HomeMy WebLinkAboutMiscellaneous - 104 BLUEBERRY HILL LANE 4/30/2018O
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AMERICAN CLAIMS SERVICE
MULTI -LINE ADJUSTERS
BUILDING COMMISSIONER OR
INSPECTOR OF BUILDINGS
1600 Osgood Street
North Andover, MA 01845
RE: INSURED:
PROPERTY ADDRESS:
POLICY NUMBER:
LOSS OF:
FILE/CLAIM NUMBER
BOARD OF HEALTH OR
BOARD OF SELECTMAN
M
ff
NT<
Mukti and Mitra Das
104 Blueberry Hill Lane, North Andover
1045406
03/30/14; Water Damage
30792 PD
Claim has been made involving loss, damage or destruction of the
above -captioned property, which may either exceed $1,000.00 or
cause Massachusetts General Laws, Chapter 143, Section 6, to be
applicable. If any notice under Massachusetts General Laws,
Chapter 139, Section 3B is appropriate, please direct it to the
attention of the writer and include a reference to the captioned
insured, location, policy number, date of loss and claim file
number.
Tim McLaughlin
Claims Representative
On this date, I caused copies of this notice to be sent to the
persons named above at the addresses indicated above by first
class mail.
Unless we hear from you within the next 10 days, we will not be
obligated to pay any portion of this claim to you.
Date 03/31/14
7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940
TELEPHONE (781) 245-9516 • FAX: (781) 245-1077
N2 3 31 8 Date ..... Z-.. � A
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... I ..................................... ( .............................
has'permission to perform ............. Hcj Tc,. tv
.................................................................
wiring in the building of ........ /") al .. I .......................... ..............................
at ......... / ...... eLe. t e9�1 ..... North Andover Mass.
Fee..41/
.�-.CA) Lic. No. .737 . ............................ ..................
ELECTRICALINSPEC'MR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
M1�4t „'Js h_`. fi_c ,°r{. h� 1 l.dllinf0/rWfR��'O rr/a ac/Ln�Q��1Official Use Only °
? r a /i'
Permit No.6
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION °REGULATIONS Rev. 11/991 (leave blank)
APPLICATION FOR PERMIT,TO PERFORM ELECTRICAL WORK:
All work to he perl'ornncd in accordaocc with the Massaehuscus Electrical Code (.I •C), 5.27 CNIR 12.00
(PLEASE PKIN7 NK OR T 'E ALL 0FORM,17/ON) Dnic:
City r "1'o��'n f: ,. 1 �� To the lu sect r of I.v- s:
By this application ni ersigned t:Ives notice of its or her intention to perform t e Iect 'caI work described below.
t
Location (Street R Number) a
X.
Owner or Tenant
C9-iJ Telephone No.
Owner's Address i r2 or:Ch
Is this permit in conjunction with a building permit' Yes 0 No (Check M)proprin(e Box) —
I'urpose of Building Utility Authorization No.
Existin,, Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ . No. -of Meters
Number of Feeders and Anipacity
Location and Nature or Proposed Electrical Work:
Cunnplelion ufthe folluu•ine table may be waived by the himrrinr of IVirr•c
No. of Recessed Fixtures
No, of cea. Susp. (Paddle) Fans
No. of Total
fransConucrs KVA
No. of Lighting Outlets
No. of Ilut 'tubsGenerators
KVA
No. of Lighting Fixtures
Swinantiug Pool Above ❑ In- ❑
nid. griid.
o. or Effiergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAM MS
No. of Zoites
No. of S+/'itches
No. of Gas Burners
of Detection and
No. Initiating Devices
No. of Ranges
No. of Air Cond. 'total
Tons
No. of Alertiva Devices
e
No. u[ Waste Disposers
Heat Pump
dumber.
'Pons
hW
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal F1 Other
Connection
No. of Dryers
Heating Appliances ICI
Security Systems:
No. of Devices or Equivalent
No. of Water 'C1V
No. of No. or
Data Wirinb:
I'Ieaters
Siotts Ballasts
No. of Devices or Equivalent
No. Hydromassage Batlitubs
No. of Motors Total IiP
Telecommunications Wiling:
No. of Devices or E uivalent
OTHER:
Attach additional derail if desired. or as required by dee Inspector of Wires.
