HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (12)+!
f
• a�:i
,`4
� C� 4
I
I
& Date.............
�� NORTH _ .•�,•,
Ot�r�a° ,e,ti
_TOWN OF NORTH ANDOVER
PERMIT FOR WIRING:
4A U5
This certifies that
has permission to perform ........
wiring inthebuilding of...... Wim.... -�r ::�: ..,.. ... �,,,,... r
f �.
. .. . .... ........... . . ort�MAndover,Mass
Fee. —MLic.No ..-..-..f.... ............
s-
...........
ELECTRICAL INSPECTOR
4 Check # 1/%J
5249
C
l
�'-.��-v�/ /
C:¢.�2.f.C�C�L�-�Z � Gp�ctil�Q
�� ,�
���
`��
C'_�
C
i
i
i
Job# 6899 Fee: $7,500.00
• Official use
((rr// f
THE COMMONWEALTH OFMA55ACHU5:; 5 Permit No.
PublicDep-twnt of
BOARD OF FIRE PREVENTIONN REGULATIONS 527 CMR 12:00
Occupancy 8 Fee Checked
APPLICATION FOR PERMIT TOPEELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information)
Date_ 5/11/04
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location(Street a Number 1160 Great Pond Road
Owner or Tenant rooks School
Owner's Address
Is this permit in conjunction with a building permit Yes •X
No (Check Appropriate Box)
Purpose of Building Athletic Facility - - —---- ----
Unity Authorization No.
Existing Service AmpsVoits Overhead .
Undgmd - No.of Meters
New Service 25Q(1 Amps 480 277 Vats
Overhead Undgmd •X No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical work All new electrical and fire alarm wiring for new
athletci facilit Voice/data and HVAC control wiring is wxcluded.
No.of L' hti Outlets No.of Hot fuse Total
No.of Transformers KVA
No.of Lighting Fixtures Above In
Swi Pooh and and Generators KVA
No.of Rece tades Outlets No.of 011 Burners No.of Emergency g
Bat Units
No.of Switch Outlets No of Gas Burners
FIRE ALARMS No.of Zone
No.of Ra No of AM Cord Total No.of Detection and
Tons Initiating Devices
No.of Di sal No Heat Total Total
Pum s Tons KW No.o(Sounding Devices
No.of Dishwashers S ce/Area Heath NoJ of Set Contained
KW DetectionlSounding Devices
No.of D ers Heatin Devices - Municipal Other
KW Local.. Connection
No.of Water Heaters KW No.of No.of Low Voltage
Signs Bailases Wlrin
_No.Hydro Massaoe Tuds No.of Motors
Total HP
I OTHER:
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 of verage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify) 11x1 _
Estimated Value of Electrical Work; (Expiration Date)
Work to Stag Inspection Date Resquested
Signed under the Penalties of pery'ury: Ro h Final
FIRM NAME Mercier Electric Co. In
IC.No.-A - 11 062
Licensee_ Ri r-har`c( [•� Mercier A - 11062
Signature C.NO.
Address_ 139 Southbrid e St. Auburn, MA Bus.Tel No. 508-792- 200
OWNER'S INAft Tel.No
SURANCE 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)
(Signature of Owner or Agent) Telephone No508-792-9200 PERMIT FEEs-7,500.00
t
i
i
E r
f
Town of North Andover Planning Board'
Application for Watershed Special Per it
Please type or print clearly.
1. Petitioner: R,rpgkg SV
Petitioner's Address: 1160 Great Pond Rd, No. Andover, MA 01845
Telephone number: 978-686-6101
2. Owners of the Land: Sante as above
Address: 1135 Great POnd Road No. Andover, MA 01845
Number of years of ownership: 37+
3. Year lot was created:_ C. 1967
4. Is the lot currently on septic or sewer?On campus Gyst.em, which tips to Town system.
If on sewer,please provide date the sewer connection was completed: c. 1982
5. Description of Proposed Proj Addition of screened porch on rear of house.
.
6. Description of Premises: Single familv house on 7.5 acre wooded lot.
Faculy residence for Brooks School.
