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HomeMy WebLinkAboutMiscellaneous - 115 VEST WAY 4/30/2018 (2)N pO W O g� O O LUT 34A 9b t 112 ME 331 LEACHING ANu RESERVE ,. TRENCHES Io COMMON —_, DRIVE NI, I,HOUNDARY AND DWELLIN,71 LOCATION FROM PLOT PLAN BY R'F KIMINSKI AND,•ASSOC DA] ED. 6/19%63 2.GRADESWERE FIELD ADJUSTED TO MATCH TOPO i AND DESIGN CRITERIA: 3.1 CERTIFY THAT .THE SSD&. WAS INSTALLED AS SHOWN' AND WITH CONS] RU( -TION MATERIALS AS SPECIFIED` IN ] HE RELATED DESIGN. . ELEVATIONS: TOP FOUND 171.7 DWELLING OUT: 16�_9p SE PT IC TANK = INLET= 161.79 OUTLET 16153 D -BOX INLET- 15 8.9 1 OUTLET= 158:6 END OF TRENCH= '# I = 158AG 02= 154.75 113: .151.51 04' 14 6.7 0 PLAN OF AS BUILT CONDITIONS LUT 34A VEST W A Y OWNER=JO-DEE RT DAT E'8/3I/ 3 SCALE:I '/40/ i PREPARED BY FLYNN Assoc. P. c. CIVIL, SANITARY and CONSTRUCTION ENGINEERS Plaistow, New Hampshire 03865 P.O. Box 569 s A 7 1 M r > > ^ n p n 0•> s 0 r N A�<<<:)�>>ozfRfq j r r w 0 0 0 > n ; 1 . 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H 1 1 zo �o cn z N m o 0 0 CD : V moCD: anW o''o (` � o � O 0O PVm T 9 p r •--� :1O L- ►d tzi\�+11 °'- p ac O �s w z O . \ yM U M 0 1 71 1 N f f c ( z • r o i F a. v ss_ A'= 9-b. i r i Z �• :1 .:i..t 1i�. SIA �7 d M -i r �`� .. es w N S g .2 o�.e+. t.. m r 1..• 1 o .a.. w i A.t y U ap .+ 40 .q.. up cn F 1 • o I I 4Q. a °D .. C.. c 1 UP • CF) r N ( i F a. v ss_ A'= 9-b. i r i Z �• :1 .:i..t 1i�. SIA r �`� .. g .2 o�.e+. t.. .+ 40 .q.. up UP N U t am a nomeowner performing all work myself. ❑ I am a sole proprietor and have no one working, in any capacity comoanv name:.... ...... ....... . address: city: nhnne #- ntnrinre'rn'`'% ... failure to secure coverage as required under Section 25A of MGL, 152 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 5100.00 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 ceinlilfy under the p1dift and penalt es of perjury that the information provided above is true and correct Signature /�jJ ' ate Print name / l ee/ 1. / ml, 0 r! " 'Phone # official use only "do not write in this area to be•completed by city or town official . _ �.... .. ._ .. _ . city or town: permit/license q riBuilding Department �pLlcensingBoard . ­' 0 check if Immediate sponse is required CSelectmen's Office C]Iiealth Department contact person: phone 0; rIOthcr (Mir/ IM PIA) SS Location No. l'n Date NORTq TOWN OF NORTH ANDOVER F w f • y + ; , Certificate of Occupancy $ Building/Frame Permit Fee $ j- ACNUS Foundation Permit Fee $ Other Permit Fee $ f N ' TOTAL $ (e(, r Check # r 'iGLJG Building Inspector 4— TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r Ia.?Fi1C;Qiii Q>ttl BUILDING PERMIT NUMBER: �j / � DATE ISSUED: 4/— SIGNATURE: Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Propetty Address: 1.2 Assessors Map and Parcel Number: oq3 Number Parcel Number AMap -�- wl 1.3 Zoning Informational: Zoning Distrid Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided 1 1.7 Water Supply M.G.L.C.Q. 34) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service Signature Telephone ,\ caner of Record. A Name Print Address for Service: r�- t Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable L r \ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ;Company Name Registration Number Address Expiration Date Signature Telephone M M X ic Z O v n M O O Z M 90 O mn r v M r r Z YI 9 SECTION 4 - WORKERS COMPENSATION (M.G.t 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 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building { , . { ..