INSUR-UtiCE COVEILIGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including. "compleLed operation" coverage or its substantial equivalent. 1'he
undersi-ncd certifies that such coverage is in force, and has exhibited proof of same to the permit issuingoffic .
CHECK ONE: IN'SUR+\NCE [3 BOND [:1 0-11-11311 [:1 (Specify:) i' 6
, , r^rr (EXpiration Date)
Estimated Value of lectri I Work: �� ` f (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion
certifj-, under the pair .• nurl penalties of per jarj•, that the information air this application is trite and complete.
F1101 NAME:
N
LIC. NO.: 7394A'
Licensee: S . A. Decker- . T- Signature• t' LIC. NO.:
(If applicable, enter in the license number title.) Bus. Tel. No97 8 _ S A 9 _ A 6'1 1
Address: 9q Main St W st- fmrd, MA 01886 Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I ani aware that the Licensee does nol have the liability insurance coverage normally
required by law. By nay signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owHen's agent.
Owner/Agent
Signature Telephone No. PFR/11IT FEF.: soO
N23 Date ..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............... A ........................ I ...........................
l/ ...... 1. .
has permission to perform ......................................................
wiring in the building of ............................................................
o"
P
at.Yn.X ....... 44. � .........................
7 .......................i..
...
.... . North Andover, Mass.
Fee:::Z) .............. Lie. No.42.4�t .. . ..... ....................
-E LEcTRICAL INSPECTOR
Check#
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
� a
�' ' tt r { } s ;� ► t y'rr at3r } s{,� 'V tr
'$'
�dIriJNOnWtaLrO.l;..OftlCiJl Use Qnly.�'r h -t
Permit No.
. Uepart'.ntsiil o�, tira �arvrcad —CN
r Occupancy and Fee Checked
BOARD OF FIRE PREVENTION, REGULATIONS Rev. 11/991 tloave blank)
APPLICATION FOR PERMIT ;TO PERFORM ELECTRICAL WORK:
All work to he perl'ortned in accordance with the Massarhuscus Electrical Code (-N1EC , 527 AIR 12.00
(PLEASE PRINT IN INK OR TY�PtE .•1 / L ItVf•Oliit•/. I T ION) Datc: 7 � �' 1
City or A)
1'own of: ,A,-do'0!_r To the Inspector of f -ares:
By this application the undersigned �ives notice ofhis or her intention to pert rm lh elec al work described below.
Location (Street R Number)' �Lt�-r7 7,
Owner or Tenant t Telephone No.1779" .6 &S
Owner's Address
Is this permit in conjunction with n building permit' Yes ❑ No ❑ (Check M)proprinte Ilox)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ . No.•ori•leters
Number of Feeders and Antpacity
Loca 'on and Nature f Proposed Electrical Work:
t r
Conmtetion Jitiie folluivine table matybe waived by the In mrrtar n% 111irr•c
tY
8
No. of Recessed Fixtures
No. of Ceil: Susp. (I'addle) Fans
No. of Totat
Transformers KVA
No. of Lighting Outlets
No. of Ilot Tubs
Generators KVA
No. of Lighting Fixtures
Above In-
Stvinuuing Pool rnd. El I"- ❑
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALA VIS
No. of Zones
No. of Switches
No. of Gas Burners
of Detection and
No. Initiating Devices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
P
Heat Yum
Totals:
tp umber
............................_..........._..._
........_......_ ... ..
'Pons
_..
\\
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ rylwticipal ❑ Other
Connection
No. of Dryers
Hearin Appliances
PP IC\\'
Security Systems:
No. of Devices or Equivalent
No. of Water
Heaters '``\V
1 o. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. HN•drotnassane Bathtubs
No. of Motors Total IIP
Telecommunications \\•iring:
No. of Devices or E uivaleut
OTHER:
Attach aaatuonat aetart q aesirea, or as required by the /nspector aj Wires.
