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HomeMy WebLinkAboutMiscellaneous - 104 MAIN STREET 4/30/2018cn" m - PERMIT NO. 6/-2, APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION log M&� (1 y r PURPOSE OF BUILDING L?_ ! O+ N f� J OWNER'S NAME I/y\ 11, /� , NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME %�A,7y-ice C� SPAN DIMENSIONS OF SILLS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR " GIRDERS AREA OF LOT FRONTAGE IS BUILDING NEW HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREME F CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEDANDAPPROVED BY BUILDING INSPECTOR DATE FILED rzll 6 `Y! SIGNATURE OF OWNUAUTHORIZED AGENT FEE ����_ PERMIT GRANTED 19 �� 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNERTEL.# CONTR. TEL. # �U L (84? CONTR. LIC. # / ?8-61- H.I.C. # 8-61- H.I.C.# 1���-k BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 113 PINE CONCRETE CONCRETE BL K. BRICK OR STONE P _ PIERS PLASTER _ DRY WALL 17N FTN — — — 3 BASEMENT AREA FULL FIN. B M'T' AREA _ 1/4 1/2 FIN. ATTIC AREA N_O B M T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH HARDVJ'0 COM1,ACN ASPH. TILE ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRFCK N MAS N Y BRICK ON FRAME ATTIC STIRS. & FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE I GAMBRELMANSARD FLAT I HIP BATH Q FIX.) TOILET RM. 12 FIX.) SHED WATER CLOSET — ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ tit 13rd I ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS 'OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. VA cc 5 0 �m Sc O 2 G� C h O O CO C v c.i f •dam d C W O CD e o m c ow �o t; c" m c-fti E . y O �m o z ` h y C.0 C 'J m H �• Z1 �� = T� to Go cc C C �Em Q� .ta O m. 4b y t t o of :_ CCD /� N •O m V y Z L w o O „- o► C O c = o ICD Q F.. O . CO3 •r y m a0„ m N uu p �_".O= w ui LL O C p � M � o C Z LAJ E ca.0�y o �%O CM L O� O C 1�--1 CO) O ; 'O � CLO In 2 m � o 8 a=m w a chi r W ro G w w u co a W a' w0 C/) J a a W Cn u G C7 O C a W ca o z cn C4) O cn cc 5 0 �m Sc O 2 G� C h O O CO C v c.i f •dam d C W O CD e o m c ow �o t; c" m c-fti E . y O �m o z ` h y C.0 C 'J m H �• Z1 �� = T� to Go cc C C �Em Q� .ta O m. 4b y t t o of :_ CCD /� N •O m V y Z L w o O „- o► C O c = o ICD Q F.. O . 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N3 O C . i. c CLy b i!q cak:yJ in; JSUPouj Jrel lr:il'3 U1 uwq ol4 'i!t'^V vUL Y1:iUJ 31V4 31VOS AS a3NO3HO A8 a31V1f1OlVO 'ON 133HS t1 0 4. 4 10 aor Z86b-Z89 (805) ib8T0 bW 'aouajmel 409AIS IlaMol 16Z ':DNI x'00 N0113nHISN00 �11V21 rte£ e0'%iri1t0".ZI�Jfril'? d> 1// ??f.45-514eWUS-l75 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office UseOnly Permit No. Occupanc/ & Fee Checked 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) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Date � � � ' 15 To the Inspector of Wires: Location (Street & Number Owner or Tenant 1 AZA (K )©-A- -4" P ,4 w & c f aA�- L U, .h- r C.L� Owners Address Is this permit in conjunction with a building permit Yes ❑ No (Check Appropriate Box) Purpose of Building kC—­r4-"--- Utility Authonzation No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed E'.ectncai V ,ti L OTHER: INSURANCE COVERAGE. Pursuant to the requiremenfils of sacnusetts General Laws I have a current Liability Insurance Policy including Compl Operations Coverage or its substantial equivalent YES O = have submitted vel roof of same to the Office YES O If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE BOND = OTHER = (Please Specify) Estimated Value of Electrical Work$ 60o.,,- ���� (Expiration Date) Work to Start Inspection Date Resquested Rough Final NO. --1 ' !Ci NO. J1 -77W0 `N" 4 _ Bus. Tel No. 41y3 3`0 Z 4 ZO Address 0 L'`� 4) S r S % � Alt Tel. No. OWNER'S INSURASCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts GeneraiQ(.aws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $--------- of Owner or Agent) Total No. of LightlIng Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Liqhtinq Fixtures Swimming Pool qmd C gmd C Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Bumers Battery Units No. of Switch Outlets No of Gas Sumers FIRE ALARMS No. of Zone No. of Oetection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Dicosal No. Pumos Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Soace/Area Hearing KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heatinq Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Satlases Winn No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremenfils of sacnusetts General Laws I have a current Liability Insurance Policy including Compl Operations Coverage or its substantial equivalent YES O = have submitted vel roof of same to the Office YES O If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE BOND = OTHER = (Please Specify) Estimated Value of Electrical Work$ 60o.,,- ���� (Expiration Date) Work to Start Inspection Date Resquested Rough Final NO. --1 ' !Ci NO. J1 -77W0 `N" 4 _ Bus. Tel No. 41y3 3`0 Z 4 ZO Address 0 L'`� 4) S r S % � Alt Tel. No. OWNER'S INSURASCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts GeneraiQ(.aws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $--------- of Owner or Agent) Date.. ....�... . ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that....................................................................... haspermission to perform ............................................................................... wiring in the building of —.Z.. .. ............................................... .. ................. at ................. . North Andover, Mass. 4r.."ru ...... Lic. No.'.'.��4 ............................................................. ELEcrRICAL INSPECrOR O WHITE: Applicant CANARY: Building Dept. PINK: Treasurer rtYY. r a a, .� -�. +r .. .+ ter- �+4.`ti-• �..v -.� �- ar .. ._ ,� .Location Nol ��d/ Date�,L3 oR,M TOWN OF NORTH ANDOVER oc✓ —i'M .-; 66:7 -- P§rtificate of Occupancy $ "Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permitee $ er Connection Fee $ Water Connection Fee $ �s TOTAL $ ///,.0 Building Inspector Div. Public Works PERJiIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. A% i /PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK '.PAGE .O SUB DIV. LOT NO. I OCATION Xot URPOSE OF BUILDING !' OWNER'S NAME L �CJNe NO. OF STORIES SIZE OWNER'S ADDRESS r ' BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME r_dtf e-_ /` � �j SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR "" "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE / w IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS I - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE TURE OF OWNER OR AUTHORIZED AGENT FEE �� U PERMIT GRANTED /�lla� '1�1 19 OWNER TEL. kd] l CONTR. TEL. # CONTR. LIC. #-0SCJ" 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. w 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR �1`t 1 OCCUPANCY SINGLE FAMILY S ORIES MULTI. FAMILY OFFICES _ APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE HARDW'D PLASTER 3 1 2 13 CONCRETE BL'K. BRICK OR STONE PIERS RADIANT H'T'G _ DRY WALL UNFIN. UNIT HEATERS 7 NO. OF ROOMS GOAS 3 BASEMENT CLEHTRIC r AREA FULL B'A'T 2nd 13rd I FIN. B M'T' AREA 1/1 1/1 % FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 �_ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING CONCRETE EARTH HARDW D COM/ACN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ _ BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR _ WIRING STONE ON MASONRY STONE ON FRAME SUPERIORI� POOR ADEQUATE NONE 5 ROOF HIP MAI 10 PLUMBING BATH Q FIX.) TOILET RM. (2 FIX.) WATER CLOSET LAVATORY KITCHEN SINK NO PLUMBING STALL SHOWER MODERN FIXTURES TILE FLOOR 6 FRAMING (I 11 HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. _V_ WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOAS CLEHTRIC r B'A'T 2nd 13rd I NOEATING Location__ No. Date �V� M'60 TOWN OF NORTH ANDMA F p Certificate of Occupancy $ Building/Frame Permit Fee $ a MUs c� Foundation Permit Fee $ °= Other Permit Fee $ Sewer Connection Fee $ a Water Connection Fee $ TOTAL -,-4, / $ � Building Inspector Div. Public Works W i a � a Y 0 0 m W F W N N H a Q X N ec W W Z 3 Q 0 z_ Z W Q < 0 _J J 3 co N in W_ OC 0 Z0 0 O O Z W N N W In 0 IL m N Ii Z m m 0 H 1C� M W d z 0 .0 ~ Z v � d 0 IL Z 4 � m 0 r W IL H I 1 N WI� a Q O z N N N C W LO f F 0 0 J LL IL 0 W N N N N W Z Y U x I NZ It 0 J F Q F W J NO C < m a Z t7 = LL 0 Z U 0 00 4 0 z0 0 0 41 J z i 0 < f W < WN O I N i lY < W tt W U < H Z O rc iL W O 0 u IL 0 N F Z Q W m 0 H Z z 0 0 < Z 0 O U O J 0 < < Z Z z 0 J O O J J m 7 � W m J z z 0 0 VV J U D ^tJ W C F V L N Z_ i j W H N m 0 ^ ^ < Ir 0 N L = Z Z L W O O 3 W Z F Z i i mz W W ; N N N p m } L ~ L 0 4 J_ < O N Z 0 F m y d Z < d 4 m 0 W N J N N u W LC u u u 4 _Z Q w C H W Z Z Z O J LM m O v v W l Z z U O d u m m N N N W m 0 0 < m O O < N W O 0 u IL 0 N F Z Q W m 0 H Z z 0 0 < Z 0 O U O J 0 < < Z Z z 0 J O O J J m 7 � W m J z z 0 0 VV U D ^tJ j W W V L N Z_ j W H N m ^ ^ o 0 N L = Z Z L O O ciC mz W ; N N N p m } L ~ L 0 4 J_ LC LY LL W 0 F y d N W d 4 W 0 u u u I a LM m O v v W l p O Q O d u m m m u Z W W M J W a v N z L 0 VV U D ^tJ j W W V L N Z_ j W H N N ` ^ ^ o N N L = Z Z L O O W W ; N N N p m ~ O J L ~ L 0 4 J_ x 0 0 LL W 4 L N L W h W< < N G d 4 VV ^tJ W W V W H V o o 0 U V = w O O FM4 r x w O w � z O w � a � U w b g a � co w° C2 U ro w Ga.toW c�° w w a°' w moo c�° co w w b ra z vii vii W) \3 W � =o CD �o o 0 G N O r O C V :.n V a C ev ev CD Y i ;�• I • �Z. W , y.. V J=�N O O. ,16. o 0 P .G o O O.L CCA E l o y CD y... cm O y O r_m • N06 O O p m N O CD > G: C" C C aG= � CD p m Z O `(d CM CL C Q O - y O G •O CD d=.. p N o p 1-- o COD w o CD o W G •..�_ O.y CL= •... O C = • LU .E V O C7 -C ca O 7i:L Go -M 0 2 G3 m p ,O :E G 1' -i y Q p O 5 R 0 p-= m� 5 0 r DEPARTMENT Of PUBLIC SAFETY f. 1 CONSTRUCTION SUPERVISOR LICENSE w # Nuiber: Expires: Birthdate: j CS 012995 05/21/1998 05/21/1941 Restricted To: 00 ROBERT H STECCHI o- 11 STEVENS ROAD PELHAM, NH 03016 Golf„r,.l..liu IV'- HOME V' HOME IMPROVEMENT CONTRACTOR Registration 124116 o Type - INOIVIOUAi Expiration 05/15/99 Robert Stecchi _ Robert H. Stecchi .1 Stevens Rd �ADMIN161hAlvR Pelham NH 03016 i rJ Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street lII.I.IAM J. SCOTT North Andover, Massachusetts 01845 Director In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number 0 1_ is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by 1ViGL c I 11, S 150A. The debris will be disposed of in: • (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. If 90ARD OF APPEALS 688.9341 HUII.DIIVO 688-9343CONSERVA71I0N 688-9330 HEALTH 688-9340 PLANNING 688-9333 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFiTT1NG MfInt or Typo) /�(fLfi aj)d 10V0` -amass. Oat• 4 Permtl d► �� 1 euildln Location /WOC 1)01)glc l�Q j' hfOC: 1D fid/d 0 </ /D!1 Owner's Name Fio�7/� 104-1-n vii :S� Mo- Blida ver, m rte_ Type of occupancy 0 Fu New p nenovatlon Q Aeptacament Cl Plans Submitted: Ytsp No p ig Company Name WHITE Rn( -,K PLUMBING & HTS Check One: Certificate I s P.O. BOX 728 10� Corporation -'160qC p Partnership ss Tctcphone q'2& ❑. Firm/Co. :f Licensed Plumber or Gas Filter �b e r' B l 4f (- h E T f ANCH COVEnAGE: i cufnenj llabllfty Insurance policy or Its substantlal equivalent which meals the requirements of M(3L Ch. 142. Yes No ❑ >ave checked y�. please indicate the type coverage by checking the appropriate box. ly insurance policy Other type at Indem13ntly hand O R'3 INSunANCE WAIVEn: 1 ■m aware that the Licensee dogs not hove- the Insurance coverage required by r 142 of the Mass. General t..awa. and that my slgnature on t10t permit applical)on.watves this requirement.' Check one: ownerO Agent ❑ 01 of or OWnu s Agent csdlfy that aM of the dalaltt and Inloin+allon i have submflted for onloredl In above application ata We and sor:urele to the best of my If" that all plumbing work and Install Otis performed under tial potmll lsftred far this app9callon wIM be M Rance with if movtslons of the Massachusalls Slate Gas Code and Chapter 112 0( the awwfl.IJw,. A � q A T n of Ucthsa: L'fumber na tug of