — — — —— -- — --- ` — — — —— TravelenProperty Casualty 002752 W201311-1195 .-.Tiawle sGmup The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. EZ----' 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. (_mmnanv namp��^� Address -3 rifir-Flit cG i ,�q Phone Tt/ 13 73 d S. Serio a, 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.as weU_as_civiLpenaltiesin-thelom4-a-STOP WORK_ORDER-md.a.fine af�.$1-0100)-a AMKjainsi.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of penury that the information provided above is true and coned. ,b2 /31/07 Print name J UY P_hone.# Official use only do not write in this area to be completed by city or town official' City or Town PermitlLicensing. Building Dept E]Check if immediate response is required [] Licensing Board p Selectman's Office Contact person: Phone #. E] Health Department El Other 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 dis sed of in: -A7L-S pyo Facility) Signature of Permit Applicant 1 110 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Page No. of Pages Builders License # 58443 Home Construction Reg. # 109288 ® / l.J AL OOHNG CertainTeed/Certification # 1911 F P.O. Box 637 / 184 Park Street GAF Certified Master Elite ® COLLLCTIO No. Reading, Massachusetts 01864 F•'dcl (781) 944-1994 • (978) 664-2557 vBAT 1�` PROPOSAL SUBMITTED TO eoNE-2 `// fF, 61 DATE ? ST¢E T /) s JOB NAME CITY,. STATE AND ZIP CODE J JOB LOCATION !.i c. v t ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) !• Rip & Remove all shingles & debris from roof & job site 1 layer 2 layers ❑ 3 layers or more L*-' Repair/ or Replace any roof decking if needed; not to exceed 50 sq. ft. Install aluminum drip -edge and rake -edge over entire perimeter. Choice of miK,.white or brown .�.- Install ICE & WATER underlayment - Installed under lower courses of shingles as a water tight shield between roof - deck and shingles; self-sealing around nails and deck joints for maximum protection/ W.R. Grace or GAF Weather Max r #30 Atlas–Premium Asphalt -base underlayment or GAF Shingle Mate Install choice of 25 year CertainTeed, GAF or Tamko roof shingles, traditional 3 -tab ❑30 year � Install choice of 30 year CertainTeed, GAF or Tamko Architectural shingles / random - shake ❑40 year ❑60 y a t�9- Install new vent pipe flange(s) • Chimney – Rip & Remove old lead flashing – install new lead flashing V Chimney – Re -step existing flashing, counter -flash if necessary Install Cobra 40 year / shingle; ridge -vent • Install soffit -ventilation • Seamless aluminum9 utters • Aluminum downspouts Other Price includes all items above that are checked only / others may be priced separately upon request. *Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off e Proposehereby to furnish material and labor — complete in accordance wit" above specifications, for the sum of:. Total price not including options. dollars Payment to be made as follows: 30% deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P ,. Box 637, No. Reading, MA 01 Author+zed Signature. __— Note: This proposal may be `% _' l withdrawn by us if not accepted within `1) 0 days. (`ICCPttMYiCP iiixLt053a1 — The above prices, specifications Pp and conditions are satisfactory and are hereby accepted. You are authorized to Signature do the work as specified. Payment will be made as outlined above. ` „ Date of Acceptance: __._ __ _--_. Signature ~ ✓�•e La9)G7h(i�lP(1{(JL a�✓��trk7acitc[ae�i4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Lit Number: CS 058443 B i rthdate: 12/10/1966 Expires: 12/10/2003 Tr. no: 9505 Restricted: 00 KENNETH P DUVAL PO BOX 190/72 NORTH ST N READING, MA 01864 Administrator ✓1;e Co97 mo.,wAea dt, a i�7rtlQ3Cl.!