� (a) Building Permit Fee Multiplier 2 Electrical C nay-) (b) Estimated Total Cost of Construction 3 Plumbing _ Building Permit fee (a) X (b) D -� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 . Y`'`� "'� Check Ntunber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, SH (�%J N G , as Owner/Authorized Agent of subject property Hereby authorize Ira M, `N 9 6 N T 6� A - S to act on My behalf. in all lati ork authorized by this bllding permit application. % Signature of Owner ate SECTION 7b OWNER/AUTHOORIZED AGENT DECLARATION NiNi P t 3+1 Q V"t as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print' , St aura of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f=1bK I'ZrQ_ n� AP FORM U - LOT RELEASE FORM 3-1c,— 0 3 .. INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT T AS" A A S \A) N Cr kC .a -L' j� LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) ,16 STREET_//S VCS /-7- W it y -(%oST. NUMBER ************************************OFFICIAL USE ONLY********************************* RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMM I UWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD 4NSPECTOR-HEALTH DATE APPROVED �(• r- I - r S -S DATE REJECTED SEPTIC INSPECTOR -HEALTH COMME APPROVED L PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: S A �_E M Mli)-Tr,ptr\lS-�eCZ 1t -k SuvVimPScol1. (Location of Facility) Signature of Permit Applicant Date A v f, 2 fly_ NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector O ` ti Town of North Andover Building DepartmentAT­ 27 Charles Street �SSacHusEs�` North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE-; 1 17 1 0 JOB LOCATION . 11S V P_ S) `T I pq l Number ` t Street Address Section of Town "HOMEOWNER—TigSH o A SH A 1V G L f L -x c ^I I-97a"7,S6" 1©:?ii Number Home Phone Work Phone PRESENT MAILING ADDRESS S V9 rn(F City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. m m m VJ 0 3 0 X - d BUPA CD vCID y. W 0 0 CD ED" Y 0 z = 2 O —• to G or to EL CD to a �m C) C7 0 H 0 do � m Z a-• (a -�_•i O� .ar = .d+ m C T CL CD a?d = y CD O m y p O gym' 2 1 a =mo c.)CD sr 0 to to E; O O if 1 a D O CL W CO CD a: k- VJ CD :v CD W CD C1 �� 1-- Fw /fA� to CD CD 0 O L' H R3 CD CD CD CD d CD C: a =o: y: o_: O _" o wG o r- .� �y M � °= n� or o �: a 0 w � z o 0 rt rb 0 ED" Y 0 z = 2 O —• to G or to EL CD to a �m C) C7 0 H 0 do � m Z a-• (a -�_•i O� .ar = .d+ m C T CL CD a?d = y CD O m y p O gym' 2 1 a =mo c.)CD sr 0 to to E; O O if 1 a D O CL W CO CD a: k- VJ CD :v CD W CD C1 �� 1-- Fw /fA� to CD CD 0 O L' H R3 CD CD CD CD d CD C: a =o: y: o_: O _" s- o wG o r- .� �y M � °= n� or o �: P -W z o 0 rt rb cn s- Mk Date............................. . '01"`° '•'"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ...... .......... ........................................... has permission to perform......, .................................... wiring in the building of ...........:........................................ at ............. .. �� .................... . North Andover, Mass. J.... ....... �.... Fee.`.' ............... Lic. No3.dE............................................................... x ELECTRICAL INSPECTOR Check # // 5� HT C0A10NWE4L7H0FM4S,4CHUSL'J,S Office Use only . D1%1'AIO,1ILfir1'OFPUBUC, A L -Y Permit No. �2— BOARD OFFRiEPREtEMONREGULA77ONSR7CNIR12M ��+•��' Occupancy & Fees Checked APPLICATTONFOR PERM. HT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUS STS ELECTRICAL CODE, 527 CMR 12:ODatOl%e (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. Location (Street c Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes =No � (Check Appropriate Box) Purpose of Building (] yip yc4hdca D 4ft<_� Utility Authorization