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Miscellaneous - 105 SULLIVAN STREET 4/30/2018
105 SULLIVAN STREET 210/107.6-0010-0000.0 Date...... C�-. .�.. .......... OF r►OR 7h,h oma; oop TOWN OF NORTH ANDOVER * * PERMIT FOR WIRING ss,CHU56 .,,. This certifies that ............. �. has permission.to perform .... ........ G (`..... n..... �iyz wiring in the building of...'•...•.. v............................................:......................................... at ....,..'".?:........l .1 t.1 `!.._ ..............North Andover,Mass. l=" I, Fee. .0. .................Lic.No2045—A................................................................................. ELECTRICAL INSPECTOR Check# tom-(`D 3:: � Use On}� . Commonwealth of Massachusetts Official IfIZ�+�� 1 Department of Fire Services Permit No. ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE.ALL INFORMATION) Date: l>ylOee-f71 �?,5 , eO/gyp City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /0S ,�ee-T- Owner or Tenant '/SSS Telephone No. Owner's Address IAS �_Sq///v4A/ !::5 e Is this permit in conjunction with a building permit? Yes 2No ❑ (Check Appropriate]Box) Purpose of Building Utility Authorization No. - Existing Service 244 Amps iZD /0410 Volts Overhead N, Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters F Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: U Completion of the.following table maywaived by the Inspector of Wires. Trans No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- F1o.o cy Lig ting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners 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. Tons TotNo.of Alerting Devices No.of Waste Disposers HeatPump Number Tons KW No.of Self-Contained P Totals: Detection/Alertin Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal El Other p g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No. f Devices or E u valent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA=NCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pen Ities ofperjury,that the information on this application is true and complete. FIRM NAME: . JLLSP �1«'rvS�G� L�/PC %G if/ LIC.NO.: J7 ya Licensee: Joe— e:�;OxC Signature LTC.NO.: (If applicable,enter "exempt"in the license number line) U Bus.Tel.No.: 76 Address: z1 2;-e tA10,�t112 V 01gol Alt.Tel.No.-P?,3/-303 *Per M.G.L c. 147,s.57-61,-security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent Fp-t"ITFEE.-$ Signature _ Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c,143,§3L,the f permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension dict—Permit/Date Closed: Trench Inspection Pass 0 Failed(] Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 1Z Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS CTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: w 4 so Inspectors Signature: Date: FINAL INS CTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: " DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts M Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): �1 j)S �`f �Q� /«N$C'G� Fl ec1,;, l el"ul Address: Wi9�/�inydl/ / yy'fI CG City/State/Zip: 0[),1 V N, /80 Phone#: -�781--93/ — 3 25-6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).' 7. ❑New construction 2 a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F-1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.FJI am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.F-1Weare a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors 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 state whether or not those entities have employees. If the sub-coritraciors have employees,1hey must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#: Expiration Date: Job Site Address: �d cJU U'`1y2�ee City/State/Zip:�NAV&*--, ; Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and epains andpenal ' s ofpetjury that the information provided above is true and correct Sinature: Date: � � � ,Pc-/ .