•!t(l4P.i�6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 109288 Expiration: 9/9/2004 Type: DBA DUVAL ROOFING Kenneth Duval PO BOX 190/ 72 NORTH ST N. READING, MA 01864 Administrator Ri71 W S H c c �a� c ma C � N O C 'r O v V CLC R � s o o Cc 0 Q CD C �0. O. N O = O V r0CD„ O C NCD W 4 O 'C3 cm CD N J C C m Cc N CO N o aV ` y o m i � � O 'O C� o fJ y O W C Z C O O ts CL !7c = o r o F- w y o H W C t LL C2 •ca N �dt O C •� t7 C _V cm O oC O. OO� Cc c O E d N t N O N C O 75 m o C: m m O , m c 'c N 0 O Z O O F. CO z 0 w w P-4 L-91, co O co L O v Z co CL O h c: I O co CO2 co '9 m CO CD CD CD CL CD 3� CD L CL C- CM < 0 C V �O 'O •a. O,� CO) Z CD C2 CL V y � C C •0 _cc CODQ. 0 0 V) Ir w W CO ocoW O w U v cn ° U z p w .� w G U x w � ►-� .� w r, w w .� w v crU v� co w x p z w' w z A w r� z cn cn W S H c c �a� c ma C � N O C 'r O v V CLC R � s o o Cc 0 Q CD C �0. O. N O = O V r0CD„ O C NCD W 4 O 'C3 cm CD N J C C m Cc N CO N o aV ` y o m i � � O 'O C� o fJ y O W C Z C O O ts CL !7c = o r o F- w y o H W C t LL C2 •ca N �dt O C •� t7 C _V cm O oC O. OO� Cc c O E d N t N O N C O 75 m o C: m m O , m c 'c N 0 O Z O O F. CO z 0 w w P-4 L-91, co O co L O v Z co CL O h c: I O co CO2 co '9 m CO CD CD CD CL CD 3� CD L CL C- CM < 0 C V �O 'O •a. O,� CO) Z CD C2 CL V y � C C •0 _cc CODQ. 0 0 V) Ir w W CO Y' Gi 4e (fammanwealtr of �oar4md o 't � -'Eeparffittnt of'Puhl-tc —*afdq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only L l Permit No. ✓ �% Occupancy & Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 6-1 8-9(0 Q )I or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1 O I O �l Ohitjz 1J t Owner or Tenant Na ft RS C00)CS 0hl SA -nn e Owner's Address Is this permit in conjunction with a building permit: Yes _ No L- (Check Appropriate Box) Purcose of Buildina of Switch Outlets Utility Authorization No. Existing Service a 0O Amos I ZO / 230 Vets Overhead Undgrnd r ' No. of Meters New Service Amps —� Veits Overhead _ Uncgrnc r No. of Meters Number of Feeders and Amoacity 2, At- SEE CA311- IN 1)-/i PVC �f�s �OrJrif%f� No. C Wet:TI�)G- IDOA,titP- Pr-IJrZ. lJ4 MDg/Lf- SME Location and Nature of Proposed Electrical Work No. of Sounding Devices jXIST c_ HDd�rc 5r-2VICcDoe 7?) r-1f2E //v rl afi,:� -- L=F12 i' r_[ otjL No. of Lignting Cutlets No. of "ct -.:-s of Cishwasners i No. of-ansformers IKVA Accve.-- In - No. of Lighting Fixtures i Swimming Pcol grra. _ grnc. _ Generators KVA iNo. of=mergency Lighting No. of Recertac!e Cutlets No. of Oil curners _ Battery Units No of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Cetection and No. of Ranges I No. of Air Cone. tans Initiating Devices No. of Disoosals "eat Total I No.of Pumcs Tors iotat KW No. of Sounding Devices Vo. of Self Contained No. of Cishwasners i SoaceiArea Heating KW Oetec;:oniSounetng Devices No. of Dryers Heating Devices KW — Muntcioai Other Local _ Connec;:on _ No. of No. of I Low vcttage No. of Water Heaters KW ! Signs Saliasts Wiring No. Hvdro Massaqe Tubs i No. of Motors ,brat HP OTHER: No HbvsC w11z42 7b Ac POZ60"t� INSURANCE COVERAGE: Pursuant to the redutrements of Massacr.useas general