No. NIC uL Existing Service 00 AmpsW I 123Z Volts Overhead Underground No. of Meters New Service d LAmps / Volts Overhead Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work tvo. or Ltgnttng uuuets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges Vo. of Disposals r, To. of Dishwashers `o. of Dryers No. of Hot Tubs Swimming Pool Above ground No. of Oil Burners Space Area Heating Heating Devices of Water Heaters KW I No. of No. of .). Hydro Massage Tubs HER No. of Motors Total HP ou. or i ransrormers Below M Generators >round No. of Emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Connections Total KVA KVA No. of Zones Other MMCovetage Ptnarattk�therecgatarta�sofM�sad� fts(,alaalLaws :aarmtliabhty1n==Pblicymc1txkECorrpleeO VMrageorZst>1 le urvaiu t YES NO 0. st>brrlit�dvatidproofofsarnetotheOlhce YES U Fyc�uhmNedlads IEY plemmxhcatethetypeofcc)wr eby ingth�W RAS QMHER EVirdfionftie- Estrm*dValtleolflccftcalWotk S`c u toStart I tDPkReged Rao Final tmaer�ieP .Terri , NAW w G l amseNo 38 s C Signw,re L=wNo S r 1% BtsimTeiNo (`l7b)34D-6_ 1 0UGedy-e13e) Alt Tel No. R'S ANIItIama thattheIic edoesnothavetheirmaancem oritssu(�ttial val as egtn ragttited byMassadnimtls (,eneral Laws my signahue m this pemrit application waives this ragttnmff t check one) Owner ® Agent Telephone No. PERMIT FEE $_ Signature of Uwner or Agent No. of Gas Burners No. of Air Cond. Total Tons No. of Heat Total Pumas Tons Space Area Heating Heating Devices of Water Heaters KW I No. of No. of .). Hydro Massage Tubs HER No. of Motors Total HP ou. or i ransrormers Below M Generators >round No. of Emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Connections Total KVA KVA No. of Zones Other MMCovetage Ptnarattk�therecgatarta�sofM�sad� fts(,alaalLaws :aarmtliabhty1n==Pblicymc1txkECorrpleeO VMrageorZst>1 le urvaiu t YES NO 0. st>brrlit�dvatidproofofsarnetotheOlhce YES U Fyc�uhmNedlads IEY plemmxhcatethetypeofcc)wr eby ingth�W RAS QMHER EVirdfionftie- Estrm*dValtleolflccftcalWotk S`c u toStart I tDPkReged Rao Final tmaer�ieP .Terri , NAW w G l amseNo 38 s C Signw,re L=wNo S r 1% BtsimTeiNo (`l7b)34D-6_ 1 0UGedy-e13e) Alt Tel No. R'S ANIItIama thattheIic edoesnothavetheirmaancem oritssu(�ttial val as egtn ragttited byMassadnimtls (,eneral Laws my signahue m this pemrit application waives this ragttnmff t check one) Owner ® Agent Telephone No. PERMIT FEE $_ Signature of Uwner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policy # Company name: A Address City: Phone #: / insurance Co. _ Policy # Failure to secure coverage as required under Section 25A or MGI. 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonmerrt_as_welLas_tial.penaftiesin-thelorm-da-ST_OP VjKM oRDEftaid_a fire-f($1DO.DD)-aAayagainsi_me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties ofjoa jwy that the k*m)abon provided above is live and correct Signature Date Print name PbonQ # Official use only do not write in this area to be completed by city or town officiaf City or Town Permrl/licensing D Building Dept []Check if immediate response is required E] Licensing Board E] Selectman's Office Contact person: Phone #- E] Health Department 0 Other ,a MASSACHUSETTS UNIFORM APPLICATION.,FOR PERMIT;T0.00-;:PLUMB1 (Type or Print) NORTH ANDOVER ,Mass. Dater / 7 Building Location _s/ 1, . 7- 4�i — Permit Owners Name /VV New Renovation j] ' Replacement [] Plans SVbmitted .' FIXTURESi.. (Print or Type) Installing Company Name �e Address 0 Z Y,4/,q/ Business Telephone Name of Licensed P Check one: Certificate �] Corp. L Partner. E---Firm/Co. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policythey type of indemnity Q Bond Li Insurance Waiver: I, the undersigned, have been made aware -that the licensee of this -'app ication does not h ve any one of the above three insurance coverages. ture"of owner a nt o,f property Owner Agent�� (� I kabp attify dial alto( die dcl ails and infotnlalion 1 have suWed (tcd lot enlcicd) in aha.c application sire Isle z1ale toOte bell of Illy �• - knowkdgc and dut all plumbing work and installations latfninscd under reemit issued lot this applicalioa will be iw ooNylliatlale Wilk W polligept FW.0 wilio" of the Massat:ltusetu State Plumbing Code and Chaplet 142 of 11Vc ua1 ws- , • I• I ,v By Title. City/Town: Si ature of 'Li Tvpe of Pf License Number hsed PlwQber bing License ❑ Master . J uo rney"a z z w Cl W to yc J a• LL a Q h m N Z a a = 0 z z 0. . a O) 0 XalU C Q a >••< V Z• IL O 7 cc >- 0: (n W A zo 4 O J. W ¢ W W Z f. < t. Y W m O A z x. J 1) a it 0 a 1• J- Q a ly • Cl IL 4. >< aC W • • ; 1- < 0> F- r o h ° h to Q h- 0 z 0 J Q W Q Z z Y a: w 1•� < p o V= 1- ; ; Y < J < m A A A Q J = Q H W J Is. O a 1G < Q SUB-%BSMT. ' BASEMENT 1ST FLOOR 7 3 nn O' 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Installing Company Name �e Address 0 Z Y,4/,q/ Business Telephone Name of Licensed P Check one: Certificate �] Corp. L Partner. E---Firm/Co. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policythey type of indemnity Q Bond Li Insurance Waiver: I, the undersigned, have been made aware -that the licensee of this -'app ication does not h ve any one of the above three insurance coverages. ture"of owner a nt o,f property Owner Agent�� (� I kabp attify dial alto( die dcl ails and infotnlalion 1 have suWed (tcd lot enlcicd) in aha.c application sire Isle z1ale toOte bell of Illy �• - knowkdgc and dut all plumbing work and installations latfninscd under reemit issued lot this applicalioa will be iw ooNylliatlale Wilk W polligept FW.0 wilio" of the Massat:ltusetu State Plumbing Code and Chaplet 142 of 11Vc ua1 ws- , • I• I ,v By Title. City/Town: Si ature of 'Li Tvpe of Pf License Number hsed PlwQber bing License ❑ Master . J uo rney"a NORfM O0 O 9 ,SSACMUS� Date. . 7 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that pd- 14 has permission to perform ... I � ne'. t- 41., i? � ! GN.. r ................ plumbing in the buildings of ...�. G!z." .S ...................... at ... V.r.s..4... L.." 9x �O\rth Andover, Mass. „.. Fee. 7✓, .' .. Lic. No. ,Z .v .6 y C ...... ... .. ....... . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer O 00 :7 0 co m 0 CU cv 351 ��j�� s Date ........ ..... ........... �i If NORTH 3?;•,�`` "�,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING /1 ( -/-,�, /, ; /,,- (- . This certifies that ............:.1.! `........................................................... has permission to perform ................................................. wiring in the building of �� �< < v` ................................................................................... at .............. . �............................................... , North Andover, s. Gni 7 � �7 Fee.Z. ............. Lic. No��..�%5�}�........... .