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Home My WebLink AboutMiscellaneous - 104 FRENCH FARM ROAD 4/30/20189 D . L Date.6.:?.- �.�. . NORTH TOWN OF NORTH ANDOVER it �� •+ •� OL PERMIT FOR PLUMBING si,_ i �► +°+,..° .q''`ty ,SSACNUS� This certifies that . ��: ,...`3�- �.L... �. o .................... has permission to perform ... ,3...... . Sy... ,, c',,c f ........ plumbing in the buildings of .. 4.iZ.t)s!74-`!.................... at. ..T-AVrt (1. . N,.AD ...... North Andover, Mass. FeP�9.0.ca'-).. Lic. No.. ...... �1 PLUM ING INSPECTOR Check # I ob- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: �� (.��►r��`L , MA. Date: Permit# Building Location:jbkk Fc'ev \ Owners Name: _ Crp Ch�,q Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New:5 Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No n INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 7 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner s A ent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title own Type of License: C �� Plumber Signature of Licensed Plumber Master Journeyman License Number: FIXTURES DEDICATED LU Z SYSTEMS Z W > Y Z O d ti c Z Z Z Y LU w /d G Z m W tn V) W Q D: LU Z lA �• Vf W Z Q N to Y H Ln C7 J _Z X Q Q C W Uj Uj Q Y = a = Z Q Q D: = cd _J O Q W g Q W C Q Q = Vl VI 0 0 f. > > O O O Y Z S W Ln Q Q W Uj Q = W �• t~/I Q 00 00 0 o LLFQ- D 3 3 3 0 pn V ' u Q Vl a a L Q 3 SUB BSMT. BASEMENT 1sT FLOOR 2" FLOOR 3RD FLOOR 4T" FLOOR ST" FLOOR e FLOOR 7' FLOOR 8T" FLOOR Installing Company Name: (fin Check One Only Certificate # Address: 30 SVsN� ( City/Town: ❑Corporation C State: Partnership Business Tel: '1g1•'1\tl �}�"� tl Fax:_'1�'�' ,, "I�tZ` <�<<al Firm/Company Name of Licensed Plumber: A. +r t . a INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 7 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner s A ent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Title own Type of License: C �� Plumber Signature of Licensed Plumber Master Journeyman License Number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street s� Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers rmlicant Tnfnrm a+;in Name (Business/Organization/Individual): City/State/Zip: Phone #: —R- I .1I C2 . DLU Are you an employer? Check the appropriate box: w 1. M I am a employer with. / 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] *Any applicant that checks box # I must also fill out the section below showin their k ' Type of project (required): 6. El New construction 7. El Remodeling 8. ❑ Demolition 9. ❑ Building addition 10-ElElectricalrepairs or additions 11.❑ Plumbing repairs or additions 12.❑Roof repairs 13.❑ Other Homeowners who submit this affidavit indicating they are doing all work and then hire routside ontrac ors 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. Insurance Company Name: �; rMN N -f •e 1:Z%k Policy # or Self -ins. Lic. #:_ a� 15� It Expiration Date:_ � 1 • �`, \ � Job Site Address: 16 1 �c¢ tr ��M t 9 City/State/Zip:.. �1 . (1� L4 -p0 � Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration 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 coverage verification. I do hereby certifyunder the pains and penalties of perjury that the information provided above is true and correct. Phone vfficra[ 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other \1 Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial ` Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy; please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Cornmontaealth of Massachusetts Department of industrial Accidents Office of Investigatitons 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1877-MASSAFE Revised 5-26-05 Fax # 617,727-7749 www.mass..gov/dia COMMONWEALTH . , OF MASSACHUSETTS • .., - LICENSED AS AT' •A ' 4. ' A,�ASTER PLUMBER ISSUES THIS LICENSE TO 1 MICHAEL J BELL 39 SUSAN DRIVE -RE A_D:ING t-- MA 01867- 1239-. i 12124 05/01/12'rl 75937yll 113 CONTROL # F 8 6 5 16 9 IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 239 Causeway St., . 