Laws _ I have a current Liaotiity Insurance Policy inctucing Comc:etec Cceranons Coverage or its substantial ecuivaient. YES ,r NO - 1 have suomtttea valid proof of same to the Office. YES X NC - if you have checkea YES. clease incicate the type of coverage ey checking the approortate oax. INSURANCE A BOND - OTHER - (Please Scec:fy) (Execration Dater Estimated Value of E'.ectncal Work 5 Work to Start -T o U t -- Insoec;ton Cate Recuestec: Rough Final 6-19- `lO Signeo uncer ;he Penalties of perjury: A)) j`� FIRM NAME 2 ' LI ' L - CS LIC. NO. Pr-� S HAFLL- Si azure L 23391 Licensee gr. LIC. NO. _.�--- r� n F� Bus. ;et. No. 1 -pod Y& N"of03_ Address V. C) - -goy 6v Woa 1) I dO ( Alt. :el. No. - O OWNERS INSURANCE WAIVER: I am aware that the Licensee eoes not nave the insurance coverage or its suostanitai edutvalentt ente- ducrea by Massachusetts General Laws, and :hat my signature on .his Lerma aopltcatton waives this reautrement. Owner 9 (P!ease check one) Tececnone No. PERMIT FEE Sb,�� Signature of owner or Agent) x'6067 2452 y Date.. TOWN OF NORTH ANDOVER cm PERMIT FOR N�STALLATION rA This certifies that . �......... has permission for t ruN to latio in the buildin s o t.. .......... at d"� l � . ... . ! ......... Northtnd:�®r,�S- Fe !J /-20/kjc i2,�(� .. ........... CTO ........... 7 1`J. 00 PAID INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Office Use Only _ The Commonwealth of Massachusetts 61 Department of Public Safety Permit No CW! i4i WEs__ - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy a Pee Checked '�,• �r 3M (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be ZNr 'rmed ie aoeardana with uw I4meou"m Secnleal Cade. 527 CUR 12011 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date City or Town = 4% t- — To the Inspector of Wires: -The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) / 0 !/�0 v 7-r /U `SQ � S �' 1 Owner or Tenant fi o Bea T- � � 0 0 % S' 0 /v Owner's 'A- 6%/s0 a-0-0G2-64�/.6 P90 Is this permit in conjunction with a building permit yes ❑ no ❑� (Ch ;k Appropriate Box) Purpose of Building Utility Authorization No. Existing Service A.mps_I Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps, / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Location and Nat e of Proposed Electrical Work W IRE -/9/9 OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policyi luding Completed Operations Coverage or its substantial equivalent. YES 0 NO 0 1 haave submitted valid proof of same to this office. YES U NO 0 It you have checked YF7S, 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 Starr NU (/ "L C Inspection Date Requested: Rough Final Signed under the penalties of perjury: �1 FIRM NAME SCJ `Z G - a S'1` `/ N y e LIC. NO �- Licensee �s�4AJ'C Signature.,jOevi—,z—o UC. ' NO ry Address / '0-9 T + [ j�1'%Tj '.S 61r � 7 Bus. tel. No G ,3 - %7 �-.� Alt. Tel. No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this applicatlon waives this requirement. Owner Agent (Please check one) ; y Telephone No PESMIT FEE $ (Signature of Owner or Agent) TOTAL No. of lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In ❑ ❑ No. of Lighting Fixtures Swimming Pool gmd. grnd Generators KVA oe'va(C No. of Ettergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets 1 No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and TOTAL No. of Ranges P A No. of Air Conditioners TONS Initiating Devices No. of