IIcensa M=Dar of GAI er - Gisfillal gj s q,7 .32101 Utense Humbef V t Join n eyrn an rTT�iT�' U N � N s Z .i N N V :1 N 1c n �t u as �' = ac a = p w 1' h tas N of 1 w I - p ` asat yZ ow J F W b a l? Y W .J. K Z O: ~ 1' W V. N O A Z a x a 't es x o IC v W a: W _• fl 'f 31 a o 3 W a > o i O sus—asslr. eASEME11T �• 1sT FLOOn 2110 FLOOR sae (Loon 4TH FLOOR ST11 FLOOn 4711 FLOOR 1T11 FLOon eT1/ FLOOn ig Company Name WHITE Rn( -,K PLUMBING & HTS Check One: Certificate I s P.O. BOX 728 10� Corporation -'160qC p Partnership ss Tctcphone q'2& ❑. Firm/Co. :f Licensed Plumber or Gas Filter �b e r' B l 4f (- h E T f ANCH COVEnAGE: i cufnenj llabllfty Insurance policy or Its substantlal equivalent which meals the requirements of M(3L Ch. 142. Yes No ❑ >ave checked y�. please indicate the type coverage by checking the appropriate box. ly insurance policy Other type at Indem13ntly hand O R'3 INSunANCE WAIVEn: 1 ■m aware that the Licensee dogs not hove- the Insurance coverage required by r 142 of the Mass. General t..awa. and that my slgnature on t10t permit applical)on.watves this requirement.' Check one: ownerO Agent ❑ 01 of or OWnu s Agent csdlfy that aM of the dalaltt and Inloin+allon i have submflted for onloredl In above application ata We and sor:urele to the best of my If" that all plumbing work and Install Otis performed under tial potmll lsftred far this app9callon wIM be M Rance with if movtslons of the Massachusalls Slate Gas Code and Chapter 112 0( the awwfl.IJw,. A � q A T n of Ucthsa: L'fumber na tug of IIcensa M=Dar of GAI er - Gisfillal gj s q,7 .32101 Utense Humbef V t Join n eyrn an rTT�iT�' U i A TOWN OF NORTH ANDOVER 1-1 o0 F" PERMIT FOR GAS INSTALLATIO -71 This certifies that :.. 'r.':..' !.....:''. !�''..f.. �..'�......... . has permission for gas installation ........... `.`..: .......... C . in the buildings of . 1 :.. " - .... .. ...:.` ' ' ............ at : r ... " rr............. . North Andover, Mass. Fee' f',. , .. Lic. No.x . l .. .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r 1 • r-. Office use Only V ►:: = The Commonwealth of Massachusetts Permit No. Department of Public Safety C Occupancy 8 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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_ `p9 719 S" City or Town of AN WD To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) LO°F IrYiA 1 N 5T. Owner or Tenant I ! CW rN A L,�) PA /V ( Owner's Address S A m Is this permit in conjunction with a building permit: ❑ Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ New Service Amps Number of Feeders and Ampacity_ Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work REPLAc ( 1-3A LAST A�J b OR lr/XTU R C � AMSC - !C/I!7!?1/' 42F'T20 Gi T �DD. - rN - No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA ,'o. of Lighting Fixtures SwimmingPool Above In. grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of es Ran 9 Total No. of Air Cond. Tons No. of Disposals No. of Heat Total Total Pumps Tons KW No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑ Other No. of Dishwashers Space/Area Heating Kyr No. of Dryers Heating Devices Kyr Connection No. of Water Heaters KW No. of No. of - Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP L; n. S.Z fj AS 7- lei", ANI 5 1995 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws, I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES x NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE %, BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury FIRM NAME ON L/NE Z-46CT'P(C A L. C c, /+vC, Licensee DAU/7) D�ENTRF/Lro�vT Signat Address /a GALe-owS fJ/GL Rb $,gLEirt MA, (Expiration Date) Final LIC. NO.AI06S`% ( LIC. NO. Bus. Tel. Alt. Tel. No.&/9 -5,%k /f,Aa OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not haye-the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement.. Owner Agent (Please check one) (Signature of Owner or Age ) Telephone No. PERMIT FEE $ LB a rr Date . �/.l.�a. G .y.... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... t�... �✓. !