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HomeMy WebLinkAboutMiscellaneous - 106 SANDRA LANE 4/30/2018 106 SANDRA LANE 210/097.0-0083-0000. Claim # 3003964 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner Or/ Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA 01845 Re: Insured: John A. Sena Property address: 106 Sandra Lane North Andover, MA 01845 Policy #: 3003964 Loss of: 2013/01/27 File or Claim No. AD 9832 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass._Gen._Laws,_Chapter_143, Section_6 to be applicable. If any notice under Gen-Laws,-Ch.-139-Sec.-3BMass_ is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster I On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by.first class mail. VIA�,J�- — 02-27-13 i ature and date I Claim # 3003964 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health de Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA 01845 Re: Insured: John A. Sena Property address: 106 Sandra Lane North Andover, MA 01845 Policy #: 3003964 Loss of: 2013/01/27 File or Claim No. AD 9832 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass._Gen._Laws,_Chapter_143,_Section_6 to be applicable. If any notice under Mass_Gen_Laws,_Ch._139_Sec._3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by.first class mail. 02-27-13 i ature and date Location No. �` Date HORTM TOWN OF NORTH ANDOVER 'Ila 016. A • s • � ; , Certificate of Occupancy $ cMU 4E<� Building/Frame Permit Fee $ s� s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ A- Check #1-1-29 18764 1-1- 187b4 /Building Inspect-r— r f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. !'TI SIGNATURE: Buildin Com miSsioner/lnsnector of Buildings Date SECTION 1-SITE INFORMATION Z' 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I b( AU'7)R L, JU 11 1�/1a;/`Q Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: , Zonin9 District Proposed Use Lot Area Fronta a 0 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide —Required Provided R uired Provided 1.7 Water S M.G.L.C.•l0.t54) 1.5. Flood Zone Infomration: � �P�h' 1.8 Sewerage oral System Public ❑ Private 0 Zona Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 4 2.1 Owner of Record EI.AJAr& SENA Name(Print) Address for Service L514# Signature Telephone 2.2 Owner of Record: .a Name Print Address for Service: — O Z Signature Tele hone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Su rvtsor: Pe o License Number Address g Tele hone Expiration Date ic Si nature p r 3.2 Registered Home Improvement Contractor. ��t J C� ��STn) �D � � Not Applicable ❑ Company Name IC C � � _ _ _� M Registration Number �o �S u"�T. o c � `u G �I r Ad r 2.3-3 1� G z t:pr� � jSin.t:.,�e �jTelephoneL "'�V Expiration Date 7 SECTION 4-WORKERS COMPENSATION(AG.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.......0 No.......0 SECTION 5 Description of Proposed Work(check-all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ 7dition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Col' leted b permit applicant 1. Building (a) Building Permit Fee S 0 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) 4 Mechanical(HVAC) 76 •D 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 OWNER/AUTHORIZED AGENT DECLARATION l,-DA-V11 CA�K i cz/VE ,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 VA V C D c,/'4 s T7RI(�,QnI F Print ai r n A? /0' Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 2Fie Commonwealth of wazachusetts (Department of Industria Ax dents off=ofInvestigations 600 Washington Street Boston, WA 02111 Workers'Compensation Insurance Affidavit APPLICANT INFORMATION p Please PRDT Legibly' Name: FL-. 19 FE SE Location: —I d(a h dDAA I—Alr CiTelephone#: 0 I am a homeowner performing all work myself. 0 I am sole proprietor and have no one working in my capacity I am an employer providing workers'compensation for my employees working on this job Company Name: 'Dow n GO )q Sidi —rfl(. Address: ego o U o f}on S4 i C e Jul I City: /r �/L(l Q vex— Telephone#: 1�,�7 8 6 ��/f Insurance Company: 1#1 --274YVi /—t • Policy#: Y e �00 0 /o 7 I e0l I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy#: Company Name: Address: City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to 51,500.00 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 hereby certify under the pains -and dppenalties of perjury that the information above is true and correct Signature: ,,_� ,�, / .