5th Floor, Boston, MA 02114. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing ct next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege, and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. V 4i 141 -- - r -275 coRo° CERTIFICATE OF LIABILITY INSURANCE DAT04/14//14// �'' 01 11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions Of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERNTACT Phil Richard & Assoc Ins., Inc 378-774 338 27 Garden Street Unit 10 978-774-1318 Danvers, MA 01923 Philip W. Richard N COME: FHON o ac No : AADDREsa: CUSTOMER ID g:MJBELL1 INSURER(S) AFFORDING COVERAGE NAIC S 04/13/11 INSURED MJ. Bell Plumbing Co. INSURERA:Arbella Protection Michael J. Bell 30 Susan Drive Reading, MA 01867 INSURER 0: INSURER C : INSURER 0: - INSURER F: GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC INSUPE INSURE F $ - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/DD/Y p MMIDDIYYYY LIMITS A GENERAL LIABILITYEACH X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-] OCCUR 8500033941 04/13/11 04113/12 OCCURRENCE $ 1,000,00 PREMISES(EV. oocurewce $ 100,00 MED EXP LAny one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000.000 $ - AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ ' (Ea accident) BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAR EXCESS LIAB HOCCUR CLAIMS-WDE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION S $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTNE r-- OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If Yyea describe under DESGIRIPTION n OPERATIONSbelow N/A WC STATU- 0TH - E. L. EACH ACCIDENT $ E.L.OISEASE - EA EMPLOYE $ E.L.CISfASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Atlaoh ACORD 101, Additional Remarks Schedule, If more spgco Is required) Evidence of Insurance Town of North Andover 1600 Osgood St North Andover, MA 01846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t♦ m 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109 The ACORD name and logo are registered marks of ACORD Printed with , Factory Pro trial version - purchase at www.pdffactory.com a 9 Location O �/ %� : �•, r ll, No. C/ a ':— Date �r U Of MORTh TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ - J�cHusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 5 Check # /CJ—y .Building Inspector /T!\it TAT AT 1&T/\71►TT7 ♦ 1Tw%At rvnv% .f it v w N Or N UK i n AN V EIR BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING F r .�.r' ci;'^ `•r;»r ,� s.. .. r�.n ��=.e e z _ ^, �.. '•. « a.-.a:.W. x. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: �--� Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.2 Assessors Map and Parcel Number: L/�1��1. ��Addrt�,1 I I t�� / 1 � �- 35.0 ---- !O �d S� S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sew System: Public ❑ hi � ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of ecord Name (Print Address for Service : NOM /1 MA 01610 ^ ' CIO OVJ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicabl Licensed Construction Supervisor: License Number I Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone rn X 3 Z O N v rn p\ O rn 90 ic r v M r Ism Z e 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 buildin¢ permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Descrip 'on of Propos d Work: Z " l 11 MU6 fd 0 SECTION 6 - E.STiMATF.n Item Estimated Cost (Dollar) to be Com leted b permitapplicant OFFICIAL USE ONLY 1. Building Sh V V O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) O 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number p or,%,iiv1'1 iu vvvl\r,1CAV 1V BE UUMFLE 1Ell W11ET4 nn G OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT lfLE �e rrmh1, ` �+ , s Owner/Authorized Agent of subject property Hereby authorize �) ! to ac on My behalf, in