HomeMy WebLinkAboutMiscellaneous - 122 LANCASTER ROAD 4/30/2018 / 122 LANCASTER ROAD 210/104.D-0167-0000.0 Date ♦ TOWN OF NORTH ANDOVER PERMIT FOR WIRING AIleW 6 �-f c� e 4 /�This certifies that . . . . . . . . . . . . . . . . . . . . . . .�. . . . . . . . . . . . . . . has permission to perform. . e!r nocQ .! s wiring in the building of . . . . . . . . . . . . . . . . . . . . . . . . at . 12-z- .L--(� e c`.%�P ? . orth Andover, Mass. Fee� . . . Lic. NM1.M.'.N. ELECTRICAL INSPECT R C�eck#b%-�J`�Jn 4 11380 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT INMK OR TYPE ALL INFORMATION) Date: l A,?• Q 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) )a a o121Ad Owner or Tenant 0-0,- ���„, /. Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building_&Au ezUtility 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: ' Completion of the following table may be waived by the Inspector of Wires. No.of Cell:Susp.(Paddle)Fans Tr s Total No.of Recessed Luminaires o Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA R Above In-rno. mergency ig tmg No.of Luminaires Swimming Pool rnd. ❑ d. El Batteo r Um s No.of Receptacle Outlets Ll No.of Oil Burners FIRE ALARMS No.of Zones Q� No.of Switches No.of Gas Burners No.of Detection and Q; Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices Heat Pum Number.Tons KW _ No.of Self-Contained No.of Waste Disposers Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: 1 Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent " OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 'd5LV,GYi (When required by municipal policy.) Work to Start: /-,),j d j 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM N 9 LIC.NO.: Licensee: /," Pa2k,am Signature LTC.NO.: (If applicable,enter "exempt"in the license number line) Bus.Tel.No.•,&0-36o-<.36 Address: Alt.Tel.No.: *Per M.G.L c. 147,s. -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 insurance coverage normally required by 1 tw,.�By my signature below,I hereby waive this requirement. I am the(check one)[I owner E]owner's agent. Owner/Age "�/�" J / Signature ,uc�t Telephone No. 3 �6a $3�S PERMIT FEE: $ Q ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed 1. . on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and maybe deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 151 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INFECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: ter! r Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 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/OrganizatiorvTndividual): pmaad�,e4- Address: s�p City/State/Zip: atM40n Q?gl l Phone 346)- V6 Are y an employer?Check the appropriate box: Type of project(required): 1.KI I am a 4 employer with . ❑ I am a general contractor and I _�_ 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# �• El Remodeling ' partner- ship and'have no employees These sub-contractors have 8. ❑Demolition � P working for me in any capacity. workers'comp.insurance: 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] o 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 1311 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. uM4 NAi44.�ccl�l� u Policy#or Self-ins.Lic.#: Expiration Date: t Job Site Address: City/State/Zip: 'i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 DTA.for insurance coverage verification. I do hereby certlo under the pains and penalties of perjury that the information provided above is true and correct. - Signature: Date: Phone#: I 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#: 1/ Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. 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 fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if V necessary,supply sub-contractors)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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston.,MA 02111 TO.#617-727-4900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 Fax#617-727;7749 www-mass,govfdia 09739 Date . C?�. . .q/3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . . •d has permission to perform . . . CZ . . . . . . . . plumbing in the buildings of. ./6'.717-1:1�P . . . . . . . . . . . . . . . . . . . . . at . . . .1c,),2-. . - 1-191r .4,s e i. .`�: . , North Andover, Mass. Fee ./.V'`—. . . . Lic. No.I.345.)�. . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check 4 '}733 A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY +_oma•r� ( MA DATE Z /3 i PERMIT# JOBSITE ADDRESS Z L ter-, 4 cf OWNER'S NAME P OWNER ADDRESS TEL FAX ` f TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL®, PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES E0 NOD FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _f �( __-J _ _I f f .._.