INSUR.4.,NCE COVEd
RAGE: Unless •aivcd by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including."completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuin, office.
CHECK ONE: INSUR.r\NCE a BOND ❑ O.1.1'IER ❑ (Specify:) y r d f %;%�
(Expiration Date)
Estimated Value of E -c Tical Work: fJ le (When required by municipal policy.)
Work to Start: C1 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I cer•tift•, ttrrticr tlr p Tins acrd penalties of perjury, that the information on this application is true and complete.
FIIUMNAtME• N.H. Electric on behalf of Electritmaxt Inc. LIC.NO.: 7394A'
Licensee: S -A.' --Decker;:' T' Signature IC. NO.:
(tf applicable, cuter "exempt •• in the license un/ Ger lig t+�— Bus. Tel. Nog? R— 5$.9 961 1
Address: 94 Main St WPstfmrd_, MA 01 886 Alt. Tel. No.:
OWNER'S INSURANCE \VAI VER: 1 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 ant the (check one) ❑ owner ❑ owner's agent.
Owner/Anent
Signature Telephone No. PFRt11IT -E, : S a(� t
Date. .......... i
N2 4941
NORTH TOWN OF NORTH ANDOVER
O� 14•
•.• O
�j �at_�,` •.. OL
° p PERMIT FOR PLUMBING
i1 • i
A SACHUSEi
Z
This certifies that 0......./ /... J . . . . • .
has permission to perform ....��� �� !7?!•`•`••'•••••••••••••
plumbing in the buildings of ... !? : ........................
at. %.`.!.. �s-. r..� r `' .` >- • •��. •'• •�� . North Andover, Mass.
Fee. Lic. No.).? .1. �.�'. ...... �-............ 7.-......... .
,PLUMBING INSPECTOR
Check At U 7
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
�f Date
Building Location �� �)GUfl�Src2y I'lLt ).-, Owners Name �u,e7-/ % _ Permit #
Amount R
r
Type of Occupancy
J.
New El Renovation M Replacement F1 Plans Submitted Yes 11 No 11
(Print or type) it
Installing Company Name
Check one: Certificate
Corp.
Partner.
E]�"Finnn/Co.
Name of Licensed Plumber-
Insurance
lumberInsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ly Other type of indemnity ❑ Bond ❑
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insuran/e
ignature Owner F1 Agent
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 Massachusetts S lnmbin ode=md Chapter 142 of the General Laws.
By: 71—p - =T oo icens um er
Type of Plumbing License
Title 2
O'7
City/Townicense 7quinoer MasterElJourneymanPM
APPROVED (OFFICE USE ONLY
r
M.W 305 Bel
...
.........................
EFA
(Print or type) it
Installing Company Name
Check one: Certificate
Corp.
Partner.
E]�"Finnn/Co.
Name of Licensed Plumber-
Insurance
lumberInsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy ly Other type of indemnity ❑ Bond ❑
Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insuran/e
ignature Owner F1 Agent
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 Massachusetts S lnmbin ode=md Chapter 142 of the General Laws.