all r e tiv o ed by this building permit application. O� Signature of Owner aate SECTION 7b OWftR/AUTHORIZEDISGENT DECLARATION 1, 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 Name Sip -nature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1Sr2 ND SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 7 I V Gerald A. Brown Inspector of Buildings Please print DDATE: 1, JOB LOCATION: HOMEOWNER TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION Number 5 Street Address Telephone (978) 688-9545 Fax (978) 688-9542 Map/Lot [oSo aofib 45 PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and reirements and that he/she will comply with said procedures and requirements. % Y N A HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption ,. Gerald A. Brown Inspector of Buildings Please print DDATE: 1, JOB LOCATION: HOMEOWNER TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION Number 5 Street Address Telephone (978) 688-9545 Fax (978) 688-9542 Map/Lot [oSo aofib 45 PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and reirements and that he/she will comply with said procedures and requirements. % Y N A HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption V 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. PPLICANT FILLS OUT THIS SECTION Q G APPLICANT LV nn U�U\U PHONE LOCATION: Ass ssor's ap Number U05. O PARCEL SUBDIVISION (`I F� r In , Fum n LOT (S) STREET l U ST. NUMBER IM OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE z arr w .rp 47'+ apt/04 4* 1 i �= S6, I NEK a0y CS'4 T/F Y M 110.SW/C-V U vljvC S QANAC , /7-CSUCC E.Sso es AAO/6'e o=1 G^/S, AND � r Cld-AWfY 7F7 Tye TITLE 1AlSe1Wf.4VO Mczor-45 5-wor.v.4ww 71wT/rom-s lY/TN >•VE ro-- 40,,- NO • A�✓ao„C,e Z4,vmia .CE6V,e.4rA 1s 4W44AMW ferAt IC•VX PWIlAf SlWrrJ / COT L/•vEJ. '' 1' /r!/.�7' •!' 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CE.!'T/IrY 7Wf,- 7WIS =0116"ROM, 12 No aw.v mN i!'^+�f • , • /rY P..r vct '* ZSCO98 ,At OQOS'C*:`�•'r'd%;;,fA/*OATLr6-2-9 3� 00051 C Ifisir- j N RL O T Rz x v /N NO/2 rg R1l1Gl7 ✓4FR j MASS. ,4ze 4Ne.,V - FO.P XoacpT V64YNR/ eaOSCY .447W / �►_ Soy JUG Y /993 • � .vO7- FO.P •-� . /NE.P.P/irlgGt' E'.�/B.�t/EE.P.�i'/6 SE.Pi�/CES .4T.nv yweE.y fw,r,• Exrrriv6 .eezatos. 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X0.1 X0.4 11 K P! Y4 Y! 7! K Y! Y! Y! 04 OV O O O O O N N N N .--i ,--i ,--, � �+ n-,. ti ,--i � v.i — C" cl c � Q)cz H .a O U ° �_ W cn N V10 3cd 0 a 0 110 O 'C ti) a) a) bA a) - � o ° - U o o �O x q:° C7'�, 0 _ v a CoCIO C-0 o ti C,3. x a��'•�A az�wa3�Oti�'r; 00 cz C,3 0 CZ w P. 6 z a a ymc a � CD �m c a c a low r W C N C, C a.t C C� V �aa d� ID CL C /0 a d r 7 � a., c® O � m G c o a y s -bD cc c4 - d 0 a a ymc CD �m c Rb: c o ` r W C N C, C a.t C C� V h d� ID CL C /0 m C ;Z O r .c a., c® O � m `m c o a y C c4 - my o m c m y cm3 m C �y m �@ o aa M m O C ya TLo y O C O a a ymc CD mz3 :a ++ O W C v r W vs a.t C h O' ID _ .0 r .c a., c® g 0 0 z 0 U III U 0 O I C� o'- y C � .— CD y OCD CD O = t0 � 3.0 OQ CL cc0 CM. L 9:cma c_ o = Cc v� .y Z C.3 y C c C H 0 Date-& ..... .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that,....:'r..............^^.....-.r. ...................................... ........ has permission to perform --f wiring in the building of ..,* ....... ............................................. atZ........ r ................ .North Andover, Mass. Tee --.1h! ..... I ..... Lic. ... ....... ELEcrRicAL INSPEqrOR (7 Check # X Commonwealth of Massachusetts Official Use Only Permit No. 64 a r, Department of Fire Services Occupancy and Fee Checked��T� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC 527 CMR 12.00 (PLEA,SE PRINT IN INK OR TYPE f�LL WFORMATION) Date: Li 1 2 - 0,5 -- City or Town of: /1/c7Al C�" To the Inspector of ires: By this application the undersigned gives notice of his or her intention to perform the elgctrical work described below. Location (Street &Number) /o,/ �-1 -e, li / .4k? izj /P Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No L!d (Check Appropriate /Box) Purpose of Building -5.L� Utility Authorization o.c�J 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: &Al pts U UG ZOO ",2—T /L Ce- Can letion of the following table nzav be waived hv the Ins ector nfWires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o mergency Lighting Units No. of Receptacle Outlets No. of Oil Burners -Battery FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. of Water KW Heaters Heating Appliances KW No. of No. of Signs Ballasts Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:).��?��, ( xp atiot ate) Estimated Value of Electrical Work: (When re uired b munici al l' Work to Start: I certify, under the FIRM NAME: W q Y P Po icy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. dties of perjury, that to info on on this application is true and complete. ,i-ec�h't C n LIC. NO.: i _ t, Signature (If applicable, a "exem i the �}�ense num r linej�� ;� Address: 5, /Gly ent h. �X�( 4j OWNER'S INSURANCE WAIVER: I a aware that the Licensee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: Bus. Tel. Na Alt. Tel. No.: tzot have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE: $ d�3_ Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS - -- -- Official Use Only -- -- ---_— I �) G Permit No. Occupancy and Fee Checked�17� [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MHC , 527 CMK 12.00 (f'LEA,S'E PRINT IN hVK OR TYP.F,LL FORMATION) Date: City or'Town of: /i�zr rlj-�c� To the Inspector of fres: By this application the undersigned gives notice of his or her Intention to perform the electrical work described below. Location (Street & Number) �l� ��-tf:-?r `/ I y1/.yj �� , Owner or Tenaut P I (_, "I Telephone No. �<I AAS Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No r1-1 (Check Appropriate Box)_ Purpose of Building �` yy I % Utility Authorization No.j / 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: _mmnlrnn nFlho Fn//n..d„� r.,f,/., ..,,.., 1,,, ,..,,:..,.,1 ti.. ,r.,, r ................ _r No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of [lot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ t o. o Emergency Lighting rnd. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection and InitiatingTotaDevices No. of Ranges No. of Air Cond. Tons l No. of Alerting Devices No. of Waste Disposers Beat Pump Number Tons KW No. of Self -Contained Totals: Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers heating Appliances KW Security Systems: No. of Water No. of No. of No. of Devices o Equivalent Beaters KW Sins Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: attach aaamonat detail itdesu ed. oras required by the Inspector of Wires INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove • ge is in force, and has exhibited proof of same to the permit issuing once. CHECK ONE: INSUR❑ OTHER ❑ (Specify:) ANCE L`1 BOND '� � (!t'? �JIS 3 Gj (xp' ation ate) Estimated Value of-lectrical Work: (When required by municipal policy.) 7 �t ai P � t fP J i3, H fo on on this application is true and complete.�t I�IRIM NAME: --J c'C,li� C 60 L --) r� r.rr urn • �1 �;�:? Licenseer� � � IIJ aPphcable,` er�tE Address: OWNER'S ENs required by law. Owner/Agent Signature _— �'✓ork to Start: � [nspections to be requested in accordance with MEC Rule l0, and upon completion I certify, wider rl:e pain id enalties o er'tt ,that se in ' f c:' .