__J f _i J f I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _I ______( _._._J __._.J f DEDICATED GAS/OIL/SAND SYSTEM ( f _ I ( _ -1 DEDICATED GREASE SYSTEM —_f ...____i _ i .__.__.._.I _. _l I _...._...__4 f -__ _I _j ._..____1 1 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _-..J _I DISHWASHER DRINKING FOUNTAIN _ ( ( .--....__1 I i _--____I FOOD DISPOSER FLOOR/AREA DRAIN .f ___._.__J ._.___j============ INTERCEPTOR(INTERIOR) _._...._..J ._--_---I _._.._.._i KITCHEN SINK LAVATORY ROOF DRAIN f SHOWER STALL SERVICE/MOP SINK J ___ _J ( i ____J _.__-I ___.__( TOILETf __.._.C _..._ _ i E-7-D URINAL WASHING MACHINE CONNECTION -( -_ i _........J _ - __-..f ._ J _.._ .J I . ( _...__I __. J _-- _ I ._---..._ .l _ i WATER HEATER ALL TYPES WATER PIPING OTHER -f __---_ _._.....l[_I J .__._._._J _ .__._ J IF _.J ...._.._.._.1 ._.___, . ...._J -� INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO M If YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY © BOND 0 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 _! AGENT I� 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 r' I�-�_ !�✓� , LICENSE# 1 �� I SIGNATURE MP® JP Q CORPORATION(�.1# PARTNERSHIP 0#=LLC U j COMPANY NAME - --- o- G/ ADDRESS 1 CITY ISTATE ZIP TEL FAX CELL r EMAIL - -�- -- - -- - 4N MA07 e ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ LIQ FEE: $ PERMIT# PLAN REVIEW NOTES �i 2 C Xj A- q r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 V www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: S_ L ie City/State/Zip: ScAl 9033/4Phone#: 7 7 F 8 y7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ElNew construction 2.[�I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity, workers' comp.insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9' ❑Building addition required.] officers have exercised their 10-ElElectricalrepairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Date ,/ hone#: 9 `2 8 �'�'- 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 employees. 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 fill out 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www,mass.gov/dia a_ f, :. COMMONWEALTH OF MASSACHUSETTS , RS A• GAS T S \ LICENSED AS A MASTER PLUMBER i. 18UES THE ABOVE LICENSE TO PATER G. ASHWORTH IRV ` 5 ;1`ER`0Y; 115 1 Date. ..'. �. 1� �.�. ... . NORTH of °` TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 4 C. SACMU5Et r This certifies that . . .0 C.A:':(%,.k .o�.`.� ... . . .� � . 1A L . an has permission for gas installation . �._��. . �. s.s�•. . . . . . . . in the buildings of . . .IB P.,(.YN.e-V:7 . . . . . . . . . . . . . . . . . . . . . . . . . . at . . S.?.Z- - ✓�.�.G. s'. . , . . ., North Andover Mass. Fee :Q.Q. . Lic. No..Q+ .f•3 ,t'! ,r C GAS INSPECTOR Check# i �WIASSACIH—USETTS UNIFORW APPLICATION FOR PERMIT TO Do GAS FITTiklG Cityl:vrE:. N, AOa-4•er Cate: ?JS/i' llermlt# I uildina Locatio 7-Z -F �L �____ �r�ec'•s --i`� • _, Ov<<nsrs i�?arne: 0LrA9- Typa of t3ccttpGnct: Commercial Educational Industrial Institutional Residential Nevv:: Alteration: Renovation; Replacement'X Plans Submitted: Yes No FIXTURES ccLU z LU 0 to 0 0 z z o w z reozwle W lmW g In O 1- z a Uj Lu w z w D� a- o a W w W � F- O . J a U. W x Z w r1� t V I— W W IF V 5 A W 0 0 x x 5 > 0 g 0 0 z z z �Q SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 6 FLOOR 6 FLOOR , 7 FLOOR 8 FLOOR Installing Company Name::Central Cooling&Heating, Inc. Check One Only Certificate 4 ' Address:. 9 North Maple Street City/Town: Woburn State: MA Corporation. 2806C Business Tel: 781-933-8288Partnership Fax: 781-932-9017 tlaiYie of Licensed rlufni�er/Gss Fitter: _ Finn/Company Mike Semasconi F SURANGE COVERAGE:ave a current#01WInsurance policy or its substantial equivalent which meets the requirements of MGL.Ch,'142 yes ✓ tqo If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ,` tither type of indemn!4, Gond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required b � Massachusetts General Lawns,and that my signature on this permit Aaives this requiremen q � Chapter ,42 of tine Check One Only Signature of owner or Owner's Agent Owner Agent ac cnecurate tng this box ;1 hereby certify that ail of the details and information 1 have sub d(or teredi regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Instanations p o d under he compliance with all Pertinent