-............................. ELECTRICAL INSPECTOR Check # .3,� V �efiwteuat as �u8[le Saaety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No. ( 2 Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perforated in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 0//2-/0'- To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform Location (Street & Nuygber / below. Owner or Tenant,/G``,� iv Owner's Address S/I/�le:!F� Is this permit in conjunction with a building permit Yes ❑ No Of (Check Appropriate Box) Purpose of Building Utility Authorization No. basting Service Amps Voits Overhead ❑ Undg� No. of Meters Nervice Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacit! Location and Nature of Proposed OTHER: or 7v S INSURA RAGE. Pursuant to ment3ts of Massachusetts General Laws I have a current Liability 1'nclu�ding Completed Operations Coverage or its substantial equivalent YES = NO = ave submi valid proof of same to the Office YDS` NO = If you have checked YES please indicate t typyof c��er�9e by checking the appropriate box RANCE BOND = OTHER = (Plls�U--, ' (Expiration Date) Estimated Value of lect ' I ork5 V Work to Start Inspection Date Resquested Rough Final Signed under the Pe tries of perj ry �%�5F: FIRM NAME LIC. NO. C _ao NO. // a B. Tel No. Addres^/l Y,�� -Q�T`jG Ak Tel. No. T 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) VO Telephone No. PERMIT`FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained a No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of &,ryers Heating Devices KW Local Connection t No. of No. of Signs No. of Bailases Low Voltage Wiring No. H ro Massa a Tuds No. f Motors Total HP OTHER: or 7v S INSURA RAGE. Pursuant to ment3ts of Massachusetts General Laws I have a current Liability 1'nclu�ding Completed Operations Coverage or its substantial equivalent YES = NO = ave submi valid proof of same to the Office YDS` NO = If you have checked YES please indicate t typyof c��er�9e by checking the appropriate box RANCE BOND = OTHER = (Plls�U--, ' (Expiration Date) Estimated Value of lect ' I ork5 V Work to Start Inspection Date Resquested Rough Final Signed under the Pe tries of perj ry �%�5F: FIRM NAME LIC. NO. C _ao NO. // a B. Tel No. Addres^/l Y,�� -Q�T`jG Ak Tel. No. T 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) VO Telephone No. PERMIT`FEE $ (Signature of Owner or Agent) t ._. .. . +it..s OMCO Use OntY �d:.T � •.?.. -- 01 L: i tan of � LPermit No. �{ vt b& irOtxsapancy b Fee Cttedcsd ,�--- BOARD OF FIRE PAEY�"riTtON REGULATIONS S27 COIR 1200 (lefty blawrI144 APPLICATION FOR PERMIT TO. PERFORM ELECTRICAL "WORK All Waris to be performed in ac=rdance-with the Massaatusetts Q4:s"sit:ai Cade, 527 CIMR 1290p (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date a* or Town of NORTH AffDOVER To the inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 5 7 � r Owner or Tenant m P, TO ki F—-5 Cwner's Address 5,4 m r Is this permit in conjunctiontwith a �uiicirg �errnit: Yes ]� No F (Check Appropriate Bax) Purccsz ct Suilcing fi #— Lu Jk z 0 1-ytt Utility Aumcnzaticnri No. Existing Service Amps _ 1 `/sits Cverread Uncyma C No. of Meters New Service Amps Volts Cvemead r Unagmd 1_i No. of Meters Numoer of Feeders and Ampacity Location and Nature at Proposed E:ec:::cal `Ncrr Qi NO. a ranstcrmers Tatar No. at L:gnung Cut!ets V No. :t KVA Va_c: No. cr !gnt:ng = xtures S«.r..r..:r., :.. c _ —c. i Generatcrs A No. at Ernergenc/ Ugnttng No. ct Geceotac:e Cuuets No. at C:l Surners j Barery Units No. at Sw,tcn�t I No. at Bas Burners FIRE ALARMS No. of Zones tat No. at _etection aria No. at Ranges i No. air Circ. ours I Initiating Cevtcas meat stat No. at pisccsats Nc.af :s -ors C.V No. or Sounding Cevices No. 7r Sett Conta,nee i No. at Cisnwasners S=acetArea --__.:rg (•! I Catec-:cmSouncing Cav,ces ! -C3 — Mun,c:cai -Cthar No. at vrvers yea -g Zav:ces C%� = _ Cannec::on No. at No. Z! I Low •ioitage j No. of 'Nater Heaters }CW i Signs 3a:iasis Wirnc No. Hvcro Massage Tui73 No. ct Motors Total i"P I CTi-!E�: !NSUPANC_ CCVE?AGS. Pursuant :o :na rec_:rerner..s : aassac._sers general laws _ _ I nave a current LPal icy Insurance Poc/ :ne_c:rg C.:r-_._=.ec Cceranens Coverage or ;ts sucstanttal ecutvatent. YES _ NO _ 'lave suamtRea valid creat at same :a :rte C!fts. YES _. NC _ :t !cu nave cnecxec Y=_. :teasa inctcate :ne type at coverage :v anecxmi; the accroonate pox. INSURANCE = 3CN0 = OTHER = :Please Sce=!y) ._ (Ecarauon Oatet 0 Esttmateo Value of E'.ecncai work 5 .