� Date: Print Name: b A✓I a C A'S T UfA Phone# 991613 3 V d-0 _ Official Use ONLY-Do not write in this area ❑Building Department Ci or TowPermit/License#: ❑Licensing Board Ty n: o Selectmen's Office o Health Department ❑Check if Immediate response is required o Other I INFORMATION&F INSTRUCnONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law" 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 section 25 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, 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 beenpresented to the contracting authority.. Applicants Please fill in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. City or Towns 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. Tlease.be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ]Boston, MA 02111 Fax# (617) 727-7749 Telephone 4 (617) 727-4900 ext. 406, 409, or 375 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: ZLt A-IJ)- (106 (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit �l Date i i NORTH Town of _ 4Andover 0 I -V ...... Z. .0W o dover, Mass., Mo .'S� COCMICMEWICK � A�RATEO PPS` 5 �'s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �� � ,� BUILDING INSPECTOR THIS CERTIFIES THAT..... .......... ... l . ... .�.......... ..... . ""' Foundation has permission to erect....... buildin n . ....... � *4.. �� Rough to be occupied as........... . a . .. . aa. ................................................................ C imn y h' eprovided that the person acce�0.tinth permit ll a pe conf to the terms of the application on file in Final this office, and to the provisions of the Codes 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 PERMU EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU START Rough ........ ....... ... Service L EC OR Final Occupancy Permit Required to 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. IL SEE REVERSE SIDE smoke Det. Location 19ti DeA IZp,vE No. Date t//g&-7 A rr M°"TM TOWN OF NORTH ANDOVEl F : Certificate of Occupancy $ s - a . Building/Frame Permit Fee $ /70 ,SSACMUSEt Foundation Permit Fee $ Other Permit Fee $ o; Sewer Connection Fee $ _ Water Connection Fee $ _ IL TOTAL $ l30 bo Buildingn"sp `iector TJ � 10834 Div. Public Works PEEf*iflT NO. l APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. l/ PAGE 1 MAP KJO. U Cr'? LOT NO. o® 3 2 RECORD OF OWNERSHIP DATE BOOK :PAGE ZONE SUB DIV. LOT NO. FI I LOCATION PURPOSE OF BUILDING ��i0,`.�_ f-l-el fFv OWNER'S NAME NO. OF STORIES SIZE /� OWNER'S ADDRESS BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME (� � SPAN DISTANCE TO NEAREST BUILDING v 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 V SIZE OF FOOTING X IS BUILDING ADDITION � l© MATERIAL OF CHIMNEY IS BUILDING ALTERATION vve C o A ` IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TV REQUIREMENTS OF CODE O/�5 IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY �J IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST 'SEE BOTH SIDES EST. BLDG. COST ��, D� PAGE 1 FILL OUT SECTIONS L.- 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE�FILED DJA D APPROVED BY BUILDING INSPECTOR DATE FILED 7 /a �2 e' 04 DUILDING INSPECTOR SIGNATURE OF OWNER O AUTHORIZED AGENT FEE l o •od OWNERTEL # (fls^`C<J��� PERMIT GRANTED CONTR.TEL.# V �'57/Z/;7 ��•� /9>19 CONTR.LIC. H.I.C.# /V BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILY 11 IS.ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION ale 2 FOUNDATION _I 8 INTERIOR FINISH a/ CONCRETE I _ a 1 2 13 �G/�� (((-��� CONCRETE Bl'K. ���III PINE BRICK OR STONE HARDWD PIERS PLASTER _ DRY WALL 3 BASEMENT UNFIN. /�%Fei�"^��'L/ �(/A/!�!/C� I �!✓!/'V / ���! I / AREA FULL FIN. B'M'T' AREA '/, 1h '/. FIN. ATTIC AREA `J�j /1 / �/J `fie,jj NO B M'T FIRE PLACES /�'-c.'� HEAD ROOM _ MODERN KITCHEN / V,/le— 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'0 ASBESTOS SIDING COMfACN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE f HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. FIX.) _ FLAT IA 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. 3 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 GAS OIL B'M'T 2nd _ ELECTRIC 1st 1-3rd I NO HEATING ovm Of a - - over No. 1Co�o -T o LAK ' ~ dover, Mass., �'►f'�2�L 1997 O CHICNEWICK '1• S q4 T E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System .E�, • rt �G \� ���1�' BUILDING INSPECTOR THIS CERTIFIES THAT Al *..........1n a st ...... ..........T.�.....,.J.........��............................................................. Foundation t has permission to en�t...... �-'�"MI ............. build' gs on ...../04.....5i'►ND�C�.... F. 4�............................. Rough to be occupied as..................................kkV4496.01L....A-1ia C—A)............................................................................. Chimney ' e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating:ta:the:Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATIQN of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS _ ELECTRICAL INSPECTOR Rough L..,T............... Service ..............ft.................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �i ,q ✓/IG' L�IUIIL�AdU JIlU('C!(lfiUL✓��OCLC/tlLQf��il { � =•.-f,' tlL��11�T1'a^! l�" 1'bia 11 .'tt i[f�• f�uiT, EC S 12 9 Tk�oom,,.on, C aa�taefl'e r MORE IMPROVEMENT CONTRACTOR ReOistratioa 103045 , Type - PRIVATE CORPORAT ON EK . piration W4Og • PETER C. DESJARDINS CONTRALTO; Peter C. Des'ar ' � dins ADMINISTRATOR X33 E1110t St Beverly MA 01915 J. • ••• �•�.