provision of the Massachusetts State Piu bang a nd apter 14 oft se eine al Lawsr this�pRRication will be in By T e of License: mber Title FitterSigna re of Licensed Plumber/Gas Fitter MasterCitylfovvnrneyman APPROVEt3(OFFICE USE ONLY) P Installer Licens Number: 15137A� FJ!NAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: PERMIT# APPLICATION FOR PERMIT TO DO GAS Fn-nNG NAME&TYPE OF BUEL DING ' - LOCATION OF BUILDING SEETCH PLUMBER GASFITTE LP INSTALLER t ' LICENSE NUMBER: PERMIT GRANTED F-I DATE: + GAS FTITING INSPECTIOR The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Map# Lot# 600 Washington Street Address: Boston,MA 02111 Permit# t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information. Please Print Legibly Name(Business/Organization/Individual): CPa}-(I Ory-)' e64 P/),Q , Z 7 C Address:.. Lal 61 a JP sa ee± City/State/Zip: V J 0 Phone#: -79 ) - 933 Ed.,?f Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with_�S 4. E] I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. F]Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.$ 9. Building addition required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner,doing all work officers have exercised their 1 LQ Plumbing repairs or additions myself. [No workers'comp. right.of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[4 Other_a;,��� comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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: GLOBAL TN SkF,6 N CE N67.Wd RH TNC Policy#or Self-ins.Lic.#: $S()O 0,J 9 6 3 6 Expiration Date: Job Site Address: Z L U t, c as 1R City/State/Zip: lam(, Ara a, A 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 certi un 'is and penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: `7 g3=�0 I ficial use only. Do not write in this area,to be completed by city or town officiaL ty or Town• Permit/License# uing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ntact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. 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,porporation.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 fill out 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 permittlicense 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 U.#6I7-727-4900 ext 406 or 1-877•MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS LICENR�EA&SEAB�RYIMV_MAN PLUMBER MICHAEL C BERNASCONI R `^ 58 ALBATROSS RD N ; QUINCY MA 02169-2658 • COMMONWEALTH OF MASSACHUSETTS -. - c IN PLUMBERS AND GASFITTERS •...... LICE� SJRT&�y.PLUMBER . MICHAEL C BERNASCONI 58 ALBATROSS RD QUINCY MA 02169-2658 COMMONWEALTH OF MASSACHUSETTS BOARD OF SHEET METAL WORKERS AS A MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO: MICHAEL C BERNASCONI 58 ALBATROSS RD QUINCY MA 02169-2658 773627 9801 1l_ ac�10 Date..... ......................... NORTF� °f, °;•'"� TOWN OF NORTH ANDOVER F p PERMIT FOR WIRING 41 ��Ss�cMus� Q �cT r This certifies that � � � � � has permission to perform .........� �... ..... �/ /l rcr��.......... ..... ........... wiring in the building of......... l, !m.ti T.,............................................ at...........12-.?...... !fiiv. e!s-7kxe.....10.?Z2... ,,N rth Andover,aMasFee...� .. Lic.No. h�................... ... ....... . ........E . Eta ;c�u.IMPP *oa �/ Check # SS^�� Conulmieruaa��e a� ad�aefart7ai Official Use Only e1JaParfneaiel`o�.fira Jaruicaj PermitNo. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 Move blank-) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfarmed in accordance with the Massachusetts Electrical Code(MEf-),S?7 MR 12.00 (P.LEriSE FR1NT 1 EVE OR TTP+ rFO 1AUON) Date: d City or Town of: To the Insp for o Mies. By this application the undersigned gives notice of his h r intention to perfoUp the electrical work described below. Location(Street&Number) rG Owner or Tenant Telephone No. Owner's Address &/ Is this permit in conjunction with a building permit? Yes F] No (Checlr Appropriate Box) Purpose of Building ` (y1 c �� i.' y Utility Authorization No. Existing Service Amps ! Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhand❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work., i Coni letion afthojollonhiz table may be valved bit the Jus ectal'of f ljres. No.of Recessed Luminaires No.of can.-Susp.