7. Address of Property Being Affected 1135 Great Pond Rd.
Zoning District: R-2
Assessors: Map: f103 Lot# 2
Registry of Deeds: Book#: TQC Page#: -j-g
Not available at Assessor's Office. Will obtain.
8. Existing Lot:
Lot Area(Sq.Ft) 326,700 BuildingHeight 25'
Street Frontage: 1 -190 Side Setbacks: 400' ; 656'
Front Setback: 35' Rear Setback: 336'
Floor Area Ratio: 01 Lot Coverage: .02
9. Proposed Lot(if applicable): Same
Lot Area (Sq.Ft) Building Height
Street Frontage: Side Setbacks:
Front Setback: Rear Setback:
Floor Area Ratio: Lot Coverage: Mal I
AUG 13 2004
BUIL®Ily(3
10. Required Lot(as required by Zoning Bylaw):
Lot Area(Sq.Ft) 43,560 Building Height 35'
Street Frontage: 150' Side Setbacks: 30'
Front Setback: 30' Rear Setback: 30'
Floor Area Ratio: N/A Lot Coverage: N/A
11. Existing Building(if applicable):
Ground Floor(Sq. Ft.) 1,356 #of Floors: 2
Total Sq. Ft. 2,81q Height: 25'
Use: ]—f ami 1 v Type of Construction wood frame
w
12. Proposed Building:
Ground Floor(Sq.Ft.) 168 #of Floors: 1
Total Sq.Ft. 168 Height: 10'
Use: Attached screened porch Type of Construction wood frame w/ conc.
piers
13. Has there been a previous application for a Special Permit from the Planning Board on these
premises?_ No If so, when and for what type of construction?
14. Section of Zoning Bylaw that Special Permit Is $eing
Requested 4. 136.3.c.ii(6) — construction of accessory structure in
Non—Disturbance zone of. the WPD,
15. Petitioner and Landowner signature(s):
Every application for a Special Permit shall be made on this form which is the official form of the
Planning Board. Every application shall be filed with the Town Clerk's office. It shall be the
responsibility of the petitioner to furnish all supporting documentation with this application.
The dated copy of this application received by the Town Clerk or Planning Office does not
absolve the applicant from this responsibility. The petitioner shall be responsible for all expenses
for filing and legal notification. Failure to comply with application requirements, as cited herein
and in the Planning Board Rules and Regulations may result in a dismissal by the Planning B oard
of this application as incomplete.
Petitioner's Signature:
Print or type name here:
Owner's Signature:
Print or type name here: - Brooks School J
&A CO VA3e_ r/i e t t.tTUE S D i
16. Please list title of plans and documents you will be attaching to this application.
Plans by Rist-Frost-Shumway Engr. :
1 - Site Plan
2 — Watershed Porection District Plan
Narrative
List of abutters + two envelopes each + 22 1st class stamps
Copy of Assessor's M^p
SUet,h of porch construction by prospective builder
Fee check
Copy of Brooks School Turf Management Program
2
v
NARRATIVE
Application for Watershed Special Permit
Addition of Porch
to
Goelet House Faculty Residence
Brooks School
North Andover, Massachusetts
August 9, 2004
Introduction
Brooks.School proposes to construct a screened porch on the rear of Goelet House, a faculty
residence at 1135 Great Pond Road. The property is on a separate parcel located on the opposite
side of Great Pond Road from the main campus of the School.
Included herein is information from the prospective builder as to the type of construction
proposed. It will attach directly to the exterior of the house, with floor elevation matching the
main floor, and steps down to the rear yard.
Watershed Protection District
A wetland exists to the rear of the parcel, which was flagged by Norse Environmental. The flags
are located on the site plan.
This wetland is hydraulically connected to Lake Cochichewick. It is piped across Great Pond
Road near Maple Drive, and the water passes through a piped.drainage system on the southern
portion of the campus, ultimately discharging to a swale into the lake near the existing boat
house.
Drawing No. 2 shows the relationship of the property - as well as the main campus of Brooks
School - to the lake and the various zones of the WPD.
Stormwater Management
The Building Requirements of the Zoning Bylaw require implementation of best management
practices in regards to site drainage. Special Permit requirement 4.g. requires groundwater
recharge for projects involving new impermeable areas in the Non-Discharge Zone.
Groundwater recharge will be accomplished by intercepting clean roof runoff from the porch via
a stone drip trench the full width of the porch. The area between the porch and the wetland is a
gently sloping well-maintained lawn. Although the only excavation will be for the concrete piers
and the drip trench, a silt fence will be constructed to assure no muddy runoff from the site gets
into the wetland.
General Requirements for Watershed Special Permit
1. Encouraging the most appropriate use of land. No significant impact.
2. Preventing overcrowding of land. No significant impact.
3. Conserving the value of land and buildings. The project is consistent with the high quality of
buildings and grounds on the School campus and on neighboring parcels.
4. Lessening congestion of traffic. No significant impact.
5. Preventing undue concentration of population. No significant impact.
6. Providing adequate light and air. No significant impact.
i
7. Reducing the hazards of fire and other danger. No significant impact.
8. Assisting in the economical provision of transportation, water, sewerage, schools,parks, and
other public facilities. No significant impact.
9. Controlling the use of bodies of water, including watercourses. The project design respects
the fact that Lake Cochichewick is the Town's water supply.
10. Reducing the probability of losses resulting from floods. The scale of the project and its
relation to the Lake mitigate any increase in the potential for downstream flooding.
11. Reserving and increasing the amenities of the Town. Brooks School itself is often
mentioned as an amenity of the Town, and this project is entirely consistent with the character of
the campus.
a. The specific site is an appropriate location for such a use, structure, or condition. The
project is consistent with the long-established campus.
b. The use as developed will not adversely affect the neighborhood. No significant impact.
c. There will be no
nuisance or serious hazard to vehicles orpedestrians. No significant impact.
d. Adequate and appropriate facilities will be provided for the proper operation of the proposed
use. Not applicable.
e. The Special Permit Granting Authority shall not grant any Special Permit unless they make a
specific finding that the use is in harmony with the general purpose and intent of this Bylaw. We
believe there is nothing about this project that is inconsistent with any Town plan, regulation, or
policy.
Specific Requirements for Watershed Special Permit
1. Certification of no degradation. The undersigned, a Registered Professional Engineer in the
Commonwealth of Massachusetts, hereby certifies that this project, if constricted in accordance
with the plans, will not result in any significant degradation of the quality or quantity of water in
or entering Lake Cochichewick.
2. No reasonable alternative location. There is no other logical place for the porch.
3. Waste treatment. There is no industrial waste treatment associated with the project.
4. Groundwater nitrogen. It is the School's policy not to use fertilizers in the Non-Disturbance
and Non-Discharge Zones. Attached is a copy of the School's Turf Management Program.
Other than fertilizer, there should be no other potential activities associated with the project
which might raise the levels of nitrogen in runoff or groundwater.
i
5. Downgradient nitrogen or phosphorus. See 4., above.
6. Other supporting documentation. The submitted documentation is believed to be complete,
but the applicant stands ready to provide additional materials should the Board dictate.
For Rist-Frost-Shumway Engineering, P.C.
J L. Scott, P.E.
Man ger, Civil Engineering
H OF MAssq
JOHN P,y
L N
SCOTT
U CNIL y
NO.29134
/STERE
�SStONAI ENG��
Abutter to Abutter( x ) Building Dept. ( ) Conservation ( ) Zoning ( )
Town of North Andover
Abutters Listing
REQUIREMENT: MGL 40A,Section 11 states in part'Parties in Interest as used in this chapter snail mean Oe petitioner,
abutters,owners of land directy opposi!eon any public or private way,and abutters to abutters within
three hundred(300)feet of the property fine of We petitioner as they appear an the most recent applicable
tax list not withstanding:hat the land of arty such owner is located in another city or town,the planning
Board of the city or town,and Me planning board of every abutting city or town"
Subject Property:
MAP PARCEL Name Address
103 2 Pico Trust 530 Turnpike Street
Abutters Properties
Map Parcel Name Address
103 1 Brooks School 1160 Great Pond Road
103 3 Brooks School 1160 Great Pond Road
103 10 Brooks School 1160 Great Pond Road
103 24 Deora French, Trustee 1092 Great Pond Road
103 26 John Blaeser 1116 Great Pond Road
103 28 Brooks School 1160 Great Pond Road
103 125 John Blaeser 1116 Great Pond Road
103 129 Debra French, Trustee 1092 Great Pond Road
'03 133 Marc Rudick 1046 Great Pond Road
Page 1 of 1
This certifies that the names appearing on the
records of the A sessorsce as of
Certified by: ate
i
Z 'd
9629-S2G-8G6 idaQ sailTIToej sActoig dSS =zT '110 06 in[,
BOXFORL
1
109 4 55
44 ^, ,a
43
JJ
3 40 41 42
1 I)1' 71' tii 'QO�
GREAT l
„a
i
123
SNORT
P
hi
1
10 133 27 25
,r
;al ' 24
R125
om
Y�
11611
26
g
1 Lake
FISCAL 2001 MAPS DRAW, BY FRANIJ
SCALE-4100 FEET= I INCH MEASUREMENTS ARE SCALED ON Y NOT FOR� S. URVEGILES, PUp
SURVEY PURP(
SEE PLAT
{
PARCEL ID: 210/103.0-0002-0000.0 MAP 103.0 BLOCK 0002 LOT 0000.0 PARCEL ADDRESS: 0 GREAT POND ROAD as of: 12118/2003
PARCEL INFORMATION Tax
904 Sale Price: 0 Book: Road Type: T Inspect Date:
Tax Class: E Sale Date: 1/1/1000 Page: Rd Condition: P Meas Date:
Tot Fin Area: 2608 Sale Type: Cert/Doc: Traffic: M Entrance:
Owner: BROOKS SCHOOL Tot Land Area: 7.5 Sale Valid: N Water: Collect Id:
Grantor: Sewer: Inspect Reas:.
Address: 1160 GREAT POND ROAD I Exempt-B/L% / Resid-B/L% / Comm-B/L% / Indust-B/L% / Open Sp-B/L% /
NORTH ANDOVER MA 01845
RESIDENCE# 1 INFORMATION LAND INFORMATION
NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2
Style: CL Tot Rooms: 9 Main Fn Area: 1356 Attic: Y Seg Type Code Method Sq-Ft • Acres Influ-Y/N Value Class
Story Height: 2.35 Bedrooms: 5 Up Fn Area: 1252 Bsmt Area: 1161
Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 904 S 43560 N 158122 R
2 R 904 A 6.5 N
Ext Wall: FB Half Baths: 1 Unfin Area: 406 Ssmt Grade: 29250 R
Masonry Trim: Ext Bath Fix: Tot Fin Area:
Foundation: CN Bath Qua]: T RCNLD: 205874
Kitch Qual: T Eff Yr Built: 1977 Mkt Adj:
Heat Type: HW Ext Kitch: Year Built: 1967 Sound Value:
Fuel Type: 0 Grade: G Cost Bldg: 205900
Fireplace: 1 Bsmt Gar Ca Condition: G Att Str Vall: DETACHED STRUCTURE INFORMATION
Cental AC: N Bsmt Gar SF: Pct Complete: Att Str Va12: Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond %Good P/F/E/R Cost Class
Att Gar SF: 462 %Good P/F/E/R: /100/100/87
Porch Type Porch Area Porch Grade Factor
VALUATION INFORMATION
SKETCH Current Total: 393300 Bldg: 205900 Land: 187400 MktLnd: 187400
Prior Tot: 363200 Bldg: 188900 Land: 174300 MktLnd: 174300
—13 PHOTO
J7 l
�15
- - - 23
FM
1513 G
1356 Sq.Ft. 22
462 Sq.Ft.
27 8
17
14 21
43
1. PT, 2X 16 ON CEAaeVuT t
p�)RS
2. txtl ►.�►a.F�G aN�' neck«�,
`3o A FM
} AC4 TAI►
�c . LX 10 �c�F ftARs
w Ire C'Dk `F'G4 woe o�
t C.0 L W A 1699, -
`� —
III lilt
J
7 ��LL ZE/tLU7'� SCRE,�!
G J }.►l Tom' 119/NT ) � --�
Ku - ouT >
GOEC.ET M(ju34
5��'6•t! /3 Uo�[
�,C��KS SCtlar�L�
f
Brooks School Turf Management Program Application Schedule
AREA SCHEDULE APPLICATION APPLICATOR
AREA 1 Aril INPK Brooks
June Post emergent Trugreen/Chemlawn
June NPK Brooks
August Broadleaf weed Control Trug reen/C hem lawn
August NPK Brooks
Se tember NPK jBrooks
October NPK 113rooks
AREA 2 Aril NPK 113rooks
June Post emergent Tru reen/Chemlawn
June NPK Brooks
August Broadleaf weed control Trugreen/Chemlawn
September NPK Brooks
AREA 3 April NPK Brooks
June Post emergent Tru reen/Chemlawn
June NPK Brooks
August . Broadleaf weed control Trugreen/Chemlawn
September NPK jBrooks
AREA 4 Aril NPK 113rooks
June Post emergent Trugreen/Chemlawn
June NPK Brooks
Au ust Broadleaf weed control Tru reen/Chemlawn
September NPK Brooks
AREAS
Area 1 = North lower fields : Girls Softball, Field Hockey and Girls Lacrosse. No phosphorous is to be used in this area.
Area 2 = The upper north fields and west fields : Boys 1 Baseball, Football game and practice, Boys 1, 2 and 3 Soccer and Lacrosse
Also included are Boys 2 Baseball and Girls 1, 2 and 3 Soccer.
Area 3 = Campus lawns (front and side), from the intersection at Russell Drive along both sides of Main Street to the Library Building
Also include the areas around the Student Center and the areas along the south side of the Chapel to Maple Drive.
Area 4 = Stevens House, Goelet House, Dearborn House and Bigelow House. The grass areas outside the North Gate, The front
of Russell House, Hayden Smith and Dillon House And the area between the West Service Drive and Russell Drive.
2/12/2004
1
Brooks School Turf Management Program Application Schedule
NOTES:
Note 1 =All applications will be made in reference and rate to soil tests conducted annually in all four areas.
to No pesticides, herbicides or fertilizers will be used in any areas considered within the Conservation, Non-Disturbance
_ and Non-Discharge zones of the Watershed Protection District.
NI-it No pesticides, herbicides or fertilizers are to be used within the 100' buffer zone of any Wetlands.
Note 4 = Other applications will be made as required and in reference to the applicabilty of Notes 2 and 3
Note 5 = Soil tests/sampling will be conducted annually in the month of October in all four areas
Supporting Information
Note 1 : Is Standard Written Notification required if a school is on vacation?
Usually school vacations or school breaks are times when classes or activities are not taking place for 5 days or more and would therefore be an acceptable time
to make pesticide applications if warranted. If pesticides are going to be used on school property during a time like a summer vacation or a winter break,and
classes will not be scheduled,Standard Written Notification does not need to be sent out.However,posting is still required both along the perimeter of the area to
be treated and at a central location.
Note 2 :Are private athletic organizations (e.g.youth soccer, little league),whose memberships are exclusively school children
considered within the requirements for notification purposes?
Under the law,only groups that are school managed or school sponsored are required to receive Standard Written Notification.
Therefore,because these groups are not school sponsored,it is not required that they receive the Standard Written Notification even though they may be on
school property. Sign posting should provide enough protection for these particular groups.
Note 3 : How many pesticide flags are needed around the perimeter of a treated field?
There is no set number of pesticide flags that will need to be placed around the perimeter of a treated field. The flags to use are the small yellow lawn care flags
required by Massachusetts lawn care regulations.Such flags can be purchased from Gemplers at www.gemplers.com or by calling 1-800-382-8473.However,
the Department is recommending that an applicator post signs conspicuously around the field so that someone entering the field from any direction would be
notified that a pesticide application had taken place.
Note 4: Are fertilizers covered under the law?
Fertilizers containing only nitrogen, potassium,and phosphorus are not defined as pesticides and are not covered under the children's protection law. However,
those fertilizer products that contain insecticides and herbicides(commonly known as weed and feed products)are in fact pesticides and are governed by this law.
ow do the North Andover Zoning Bylaws pertain to the use of garden products? _
The Town zoning bylaw prohibits the following in the non-discharge,non-disturbance,and conservation zones: "the use,or method of application of,any lawn care
or garden product(fertilizer,pesticide,herbicide)that may contribute to the degradation of the public water supply." See 4.136.3.b.iii(2)(page 60); 4.136.3.c.iii(4)
(page 62);and 4.136.3.d.iii(9)(page 63).