���nnrs ^rrs.ra.r d&%j" f%jn rtnnni i a u u%j rL-WAYIOu.%.+ (Print at Type) NORTH ANDOVER, Mae@. Oats Building I Permit 3 3 (Z41 -3 U vel Location /7.<0-- Owner's Name sZ /i/ 1 o/ New ❑ Renovallow--tf Replacement ❑ Plans Submitted: Yes❑ No.❑ FIXTURE aE w Z >< .mss w } u s N = U Y 0 S et » X a► s '4 ` ;O F u06s o Y a s v s _ sic 1 $ 0 u S ami a o 3 j s w is i a e i pin i O sus—esrrlT. @Ae[al[NT IST PLOOR iN0 FLOOR $NO FLOOR ITN FLOOR aTH FLOOR eTH PLOOK. YTH FLOOR LOTH FLOOR Installing Company Name Check one: Certificate Address 9a �6 � d � �ji/�?9t//� 13 Cpm. /�'� ❑Partnership G � rmxo. Business Telepho 9 � / •Name of Ucensed Plumber INSURANCE COVERAGE: Cliecli one 1 have a current liability Insurance policy or Its substantial equlvatenL Yes ❑ No ❑ It you have checked M,, please Indicate the type coverage by checking the appropriate box A Ilablily Insurance poltyl Other type of Indemnity E3 Bond ❑ OWNER'S INSURANCE WANER: I am aware that the Ilcensee does not have the Insurance coverage required by Chapter 142 of the Maas. General Laws, and that my signature on this permit application waives this requlrement. Check one: Signature o er or owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the dataAa and information I have submitted for entered)h tion are(lug ocurate to the best of my knowledge and that NI plumbing work and Installations performed under the p mM I Ws in comp9 with aA pertlnent provisions of the Massachusetts State Plumbing Code end Chapter r o By Title nature of U*sod Plumber Clty/Tawn License Number OA00S M I'fMO (OFFICE USE ONLY) Type of Plumbing license: Master ❑ ,� Joumeymancal h i g Date. . . . 3341 HORTN TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING +0+.r.o ,SSACMUS� This certifies that /,(►�/` r���'�'. ... . . !� has permission to perform . . . . . . . . . . . . lt�� plumbing in the buildings of . L��. . . . . . . . . . . . . . . . at. . . . . . . . . -Pa-W dC.4. .ZaXi . . . . . . . .. North Andover, Mass. Fee-7k-'—v. . .Lic. No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR �. r05/16/97 09:56 30.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer .�' Office Use Only ul: �ommIIuw�ttl of >x000Luol: o Permit No. kv/, 3epaTtment of Vuhlil: _afrtu Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM . 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date L_/ `1Z 9 � (M* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) les ShIlmRA L P L Owner or Tenant I-L L V S L Owner's Address' 1t Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps __J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures (� I Swimming Pool Above In- KVAgrnd ❑ grnd. ❑ Generators No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Air Cond. Total No. of Detection and No. of Ranges �. tons Initiating Devices No.of Heat Total Total No. of Disposals Pumps Tons KW No. of Sounding Devices ` I No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices I KW Local Municipal Other i No. of Dryers Heating Devices 11Connection El No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: 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 the Office. YES _ NO _ If you have checked YES, please indicate the type of coverage by checking the appropriate box. /Z Cc t- �ti �inL V ^�0 � INSURANCE--Z— -BOND OTHER (Please Specify) — � (Expiration Date) Estimated Value of Electrical Work S y©O' Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: i13 L6 FIRM NAME (+2 E-1-11 .-t C_ LIC. NO. Licensee rnP n�< EiA Li[o w S i Z I Signature LIC. NO. Bus. Tel. No. S c,- r32 Address L=-lo d>t) Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- and that m signature g nt fired b Massachusetts General Laws, Y nature on this permit application waives this requirement. Owner A 9 re- quired Y (Please check one) V Telephone No. PERMIT FEE 5 (Signature of Owner or Agent) �( (f � x•6565 - Date.... i 881 A¢¢ 40RTN 6 °t<•``°:°�"° TOWN OF NORTH ANDOVER p p PERMIT FOR WIRING g ,SSACNUS� M This certifies that .M....9. F �.. e �'� L has permission to perform ........I ..0 l s.... e co ig wiring in the building of....... .�n. 4...:........................................................ j at.....lQ...�r..... �!.'t '�1�s.......L P...................... .North Andover,Mass.. r LA)......... Lic.No..Aj: .3i C ............... S ELECTRICAL INSPECTOR C- WHITE:Applicant CANARY: Building Dept. PINK:Treasurer t '-. Date..... ..Q�..J. ... 7 882 p Q� ,FORTH L1 `_`° " TOWN OF NORTH ANDOVER 8 p PERMIT FOR WIRING �sS�cMusE� / .. This certifies that .... �...5......... .....1.4?........��2 ....................................... o has permission to perform .... 0 U.' %�4�? �c�i��✓L- °' .1..... f. ` ......................... wanng in the building of.... Y1 . � . ...................... �-� at... (wa .t<.G� .�... . ..U...�....... ,North Andover,Mass. Fee....rl.5......... Lic.NoffA.776 ............................................................... ELECTRICAL INSPECTOR C k- WHITE:Applicant CANARY: Building Dept. PINK:Treasurer