(Paddle)Fans No.of Total Transformers ICVAi No. of Luminnire Outlets No,of Hot Tubs Generators ICV. �D AboveDn- o.o mer No.of Luminaires Swimming Pool gency !g Ing rnd. Elrad. El Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an InitiatingDevices No.of Ranges No.of Air Cond. Tonnss ToNo.of Alerting Devices No,of Waste Disposers Hent Pump Number Tons IC o.of el[ ontained Taints: Detection/Alerting Devices i pal No.of Dishwashers SpacdAren Heating XW Local❑ Connections Muniectio ElOther No.of Dryers Heating Appliances I0y Security Systems: No.of Devices or Equivalent No.of Water 1C>Y No.of No.or Data Wiring: Heaters Signs Ballasts No.of Devices or E nivnlent No.HydroTelecommunications Wiring: Bathtubs No.of Total HF No.of Devices or 1C uivnient AOTHICR: i Attach additional detail ifdesired,oras required b3+fbe lnspector ajH-ires Estimated Value of Electrical Worlc (When required by municipal policy.) Work to Start: inspections to be requested in accordance with MEG Rule 10,and upon completion. =::=.:--::--.:=-INSURANCE=COvi1RAG7;:-Unless-waived-by the=owner;rio=penniGfdr this=performafia:i5rdledtricaI iivork=rriey=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 proofA),S s o th snail issue go ace_ CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify.) �d `� ` I certi render tete Rills al L'!la tics r7 er u 1 hat tJ arl)lation a) licallon istrite alid Din.f�, P � fP J t74 �fp p1et� L FIRM NAME: � C LIC.NO.: V LicenseeSignature LIC,NO.: plapplicable aljkr er!Jr t"int a license nunibe Ji e.) �MZ I Bus.Tel.No.! Address. / Alt,Tel.No.: *Per M.O.L.e. 147,s.57-61,security vgdk requires Department ofPublie Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not Jtmve 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 a lent Owner/Agent Signature Telephone No. PERMIT FEE:$ 75` 2 Date.,/. .?j/.�f/. �...... HORTPI Of 1ti F? y`,..o °p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACMUSEI 11'' t1 This certifies that . . . . :. .t . . . . has permission for gas installation r./. S'4. !: . . . . . . . in the buildings of . . . ..1 F.���. . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. . .3(�. . . Lic. No.. 5 S : . 1. . . . . .�?`�.� .--. . . . . . . . . . . . GAS INSPECTOR Check# _(J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:� /x �� MA. Date:/,.2 e f 7Permit# Building Location: i22Z�e�'P-5`7q2 Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential,k New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No,f FIXTURES Z LU F vi x m = 0O LU W U U) ~ (A O r2 W Lu Lu W Z O O Z Z O H D Lu 0 Q H LU W w m 0 Q a I— W w w x > z w Q x LL LU w L z x I— w f' 0 ww > v w Z O H O Z —1 0 u_ N w w w w Z w } (n � Q Q m w O Z 0 ~ I ~ / G v o a � 0 � _ _ O Oa a > > > O BASEMENT 1 FLOOR 2 Nu FLOOR 3 FLOOR --4'FLOOR 5 FLOOR 6 1HFLOOR 7rff FLOOR 8 FLOOR Company Check One Only Certificate# InstallingCom an Name: Iorporation Address: G~/ �' City/Town: State: ❑ Partnership Business Tel: ���1?5r3G2� Fax:` 7L?- 7 1-7 6- ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: Cy INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner El Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;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 L S. Type of License: BY ,Plumber Title El Gas Fitter Master Licensed Signature of Plumber/Gas Fitter City/Town ❑Journeyman License Number: /92 APPROVED OFFICE USE ONLY ❑ LP Installer CERTIFIED FOUNDA TION PLAN LOCATED /N o SCALE:/' = -4d' DATE: Scott L. Gi/es R.L.S. 50 Deer Meadow Road - North Andover,Mass. LOT 35 49230 S.F. LOT 33 �o-r 37 r 2 2 1993 LANCASTER ROAD / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUIL DING/NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE WITH THE ZONING DETERM/NA77ON OF ZONING E SY LAWNS OF CONFORM/T Y OR NON-CONFORM/TY INHE/V CONSTRUCTED. �FESE° WHEN BUIL T. �D 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 local or state law, regulations or requirements. ****************A'`pppplicant fills out this section*****************2 APPLICANT: ,, � T}'. �t/ i Phone L� �w LOCATION: Assessor's Map Number 0 v Parcel Subdivision Lot(s) Street /,,zv C 4 S �{ K /� St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: )rs Date Approved 11A�0,5 Conservation Administrator Date Rejected Comments z Date Approved Town Planne Date Rejected Comments Date Approved Food Ins ector-Health Date Rejected Date Approved �/ Z Septic Inspector-Health Date Rejected ( Comments J Public Works - sewer/water connections - driveway permit -Fire Department Received by Building Inspector Date 1 y �--- ........... fi 1 33�/ `O J / 37 t i ORTH Town of Andover ° No. 557 �` :i�i���G;��AI sw. � �. ^�Ado dover, Mass., /VD V ..i. 19rj' /�. COC-C EWICK �A0RATED �S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �. 00. ���� � � BUILDING INSPECTOR THISCERTIFIES THAT....... .. ..�.. ......../..