� Signature � •t '� I,IC. NO.: • "exem t the license number liltc '•`— ,;, 7 � iG/� Bus. Tel. No. _ Alt. Tel. No.: 7R-NINCE WAIVER: I a aware that the Licensee does not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) El owner El owner's went. Telephone No. PERMIT FEF.: $ -' • NJwJ I i i � ■ I � N W i W d 0 = U � a W N J J J u ] 0 r IK s2 . o, IW I IL = • a = N W � F i o I i i � ■ Z N W i Z M 0 = U � a W N J J J u ] 0 r IK s2 . o, IW M = • a W � 0 i o • 44 r Z 0 i Y Z • • N L r w L K I k �y C� -1 'I\ I N w ■ Z N i Z M U � a x999 J J J u ] 0 r w ■ Z N i Z J Y U 0 ] 0 r IK s2 . o, Z i ,4,• 7 • 44 ^ 0 i • • Z 1 N 0 0 N N 1 0 0 0 i C a u N r r Y u L Y M L w ' a 0 [ r q m C Z W : 4 • 14 U s2 . i ,4,• 'e • 44 ' a 0 [ r q m C Z W : 4 • 14 60 Nci2E -f"2E: S e- p? -6 s�2 FELE ��"' x yo �-- Al O -r i A/ Fc C1 J w/ GU i 2 t lut �S ff ,� F /-(-d U.5 E loo,2c k 7 r /6 y rX R,,(c q F!npq P23 '�i2 i CR G S/�/ 9/07 2 g y - q5; f S- O y CA CM) C O ■ 'v O CD 0 Z CO) C-4, ■ CL ? C O y � O � c v CD CDCL o CD CD O w t C, CDCD Vi �O y �C CD � v y O 1 Z CD � a o CD 0 CCD C c O:., O ? _ d O O _ �m e07 m C) mc�a� m ZCO) o m CL •» a o CO) Vl � N o?m _ _ = m y 0- U2 m O O o y. C W m � fA i PA r a Om 2 -► : rr^^ co o o s?: /VJ m 1 A y N � C Q m O= cu CO) t^* V ✓V y d � Q j•�V� C W c VV !D c •� c cn CL C43 oto � .. :EC y cn CA 0 m -C- -� .► I l ON ; to = m �. Or+ o c o r) Z � cz) Err CD CD My r _ CD rZ _ ate. �. Cl, Cl) o C = Z =gym ox O�►rJ+ " w• G O w o 7' UO T -r, w 7 C " h7 O r\ C o a x g Omq 0 O C i i FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having have been obtained. This does not relieve the applicant landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: R6,S927- C /d og %�' Phone 75?41 - LOCATION: Assessor's Map Number :36- Parcel Subdivision Lot(s) .sd Street /oV Fit- 51YC/t St. Number %CY ************************Official Use Only************************ CO DATIONS OF TOWN AGENTS: L Conservation Administrator Date Approved Date Rejected 2\ Comments To Planner Date Approved . Date Rejected Comments Food Inspector -Health Septic Inspector -Health Date Approved Date Rejected Date Approved Date Rejected Comments Public Works - sewer/water.connections driveway permit Fire Department Received by Building Inspector Date Town of' North Andover BUILDING DEPARTMENT Homeowner License Exemption 'Lease print) DATE `j % JOB LOCATION /6"Y Number. Street A< 11 "I .>MEOWNER"'�--'� ame 'RESENT MAILING ADDRESS -J%,e /Z__� ress q`* me Phone ection of town Work Phone City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied-dwellings of six units or less and to allow such homeowners to engage an.individual for hire who does not possess a license, provided that the owner acts as'supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended tq_ be, a one to six family dwell- ing, attached or detached structures accessory t.o such use and/or farm ..structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. Phe undersigned "homeowner" certifies that he/she understands the Town of ,orth Andover Building Department r0_nimum inspection procedures and ,�quirements and that he/she will comply with said procedures and equirements. IOMEOWNER' S SIGNATURE `,PPROVAL OF BUILDING OFFICIAL ,lute: Three family dwellings 35,000 cubic feet, or larger, will be ,-squired to comply with State Building Code Section 127.0, Construction ;Untrol. /Q/Cff�L[�E %1f/gJZT/�✓ �. �,,,,Oe�u/��/�o.-. Com' w...,.�,a�-tri.. �va� _c-f�rr� lwel° 6 3 S o L AND // o o /31-ocK 6076 /3CAc� l q 3 q(., - L49 -r (.,-(.oT 00 7'Ti9L 22L/S00 Doc nla, tfIA5S o/ �bT /�l�m �/1Prti. /72 o/LTy�JG�F �aC S . G o 7 *moo 1O(ftA1 T/TLE f DC`,N,T/✓L=7 SU�3a/v�f/o.v �OCf}N �F G�n�D OF Fil�.vcH �.92�n v/LcAGAl,i i E L 6 GATE 7 /.v �iv�W'E/2 OC/iuc� �Tfl/In�HRli �E/��7`Y MUST Jl�Pcic�iv 91�nk-r-IZ STREET T/zUS7- j'cjLE I /I= c/o / V -&LY /3/ /.?S,/ A2W�� 04' N, E , 2 , 2) , a -J i°L lv 0- 8 9 31LcJ DT 3A/8 y �bT /�l�m �/1Prti. /72 o/LTy�JG�F �aC S . G o 7 *moo 1O(ftA1 T/TLE f DC`,N,T/✓L=7 SU�3a/v�f/o.v �OCf}N �F G�n�D OF Fil�.vcH �.92�n v/LcAGAl,i i E L 6 GATE 7 /.v �iv�W'E/2 OC/iuc� �Tfl/In�HRli �E/��7`Y MUST Jl�Pcic�iv 91�nk-r-IZ STREET T/zUS7- j'cjLE I /I= c/o / V -&LY /3/ /.?S,/ A2W�� 04' N, E , 2 , 2) , a -J i°L lv 0- 8 9 Tkt'o4 � is IL > 1�), �( MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) NORTH ANDOVER Mass. Date 1/ 2 7 19 97 Permit # 3 Z Z L Building