�)Do o F;nal ��� Insaeeten 0a:a e.eet:es-.eC: Reugn / worx to Start� � �� Signed unser me Penalties at per)ury:�p L (L G t . N FIRM NAME i/ ��1. L1C. NIX licensee U i' S;S'att;m UC./NO. /_iL — ✓ G -f' 2 /, alis. Tal. No. Accress Qu%6 7/ S7G� lr1 l�•l� LIEV--Alt.:al."lo. CWNEWS iNSURANCE WAIVER: I am aware sax —,.e Licensee aces -ct 'lave .rte insurance coverage or its suostanrial equivalent as -e- cutrec cy Ma33acnusetts General Laws. anc that . v s:gna:ure on its :Kmtt aecucanon «awes tnt3 requtfemML OwnK Agent tP!eaam cnecx one) eteenane No. PS:;Mrr FE= S ($,QnatUre at owner of ASenll r • 'o Date.. ..... .. ........ A TOWN OF NORTH ANDOVER R PERMIT FOR WIRING g i This certifies that .....................................- --� ` , .... .............. '.4=1. .. has permission to perform ...... �... *..................%.. U......... ............... wiring in the building 00 7?. `... . . ............................................ /1.y6,1 ............. . North Andover, Mass. Fee!/.'l....� ..... Lic. No. ' V.7 f .......................................................... ......... ..... ..... ELECTRICAL INSPECTOR r+" WHITE: Applicant CANARY: Building Dept. PINK: Treasurer This certifies that Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING J i -- �w w -rte- C -C ltrt,l7G% .. .... _ j. ... .. �has permission to perform ... �!�`z..;.a. .':L --.;4.G- �...... . plumbing in the buildings of . a t..././s'�..`��!-�- !.. Feel��..... Lic. No..V. 9333 Check # 6642 ............. North Andover, Mass. ............. PLUMBINGOSPECTOR NOR7p F 9 "'SA HUS This certifies that Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING J i -- �w w -rte- C -C ltrt,l7G% .. .... _ j. ... .. �has permission to perform ... �!�`z..;.a. .':L --.;4.G- �...... . plumbing in the buildings of . a t..././s'�..`��!-�- !.. Feel��..... Lic. No..V. 9333 Check # 6642 ............. North Andover, Mass. ............. PLUMBINGOSPECTOR �J NiAbbACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING 4A"ass. Date V # Building Loc tion 2 P rmitAN I .Owner' Type of O cupancy New ❑ Renovation ❑ Replacements Plans Submitted: Yes ❑ No ❑ FIXTURES B.P. # 'stalling Company Name isiness TeleAone ime of Licensed Plumber or Gas Fitter SEWER # NSURANCE COVERAGE: have a current Ii billty insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No.❑ f you have checked Yes, please indicate the type of coverage b check the 1 / g y 9 appropriate box. liability Insurance policy 11 Other type of indemnity ❑ Bond ❑ ,WNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on this permit application waives this requirement. gnature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ eby certify that all of the details and information I have submitted (or entered) In above•applicatlon are true and accurate to the best of cnowledge and that all plumbing work and Installations performed u r the permit Issued for thi a Iication will be In compliance with ertinent provisions of the Massachusetts State Plumbing Code and h to 42 of e G oral Law . 3y title Signa re of Licensed Plum er . yrI own TPROVED (OFFICE USE ONLY) Type of Licenser Q Altafster 0 Journeyman License Number Lt 3 3 a on r_j 0