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HomeMy WebLinkAboutMiscellaneous - 121 GREAT POND ROAD 4/30/2018 (2) 121 GREAT POND ROAD 210/0370000.0 -- - - - - -- -- -- -- - - - - - - Date.. .1. ..3 ...! . . . . ...... .. RTk o� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SACHUSEt Ibis certifies that .m I J 7>A has permission for gas installation 3. �L r.~°`.:` S ( WA r r►,G ,i w in the buildings of . Ke�t�N �. . .. . . . . . . . . . . . . . . . . . . . . . . . at . . . 9 1 . . . r. . ....`. .. . . . . . . . . . . . ., North Andover, Mass. Fee. Lic. No.J.a.�-� 3 !�:.�t�5i'� 1 Y!(r'.' �GASINSPEOORf Check# 3 . 3 950 Date...... .'.................... J NORTI{ � '�" � TOWN OF NORTH ANDOVER ` PERMIT FOR WIRING SSACHUSES ) / L/1JG� /l a7'c�TvF ,�yS This certifies that ...................M........bzo.57"q . .............................. has permission to perform .............oe-1-/1...e...... wiring in the building of..............I/cE��.!ll�h?�.1��........................... I at.........r�r.. .. 1�<.ri .�!�1 .�(...r1. ..........PECr North Andover,Mass. Fee. �"' Lic.No....... GECAL INSPECTOR Check # 1 9577 Date........ ...................... gORT" °f�"`°:•1"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACHUS� This certifies that ............................... � (�- . ..................... ...... (, (�15r has permission to perform ... .. ............ ..............�.........�......... wiring in the building of..... E��C at °L .t .....iE?c ,North Andover,Mass. A Fee..�.2�`. ^Lic.No..J..yq�......... ......... TRICALINSPECTOR Check # � 2-�2. � (:ommontueaGi o� a6eacizu�e Official Use Only�-7 .UeparEment o�,tire�ervicee Permit No. 9,577 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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 FO TIOA9 Date: ko City or Town of: , v �� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pe the electri a work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address _ Is this permit in conjunction with a building erne Yes P., No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. ' ��� Existing Service Amps / Volts Overhead❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity (e—. v\t rS o �Location and Nature of Proposed Electrical'Work: m15� Completion of thefiollowingazfable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Sus o.o . ota P•(Paddle)Fans Transformers KVA No.of Luminaire OutletsNo.of Hot Tubs Generators KVA Above. n o..o mergency g ng No,of Luminaires Swimming Pool rnd. ❑ rnd; ❑ Batte Units No..of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.'o .Detection an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Totals _.____....... .:._................ Detection/Alertin Devices Heat um umber Tons o.o e -Contained ea No.of Dishwashers Space/Area,Heating KW Local❑ Municipal Connection [I Other �.d No.of Dryers Heating Appliances KW ecu ty. ystems: No.of Devices or Equivalent No.of WaterKW._ 0.0 o:o Data Wiring: HeatersSigns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommunica ons irm No.of Devices r E uiva�ent H J OTHER: CC) F W�� �rrt SCS v. tach additional detail.if desired,or ks required by the Inspector of Wires. t 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 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 coy rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [Z BOND ❑ OTHER ❑ (Specify:) I certify,under theains andpenalties ofperjury, at the information on this application is true and complete. FIRM NAME: e ice ye r✓! e S LIC.NO.: 15L M Licensee: C7p rc 6 n SmckwDod Signature LIC.NO.: a19)b (If applicable,enter " empt"in the license number lin Off'X Bus.Tel.No.: 4?3- Address: 3) ,P 2S a QM3 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work re es Department of Pub Safety"S"License: Lie.No. 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. Owner/Agent PERMIT FEE: $ 1:7—S Signature Telephone No. I The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):G&B Electrical Services,Inc. Address: 31 Pleasant Valley Rd City/State/Zip: Amesbury, MA 01913 Phone#: 978-388-7557 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 13 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. E]New construction employees(full and/or part-time). i 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9. ❑Building addition required.] 5. E] We are a corporation and its 10.❑✓ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.0 Other I 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: Ace Fire Underwriters Policy#or Self-ins.Lic.#: NWC 045859101 Expiration Date: 10/25/2010 Job Site Address: 121 Great Pond Road City/State/Zip:North Andover, MA 01 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby I cernOlnder the pains and nah*s of erjury that the information provided above is true and correct Signature: , Date: August 6,2010 Phone#: 978-388-7557 r Oficial 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#: i I i n /f amacha4etb Official Use Only (,o`nnwr ea�t�o9 Permit No. q,✓ 0 7 �..\ `7jeParE„teyt o� }ire-ervice6 G` Occupancy and Fee Checked WARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: August 10,2010 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 121 Great Pond Road JOB#100709063 Owner or Tenant Mr.&Mrs.Michael Kettenbach Telephone No. 978-640-8328 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 Amps ! Volts Overhead ® Undgrd�] No.of Meters New Service Amps / Volts Overhead Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Add on to existing Low Voltage Burglar acid Fire Alarm System. Completion o the followingtable maybe waived by the Inspector oWires. 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 Ej In- o.o Emergency Lighting rnd. rnd. 0 Battery 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 19 Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump J.Number TonsKW No.of elf-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 8 Municipal 0 Other j Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telccomr.Deviceso r firing: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required y Thens . 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 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 M BOND [] OTHER ® (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Ultraguard Protective Systems LIC.NO.: 1608C Licensee: Michael A. DeCosta Signature LIC.NO.: (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.:781-897-4900 Address: 18 North Maple Street,Woburn,MA 01801 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. 000986 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 E]owner's agent. Owner/Agent PERMIT FEE. S �. Signature Telephone No. i f�I MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING I a (Type or print) Date NORTH ANDOVER,MASSACHUSETTS � Building Locations C/- ./ Permit# Amount$ Owner's Name New1:1Renovation Replacement El PlLs Submitted ❑ U z a a O c w ° x z z o $ w0 H x H a o x �' d d m O O 0 a SUB-BASEM ENT BASEMENT + 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR (Print or type) , - �i k one: Certificate Instal ing ompany Name, h'�' �� J G - �� Corp. Address Partner moo/ / riu� �f�G'✓� 1� ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No❑ If you have checked yes,please in icate the type coverage by checking the appropriate box/ Liability insurance policy 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 ❑ lr hereby certify that all of the details and information I have submitted(or entered)in above application are true an accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this apP;'6Won will be in compliance with all pertinent provisions of the Massachusetts Sta s C nd Chapter 142 the e ws. By: S' ature of Licensed Plumber O s Fitter Title Plumber City/Town ❑ Gas Fitter License Number ® Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Location No. Date MORT� TOWN OF NORTH ANDOVER f 9 ` Certificate of Occupancy $ �'�s�''•°'E<�' Building/Frame Permit Fee $ ,rcNus Foundation Permit Fee $ 4 4 Other Permit Fee $ _ TOTAL $ C S Check # 15167 1/ Building Inspector TOVM OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING V - . BUILDING PERMIT NUMBER. DATE ISSUED: I I r vas SIGNATURE: (f- 019�� Building Commissioner ctor of Buildings Date 2 SECTION 1-SITE INFORMATION LI Property Address: 1.2 Assessors Map and Parcel Number: iJ C.� Zi6-1h 37.:(-oal,r-.vvay Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions- Zoning District Proposed Use Lot Area, 1 roma"e $ 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.1-C.40. 54) 1:5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT (r 2.1 Owner of Record Name Priinnt) �~ �T Address for Service Signatur,& Telephone Q 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 z-14� ✓? Q Licensed Corgi traction Supervisor: �� ��S ,)�/ �� ,/ Jr ,.�---- /,�f�J License Number 4)C/*4-5 U�. /r W6'Z-42 rev/r1. , mn mn Addres v L3—S-7,71 Expiration Date Signature, Telephone L-� 3.2 Registered Home Improvement Contractor Not Applicable 0 > 9 Company Name Registration Number � Ad ess CIO " co Expiration Date Jit nature t Telephone P • SECTION 4-WORKERS COMPENSATION(NI.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes......,0 No........0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building+DRepair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition er ❑ Specify Brief Description of Proposed Work: 4N7 SECTION 6-ESTH ATED CONSTRUCTION COSTS Item Estimated Cost Dollar to beWX "' . . Completed by t applicant x 1. Building a ( ) Building Peanut Fee Multiplier 2 Electrical -(b) Estimated Total Cost of Construction 3 Plumbing 7 C—elC� Building Permit fee(a)x 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 27,G 06 Check Number SECTION 7a OWNER AUTHORIZATIO TO BE COMPLETED WHEN OWNERS AGE T O CO TO S FOR BUILDING PERMIT 1' '1 as Owner/ thorized A en f subject property Hereby authorize AZ CA',-74•,e Z--1 U to act on My beha na s relfttive tqwork authorized by this building permit application. i Sr r O er Date SECTI N 7b OWNER(AUTHORIZED AGENT DECLARATION I'— property as Owner/Authorized Agent of subject 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 Signature of Ov�mer/A ent Date NO. OF STORIES SIZE r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ISSUE ADMIUD.- CERTIFICATE OF INSURANCE S/10/Ol PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. M. P. ROBERTS INS AGCY INC OSGOOD 1060 OSGOOD ST COMPANIES AFFORDING COVERAGE NO ANDOVER MA 01845 COMPANY LETTER A ZURICH U.S . ...... _.. _....... COMPANY B INSURED LETTER COMPANY C COM-CON CONTRACTORS INC LETTER 13 SURREY LANE COMPANY PELHAM NH 03076 LETTER D GUARD INS GROUP COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ................... . CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DD/YY) DATE(MM/DD/YY) - LIMITS GENERAL LIABILITY SCP-32648546 1/05/01 1/05/02 GENERAL AGGREGATE $2 000, 000 X COMMERCIAL GENERAL LIABILITY !' PRODUCTS COMP/OP AGG. $2 , 000 , 000 CLAIMS MADE X OCCUR. PERSONAL&ADV.INJURY $1, 000, 000 ....... ...... ___.. OWNER'S 8 CONTRACTOR'S PROT. EACH OCCURRENCE $1 000, 000 FIRE DAMAGE(Any one fire) $300, 000 :... ... _....._......... ............ ................_...___...... _...... ............_.. MED.EXPENSE(Any one person) $10, 000 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALLOWNED AUTOS .._......_..........................................................__._............. SCHEDULED AUTOS BODILY INJURY $ (Per person) _..............__.._ . HIRED AUTOS ...... BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY _...................... PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM _.......... .. AGGREGATE OTHER THAN UMBRELLA FORM - WORKER'S COMPENSATION COWC2 14 2 1 5 4/21/01 4/21/02 X STATUTORY LIMITS AND EACH ACCIDENT $100, 000 EMPLOYERS'LIABILITY DISEASE--POLICY LIMIT $S00, 000 __.__... .... ...__. _......._.......__... DISEASE--EACH EMPLOYEE $1 0 0, 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER:: :: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE TOWN OF NORTH ANDOVER LEFT, BUT FAILURE TO MAIL SUCH NOTICE HALL IMPOSE NO OBLIGATION OR BUILDING DEPARTMENT LIABILITY 0 ANYZ URM TH CO AGENTS OR REPRESENTATIVES. 120 MAIN STREET NORTH ANDOVER MA 01845 AUTHo %DPRESEA-ATrvE Mi�j hael P Roberts P ACORV25, (1/90) ,. ©AG:QRD CQRPORAfiIpN 1990> r ✓,4e �o�urw.eue«!{i£ o�,�� sacliusatta ,1 BOARD OF BUDDING REGULATIONS License: CONSTRUCTION SUPERVISOR I Number. CS 055991 ' Birthdate: 01/08/1950 ; Expires:01/08/2003 Tr.no: 5981 ' Restricted To: 00 RICHARD J LEAVER 16 BOWERS AVE ! ✓' Administrator TYNGSBORO. INA 01879 � ' 4 North Andover Building Department i 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 c11, S150A. The debris will be disposed of in: (Location of Facility) Sign re of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORT1y TONM Of ®ver 0 No. 1'4 v oCH;C L dower, Mass., l I Cc-t 0 1 RATED P"' C) H � BOARD OF HEALTH PE' RMIT T Food/Kitchen Septic System THIS CERTIFIES THAT.... p-4 PD �cn• Tze.a./4.r U CBUILDING INSEECTOR ................................................. .... .... ........................................................................... Foundation has permission to scarf.212* buildings on ......:..�.a.�........`9...!^`... -....... 0:!....................... Rough f n n to be occupied as.....6.kleP� ..-L.N.... t to v- . R W—W%0 G7L4 f U lC-�S C-09 GNC It— Chimney ................................J...........I...................... provided that the person accepting this permit shall in every respect-conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspectionration and Construction of Buildings in the Town of North Andover. c3 r) C/ I S � j ri�S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR A�j 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. SEE REVERSE SIDE smoke Det. ° 3 Cf 7 G Date.../� ....... ,/�. NOR7/, af�•�`°:°�"o TOWN OF NORTH ANDOVER Siam, p PERMIT FOR WIRING �SSACMUS� This certifies that .......�.,-J !w f.!.�.... Y..`i f01-(./................................. has permission to perform .............. ......�P / I, wiring in the building of........� .t..f e Lj".c:. `........................................ at..... ..Y.... �./.? �..t...f.0.. ........ ................. ,No th Andover;Mass. Fee. .. :.4 Lic.No, . ......�� ,.. .. ............ / �ELECIRICALIN6PECTOR Check # r i WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Official Use Only I 7 Permit No. a tm 4 Pwore,sadeat Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade 527 CMR 12:000 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 12 1 A-7— P a-4 b Owner or Tenant m le- tryT rr S 1! Owner's Address kT, cc, lr_d M A-N k&N j Is this permit in conjunction with a building permit Yes e., No ❑ (Check Appropriate Box) l 'q Purpose of Building tiy✓►S£ �- 4C�G�( Utility Authorization No. by 1`ti Existing Service 2- Amps [2I)12qz, Voits Overhead ❑ Undgmd E� No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters N Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 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 Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP 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 equivalenQE� NO = have submitted valid proof of same to the Office YES= NO = if you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) /I (Expiration Date) Estimated Value of Electrical Work$ bi S Do Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of peury: FIRM NAME f--IL J�-Czt R AL, f--k9 �O % 4�V if- LIC.NO. a ZZX(l� Lkensee is irB SRT I�z, IN AR 7r) - Signature a— LIC.NO. h 7 ZA� Bus.Tel No. Address,6S.6 8 C Jj kk(S Fc:�Q4 _S71, 4J&1y� M C11- Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its subs antis equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requlrement. Owner Agent (Please Check one) r Telephone No. PERMITTEE $ aQ_ "00 (Signature of Owner or Agent) MASSACHUSETTS UNIFORM N ORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location/ / lwners Name QA OPermit# 2S 5/ � D I Amount Type of Occupancy New Renovation ® Replacement ❑ Plans Submitted Yes ❑ No El FIXTURES Cn E~ W w a cn H a O -- W xCn fes, Cn cc �CC W A A '� " O a x x x a F x w x 3 a s:c A A 3 x HP64 U =1 91 M RASE"M M HDM r ► 2ND MOOR 3MFLOCIR 5M H" 6M HBM 7MHBM r Teck one: Certificate Date. . . . . . . . . . . Corp. /�.5�O.��•-� Partner. o'<".°R':�tia TOWN OF NORTH ANDOVER Finn/Co. o ' % PERMIT FOR PLUMBING + box: i o� • ♦ ❑ -o,,ro a•`,�y Bond �,SSAGMUS� �. t cation does not have any one of the above This certifies that . . �'. . . ! . - •.• • F ` has permission to perform'/ / erform'! -. . ,. ��..� v plumbing in the buildings of •.- 0. ( . . . . . . . . . . . El1� \. North Andover, Mass. a application are true and accurate to the at . . . . . . . . . . f-" : •"• • • • • Issued for this application will be in nye.• • • • • • • • • • • • • the General Laws. PLUtNBING INSPECTOR Check # 5058 Journeyman ❑ No °J 5 7 Date.../. �� .. v..... TOWN OF NORTH ANDOVER ° ' p PERMIT FOR WIRING ,SSACHUS� This certifies that .... ......-.. .L.� f .`i l.....�..0.... ................... has permission to perform F S ` wiringin the building of................................... ............................................... � at � � ��-- � {�� � ��" .��:.;Noah Andover,Mass,: Fee A1......... Lic.No.. ...... .... ...................... ... :.,.... . .... ............ ELF, CAL INS;ENI R Check # �/U 715 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer -i4l- Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. � _ b BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] (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: January 8, 2002 City or Town of. North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 121 Great Pond Road Owner or Tenant Owner. Telephone No. Owner's Address 121 Great Pond Road Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. No Existing Service NO Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity No Location and Nature of Proposed Electrical Work: Installation of security, fire and supervisory system a Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total l Transformers KVA No.of Lighting Outlets No. of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool. Above ❑ In- ❑ o. o Emergency Lighting rnd. rnd. Battery 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 50 Initiating Devices No.of Ranges No.of Air Cond. Total No. of Alerting Devices 2 Tons g No.of Waste Disposers Heat Pump NumberTons KW No. of Self-Contained 0 fa Totals: "'.. ""' ........'""""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal X Other Connection No.of Dryers Heating Appliances Kir Security Systems: 31 No.of Devices or E uivalent No.of Water Kms, No. of No. of 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: 771 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 X BOND ❑ OTHER ❑ (Specify:) ACC061344 11/25/01 .. (Expiration Date) Estimated Value of Electrical Work: $13,000 (When required by municipal policy.) Work to Start: 1/02/02 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: CONGRESS ALARM COMPANY, INC LIC. NO.: A5372 Licensee: STANLEY KUBLIN Signature LIC. NO.: A5372 (If applicable, enter "exempt"in the license number line.) / Bus.Tel. No.: 617-269-4250 Address: 36 WEST BROADWAY, SOUTH BOSTON MA 02127 Alt.Tel.No.: 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. Owner/Agent p� Signature Telephone No. PERMIT FEE: $p�$'