By: 71—p - =T oo icens um er
Type of Plumbing License
Title 2
O'7
City/Townicense 7quinoer MasterElJourneymanPM
APPROVED (OFFICE USE ONLY
11
G�
Location
N& G Date
NORTH
TOWN OF NORTH ANDOVER
I ;
s ; ,
Certificate of Occupancy
$
�,ssACHUSE��
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
r
Building InspeJt6r
TOWN OF NORTH ANDOVER
BUILDMG DEPARTMENT
T
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
,...'T.49�b...._ 6� ��� " � �t�9'J'i±£1� .`?'•��`�.,�����'., �F.. N.a... r+.:% �, kk•;°. ��:: �' u;
BUILDING PERMIT NUMBER: DATE ISSUED: _ 1,3 —a Coo ,
SIGNATURE:
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION l
1.1 Property Address:
Not Applicable 0
1.2 Assessors Map and Parcel Number:
O W ?qZ
License Number
Map Number Parcel Number
1 3
Expiration Date
1.3 Zoning Infonnation:
1.4 Properly Dimensions:
ronin strict Proposed Use
Areas Frontage ft
..6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
R red Provided
Required
Provided
o
0
.7 Water Supply M_GL.C.40. 54)
1.5. Flood Zone Information:
Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal On Site Disposal System 0
ublic 0 Private ❑
.ECI'ION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
A Owner of Record
ame (Print)
Address for Service:
gnatur-e V
V Telephone
2 Owner of Record:
Name Print
Address for Service:
F,CTION 3 - CONSTRUCTION SERVICES
;ensed-Construction Supervisor:
dress
n re Telephone
Registered Home Improvement Contractor
npany Name
Not Applicable ❑
l 2- V
Registration Number
�= 1 o 2 -
Expiration Date
•
c`
Not Applicable 0
O W ?qZ
License Number
moz
Expiration Date
Not Applicable ❑
l 2- V
Registration Number
�= 1 o 2 -
Expiration Date
•
c`
*10
N,' 4 - WORKERS COMPENSATION (KG.L. C 152 § 25c(6)
ompensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
ial of the issuance of the building rmit.
idavit Attached Yes .......❑ No..:....❑
N 5 Descri tion ofPro osed Work check aln a ticabie
struction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Bldg. ❑ Demolition ❑ Other ❑ Specify
cription of Proposed Work:
.C2 CM
SECTION6 - ESTIMATED CONSTRUCTION COSTS
Itetn Estimated Cost (Dollar) to be
Completed by permit applicant al's
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of 11
Construction 13 , C 60,
3 Plumbing Building Permit fee l=) X (b)
4 Mechanical HVAC Q
5 Fire Protection (J
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 pennit application.
Si nature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATrnN
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
t
Print Name
L§ignature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 161 2
ND
SPAN
DMIENSIONS OF SILLS
DMv ENSIONS OF POSTS
DMIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHMdNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Town of North Andover Oltt1QRTp1
Building Department o
27 Charles Street
North Andover, Massachusetts 01845 ? 4
(978) 688-9545 Fax(978) 688-9542 °� -
�sq.e�RArea
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit. # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sI50a.
The debris will be disvosed of in /at:
P
acility 1 ati
Signature of Applicant /
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
' FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT
PHONE l 7X i �;5�
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION /sem/ LOT (S)
� J
STREET /0 7 L�%e ✓0L-, A// ST. NUMBER
*******OFFICIAL USE ONLY *****
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR
COMMENTS
DATE APPROVED
DATE REJECTED
TOWN PLANNER
COMMENTS
DATE APPROVED
DATE REJECTED
FOOD INSPECTOR -HEALTH
DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02 919
workers' Compensation Insurance Affidavit
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
0 I am an employer providing workers' compensation for my employees working on this job.
I
Company name:
Address
City: Phone #:
Insurance.Co. _ -_ -- Policy #
Phone #: o Y-� T "
/12k 1A2Policv.# f y 5 �� �
Feitureto secure coverage as required'under'section 25A orK4GL 152 can legato the imposition of criminal.penalties of;a fineup td $1,501
and/or one years' imprisonment:as waft-as-ciaril.pevatties.jn-Mal m-f-aoP_woRK ORDER..and-.aline_of-.$1Do %I --a- I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA fooverage verification.
I do hereby certify under the pains and penalties of pequry that the information provided above is true and correct.
Signature Date
Print name PhoneA
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
0
Building Dept
❑Check if immediate response is required E]
Licensing Board
p
Selectman's Office
Contact person: Phone #: ❑
Health Department
m
Other
, HONE IMPROVEMENT CONTRACTOR
t Registration 128425
Type - INDIVIDUAL
Expiration 44/06/01
4
MIKE CARP€NITO
jitE H. CARPENITO
ADM241sT€ATOR 1 E. NASHUA RD.