�� Phone#: t o l' 3/ 3 z Official 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e v 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' compensatiod'policy,please call the Department at the number listed below. Self-insur6d 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Commonwealth ofs usetts Division of Registrati A Board of Elects JOSEP s 4 WASHI ti > WOBURN,� w o '� hT Master Elec - 'a 21745-A 07/31/2016 svey\� License No. 008929 Expiration Date. Serial No. r f'[';`ERT0F1CATE OF USE OCCUPAUCY �pm4}F•"� f;,dx.y t tcwtr.<�'S £•.£^�'fF 1^�.; A�N.', ��. y�)f��..P.R"'�yF p �LT5 ` 8uttding Pam+tt Humbet 200 Data NOVEMBER 29, 1989 THIS CERMUS TRAT THE BUILDING LOCATED ON 105 SULLIVAN .STREET MAYBE OCCUPIED AS IN-LAW .APT. IN STCOND STORY IN ACCORDANCE 4Pi'i` THE PROVISIONS OF'THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Beverly Shea 105 Sullivan Street ADDRESS North Andover. Mrd 01845 Buillik sAetor a .ry i 5 V' C P URTORCATE L r -;z Rullding Ponnit Number 200 Data NOVFMBER 29, 1989 THIS CERTIFIES THAT TEM MMING LOCAl`ED ON 105 SULLIVAN STUET MAY BE OCCUPIED AS T1V-IAld APT. zri SEC ND STORY IN ACCORDANCE WITS TSE PROVISIONS OF TBE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTMCATE ISSUED TO Eeyer1y Shea 205 Sullivan Street t ADDRESS North Andover MA 01845 .� B3(tJtI11�'t��d itS�ELZAT OF�Q4u E��a AOA �O'S>C of A9?aa5 Wit. t ft tea!tha�"o Ngo A''�mt - � h�k�ra"6"�4:.inR� n oiaita 4 rte.seaat n�S!rn��io 4A.Sha"2LG pcca�"�e�to Q Aon Dar�.�= s a5 s t"``M&ti4isk y 3RD 4tc.2. 4nuCtian ¢,N41taC �y�S `�aoRd twat,tosses.taGtQ 8Y Ott Fait. t eaz tha� 6pat0 eotro HaY{,� Fra"k�4;zzt�s . . .. .... . HD oTm Of 1M a? �' TOWN OF NORTH ANDOVER t - PERMIT FOR GAS INSTALLATION SACHUSEtt This certifies that . . . . . . . . . . . . . . �[ /� �' has permission for gas installation . . . . . .�. . . .� . . . . . . . . . . . in the buildings of . . . /e...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . ... . . . . . . . . . . . . North Andover, Mass. r� < Fee.3G.. . . . . Lic. No./13 f?. . . . . -' nf.-, . . . . . . . . . GAS INSPECTOR Check# Po 5337 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type)N G /Z/1/0Mass. pate Cy 20 4 PermitBuilding Location 6 _S'��L /cyd�,,/ f7— Owner's Name .k%J 'Type of Occupancy-----V New [� Renovation Q Replacert ent ❑ Plans Submitted: Yesp No ❑ �a z W Q* W K3 F�6k �h � a� aC W W a J > 1& t- a W N Q W 63 4� SA 6 SUB-BSMT. BASEMENT ISTFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR ' STH FLOOR 6TH FLOOR 7TH FLOOR ---LH I 8TH FLOOR Installing Company Name �iiE� h �'G Chc&t one: Certificate Address c-1 S?04 ❑ Corporation 1'�7 G f 0 j ❑ Partnership Business Telephone al ? Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a cu en 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 eovemge by checking the appropriate hax. A liability insurance policy [� other tym of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware thzt the license: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 ❑ Signature of Owner or Owner's 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 perforated under the peimit issued for this application Vii be in compliance with all pertinent provisions of the Massachusetts State pas Code and Csaoter 142 of the Generl; s. By T:Journeyman of t�cense: Z-1 Plumber Signature of l�censed Plum or Gas F Title Gasfittef / 9 Master license Number / i City/Town O I US ONL BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR OASFITTER LIC. NO. PERMIT GRANTED DATE 20_ GAS INSPECTOR I A, Location No. Date NpRTM 01TOWN OF NORTH ANDOVER ,•.,tip t - s + Certificate of Occupancy $ -Ts Ect' Building/Frame