Location 104 French Farm Rd. Owner's Name Crosby Type of Occupancy Residential New ❑ Renovation ❑ Replacement N Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate Address_ 35 Pleasant ant Street EX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 617-438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 91 No ❑ If you have checked rimes, please indicate the type coverage by checking the appropriate box. A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ 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 the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By r , tw, Title Signature of Licensed Plumber City/Town Type of License: Master (X Journeyman ❑ 83 APPROVED OFFICE USE ONLY) License Number 2 2 _ U' _z NZ r cn y N o )4 Z ►' •. > y 0 W b W Y J N Q V Z (7 ¢ �4 j•d _� OJ y W !- W ¢ a- LL ? Z F ¢ Z y m N z W W Q F N Z e a Q o a a a 3 x a cd cd }� N O M ¢ Q ¢ i a W — N z ¢ ¢ J LL 'rNri x CL~i T� r"i F U Q S W 3= a a O ~ Z z wx W > H O z= !/r F Y Z O O N __ `t W Y W F O U Z Q) 14 J J a¢ a a o a, 49 �4 N LL 0 J a M W O (a ru CZ (f, SUB—BSMT. BASEMENT 1 1 IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR FJ BTHFLOOR Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate Address_ 35 Pleasant ant Street EX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 617-438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 91 No ❑ If you have checked rimes, please indicate the type coverage by checking the appropriate box. A liability insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ 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 the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By r , tw, Title Signature of Licensed Plumber City/Town Type of License: Master (X Journeyman ❑ 83 APPROVED OFFICE USE ONLY) License Number 2 2 } J z O w N n w u LL LL O m O LL 3 O -d W to N Z O 1- U w CL N z_ N N w cr U O m a N z O H U w a N Z_ J a Z 2 w W LL O Z O Z m J a O a O F- r C w a ccO LL z O a U J a a Cl z_ D J C1 LL O W a F- W a 2 a Z_ O J m m LL O z O_ p a U O J a w F - Z a 2 F- W a W h a D r `4 Date. /.b; . :.i A o'",..'. , 4, TOWN OF NORTH ANDOVER 3? ••,, .,._�. roc ° PERMIT FOR PLUMBING s •ren •A"q5 ;,SSACHUS� This certifies that Ja ! .t` �. �.... .?.�.................. W, .�. has permission to perform .. ........................... o, plumbing in the buildings of ..CP A �.4 y/ ..................... at .../. a �J... r>f'. c .':. . �fll?�=�../. C .. , North Andover, Mass. Fee. G7. t, :... Lic. No.. ��.? .. ..... .�tA�!Y ........ . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer f MpRTFj 1 'SStCHUS� Date. S ........... ` A TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... L,,,,,,,,,,,,, has permission to perform ................ plumbing in the buildings of .. . / > .'.% ................. 9: cu ....... ,North Andover, Mases Fee.. s? .... Lic. No .(7-�.-J.;.?.. . r..........., PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING au - (Print or Type Mass. % Date 19� Permit # O Building Location G- / ar" 0JOwner's Na..1"< < Type of Occupancy1�t 51 D E ti i1 New ❑ Renovation ❑ Replacement 2Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name 4�013EeT S8 (r M ATAd7 Check one: Certificate Address R C hi M rel n) <- P J ❑ Corporation /r E TW i ' F_ Al -, �'Yl A0 l � C3 Partnership Business Telephone �� Z -i97 1 2-9rm/Co. Name of Licensed Plumber l l v3Fgel7- fid ,SAmm,4 rr4e0c . INSURANCE COVERAGE: I have a current (}'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C�' No ❑ If you have checked ves. please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ 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 pefformed under the permit issu for this application will be in compliance with all ' pertinent provisions of the Massachusetts State Plum g e and apter of the eral Laws. L re o LicensedPlumber Title City/Town Type of License: Master % Joumeym-lb [3_ APPROMI:.D O FIC U NL License Number q_3 