WINDHAM NH 03087
BOARD OF BUILDING RfGYJLATIONS i
License: CONSTRUCTION SUPERVISOR
Number: CS 072992
t
Birthdate: 07/19/1967
I i Expires: 07/19/2002 Tr. no: 72992 I
Restricted To: 00
MICHAEL. H CARPENITO r
2 E NASHUA RD
WINDHAM, NH 03087 Administrator
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Location
Nb. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
(�
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�jO'$/46/% 15:58
$ 3��_�:
e
1Bu�ild!%InspectorID
Div. Public Works
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FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: (/ � U y- 6
-30� �
LOCATION: Assessor's Map Number Parcel SM
Subdivision
Lot (s)
Street 03 LU F� IJ L a-PLYl LL St. Number � � �-
************************Official Use Only************************
RECOMNIENDATIO S AO WN ENTS :
Date Approved
Conservation Adminis ator Date Rejected
Comments
Town Planner
Comments
Food Inspector -Health
C -Se cn pector-Health
Comments nn- 5 e.L . , e.✓
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
Au030
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approvedo.,,1.q c_
Date Rejected
Date
(?IC2 16f M
SITE PLAN
PROPOSED GARAGE.,
EXTENSION
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I E n IIf �5arh115ztt Permit No.
�i�iE (,IIITIi11IITi111 II ,
.f
Bepartutzrrt ,af 'Pubtit -afztg Occupancy & Fee Checked
3190 (leave. blank)
BOARD OF FIRE PREVENTION REGULATIONS 527 VR 12:00
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). Oate
(M}i� or Town of NORTEi ANDOVER _ . or of wires:
To the. Inspect
The udersigned applies for a permit toperformthe electrical work described below.
t_ocafion (Street & Number)
6lo ed ee r 1►-I� 1,1. �
Owner or Tenant / /1 Vk' DA -5
Owr,er's Address SA h
Is this permit in conjunction with a building permit: Yes, No � (Check.Approeriate 9oxj
t^ 1,
Purcose of Suildina 'FAM LJ ����1�� Utitity.Authonzation NO,
Existing Service 6� Ampsl� 510 N/fits Overhead Unogrnd:-� No of Meters
Amos _J - Voits Overread • Uncgrnc: r No. of ,ureters
New Service _ .�.
Numcer of Feeders ano Ampacity
x
r
Location anc Nature of. Prcnosed Clec:iic .i . lork
Totai
No. ai. L:gnttng Outlets l . No_ 'Hct :as I ua: =t :ranstarmers KVA
Al]ove— .n' No. at Lighting Fixtures I Swimming ?coi- grna. _ cmc. I Generators KVA f
I No. of Emergency. Lighting,
No. of Pecectaoie Outlets 1 No. of Cil Surners i" Sattery Units
ff i Y
No. of Swrten Outlets 1 No. at Gas Burners FiAE ALARMS No. of Zones
Tota( No. at `'et ecuon aria
Na.. of Ranges
No. ct Air Ccrc. tans initiating Oevtces f v;
Naaf !ear
Total Total
' No.. of Oisaosals } Pur -es Tons K',v No. at Sauncing Oewces ,
- Vo: of Sait Cantainea
No. of Cisnwasners ScaceiArea Heating Ktv. Oetect:oniSounairig Oevtces
_ Muntcicai, Ii
1 Heating Qev:ces KVV, t coat
other
No. of pryers _ Connect:en
ri
No. at No. af., Low Voltage
No, of Water Heaters Kv+1 Signs Sadasts Wir:nc.
No. Hyaro Massage was
I No. of ,Motors _ Tota( HP
i'
OTHER:
INSURANCE COVERAGE: Pursuant to the reautrements at t.tassacnusans yenerai '_aws
I have a current Liaotiity insurance Patie j; inctuctng Czaceo:atea Ocerattens Coverage or ;ts sucs:antial eeuivaient. YES _
have SU7mIttEC Valla proof at same to the Office. YES
it you nave CnecXea YES.:tease iriaiC3te, the. ;tVCe Of Coverage ay.
checxing the acoroonate oax., - - INSURANCE BOND = OTHER _ " (Pease Scec:!yF tE,cgtration Datefa
Estimatec Value' of E'ectnt�apik 5 + r`:
Werx :o Start �j/C(�Pp Inseecaon Date Facues:ac aougn '
F'nat.