Permit Fee $ cwus " Foundation Permit Fee $ Other Permit Fee $ ° TOTAL Check # G9zl 90 17209 Building Inspec 4r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI5 RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING tkv BUILDING PERMIT NUMBER: DATE ISSUED. M SIGNATURE: .,RrfA6� Building Commissioner/Ingwor of Buildings Date Z SECTION 1-SITE INFORMATION o 1.1 Property Address: 1,2 Assessors Map and Parcel Number: L irp t t / �o Map Num Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6-BUILDING SETBACKS ft Front Yard Side Yard Rear Yard —Required Provide Required' Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTH ED AGE' ffistoric District: Yes No rn 2.1 Owner of Record aw S}- Name(Print Address for Service d Sig re Telephone 2.2 Owner of Record: Name frint J Address for Service: z rn Signature Tel hone p� SECTION 3-CONSTRUCTION SERVICES R� 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: ZA- Lic;�6p6mbaf Address Expiration Date M Signature Telephone F 3.2 Registered Home Improvement ntractor Not Applicable ❑ Company Name 1716V rn Registration Num r Addr s (2 to �/ Exp ration/ate ^ Si a r Telephone L I SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes. . No.......❑ SECTION 5 Desch tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alteration ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � x OFFICIAI( USE ONLY4. Completed by permit ap licant Y M 2 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHOk09M0'& TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. -Signature of Owner Date SECTION 7b OWN/ER/AUUTT'HORIZED AGENT�DE/C�L9ARATION 1, 7 l ! / 5��� �/" C� As Owner/Authzed Ag nt of sub' t 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 Nam Si WfbwneLei DA tT NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Apr 15 04 08: 51a 7818534464 p, 1 APR-74-2804 39:08 PM ......AMPSELL 'x81333527.9 P.91 i.� �/ ti '✓ `.i tJ :J Ziac �:J `✓ ' 1.800-3Q8.2918 Federal 1.0,4 000853968 Fax:(781)853-4464 Nisea.Reptstretfon#141031 349 Broadway St., Revere,MA 02151 n hf6mimt 'o.,Inc• AGR MENT 19ddre99: city. Stater Home Phone 0 PW3 Work PZ: / D � INCLUDED A.Cover all Walls&Gables v _VINYL SlbtfdP in PTOs color,l�INGLUDDEQ, B. Ramova and Haul Away Existing 3lding(Exdusng Asba t il). I� C.Remove and Replace Roben'Wood as Nmenry to Perform Work. 7 D.Furnish and Install Exhided Weettm Barrier Around all Opedngs in octet ❑,/ E.FUMIsh and f 1 NOW Comer posts on Exterior Comers of Horne' cDbr,, � ❑ F.Wrap Horne UWerfayment 5ystarlf. G.Custom Fubri;iile SOF1<tTA;i FASCIA S*VEM For Ovefiangs in Color. ❑ H.Furnish and Install[Continuous Seamless Gutter System and Dowmspouft in cruor ❑ 1.Custom Fabricate_ _Prernium Winnow Casement Wraps in _ color. ❑ J. Custom Fabricate_ Premium Door Casement Wragfs in w(pr,(��• ❑ K.Custom fabricate Premium DoorCeseen _„�__ Garage ant Wraps In�� ?'�� cotor. 17 L.Fumish and Install _Pair of Shutters.❑Louvered❑Raised Panel in crier. QS M.Furnish and Install vnyl Gable Versa, ❑ N.Cover Front,Bade,Porch Cellingsca"ll CeiRV(Desoxiba Below)in color. O.Remove+haul away wdetlng Roofing, 77 P.Cover Root in 30 yr Roofing SNNgIs. ❑ Q.Clean All Job-liehtted Debris on a daily Basis. ❑ R.AN wait Performed by the Corttraotbr is Fully Covered by Workmen's Compensation. ['] and Public Uability Insuranos. Other Wori(fA ba P ulatd l/ �� TOTAL PRICE If {Price.wwlvdw all _ 9rurnaI .cwxunat PAYMENT SCHEDULE D=N PAYMENT� gpow gotSWAUf UPON COMPLETION— INRiALS Amount S 'r 1 S! NOTE:If financing is chosen buyer understenoa that cartcelfing the finance agreement does nol caveat da grearmt.Buyer is moponsibie for any amount American Home I"Mvement Co.,Inc.Ina7rs In obtaining fintntd",including but not limited to Gde sea ch toes,h shat be In the obligatian of the Nome Improvement Contractor to obtain