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HomeMy WebLinkAboutMiscellaneous - 118 MARBLEHEAD STREET 4/30/2018 118 MARBLEHEAD STREET 2101009.0-0018-0000.0 Date 7,... '..... 11233 OF NORT{q,� TOWN OF NORTH ANDOVER * PERMIT FOR PLUMBING 4% ,.,- g ,ss�cHus�t This certifies that....:......./...:. t- `............... ...................................................................... has permission to perform...(I.. QQfit....U`a plumbing in the buildings of.... .t�P. .....P.. ........................................ at.........,/ \ ..... - C.. ... ......'......, North Andover, Mass. Fee...f. .......Lic. No. ............ ... ................................................................................. PLUMBING INSPECTOR Check# }f`� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY,NORTHANDOVERa MA DATE 7/712015 PERMIT# JOBSITE ADDRESS1µI8 MARBLEEAD IEDE HSTREET OWNER'S NAME RRER � � �� -- OWNER ADDRESS a TEL FAX[::� � TYPE OR OCCUPANCY TYPE COMMERCIAL IE] EDUCATIONAL ( RESIDENTIAL PRINT _ CLEARLY NEW:L RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO[] FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM i Y $(_ _$r SYSTEMDEDICATED GREASE DEDICATED GRAY WATERS STEM I � � DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN t.� INTERCEPTOR(INTERIOR) KITCHEN SINK µ LAVATORY ROOF DRAIN SHOWER STALLS I SERVICE I MOP SINK TOILET ,.a" _.. ._._ = j E URINAL ( .... WASHING MACHINE CONNECTION ( l Wil" WATER HEATER ALL TYPES ( I I WATER PIPING l 9 C .� OTHER __ [r � � I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO Ej IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND j, OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER L AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME rMIKE CAPELESS ... zxs . LICENSE# 15851 SIGNATURE III MPS JP CORPORATION#[ PARTNERSHIP[ _m. LLC Lj# y COMPANY NAME'.CAPELESS PLUMBING&HEATING ADDRESS 160A PLEASANT ST CITY NORTH ANDOVER STATE€ MA ZIP 01845w TEL 978-382-1017 FAX � � CELL EMAIL I � ... . ... _.. .__ . w. _ _ 1 ' Date.... ............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 's`rACHUS�t This certifies that ...'.....L.�... ...............�..� .............................................. has permission for gas installation .. i f................................................. in the building of...... .....i.'� Q -P. P....... at.. > :.....,... .. ...... .:..... , North Andover, Mass. Fee. .b............ Lic. No. ` `? ...... ..................................................................... ff GASINSPECTOR Check# 1 �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �_)... CITY NORTH ANDOVER MA DATE 7/7/2015rr PERMIT# JOBSITE ADDRESS; 118 MARBLEHEAD STREET i OWNER'S NAME I RIEDERER OWNERADDRESS ` TELT FAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL,- -EDUCATIONAL PRESIDENTIAL m, CLEARLY NEW:; RENOVATION: REPLACEMENT: %% PLANS SUBMITTED: YES - NO� APPLIANCES'l FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 3, DIRECT VENT HEATER i g W, T DRYERS _ _ FIREPLACE _ FRYOLATOR FURNACE F.. .... „t,�_ �. . GENERATOR yh GRILLE INFRARED HEATER 1 LABORATORY COCKS MAKEUP AIR UNIT € OVEN µ- POOL HEATER ROOM I SPACE HEATER ..S .,,. ..r .,, .nv....., .....rrr mvu,vr<_;, _.. .,r,,. ,r,,,,,,.. ,.......a '.v ..e.,,,...n. r,.cn„nkF .vv., .-,. ROOF TOP UNIT .. I3 1. TEST UNIT HEATER , . �1.. _ F 3 UNVENTED ROOM HEATER ; ;''-- o HEATER _. IF- WATER OTHER ,.u., .. ......... F ' .�.,». m•. .r�- zap»«rv.'.� 'x,., ,.,�,.,, '1 E h o � INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �, NO x„ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY l'.._ BOND ; �_. OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Lj,, AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �__ PLUMBER-GASFITTER NAME MIKE CAPELESS LICENSE# 15851 SIGNATURE MP ,�„ MGF JP i JGF! . LPGI CORPORATION ga, # PARTNERSHIP; #� LLC w # COMPANY NAME,CAPELESS PLUMBING&HEATING ADDRESS I 160A PLEASANT STREET CITY N ANDOVER STATE MA ZIP 01845 STEL 978-382-1017 FAX L CELLS EMAIL The Commonwealth of Massachusetts Department of IndustrialAccidents : d 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 PERAUTTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): C tt_ Address: 166A ..11. a 4 4 City/State/Zip: Phone#: g7 - �� -/0/7 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.