�. b,:{ r' ................. . has permission for gas installation .. . % q y .................. in the buildings ,, of.. (� A C. EIJ-VA /C/ ,c . /?,�. �-��u '! '. .... . at ..Ip � ... l�'i �.t .... !........... , North dover, Mass. Fee. Q.0 ... Lic. No... `T .. r b? j �(( ;q. rr,----- GASINSPE OR Check # o� Q 4 : 4 5 MASSACHUSETTS UNIFORM APPUCATON Qype or Pmt) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's TO DO GAS F1'MNG 20 Date New E] Renovation 0 Replacement M V Plans Submitted 0 (Nint or qw) Permit # Amount $ iiiiiit•�i!•��t•���e���� , , iililiiiiii����i■��,�.�..� Name ofLicensed Plumber or Gas Fitter -2 2 e• Cettifcate Installing y Corp. r���5`� 0 Partner. 0 Firm/Co. IN iTRANCE COVERAGE Check . I have a current liability Insurance policy or iYs substantial equivalent. Yes No D 166 have checked +des, .p1 'cate the type wvemge by decking the appropriate Liability insurance policy Other type of indemnity Q Bond 0 Owner's Insurance Waiver.Famaware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner. or- Qwna'sAgot Owner Agent Q i hereby certify that all ofthe 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 instaltati under P . Issued fon' this application will be in compliance with all pertinent provisions ofthe Massachusetts)&XqCode andeqKff ofthe General Laws. 'A QVED (OFFICE USE ONLY) . JSignature of Licensed Plumber Or Gas FitterE Plumber 4LEer Gas Fitter License Number Journeyman Date.. TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING This certifies that .�l"�.t�............... has permission to perform ... 1.A..... �`{....... v-- plumbing in the buildings of ... ll.� �u v a (aQ 'A.. at . A e? C7 .4 ............... . North Andov`er_, Mass. Fee. a .S . Lic. No.. Q 8 T l� t 0 2� t jC . PLUMBING NSPECTOR Check # 6:55 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER/,' MASSACHUSETTS Building Location i T - Owners Name New ❑ Renovation ❑ Replacement TION FOR PERMIT TO DO PLUMBING Date 1! 61tiC , eermit # -e Amount Plans Submitted Yes ❑ No ❑ (Print or type) Check one: Certificate Installing Company Name _ Co Address ` ` 7 r Partner. Business Te ep one?olzl Firm/Co. Name of Licensed Plumber: / � Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy PF 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 insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have bmitted (or entered) ' above application are true and accurate to the best of my knowledge and that all plumbing work and4=41!1 all io performed Permit Issued for this application will be in compliance with all pertinent provisions of the Massi t tate Plumbi and Chapter 142 of -the -Ge Laws. Title Type of Plumbing License City/Town ':F . icense uMaster APPROVED (OFFICE USE ONLY a Journeyman ❑ i a ------------------------- o / . ------------------------- (Print or type) Check one: Certificate Installing Company Name _ Co Address ` ` 7 r Partner. Business Te ep one?olzl Firm/Co. Name of Licensed Plumber: / � Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy PF 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 insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have bmitted (or entered) ' above application are true and accurate to the best of my knowledge and that all plumbing work and4=41!1 all io performed Permit Issued for this application will be in compliance with all pertinent provisions of the Massi t tate Plumbi and Chapter 142 of -the -Ge Laws. Title Type of Plumbing License City/Town ':F . icense uMaster APPROVED (OFFICE USE ONLY a Journeyman ❑ Date ..... 4, TOWN OF NORTH ANDOVER 0 minim, PERMIT FOR WIRING ,SSACNUS This certifies that ..... (-) l.. I ..... .........1-1 t.E....... CO..: ..................... has permission to perform ............ .. /.,,.v ...f -..!.t ............................................ wiring in the building of .... ........... La at ...... M -Y ... WIP.,.n...'.. . C:?..t ............................. . North Andover, Mass. Fee../.A.*.��.. Lic. No.-4/�/-377 .......................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File