Signea unaar the Penames at penury
FiR 1,NAME ^ I / �'Ze-C-
Licensee ! Signature vZ�
No.
�L.(J,/� /�• Alt ''el NO. -
ACCress
OWNER'S INSURANCE WAIVER: I am aware that the _:censee apes not a the icatic rice coverage or Its suent. Owner
as
auirea av Massachusetts General Laws., aria :hat my signature an :hs rmtt aapticauon waives chis reauvement: Owner 4
(Pease' cnecx one( 't%v
–e+ecnone No. PERMIT FEE S
(Signature at Owner or Agenu
,.,Y- "-.. � >�w �.:i.,('... .-.y- n -tet.., r. ""'R•v�r...�_-„�_
+r
ru
}Ta 652
�" f NORTH 1
ro
RRRp»> O p
m SSACNUSE�
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
8 VYtVRdI� (� L1�cfd�t L
This certifies that............................................................................:................
w has permission to perform ....... f>�..�//�� �?•! `..........� ?.t.r.?..!. '. ` ..........
wiring in the building of ......m.q. t...1.�.��.5.............................................
at ... A....y......./✓�... F...�i'i1 /.7... H!I�f....��...... , North Andover, Mass.
Fee.....�.....v.d...... Lic. No..............................................................................
ELECTRICAL INSPECTOR
C (t c j �2f2 1% 12:07
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
3774
This certifies that 7A� ..` .........
has permission to perform .................... �... .
plumbing in the buildings of ......,
at . �� y %_�.:.� ....... North Andover, Mass.
Fee..+..Lic. No..))..%
PLUMBING INSPECTOR
07/3�� //qqpp Pf �� 7- 3 r 4�
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
h/ - C V'-- 79 3 7
�/MTE: Applicant CANARY: Building Dept. PINK: Treasurer
0
'? MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
R
(Print or Tvae)
.._._. I VI� C�
b r'. d / . Mass. Date a' 19 9 Permit #
= 4
11
A Building Location l b `i e/ t, eLP S a o, Owner's Name Da S
New ❑
i ' rA
Renovation ❑
gF.IWPPA
Type of Occupancy_
nt ❑ Plans Submitted: Yes ❑ No ❑
ES c Pan• r e,4
Installing Company Name. The Plumbing Co., Inc. Check one: Certificate #
Address P D Box 1607
121 Corporation 1219C
Wakefield Ma 01880
tl ❑Partnership
1 Business Telephone 781-246-0019 ❑ Firm/Co.
Name of Licensed Plumber __ Clifford H . Giles
sw
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes EX No ❑ I
If you have checked •ye§, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
tithapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
r Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information l 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 the permit issued for this application will be in compliance with all
Pertinent Provisions Of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws.
Ce-Wo-Ifffi
r
� Srgntunsed uber �
Tito
Gt /Town Type of License: Master E� Journeyman E]
APPf FICEGS-ONLY) license Number 8701
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SUB—BSMT.
BASEMENT
1ST FLOOR
2140 FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
eTH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name. The Plumbing Co., Inc. Check one: Certificate #
Address P D Box 1607
121 Corporation 1219C
Wakefield Ma 01880
tl ❑Partnership
1 Business Telephone 781-246-0019 ❑ Firm/Co.
Name of Licensed Plumber __ Clifford H . Giles
sw
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes EX No ❑ I
If you have checked •ye§, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
tithapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
r Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information l 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 the permit issued for this application will be in compliance with all
Pertinent Provisions Of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws.
Ce-Wo-Ifffi
r
� Srgntunsed uber �
Tito
Gt /Town Type of License: Master E� Journeyman E]
APPf FICEGS-ONLY) license Number 8701
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