Sounding Devices HEAT TOTAL TOTAL No. of Disoosals No. of Pumos TONS KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area Heating KW Municipal ❑ ❑Other No. of Dryers Heatin Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Winn No. of Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policyi luding Completed Operations Coverage or its substantial equivalent. YES 0 NO 0 1 haave submitted valid proof of same to this office. YES U NO 0 It you have checked YF7S, 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 Starr NU (/ "L C Inspection Date Requested: Rough Final Signed under the penalties of perjury: �1 FIRM NAME SCJ `Z G - a S'1` `/ N y e LIC. NO �- Licensee �s�4AJ'C Signature.,jOevi—,z—o UC. ' NO ry Address / '0-9 T + [ j�1'%Tj '.S 61r � 7 Bus. tel. No G ,3 - %7 �-.� Alt. Tel. No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this applicatlon waives this requirement. Owner Agent (Please check one) ; y Telephone No PESMIT FEE $ (Signature of Owner or Agent) TJ 4- 597 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ro This certifies that ......0 C. v.k. :. -T ...... P'. I * * has permission to perform ............ ........... f:F1471 -0 wiring in the building of........ ....... co.!�A.�!�� ...................... °R lo ......... ...... :�f .......... North Andover,M at Fee ............ G�4LEMICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer LL,0-� Location / No. Z,!;�! Date C „°R7M TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ -f)i]Ar Permit FPP �l Sewer Connection Fee Water Connection Fee TOTAL 06/20/96 11� 25.00 ppjp 9030 H "Building Inspector Div. Public Works np N ? C7 O u Z n Z m c s y m ZJ r m n m r�r > n i z > A g� 3 N o co c r > > > A °Q s n A A p p A 6N w L A ,J) A' .r p 00 "4 m m I b O > Z r w I m A r r m c w > c> D m D m ;> D w ; > n i z > A N 0 0> 3 N o co c r > > > A m A s n A A p p A -� n-ni L A Al p p 00 "4 m m I b O > Z O cre r r - f C) A > A; > c c a N i 0 h. V o b i A A m � � tori rn c r 0 C 1 1 1 1 t 0 0 H c o p z z_ C n 0 0 - - � Z Z r o° 0 c 100 i W ZI� Z ° 0 m o zi m 0 C -47 1 m > L1 m c c r D m z � N Z a tl l w I m A r r m c w > c> D m D m ;> D w ; > n i z O 2 Z 0r N 0 0> 3 1 o co c o o o'" n n A m A s n A a -� m L >D p p 00 "4 m O I b O > Z cre n O w f r N > A; ' N i 0 h. V o m � � tori rn c r 0 < m °c 1 t p H t o p C � r 0 100 ZI� ° 0 > L1 a c m l I II ce C m C m C m C 3 m m x/ i D A m Z m A m R Z v y N r r p i N � rZ 'OI m • N m D 6- m CzzzzI if O Gl O 0 Z m r 0 i 0 0 y, o f n 0 0 Z w 0 Z m o 22 2Om i r n ; 2 p C 0 i p e ' y w m r a m r m o 0 0 n 0 m z y N m z p 0 0 0 0 0 0 0 0 r N - Q 2 m > i � * A D 1 m _ > r z r A z > > Z 0 > - A i A A D w m N A O r 2 A x i x n D , t -i m X 2 m r m to 1 G D 1 0 i t 00 m U.tri W z ID WW UI < OW( Z Q� I I �0 ^I 1 1 1 1 1 1 TI FFFTTW _a ❑I - Z z -Z a V �o 005 z H o O o 0 a:E 0 ono a.ja U z5N — u M IL z JJ f WOa BZW <z� W W 0 �W 30U Ora U N LL)W W a. IZ] ZQN 0 U F- Ln UW WZ . U) I N M Ou < HJ= i U a Z 0 V 0 W z ID ^I ( I I I IT < OW( I I I I O Oi ^I 1 1 1 1 1 1 TI FFFTTW I 8 v V `a _ Z 8 0 oz= - W Da W O O a s � a V �o < Q V.SY m< Z Z z H o O o 0 a:E 0 TT <.n L U Z ax>c� O�Q p N> a a Z r Z _ Z V 0< v ` OIz 2 D ee a xU< S= :E� a 0^ = ur-1 TTT u z 0 U Z O Z o '0, IAzoliI = M -000 Z D < OW( V �? T illli� O.nOO n 0 N II[ 0 O O H 0 <.n L U YUZ IaO Z W m = N ? Tai n n W U.n.n < vo:E3pv�2 << — S JK dens<oc �o�� 0- WuVi pS Z < = < OW( V �? T illli� n 0 N II[ . OJ O O H fyg r m $ o COD 10 CDZ O O Cr CO fl. n� .0 O O41) p CL cr CD O .. a: to O cm CD O CO) CD O 7 Lim sm O C7 CD O CD CDa vi" CD CA 0 O cc o 1 6— Q �. y O Q N a O m m N m n m C± O C H CJ a C) Z � CD CD aid o m CD .'