such permits as the Owner's Agent.The Owners who secure Melt town consbt7cNon rotated pemmiti, as deal with unregi3t8red Contractors will be excluded from the guaranty,find provisions of MGLC,142A All home Improvemant Contractors and Subconbtitgota shall be registered M the Director&nd that any mQuvies stout a contractor or Subedntraclor relating to a registration should be directed to: Olne for Hoare improvement Contractor Registraiion THE OWNER SHALL PAY FOR THE WORK BY THE FOLLOWING METHOD: One Ashburton Place,Room 1301 CASH UPON COMPLUMN{ ) By ltODERNQATION LOAN( ) / L✓ soon,MA 02108 727 COMPANYSGUARANTEE:Thecompanyguarenteea(toworkmanshipforTf7 (epi '�tl years. h will replace detective material within the;period Of guarantee tree of Charge.Ali retitxsts for service must be in writing! This agreement must t e accepted by an Officer of the contractor within thirty(30)days from the date of execution. You may Cancel this egrtwment without any Nabilityrtayou,provided that you Mond a written notice to the Contractor by midnight of On third bustness day following your signing of this agreement,by ordinary trail,p9sled,by tsiegram, or sant dNfve . by rg Owner($)agme(s)that In the event of cancelletion of this contract by owner(s)atter the third business day,owners)shall pay contractor on demand (25%)twenty-five percent of the contract prke as its 0PUItt5d damages for the brea the tract WITNESS our hands and seat this " P„L�_._.day of American Home Improvement,Co.,Inc 'NO Sieh THISA6RE l3EFORE YOU ISUHJECTr E t Ab RIF RE RE LANK SPACES_ Ir (Owner) Accepted by: t (Authoi7ed WWI (Ownul A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. FI am a sole proprietor and have no one working in any capacity �am an employer providing.workers'compensation for my employeesAvorking on this job. vyte-- Com an name: . Address 2 Phone#: -PO J d 6 ✓ � 7' Insurance Co. Pofigy# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under, a pa' s a ena les of ury that the information provided above is true and correct a � Signature Date L� Print name MU Phone# d O ,,33 / Official use only do not write in this area to be completed by city or town official Building Dept []Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person. Phone A- O Health Department Other FORM WORKMAN'S COMPENSATION Official Use Only Permit No. DO-4-a P.&&S*o Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade 527 CMR 12:00 (Please Print in ink or type all information) Date To t m Inspector of.lflres: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters New Service Amps Vofts Overhead 0 Undgmd 0 No.of Meters ` Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work I Total' . No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA 1 Above 0 In 0 + No.of Lighting Fidures Swimminq Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Baftry Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Innbah'ng Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices No!of Self Contained No.of Dishwashers Space/Area Heating KW Detk¢tion/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices: KW Local. Connection No.of No.of L=Voltage No.of Water Heaters KW S' ns Bailases Wwing No.Hydro Massage Tuds No.of Motors Total HP OTHER: I INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES=NO = have submitted valid proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) + (Expiration Date) Estimated Value of.Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: i FIRM NAME LIC.NO. + Licensee Signature LIC.NO. Bus.Tel No. Address Alt Tel.No. OWNER'S INSURANCE WAIVER: i am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) + Telephone No. PERMIT FEE $ (Signature of Owner or Agent) m i v tD q Lnm CD �i VVVVi/VIfVV/ Board of Building Regula ions and tan ar s �- One Ashburton Place - Room 1301 Boston. Massachusetts 02108 )'Tome Improvement Contractor Registration Registration: 141031 Type: Private Corporation. Expiration: 12/29/2005 AMERICAN HOME IMPROVEMENT CO, INC CHRISTOPHER COLL ^-- --� 349 BROADWAY -- REVERE, MA 02151 - Update Address and return card.Mark reason for chang E] Address ❑ Renewal D Employment ❑ Lost Card �� �/die�o9lrrrtayu�eall� a�'..�l�;lialudf[W¢Q0 Board orBuuding Regulations and Standards License or registration valid for individui use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of BuildingRegulations and Standards Registration: 141031 •• One Ashburton PlaceRm 1301 Expiration: 12/29/2005 Boston,Ma.02108 Type: Private Corporation AMERICAN HOME IMPROVEMENT CO,INC. O CHRISTOPHER COLL 349 BROADWAY _ C REVERE,MA 02151 Administrator Not valid without signature �o n Mar 08 04 01 : 47p 7818534464 p. 2 03/08/2004 12:31 617-796-8968 C. JORDAN PAGE 02 M�M Lim DME NMIDCAT.. . . .. ... ...........•., @WFap. !Q x —MIN 7W FICATt ISS ISSUED AS A MATTER OF INFORMATION ONLY AND coNItERa NO NOM UPON TME CERTIFICATE MOLDEL THIS CEFMRCATIE _r:-•-;: � !gGvtfesSiOrlal•Risk Management ��MY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED By THE ,;.. .`1. IES aELOIN. Tt. •.ti ashiington St fes•.'t'Newton, KA Q2165 •COMPANIES AFFORDING COVERAGE .. LcDO"Aw A -Scottsdale Ins. Co. ...... ..•. ...........•.. . , tate Ins. Co. fAIG) 9%? Granite S •� .I9i1 Ren• ..LEM. .. .... . ........... ...... ,.. ........... . ... is ioan Rome Improvements CO.- .C 4 .. . �, •9Broadway cau Ax. ................ ........_.... ........ ....... ........ ................ . :.r. •LETIER East gliggg Ig NEE �i13-IS TO CERTIFY THAT THE POLICIE9 OF'MdSJWWCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMTED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RECIULREMINT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OCCOMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AaOFDED BY THE POUOIES DESCF45ED HEIIEIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUC FS. LIMITS SHOW MAY HAVE BEEN REDUCED 8Y PAID CIAiILS; ,..•,•.•........., t..........._............................................... ............ ••. ....._... _.................... . CD TWIN OF Iie1IR �QAT! ADN Z wAKK POIICV YUMIM #�Tl � r�h � Lflt - aesralwt u.erRnT # r AD(Si<wT6 t 300 000 ......................I...................... ...._.. c............ PROOVOTscaw R «G + aETITRAt uA91LIr Polky V: Ct.80liiTSD K '" A00, r �� �.3001.,•10Y00 :FrF.a•.....-CU11b6MA� ;•.X..�A�uvVR.i POWORIRAA'M1NAM •;... 300 000 02/18/04 ©�/1 s/05„............_..........:......•........... ' riiivra a cannACTori9 v►iar. fcAcw occtanna/ca 's ,... :300,000 H v: I.. LA�r«�SAI 5 a'000 j .......0. .,. ., ......._....... .........................•...,.........:...c............................... C......... MEO .•.rMy�e»�IS� 5,00(3, cam........ ... °'��"uluatr+r .., .•aNv Avco ...,�... �. ......................... O.W.0.0. 3 a `F LYAbM OCDULE0 AItTCB >, y Tn �. ..... ...............................................•. a IIRM MROS 0 :rionawlrto AurDe ARApE LIABNJTY �JPROPERIY DAMAGE as �_w' ►ee.nn •asI• fACM OCCURRENCE 3 _•.<�}%WELLA Foal) � �� ........... ..;...� ......'....... bmFJR MM VMaELLA FOAM ' Y _.... _ K...................:....._.... ........................... ...•.. ,•.,..•::.............................................._..... " .t .' srATuronr L1M TS R.............. ........ Penny s: TRA P2/05/04 2/05/05:s u!.ccrorT+T , .�........,. T'.ISLOTRAs LJABUFT g ;;ors e-POLICY .....5 0,0 0•. ORFAS6•rYfi 1......... 100,00 ..... .................................................•,..•..,......4................................................................. .......................,..........* .11 .........,............w_..._...........,...•..............F......