❑I am 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.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 EJ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a generacontractor and I hhid thesub -contractors hired su -contractlisted the ors soattached sheet. ❑ l 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q 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-contractors have employees,they 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 dUCi,Y1 it¢. �SYI Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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. Ido hereby certify u,der the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 17K-32c :—/b/:2 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their em cployees. 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 fiffout 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' compensation policy,please call the Department at the number listed below. Self-insured 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 burn 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia `A'�'.,ViY1TtlTt v/1Rt7:�rilfw�i.!'V :-,f1r1�GiV/�!I✓1'�LL�lll:� #V.', RLUMBERS ; ISEJITTERS; . >I:SSUES T1. " OLLOWi NG [ (C1 NSE L,I;CENSED AS A MASS ER GASE • MI.GNAEL ,N-"CAt'ELESS ;x`05 TYLER ST METHUEIN' MA { 1$4?+ gO5> 45z O5j01/1Ixz b X23411 I Location 1 1 8 hit F,CG L f-/5t—/9-y S7' No. Date ' LGRT" * T,OWN OF NORTH ANDOVER Certit06te of Occupancy $ Building/Fr�"�e Permit Fee $ s soy O •"+ F Fou`�ddt fon PFA Eee $ JACMUg t 17 tr Permit ht Fee �{ $ /y Sew c®nnection Fee $ Water Co tion Fee $ TOTAL $ I f�44k Building"lfnspecto`r Div. Public Works 1 PERMIT NO. -2-2.'D APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE"1 'MAP dJO. LOT NO. 2 RECORD OF OWNERSHIP DATE (BOOK 'PAGE — ZONE I SUB DIV. LOT NO. S D 9 I LOCATION I/g q�{� /rj1.�"1n �� PURPOSE OF BUILDING pC/�j � OWNER'S NAME/ /' lL ��• 2T S/(L,�n�T`��`v G L I VJI� NO. OF STORIES �1 1_ OWNER'S ADDRESS 9 21 A OZBZ` 1-JeAD J T. BASEMENT OR SLAB �O ARCHITECT'S NAME G /,) J.I SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAMEw NG-� SPAN DISTANCE TO NEAREST BUILDING 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 SIZE OF FOOTING LGS• /`' X t412 � IU IS BUILDING ADDITION No MATERIAL OF CHIMNEY f /C L IS BUILDING ALTERATION N D IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ."65 IS BUILDING CONNECTED TO TOWN WATER Yes BOARD OF APPEALS ACTION. IF ANY -- IS BUILDING CONNECTED TO TOWN SEWER `�icaL IS BUILDING CONNECTED TO NATURAL GAS LINE 7 (5s INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST op, /py() PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ,r PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR i�ATE ED G 1 Ai BOARD OF HEALTH SIGNATURE OF OWNER O UTHORIZED AGENT F E E / CONTR.TEL.# CONTR.LIC.# PLANNING BOARD PERMIT GRANTED 19 BOARD OF SELECTMEN i BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 18 SINGLE FAMILY S-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 RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BUK. PINE BRICK OR STONE HARDWD PIERS .t PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA.FULL FIN, B M'T' AREA _ 114 v, 1 3/4 FIN. ATTIC AREA No B 'TFIRE-PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS-7-7I 9 FLOORS CLAPBOARDS B 1 —2-yI 3 DROP SIDING CONCRETE — WOOD SHINGLES EARTH ASPHALT- SIDING HARDVJ'D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY " STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR (- BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I-1 POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.( _ GAMBREL MANSARD TOILET RM. (2 FIX.( FLAT 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. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING i . s � �� v \ �t ` .� �e= U U 9W/R/ U U rS r 5-4 4 1 1 it . FINAL NORT►y O VIANo. 220L er, Mass., �` _19 ' A C HI KE WICK � BOARD OF HEALTH THIS CERTIFIES THAT......... �'A ® BUILDING INSPECTOR �I has permission to� .M . buildings on .. Rough C= dab to be occupied as... ..... ... AOWOW. .... - .... . .. ...... .4....... Fin l Y Chi e � al provided that the person accepting this permit shalt in every re ect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the.Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR SQ e Final ... .. ... ... . ... ... .................... ... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector Date.................................. a f NORT1{,� 3?;•_`;�`�'•�_`"�O� TOWN OF NORTH ANDOVER 41 o p PERMIT FOR WIRING ��SS�cHUS J i This certifies that y has permission to perform `--^" a wiringin the building of......................:............................................................ North Andover,Mass..�: .. .. ......... ....... , Fee`:..v:............ Lic.No.15...... ,`� P .............................. -ELECTRICAL INSPECTOR Check # `� (/ THECOMMONWEADHOFAIAMOMSEM, Office Use only DEPARD HATOFPUBLICSAFEIY Permit No. �(p BOARD OFFMPREVEVHONH0AN D7C�1R 12. 0 ' Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK 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- ' Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) I A Owner or Tenant — Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 200 Amps, / ? Volts Overhead r—PT Underground No.of Meters New Service �� Amps / Volts Overhead C3 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work F rn r�« p� A,C gjp g_! ns e.� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El 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 Ranges No.of Air Cond. Total 7/'VFIRE ALARMS No.of Zones I Tons No.of Disposals. No.of Heat Total Total No.of Detection and Pumps Tofis KW Initiating Devices 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 a Nb.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• _ �rSttarreCa�A>st>antbtileragt>itaila��Ga�aalLav�s . IhmcaamotLabkkmrd=PcicY'nixktgCQnplele CoAngDOriissYES NO Q. Iha�est6rnillad�atidpoofofsamebthe0l£a;YES Ifjcutgwciw&c dYES�pleasenbretheWofw=Wbydmdalgthe apPpri*b ' )IMURANCE BO D O OTHM (Pleasespa* ExpiWmDme Hftn ad VakiedHecii W Wodc$ WOIICbStat .�2—r -tam hqac mD&—ReqjWed Rao FkW FIRIANAME _- 1 , .�_ LioaseNa Lioa�see j e !l-c. : _�_ LioaiseNo S��S d- BlsctessTeENa �,�f—A���� AkTeLNa OWNMSPWRANCEWAIVER;lam aw=9rtftL=does noths�thec�uatoeoo►+en�eoritss> dec�avatent�tixluuedbyM dxse�s(3ertaalLam mddutmysgiatseonih'sp=stapphcsbmwaiW sdmleglmsnag (Please check one) Owner Agent Telephone No. PERMIT FEE$ W `'� Date. ".O°TM`�� 1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SA US This certifies that . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . f �Q�X14, plumbing in the bulildin s of . . . . . . Y' �• . r, at.A� . . . .� . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee,,-'%s~/ Lic. No. ZY-7� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,-�. . / .�� PLUMBING INSPECTOR C.� Check # �,�._ ) 6269 MASSACHUSETTS UNIFORM AI'M/TONFORPERMUTODO GAS FTrnNG (Type or print) Date NORTH ANDOVER,MASSACHUS TS Building Locations V\c6CC1o.0 `(J\v Q Permit# Amount$ 3z� 5O Vwner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ U P4 OG O v� C9 O W z z z W W O O � w H � � o .. c a � G a a a . U S3 A a S SUB -BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3 R D . F L O O R 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR ec one: Certie Installing Company (Print o �` � L'' Corp. `1% Name Lam' Address ❑ Partner. a. mess e e �'1 O O ❑ Firm/Co. us pone Name of Licensed Plumber or Gas Fitter v J INSURANCE COVERAGE Chec one: I have a current liability In rance policy or it's substantial equivalent. Yes No❑ If you have checked yes,pled§e indicate the type coverage by checking the appropriate box. Liability insurance policy MI Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee 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: Signature of Owner or Owner's Agent Owner ❑ 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Signature of Licyaq Plumber r Gas ktter� By: Plumber -\ C'►-r� Title City/Town 4 Gas Fitter LicenseNumbQQj— Master APPROVED(OFFICE USE ONLY) ❑ Journeyman I II 7 � n Location � J '/A '���`i°�` �y° No. q117 Date HpRTIy TOWN OF NORTH ANDOVER F � A + Certificate of Occupancy $ "' wcMU E Building/Frame Permit Fee $ ss Foundation Permit Fee $ Other Permit Fee $ M TOTAL $ Check # _ 17904 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: _ J ic_ SIGNATURE: Building Commissioner/IREKtor of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: r/-Oo 1/"60 (� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: V Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 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 ❑ Municipal ❑ On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Histulic Distrin vbs N p 2.1 Owner of Record SUSkt�NA Name(Print) Address for Service: 1 ti Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O rn Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number wn Address > Expiration Date o Signature Telephone r 3C Registered Home Improvement Contractor Not Applicable ❑ 1 Cjbmpany Name M Registration Number rM Address r z Expiration Date ^ � Signature Telephone l+l, f SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) J 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 11Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑` Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �~Ql( IV O�t,�� �!✓ GY►p�� �l�a ©Irk �..�- �r� et4 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be {1tF1(~ICiAL USE U1�iLY Completed by permit a licant x 1. Building �7 M (a) Building Permit Fee �J dl7 0, 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 AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, V (A Ja1-1 w a as Owner/Authorized Agent of subject property Hergbal� thorize to act on My alltnatte lative to work authorized by this building permit application. a5-r_'- -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Print Name Si ature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIN4BERS 1 2 3 SPAN DRv1ENSIONS OF SILLS all DMIENSIONS OF POSTS DRVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BMDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM 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 SSS �!J — I � �CI� PHONE q78 6r'c^�S08 ce2e Q Ye-376 2Yog LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONLY ***** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jm NO sTM i i r TOWN OF NORTH ANDOVER '� '';^z � �ac %°a BUILDING DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER MA 01845 D. Robert Nicetta, Building Commissioner 978-688-9545 978-688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION / M/ ; U E Y[ CX D 91 Number Street Address Map/Lot HOMEOWNER &t. ,4NN/A q78-6fq—�.SOe ?Xf—27'6-2109 Name Home Phone OV Work Phone PRESENT MAILING ADDRESS 16f I A R ELEWEA D kora AtdQu� hvv City/Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two 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 108.3.5.1.) DEFINITION OF HOMEOWNER: 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,one or two family dwelling,attached or detached structures attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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 North Andover Building . Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEWOWNER'S SIGNATURE (� APROVAL OF BUILDING OFFICIAL e 4 v tOT/926n /O,OOO SF. 8 S N sN� Z STy' WFC N N .. so M�'i2 C3LCHCf�D ST,��E'7-' �I I NERBBY CERTIFY TO THE TITLE INSUROR AND PLOT PLAN TQ TIIE BANK THAT THE DIELUING IS LOCATED ON IN THE LOT AS SHOWN AND THAT IT DOES CONFORM DITN THR tOw"/ OF/10-i -'YIOO R ZONING REGULATIONS H 012TH 191.1,,OO✓Gr2 11/955, REGARDING SErDACRS FROM STREETS a LOT LINE'S.` I FiIRTHERtVVY, T T THIS DN'ELLlNG IS NOT LocAraD / � a FLOOD NASARD AREA As DRAB FOR SN011'N 0 ` r: PANEL ZSOU9$ oL.5US/91vly o9 STEPHEJiF`+ ';t` R. .S. DA y0, moz THIS PLAN FOR MORTGAGE.PURPOSES - NOT FOR MERRIMACK ENGINEERING SERVICES BOUNDARY DETERMINATION. BOUNDARY INFORMATION gg PARK STREET TAKEN FROM EXISTING RECORDS. M_I ti73Z "DOVER. MASSACHUSETTS 01810 Date. ... ................... -'A TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACMUSE'� /LL �o��L �/' This certifies that .......... .................................................................................. has permission to perform .... �k!!.....*r//.............. wiring in the building of .......................................... at.. .g.... Q4�E��.h......I ....... ,North Andover,Mass. Fee..Y...fLic.N ��.? ....... ri- .............. .....�.`��a.... ELECCRICAL INSPECTOR i Check # �_ 5b7r Lrm UU MlLYlul y rrGFu i[i yr 1Y"1aar1t1"v.3Asl A L3 •� �_ �� DF.PARDIEWOFPIIBUCSAFE7Y Permit No. 37(, 7 2— BOARDOFFMPREVEMONREGUTA770N P ORM CMR12iX1 Occupancy&Fees Checked { 5627 APPLICA71ONFOR PERAff TOELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC SSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work des ribbed below. Location(Street&Number) ((,1,� 1e- Owner or Tenant !ZUWt- ^a C 1 Owner's Address r Is this permit in conjunction with a building permit: YNo a (Check Appropriate Box) Purpose of Building � f1�p Utility Authorization No. Existing Service1 00 Amps �Volts Overhead Underground ED No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ✓•0 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 ri No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and 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• bwff aeC MrV-Ptn&=lDtlttetegtmanaisatMas XhusftGalaalLaws IhaNeacmetltLdil¢yhaaano Fbkyirc�frgCanple� Cov�eailssul baler ivala�t YES EDNO Ihave&ftriWdva6dpoofofsWW1oft0ffiice YES ff}ouhamdrdEdYES,pkeirdr*drtypec'o Nw4Fby INSURANCE � BOND � MER (Please*City) Vableofi~bMical W«k$ /J WodcbStat /c� l IiMeWonD*Rewestad Ratgh - -t.t/;/� cam,// Final Signed underlie Ftxlalties of pajuty. FIRMNAME Lioer>,seNa Lioerlsee G,r G' l ot.✓dti l�e>_ Signatiae LioaWNo a-� �ern�1/ >' -�`- i /t•�t ���� Bttsi=TelNa _ G7� ,��,�� A-t r� ft4� Alt Tel Na OW1 HCSINSURANCEWAIVER;IamawarethattheLioalsedoesnothavethein3}rrloealloWailsSllbAarrialgzvalaltasleyltiledbyMassad�GemaalLaws atrlthat sgnahaecndnspetnrtapp)rationwaiv�d>islegtlaernat (Ple ck one) wner Agent / Telephone No. 7 4 (,,,, PERMIT FEE$ Signature or Owner or Agent 1 t1C.I.VLY1ly1lllV YIEf "I n yr 10 i I DENR7MEW0FPUBIlCSAFE7Y Permit No. �lJ -7 Z" BOgRpOFFptEPREVF1Y170NRDGUlATl0120 ;. Occupancy&Fees Checked APPLICARON FOR PERMITTO P 2RMILECTRICA.L WORKALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datg Town of North Andover / To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work des ribed below. 4 f p rY ,'4C, ✓ Location(Street&Number) ;�`�g.;�nr(• � - 44\\ ''f t Owner or Tenant U Wv �.o, C *r 4ia Owner's Address Is this permit in conjunction with a building permit: Y,ds, Noy (Check Appropriate Box) R Purpose of Building// ex,� Utility Authorization No: Existing Service d., � Amps� Volts Overhead 1:3 Underground No.of Meters Nevi,Service / � Amps Volts Overhead Underground � No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work V-0 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above 1:3Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets . No.of Gas Burners Wo.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons LO of Disposals No.of Neat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices %I- of Dryers Heating Devices KW Local Municipal � Other Connections of Water Heaters KW No.of No.of Signs Bailasis Hydro Massage Tubs No.of Motors Total HP ER- R" Cc Verjr_A>WUlDthemgtmarEm fMiiwdwsftCk laWLaws aameYLi*Ttyhmm=R) ygdu*gCmrkO Com aritswb9zJWepY,&t YES NO %ftndedva6dproofef=w1odre0ffKz YES 0 E1`47 ffyouharedodWYBS,plea�irt&*fteAxofoa� pFby he bm ap BOM 0 0 _+cPm*cify) D FAirraiedVakrdnXWWWC&$ Stat �: C _ IrspecmnDateRegtressed Rao Al,` c.4...!/ lira urlder PE mkrscfpajtzy NAME LicatseNa Sigi=me qq :ate G/t ot,✓h, rdC;��tcaAl Busirrss'Ib].Na G7fj 7-7 D- �+ Alt Tel No. C4R'SNSURANCEWAMY41amawmdutheLkffwdommtha�ethei =xe or&a mild as �CclaWLaws �� Eby sgrlaGae cn the pearrt appGcabon watses this mgarerrla�t ck one) caner Agent Telephone No. 7 _ -Vi-oe PERMIT FEE$ tgna ure o wne gen I ICovs�< 0��. 4� —l1—or �Ti� �J d � 10RTM O�hTe s1a0 ti 9 NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street sic"US Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: O� NAME: ADDRESS: 1 , 1" 1 A ,�,2 Le%4-( E/ D J ZONING.DISTRICT: ~ TYPE OF BUSINESS: w � C9 C-c- BUILDING LAYOUT PROVIDED: YES KO AVAILABLE PARKING SPACES: ZONING BYLAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE Revived 11.5.04 BUSINESS FORM FOR TOWN CLERK Suzie's Organization c& Management 118 Marblehead Street North Andover, MA 01845 Phone: 978-6894508 email: Suzie@ampenberger.com Town of North Andover Bulding Department Attn. Michael McGuire 400 Osgood Street North Andover, MA 01845 North Andover, March 28th, 2005 Clearance for DBA License for the Town Clerk Dear Mr. McGuire: i Currently I am setting up my own little business as a consultant for Home Organization. I will work at my client's houses, helping them getting rid of things the, don't need anymore and organize the things they decide to keep, help pick out clo-Aet ., organization systems and set them up. I will not need my home for this work other than making phone calls and receiving mail. Kind regards, 4 V Suzie Riederer Date.. . _..�.. .�. �,.. . E NORTH o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION h S''CeMUSESS This certifies that . .: . . ? . . .�?H `''`. S. . . . . . . . . has permission for gas installation .��!°�.p C-A U:r 04 in the buildings /of . . �" ^' �'�`r Cf r. r. . . . . . . . . . . . . . . . . . at . . . . . . /�i y2 b�O�.°?.`� �!:. ., North Andover, Mass. Fee. . a. Lic. No.3 GAS INSPECTOR Check# ,F D S 4432 MASSACHUSETTS UNIFORM APPLICATON FOR PERMTT TO DO GAS Frrnw (Type or print) Date &Z3 .NORTH ANDOVER,MASSACHUSETTS ati ns GC\p�`L ^e caQ �f'� 1,010!�Permit Building Loc �� O o # Amount$ Owner's NameC\�� �� C P New Renovation ❑ Replacement ❑ Plans Submitted w � V A: F W 0 00 0 > � C7 O F C7 F z d x GW7 W W U a F ai SUB-B A S E M E N T B A S E M E N T j IST. FLOOR 2ND. .FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH _ FLOOR (Print or type) eck one: Certificate InstallingCompany Name Corp. eq Address ` ❑ Partner. Business Telephone�cq1 g 1^1 — -�'3a. ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter IN COVERAGE Chec&e: I have a current liability In urance policy or it's substantial equivalent. Yes No❑ t Ifyou have checked yes,pi indicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond ❑ 1 Owner's Insurance Waiver: I am aware that the licensee 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: Signature of Owner or Owner's Agent Owner ❑ 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S to Gas ode adtChapter 142 of the General Laws_ By: Signature o kenc Fitter 5-.)-35, Title Plumber J City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SA US This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .... . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . !"!�` ' . . . . . . . . . . . . at. .// . . . . . . . . . ./North Andover, Mass. . . . . Fee�-36� . . .Lic. No.... .. . . . . . . ... . . . ~PLUMBING INSPECTOR Check # 5683 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT-TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSE J/ �g 9" eke Date -> 3ilo 3 Building Loc r �� Owners Name O XMdP%�e Permit# Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES Z H a a wUn w aCr z > 0H d SLRBM sus meff >�FLOQt ern HOR 3M FID(R 4II3 FIDQt 5M FLOOR 6M FI= 4 7IH FIOR ' slH Fant / Check one: Certificate Instlling Company Name J ElCorp. Address ElPartner. 3� Business Telephone – � — yg�y irm/Co. ,s Name of Licensed Plumber: Insurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and info ation I have ubmitted(or entered)in above 1' tion are true and accurate to the best of my knowledge and that all plumbing w rk and insta ations under i ss ed for this application will be in compliance with all pertinent provisions of the chu Sta and ter 142 of the General Laws. By: a or LicemgWriumber of Plumbing License Title . q9�L City/Town icense um er Master journeyman ®- APPROVED(OFFICE USE ONLY E NORT1y � Town of : _ : .. Andover 0 No. A// 70 8� z o dover, Mass. COCMICHEWICK V ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.......5 V A. �I��Mh to BUILDING INSPECTOR ......................... .................. ..................................... ... Foundation has permission to erect.....y�.. ..�� buildings on...�.�. .... I .. rRough 1�I� P" w �wbft0 be OCCUpied aS t„��Gw,,,,8 r I t.. �!���'� Chimney . . . . . . . . . . . .... . . . . 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 BBy-By-Laws relating jo the Insna7*o , fteration and Construction of Buildings in the Town of North Andover. ' /� 1� / PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S Rough ................. ...... .................................. Service .. ... .. . .. . BUILDING INSPECTOR 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 J1 Smoke Det. d 1 Date...`S�.z, 17 �• 1 �aORTI� + TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �7SS CMUSE� This certifies that W....... AI&y..................................................... has permission to perform . ........................... ............................. wiring in the building of...... .......R� ��.................................. at...... ?l6KEy.....A......3 ................ ..North,Andover,Mass. .5S�--=� 3 Sp2S ... ........... .Fee..................... Lc.No. ............. ...................... f...... ELEMICAL INSPEmTroR (� Check # l 3577 7406 Commonwealth of Massachusetts Official -aUse Only Permit No. Department of Fire Services Ou BOARD OF FIRE PREVENTION REGULATIONS [Rev1/07]y and Fee Checked (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: t 5 - a3 --G'7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives tiotice of his or her intention to perform the electrical work described below. Location(Street& Number) Owner or-Tenwift Telephone No. 7 - aoe Owner's Address j Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service oo Amps //o / 7% Volts Overhead Undgrd ❑ No.of Meters New Service �L Amps /(U /?,2y Volts Overhead ® Undgrd ❑ No.of Meters _L i Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: s'�� y/c e � cw�cy►� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. BatteEy 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 InitiatinlZ Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers HeatPum Number Tons K No.o el - ontained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ un Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent 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 COVE AGE: 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Signature �-_ LIC. NO.: 3k.029-15-- (If applicable, enter "exempt"in the cense number line.) Bus.Tel. No.: 97S- �'f� Address: Alt.Tel. No.: *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 *ns rance coverage normally required by law- By nny si Signature Telephone No-9V--376-,?q09ture below, I hereby waive this requirement. I am the(check one) caner [:1 owner's agent. Owner/Agent I PERMIT FEE: $ e PAA