.� O O H O -� N o m CDCD _ c em7 cwj O C y. W m C CO) G n p O co a CD CD c H :� CL C Q. m . CD O N f O = N H a C d c H �CDca C', h = y H 1 W CD 07 N W C) T ^'C2: ** O cn 0 d rt ccn o ay d acn n�i �z C � n H n! w cn �+ C rte" n O n? m 7z C: C r" z � m n T fDe �z 0 C 11 C o. C r' C7 � cn D C CD al O 7C a ro a p7 x H 0 A A 2, CL 0 c CD I. ¢lt\ Office Use Only uhP C�AmmAIi11IPal h A� a55caihU5Ptt5 Permit No. i3i'Va tmart Af Ilublir 2-IIfrtt1 Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank) lilp",`2 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 ( ) PLEASE PRINT IN INK QR TYPE ALL INFORMATION Date CF'ye - T City or Town of /� c"t7'k 4"4_1`10-� Lvt io the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) /0/0 L,7_-yA N S /TJr Owner or Tenant ked e. &-T eto/CS ave Owner's Address S rt,_"" -e- r-- r-� Is this permit in conjunction with a building permit: Yes ❑ No 9 - (Check Appropriate Box) Purpose of Building 2 e S r Irl/ QAC -e- Utiii'v Authorization No. 7 b 6� 7,5 Existing Service 2 0'0 Amps 1201 P-40 `dolts Overhead � Undgrnd ❑ No. of Meters New Service adv A Amps 120 / 2,"G Volts Overhead ❑ Undgrnd No. of Meters Number of Feeders and Ampacity 'r71 /C Location and Nature of Proposed Electrical Work R P) < < �" �` i 5 i i f�(Y dv e r2(A e. Va.- d S ee,- r -t �P_ 7'v u h C1 e. .4 No. of Lict:ting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures I Swimming Pool Above, - Inr--. grnd. grnd. Generators KVA No. of Receptacle Outfets No. of C:i mourners No. cEmergency Lighting Battery Units No. of Switch Outlets ( No. of Gas Burners FIRE ALARMS No. of ?ones Noof Detection and Initiating Devices No. of Sounding Devices No. of Self Conu;,ned Detection/Soundine Devices Locali Municipal OOther C Connection No. of Ranges I No. of Air Cond. Total tons No. of Diecosals I No.of Heat Total Total Pumps Tons KW No. of Dishwashers I Space/Area Heating KW No. of Dryers I Heating Devices KW No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirer-ents of Massachusetts general Laws I have a current `lability Insurance Policy includin Completed Operations Coverage or its subsea -tial eauivalenL YES O NO O 1 have submitted valid proof of same to the Office. YE -S C NO C If you have checked YES, piease indicate the type of coverage by checking the apprcoriate box. INSURANCE M--60ND O OTHER O (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough fI C N-tI Final Signed under the Penal tie-s�of perjury: FIRM NAME W 'TA,A %& "° 2 2 i JtJ C . LIC. NO. l 3,5-9 Z Licensee Signature A rl LIC. NO. 1 3,QZ — (1 ��AlBus. Tel. No. l5 0 IP- (0 0A Address 2 1 ,%4 rzl <.. S SZ A • -%h d�'ot Alt. Tei. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x6565 1154 Date .....,/.,�.%. /....rte.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �� t!.!! G. ........�.0.(.......................................... .................. <� has permission to perform ..... ,�.i'..r.?...c1.�.c.!'........ . ..:l..r..... j� m wiring in the building of ............................. at ..... .......51............. . North Andover, ass. " Fee. : ... Lic. S.L� ........ nG !........`.... AL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer