HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (17) I i�� (�-�e�: ; n�rte. ter-. < <�
Date . .7.:��-�Z
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that . . . . . .
Stil��cr /Dom
has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
wiring in the bu�ildiinb-
at
of
� .�(�:11. .¢!�!t. . .A!e� . . . , , . . . . . ,
BvNo �An�over,
Mass.
Lic. No.�/ 7S-Fee .(. S . . . . . . . . �
. .
ELECTRICAL INSPECTOR
} , Check# 5-a SID
' 10903
"J 3
M �crrimoriwe1 ref
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N. r: r <rb1Rl� pR ,V 'IbN IG�IJIrA.}ISN : Oe�uparicynd> ee�heCked
lee
i� .���'a.�S � p� I;y r}t� �' \� r�r"' { W �C � ���Y'JIY'' .
�ll.;work
to*,be performed.,an accordance with.the Massachusetts.Electncal';Cbtie11C);521
(P EASE PRINK INt KOh TYKE Z NFO lA7"101� date 1 1G\
Ci. own of, v�ai
s �'o the In of.Tires:
13 this app1`6` qt7 the hdersigned:gives.r ottce ofhts or her mtei7tion;to perform the electrical work dgscribid below.
J� Locatrony(Sat�eetBiNurhbr) :� ��,. feo.kC)..�
1 Owner or Tenant Telephone No
6wtlersscldires§ � ,r' �. �ar:
is thRpet'ttli£ ct
in con3ilnding per<nit'1 Yves . No (Check Appropriate 136x)
firpose<oi Bp�lding . . e`�:�.� C1tt[ity Auth4rtzatott 3 . [ .
t. 'S SeYvrce l UU.. Amps i v j 2`lU Volts• .:. Ov�eriiead Undged:0 ;N&of Me,*teas
,APs '1 � .:/1�cu . Volts Overhead Un.dgrd...[ Na:of lVleters . _
NU ober of fieeders and Ampacity,
Location end Nature of Proposed: lecCrical Vl✓orky.iJGCo � ,,Se-°�.�c
�`-
Com letion of the ollowim .table.m be waiv¢d.b ;the Iiis ctbr o Wires.
No of Rec�ss�d Fixtures No of Cell Susp (Paddle)Fans mess KYA.
r...,
0 0.
Transfor.
No bf Y,ighingutlet§ 15TH.of f$ot TubT.
s Genet ators IVA
(b
ove : n_. oro rr[ergency 1. gg,
ofrlrrghtriig7Fixtures :. �vimmitig3�oo1 ]
tnd�: ri►d batt' Units
No of Receptacle.outlets 3. IVd of C11 i�ut`tters P :AAS :1Vo of Zones
No' of �vrtehes o' of ins Urgers 0;-
o etQct oq an
Tota
.
IhrtY'"ti" bt�ices
1110 of Ranges No.of Air Cnd" N0.:at Alerting ZSetices
Toils
:' (1X11 er Ons Q:bf:S4IPCohtXjftiW,
Nb,8f haste els bsers eat tit2t1
r,.,. <<,�� Td�" s, �e etttlon/, elthtr< :L•1' ces..
No oflstiwashers SpacelAreaYeattlrg KW L;rjcai Can�lpo� 4tker
No ofD ,cis $eating 1ppliA. ces KW
y Y,,.. . N Dvlces;or E ulfyvalent .
e..
o�-0 `g�ter KW o 0 0 1�ata!OVirul i
o g
H,eaterS Si ris $allasts�
No..dfiyir�ces.o'r.:E uialezit .. .
1Vq H dromassa eBathtub?; No afotors TotalI>F
y..
rlAitiontildetail ifdesired,;or ds r2gutred by
the l specttrr:of GVi'res:
�1 ttdch a..
iNSI7fiANCE COVERAGE tlrn:less waived by the owner,no per.'rhrt for the,perfoftange,of elgetrreal work may issue iiriless
the`Itoe"nse 'ptdurdes prdbf of liability mSurance including.;`.`dbr#ated operation"coverage;or its stibstaritral�gCiivalent; Elie.
tinders7fied certifies that Such coverage is in force,-and hasexhtbtted prop 6f Baine to the permit Ssu!ng office....
LICK OI�3E fNSt�1tANC1; Bt7Nb ] '0THIt:�j (Specrfy:) _.
(Exp}raha Date)..
n:
PstiirT'ated V;�/alue d Electric.nl Work G°, �� (When requited by municipal policy.)
y
Work to Start Yt�spe0tiops to be requested in tcddrdanoe w1th;NZ-C Rule 10,air upon coriipletion.
Y pettfy,1trlder th : utits tchti�Sentflt�eS ofpetfttry,:thut the in�o>'miztl it this applecatr ,arid r6 tplet
)E•I NAl1v1<E yv1 C� �=\o r c .. NQ
t.,IC
Licenseer� �+.C4.f 2 Slgnatu TC No
(/f ppplrcbb`tp Anter 'ezemp '.to the hcert ¢ er line.: Bu3: I el N0: 11 ' 71
Address
✓erg r� 1 �� A-1t,Tel No, St 14��if.'�'z
O VNEl�'S S i2 NCE SVA<y+ I;atn 06't.41 the L d6h0e does riot have the liability irisitrance Coffer ge normally
re ilir'ed b}�lavBy my signature below,I hereby Waive!'.his requireMenf, I am fire(ahebk one ownex: owner s a crit:.
$ig11�t5;Pe =Telephone No..
-ALL Perm--c+ �4J
BUILDING PERMIT of ttORoT" qq.
TOWN OF NORTH ANDOVER 4 o
APPLICATION FOR PLAN EXAMINATION
- Permit NO: /0 - 6 Date Received
SgCHUSE
Date Issued: /
IMPORTANT:Applicant must complete all items on this page
LOCATION 11-4,0 . �o/ 7 �C7�I� �•�� '- . _ . � _: V1�1 r
Feint _
PROPERTY OWNER ( ?
_. .. -Print.
MAP NO. PARCEL ZONING DISTRICT: Historic District yes - no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family L�
Addition, Two or more family Industrial
AftemWn No. of units: Commercial
Reai eplac
Demolition
Septic WellV?� CIGs,
Location
Water/Sewer
DESCRY No Date L---
-tm `��� • • TOWN OF NORTH ANDOVER
dentific? 1" Certificate of Occupancy $.
OWNER: Name: o (Ie Permit Fee r
Address: . <<" Foundation Permit Fee i
r A- Other Permit Fee $�–
CONTRACTOR Name: I?t, C TOTAL $
Address: x.01.
�7L<
Check#
Supervisor's;Construction.Llcen
25480Building Inspector
Home Improvement License: _.
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 7 00i FEE: $ I
Check No.: �- x Receipt No.: S�
NOTE: Persons contracting with unregistered contractors do not have access to the guaran and
Signature of Agent/OvvneF Signature of contractor
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