3; • Y • Y • Installing Company Name 4�013EeT S8 (r M ATAd7 Check one: Certificate Address R C hi M rel n) <- P J ❑ Corporation /r E TW i ' F_ Al -, �'Yl A0 l � C3 Partnership Business Telephone �� Z -i97 1 2-9rm/Co. Name of Licensed Plumber l l v3Fgel7- fid ,SAmm,4 rr4e0c . INSURANCE COVERAGE: I have a current (}'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes C�' No ❑ If you have checked ves. please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ 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 pefformed under the permit issu for this application will be in compliance with all ' pertinent provisions of the Massachusetts State Plum g e and apter of the eral Laws. L re o LicensedPlumber Title City/Town Type of License: Master % Joumeym-lb [3_ APPROMI:.D O FIC U NL License Number q_3 3; m z Q Z N V m A O w S O 9 z 0 t, Office Use Ont�lriiliPF1�Q55QC 1SPttS Permil rto. 5 i0parttnut Di Vublit 'tIICI1J Occupancy & Fee Checked _ I �• BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 ( a/90 _-(leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 2:00 (PLEASE PRINT IN INK OR TYPE A L INF RMATION) Dare_�.. � IL - City or Town of_� I/L'�/ To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work d1ps.9ribed below. Location (Street & Num er) Al�? Owner or Tenant __- n, S L/ Owner's Address L— 4�� Is this permit in conjunction ,r�rith a building permit Purpose of Building Existing Service Amps ___J Volts New Service _ Amps / _Voits (/ Yes ❑ No ❑ (Check Appropriate eoY; _�. (-Utility Authorization No.._A Overhead Undgrnd ❑ No. of Meters -"I Overhead i_. Undgrnd LJ No. of Meters Number of Feeders and Ampacity r l' �} Location and Nature of Proposed Electrical Work (_D'� _ q U �r;I No. of Lighting Outlets No. of Hot Tubs Pao. of Transformers Total KVA No. of Li nting Fixtures Swimming Poo! Abovej In- grnd. r grnd iJ Generators Kv.: No. of Receptacle Outlets No, of Emergency LighJng No. of Oil Burners i Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No of Zones _ No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices LocalMunicipal ❑ r Other Connection NO. of Ranges g — Total No. of Air Cond. tons No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers SpacelArea Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: FEB 2 5 mw INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Comple�t Operations Coverage or its substantial equivalent. YES 4-110 "" I have submitted valid proof of same to the Office. YES 4' NO i' If you have checked YES, please indicate the type of coverage by checking the app=p4&Wbox.. INSURANCE 0 BOND u OTHER = (Please Specify) Estimated Value of Electrical work $ (Expiration Date) _ Work to Start _. Inspection Date Requested: Rough w _ Final ^_ Signed under the Penalties of perjury: FIRM NAME a ✓` A --C_ I- .— Y �Z-✓i t LicenseeJ �""t1�S G, `¢'1-•+,�,✓^[ l t gignature _ 'S LIC. NO. Goll Bus. TOL—Nit--m // `% Address _ f w� (✓1 N� r1'�- S % , s4 r/-�. I t�� .t Lvl ch, d S^3 Alt. TeL No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent s re- quired by Massachusetts General Laws. and that my signat ue cn this permit appfication waives this requirement. Owner Ag nt (Please check one) ----- __._ Telephone No. PERMIT FEES (Signature of Owner or Agent) --!— X-6565 ` 7 /,/ l LORTH Of .�ao ,•�h.0 O A �,SSACNus� C.. Date......�!.y.....:. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1_ ,, This certifies that .... .......tjoz,S..f..�..............'�C..�...................................... has permission to perform ...... .........A........... CA.............................' .....�.... wiring in the building of ............ ?.US6. /� ,r % 4 �'r� 1.......North Andover Mass. at .................#'f...... ��' v.... Lic. No.��.y��'�'" Fee ............... ................ ....................... ELECTRICAL INSPECTOR 03/03/97 13:1244 �j S - ,i co0�A1D WHITE: Applicant CANARY: Building Dept. PINK: Treasurer