_ ... ...0 HNiA 'i Town of aridgqewater be•?named as Additional Insured 78081697.4640 & 978/3'14.9846 SHOULD ANY OF THE ABOVE DESCFIBED POUCES BE CANCELLED BEFORE THE +°Mw EXPIRATION DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WA117EN NDTi TO THE CERTIFICATE HOLDER NAMED TO THE Tc wn of Bridgewater LEFT.BIR F TO MAIL . OTICE SMALL IMPOSE NO OSUGATIGN Cf UABiUFf ANY ND Ll TH COMPftN1', ITS AGENTS OR REPRfSENTATTVFS. ALITN A EI Ldgewater MA m a ,4 m M - Ate � ✓� M - W3 Board of Building Re ulaYons and Stan �ars s. _ g g �a One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Dome Improvement Contractor Registration Repi9tration: 141031 Type: Private Corporation Expiration: 12/29/2005 AMERICAN HOME IMPROVEMENT CO, INC CHRISTOPHER COIL --- 349 BROADWAY REVERE, MA 02151 - Update Address and return card.Mark reason for chang i Address ❑ Renewal [] Employment Lost Card :�\ �/��arn.,wnufeall/o�'✓�iaiaGfrateQ9 = Board of Building Regulations and Standards License or registration valid for individui use only HOME IMPROVEMENT CONTRACTOR before the eipiration date. Nfound return to: Registration: 141031 gg Board of Building Regulations and Standards • Expiration: 12/29/2005 One Ashburton PlaceRm 1301 Type: Private Corporation Boston,Ma.02108 AMERICAN HOME IMPROVEMENT CO,INC. O CHRISTOPHER COLL 349 BROADWAY. C REVERE,MA 02151 Administrator Not valid without signature al h , Mar 08 04 01 : 47p 7818534454 p. 2 03/98/2694 12:31 61.7-796-8968 C. JORDAN PAGE E2 �.� ^^^ « D9"DATE IMMOO/yr, ME M.oucot »~ '•THIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RKiIITB UPON THE CERTIFICATE HOLDER.THIN CERTIFICATE !xolfiessi nal Riik Management DOES NST AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE EL DIN. "1:7) :'.1AaLshfngton St POLICIES B „ . :. ..:. ... .... !esFt'Newton, !�A 02165 •COMPANIES AFFORDING COVERAGE ................................ .......... .. L A -Scottsdale Ins. Co. ;•;,..,. • S Graxite Skito� Ins Co . . .................. ....... .... . ............ ...... ... .......... . ... ,nlerican Rome Co.' COO".C P dway ,�.. .: ,4 L 9 sroa ,,_. .... r •_. . bwAw' E.. TIkISi 18 TO CERTIFY THAT THE POLICIES OF MISJFMCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF AW CONTRACT OR OTHER OCCI)MENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE;INSURANCE AFfORDED BY 713E POLICIES DESCRIBED HE•IEIN IS SU&3ECY TO ALL THE TERMS, IIICLUSIONS AND CONOMONS OF SUCH POLICES. LIMITS SHOWhf MAY HAVE BEEN REDUCED BY PATO CU1i165. _.................... ...................... .. ............................................................ c4 TYR o1 rMOL3Gruraet .........'................. _ ...... . .'.. ,F" EIf'BGM tIMRb eurArce Y O 0 � 4ATE M+.GD^ `°+ T! A LTR ........................%............,...,.... ,..,........................ ... .. .....,..... ;.,...,.,....,......... .... �► YBMTUIL LJWKi1T i GE1a?aAL AGOL�GATIo ,� 300 000 ....... .... .......I__......................:......................... .... .X f oMMEAOUIL ueLERAIt LiA : . Pr:W�cH0Vo0cT9i�X,0W9P.A.ft.. y3 .30(1,0000 er" :I9YS ...... 0gA.,uR , '130000 0 ` r«cAsru 2/iej0402/18/050s,......... ....!:i�7W►IER'9 6 CUKiMCTOR9 PROR. ,. .. . . .. . ... '... , :. .. .. y� "Flai oAeLr (Mr We ms).. ...� �e. 's .tN3 «MED, y one Peleon)f^ V 00; • ............................._....3........_....... ....... .................K....................-....... ......... ........1.. ........ ... .._. ... ........................ u4+ 5 eLTeoro�at aruury „co�AEw+Eo srrc3L E 0 g{��� xLMAIT !��ii•cT�L�'I AUTD i 6 ...�:, ... ...,,... .............................. �311tt OWNED AUTOLi • `-! V IppIRY "ASOHEOULPD MMS ; : ..............?..............................,. :MIRED AgWe i a ;eotxr wAuu+ c`s . •••••�••as •>• `tivL eeeLeeeq ;9eora1VrE0 AUTOS ".bAPAGE LINBUTY a :. `:. PROPERLY DAMAGE a w "" �, .. VAC CCCURREN� 3 wom" ; .. ...................... ROBSELLA FM . '`bTHFA THAN UMBREUA FOW 'v ' _..... _...,; ............... ,..,....... x.............,......:..,._...,. ............................ t g sTATuronr uMrts ". ' WDIIXLBI'M OOrliI1MATEo11 " :.R......................................:...._ AND Policy s TBA 02/05 j04 2/05/05 '"a!AccrorT+T <: . UO,�,00 ..... ...........................0 00 Gviff1mC LIABUTY > mD15A A4E-POLICY LIMIT ;f �J Q 0 wsiw '•EACH UPLOYFF.....j . .. .i 00,000 ..... .........., ......._................................ w Town of Bridgewater bE?MOB as Additional Insured , 78°/8537. .0940 A 478/3'14..9846 4464 SHOULD ANY OF THE:ABOVE DESCAiBEED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRRTfN NCTIi TO TKE CERTIFICATE HOLDER NAMED TO THE 7°C vn of Bridgewater LEFT,BUT F TO MAIL 9 OTICE SHALL IMPOSE NO OSUGATION Cf UABIUTT ANY NO U TH COMPfWY. ITS AGENTS oft REPRE;SENTATIVF-5. EA A E h Ldgewater MA MEN �M NORTH Town ® ` u ®veer No. 0 } 7 � o' dover, Mass., � � 0 LAKE COCMICMEWICK RATED PPC:) U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................... ..... ................... ....................:............................ ... .. Foundation • has permission to erect........................................ buildings on ........1Q .... .................. Rough to be occupied as.......... Chimney .................................................................................................................... provided that the person accepting this per ' hall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Co and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS- ELECTRICAL INSPECTOR UNLESS CONSTRUCTION "1 S � Rough r ....:.... Service ....... BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date.:..:"//. .•• r t HORTIy, TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� This certifies that ....... . .............. ........................ has permission to per orm" ' ....... � : wiring inn the building,of Y :�.. .... ..s,�;�,....., .+%.. ..................... at. /..f!........... ....................... .North Andover,Mass. �..... Lic.No.ZPV—:e........................................................... ELECTRICAL INSPECTOR Check # /j///7 5G79 4L Commonwealth of Massachusetts Official Use %ed -d Department of Fire Services P er� `t No.—V" Q cupancy and Fee Check BOARD OF FIRE PREVENTION REGULATIONS [rev. 11/99] leave blank APPLICATION FOR PERMIT TO PEFOR, ELECTRICAL WORK All work to be performed in accordance with the Massac u as Elfctrical Code(MEC) 527 CMR 11,11 (PLEASE PRINT IN INK ORP AL F RMATION) Date:_ City or Town of: To the Inspector of Wires: By this application the undersigned gives noti of 's or her intentio erform the electrical work described below. Location(Street&N ber) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No E?" (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.•of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the followin table may be waived by the Inspector of Wires. 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- o.omergencyiging rnd. rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o.o etect�on and No.of Switches No.of Gas Burners Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I.Number Tons KW No.of Self-Contained Totals:I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Heating Appliances Security Systems: No.of Dryers g pp Kit No.of Devices or Eq uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.hydromassage Bathtubs No.of Motors Tota!ISP 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of E ectrical Work: ' (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pai s andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: Ser��icesLIC.NO.: 1 s I-I(` Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel,.No.: 603 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 46r r Date....