2/12/2004 2
3992
n.
Date....4 . .6� .. .
9
f
'10 TT 9
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
s � .�,�•"a
SACHusE�
This certifies that T'l-)+ WS ��i/T ' ..
has permission to perform ........./�Z- / .L.- S.�/�.........j����
wiring in the building of.......... 7.. ,��./ ...................................................
...�f orth Andover,Mass
Fee.. . Lic.No./�/s: ......
ELECTRICAL INS
Check #
°3 '
-�-= The a)mmonwealai of has ac��u�et � °`'`" °"
T_T _ v
DeyarnnC711 Of PwbIic Sajerl,
'I�. c.,�*•ncy !. Fcc Q1sCY-Gd
BOARD OF FIRE AREVkN1lON ftEGut_c110115 Vi
SQ7 CmR 1-,cQ 3/90
ll �vc clsnl.)
AlI �.,��ktobc.perUrrncdll) a.cc4rdancc �LEGTR.IGAL. �WDRK
APPLICATION FOR PERMIT O I� hf ORf�1
µ�lh II,yMa coehuscru L1c"1,Ica1 Cade X527 CMR 2 Oo
1
lPi�,SE PRLNT •TN ILAOR1'1a:sL1. 12��0].rfkii
8i � 55 �, 1 '•f v l�a^T � * ;.. < _ < i.,� ¢ . 1,TZ„�Q`,Ird�► i I
To 'Che Tnspecr-or o•f Wires,
The -ndersigned applir.s for a pzrullc co Poco(-u rhe cleccric-al wOrK describctl 'oalov.
Location (Street S Nucabex) ob ter`
Ownar or Tzaancy���'�_C3_.—�
v.ner`s Addresssaxnp
Is chis permit in conjunction with a building pa"r-wic: Ycs L� No ` (Check Appropriate Box)
Purpose or $uilding� �Ucility Authorization N0.
2_:iscing Service --Amps / VOICs Ovenccad El No, of Mecars
New S-crvice Amps I VolcS OverheadLndaTrd i —
L_.J El No, of }+accts
ti=ber of Feeders and Ampacicy
�4caciou and Nature of Proposed Elcccrical Wank
of Lighting
outlets Na. of Ilac Tues No. of Transformers TKVA1
No, of Lighcing.Fixtures ��Siwwjng pool Above(� Ir,
grad, L_J bind, El l neTx[ors KVA
No. of Receptacle Outlets No, of Oil burners No. of Ewergency Lighting
B3[cery Units
tio. of Switch Outlets Na: of Gas burners F1RE A.LAMS No, of Zones
No, of Ranges No. of Air Concl, local No_ of DeCaccion and
^Con(.. � tons o. of eta Devices
No, of Disposals No of Ileac Total `l'oCal
Pwu" s Tons K1I No, of wounding Devices
No, Or Dishwashers Space/Arca H,�aCing No, of Self Contained
Detection/Sounding Devices
Cto. or Dryers Hearing DeVLces K',l Local D MunicipalElOrber
of Connection
No. of Placer Heaters KW SL�"nsballasts LowWirVoltage
No. uydro-t_ ssaga Tugs No. of }Sacors To cal HP
INSUR(NCE COVERAGE; Nr5uant co the requlreuient.s of K ssachuse4cy General Laws
I have a current LiaOiIICY Insurance Policy including Completed Operations Coverage or ICs subs tanCial
equivalenc, YES NO [ I have subwi_cted valid proof of sarue cc this office. YES❑ NO 0
If you have checked YES, please indicate the type of coverabe by checking the appropriate box.
INSURANCE [a BOND CJ OTHER Q (Please "Sp�c1ly)__
' ESCLMaLed Value of Electrical Work ti (:;n, :g2_ iration ace
Work to Start Inspection Dace Requested; Rough Final
Signed -t.. -ler the penalties of perjur
FIRM NAME__? 5
LIC. NO,,
Licensee ��s�� �i2f�.�r•�Jc>� Signature � � r~- ��I�_ NO_
Addressb: EIS �! �� Bus, Tel. No' --9 � .�qU~ a�
Alt, Tel, No.
0'6NER'S INSM NU WAIVER. I am aware chat the Licensee does not: have cha insurance coverage or ic3 aub-
acancial equivalenc as required by Massachuset.cs Ceneral Laws, and chat my signature on this permit
application waived chis requirement. Owner Agent (Plaase checK one)
Telephone No. PFRMIT FEES
Z5 'C"d
(Signature of Owner or Agzn U-
y
1
Date..
NORTH .„
TOWN OF NORTH ANDOVER
H
PERMIT FOR WIRING
,SSACHU
G /�/Z g<f
This certifies that ............... .......... .......... ......... . ..... .........
r �
has permission to perform �� �G�
wiring in the building of
. ...0eh.;.......: ............................ _..�.
`. �4 tri .+ �°�
.. ...... ,North Andover,Mass.
Fee..................... Lic.No. .... . ............
°
ELECTRICAL 4NSPEC R y
° Check #
565 :
SNCommonwealth of Massachusetts Official Use Only
Department of Fire Services Permit 6--r-Y'
VUZ
Board of Fire Prevention Regulations Occ ancy and Fee Checked
" = PLEASE ATTACH WORK CARD. V. 11/99] (leave blank)
0
a
t
APPLICATION FOR PERMIT O PERFORM ELECTRICAL WORK
Sye
All work to be performed in accordance with the M sachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATI,N) Date: 3-2 2-d S"
City or Town of: X/O/t.-�-y 4(v0 O V To the Inspector of Wires:
By this application the undersigned gives notice of his or her in tion perform the electrical work described below.
Location(Street&Number) //(06 le&:l r C)Aib 2D,
Owner or Tenant 32 coo Ks SG h U v L Telephone#
Owner's Address stq✓h
Is this permit in conjunction with a building permit? (check appropriate box) Yes ❑ No ❑
!Purpose of Building Utility Authorization#
Existing Service Amps / Volts Overhead ❑ Underground ❑ #of Meters
New Service Amps / Volts Overhead ❑ Underground ❑ #of Meters
Number of Feeders and Ampacity
'Location of Nature of Proposed Electrical Work: CQA1 -9 pL 4✓/2/NG ONL Lf -5
3 �L/f�Y!/�`S 3� UNIT /-�=Rr2�S 3 CAa��u�i- y�/ir fi��2-n�" a1�✓,D/LES S.
Completion of the following table may be waived by the Inspector of Wires.
Total
#of Recessed Fixtures #of Ceil.-Susp.(Paddle)Fans #of Transformers KVA
#of Lighting Outlets #of Hot Tubs Generators KVA
Swimming Above ❑ In #of Emergency Lighting Battery
#of Lighting Fixtures Pool ground ground Units
#of Receptacle Outlets #of Oil Burners FIRE ALARMS J#of Zones
#of Switches #of Gas Burners #of Detection&Initiating Devices
#of Ranges #of Air Cond. Total Tons #of Alerting Devices
#of Waste Disposers Heat Pump Number Tons KW g#of Self-contained
#of Dishwashers Totals Detection/Alertin Devices
Municipal
#of Dryers Space/Area Heating KW Local ❑ Connection [:] Other
#of Security Systems: #of Devices or
#of Water Heaters #of Signs Ballasts Equivalent
Data Wiring: #of Devices or
s #of Hydro massage Bathtubs KW #of Motors Total HP Equivalent
Telecommunications Wiring: #of
OTHER: Devices or Equivalent
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 Q BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: U U C). (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 pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: DES //V C 4,1 s6=7?y/4--1 LIC.#: 71Y911
;Licensee: Signature: U LIC.#: W9,F7J G-
(If applicable,enter"exempt"in the license number line.) Business Telephone#• 6/7 71/2o&
Address: /,o Z3,-,x 6 0 VQ[-��a.�. q V-2 y2 e Alternate Telephone#:
`J 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.
s Owner/Agent
jSignature Telephone# Permit Fee: $
I