�'v./'......`.?........ NORTF� °',�,�°;•'+ TOWN OF NORTH ANDOVER °G o ' " p PERMIT FOR WIRING {� A-�......................................... This certifies that/.�....._ ._......,... .... ................ .... V w has permission to perform ...................... wiring in the building of......;! ` a........: -- ..................................... at.......D....... ,.. ...:. .....:............................................ .North Andover,Mass. Fee./:5...f...... Lic.NX�j�..7p...... ..:. . ..... ............. ELECTRICAL INSPECTOR Check # _ 5149 THE'COAM0NWE4LTHOFM4SSACHUSETIS Office Use only DEPAKrA1ENNT0FPUBIICS4FE7Y Permit No. BOARD OFFMPREVE MONREGUTATIONS 527 CM 12.M /r Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Ll Town of North Andover To_ e Ins ector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant �('� (�/y Owner's Address Is this permit in conjunction with a buildingpermit: Yes Check Appropriate B P �o � ( ox) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground M No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work .P%L No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units f No.of Switch Outl% _ No.of Gas Burners No.of Range No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals `'V Total Total No.of Detection and p — �� ns KW Initiating Devices No.of Dishw"' /�� U J KW No.of Sounding Devices / No.of Self Contained Detection/Sounding Devices No.of Dry( / / I KW Local Municipal Other Connections No.of W,• No.of Bailasis No.Hyr' � Ue /��/ ,,VV 7 Total HP OTHl �---_� Ili ageoritsstlbstantialegtrivalerlt YES ®/ NO y . . Ibawsublrnu.:,_ If baveclydod lease ring ,� 2 �– 5� P typeof �v INSURANCEBOIv,� (Pleasespey) _ S –�___ Fxpiratiorl Estirr Wd Value of Elandcal Wb&$ �t WodctoStatt7_a/0 Ir�spa —T-x,1eRegilested Rough Final 6 �v Q SiglledunderTie eso ERMNAME IloawNo. Sl LicYa>�e /L �7 �NO Signanne LiomseNo Bt>messTel.No. _:Qy 7 A1tTei No. OWNER'S INSURANCE WAIVER,Iamawalethatdie Iiomsedoes nothavethe instm- aoovetageoritssubstantialequivalentasreWwdbyMassachusenGmetalLam. and that my signature on thispenrutapplication waves this wq z arlellt (Please check one) Owner Agent Telephone No. PERMIT FEE$ Signature ot Uwner or Agent M COAMOATWEALTH OF AR.S' WBUSE77S Office Use only DEPARTA1ENT0FPUBL1CSA = Permit No. BOARDOFFREPREVEAWONREGUTAHONS527CMRl2 W Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) l Date Town of North Andover i To the Ins ector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) /(/ '� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes redo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground 1:3 No.of Meters New Service Amps Volts Overhead Underground No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 0 ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Range No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and s Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER' hW&1oeCOverage,PtustWtotheregun metilsofMassaclnlsettsG=1WLaws IhawaomaiLmbihtyk PblicyinckxkigComplv, CovetageorilsmbgmWegxvalert YES ®/ NO IhavusubrrladvafidproofofsametoiheOffim YES F3,imhawchedmdYPQ dictypeofco cl=ddngfir box INSURANCE BOND Or1IIQt (Plea9eSpelafy) - Q S Expiration E0natedValuecfE lWork$ WodctoStart hWecfionD&Requested Rough Final Fj Q Signedurlder r o FIRMNAME �A/ L r% LiseNo. V S� licensee Signahne I10UMNO o BusinessTelNo. 4/ C � /� Alt Tel NO. OWNER'SINSURANCEWAIVER;IamawarethatthelicedoesnothavetheinsumoecoverageoritsaibstantialequNdmtasrequiraibyMassaac iusmGaledLaws. and that my siglature on this pean t application waives this regilitenent. (Please check one) Owner F-1 Agent Telephone No. PERMIT FEE$ Signature of Uwner or Agent