�.. . ..... ................................................................................................................ Foundation has permission to erect.M.#0.0/.%04... buildings on .4iAAo&AV.1(*VwV#ro0A...Of44 #rY.+r Rough g to be occupied as nWASAWOW!,rr.. 1 / 1.04..1004�4i� Chimney 11 in v r r s ct conform tot a terms of the application on file in provided that the person accepting this permit sha e e y e pe PP Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. v KNIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA 114.S,S. B.C. Rough PERMIT EXPIRES IN 6 MOTAFIF .=��PAID o O ,) Final UNLESS CONSTRUCTION STARTS L�✓ 0 ELECTRICAL INSPECTOR e Rough PERMIT FOR FRAME/BUILDING ..... Service BUILDING INSPECTOR Final DATE.���� -FEE P l 1 a cyermit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT 0 ` Date.... .... '........ .... NOFTI/ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ;7SgACNU-j This certifies that .....�. ... .-:¢r..�............................................................... has permission to perform ...,. ..... wiring in the building of..... ...........: s ...... ................................. North Andover,Mass. Q�L` d-d Fee.. `'.............. Lic.No.............. ............. ........ . ELECTRIC ImsPEC MO Check # �� —�+ , 7309 Commonwealth of Massachusetts Official Use only � 73aJ� Department of Fire Services Permit No. Occupancy and Fee Checked s`~ 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 INFORMATION) Date: '4 f A•-Q) City or Town of: NORTH ANDOVER To theIn pec or of Wires: By this application the undersigned gives notic of his or her intention to perform the electrical work described below. Location(Street& Number) 10� Owner or Tenant Kaue., ca Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ®' No ❑ (Check Appropriate Box) Purpose of Building r Z 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: I I Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Tota 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. ❑ Battery Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.o Detection and Initiating Devices ,k No.of Ranges No.of Air Cond. Total No.of Alerting Devices iNo. of Waste Disposers r HeatPump .Number Tons KW Detect elf- a Self-Totals: ing Contained ippi No.of Dishwashers ) Space/Area Heating KW Local EJCo n nnectiection F1 Other Co ti No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.o KW 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: 1 . Q (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 [r BOND ❑ OTHER ❑ (Specify:) I certify,under 11 pains and penalties of erjury,that the information on this application is true and complete. FIRM NAME: Q 9-c m, LIC. NO.: Licensee: } Signature LIC. NO.: (If applicable, enteel, "exeml��{{ to the') ease nun r line.)]] Bus.Tel. No. Address: ��( � -iy ST Alt.Tel. No.:00 *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 insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ � r-7 7 r 1 Date 11 of T -14, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSA—Is This certifies that A.. .. .. . .. .(... . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . 4,0. . . . . . . . . plumbing in the buildings of . . . . . . . at . .(4,1 . . . . .k2k—�' North Andover, Mass. .Lic. No,IR3---� t%. Fee31-/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 7358 MASSACHUSETTS UNIFORM-APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) a 1141 DO ,'I , Mass. Date �I_IA 2D /7 Permit # - Building Location_ P Owners Name KQALeM' .� Type of Occupancy New ❑ Renovation ❑ Replacement LJv Plans Submitted: Yes ❑ No ❑ B.P.# SEWER# FIXTURES SEPTIC# _z z x {! Y J N V Q� N O O W a) N 2 N a ¢ < _ ~ z 0 z OW N F- N d xt 4j !� W U ¢ N W W z z a) x J N - 0 0 x ¢ d W N . -< y Q d C 31: E •H U Z9rin O 7 ¢ N W ¢ Q w N W ? O Q U) z ¢ a x O W ¢ W H . d rA O . -1 N C Q J _ O O 1J tL x S x a 0 z z Q W W x = a) < _H > r_ O W W O W F z o O W _ _ W f" 0 V a Q Q x _ _ Q Q 0 Q J J Q ¢ r� Q n a 0. 3C J C. N O O J N W 0 O F- O Q 3 C .- 3 m 1 Ca 0 SUB-BSMT, BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR �• installing Company Name Paul ✓ aI Check one: Certificate # Address ❑ Corporation OAX4 _W / 30 2/c ❑ Partnership Business Telephone 9?—e5�J� ❑ Frm/Co. Name of Licensed Plumber V 4ci /.� INSURANCE COVE 4 have a cu ent i U�Yes No El policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Vis, please indi he type coverage by checking the appropriate box A liability insurance policy Other type of Indemnity 0 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: Ngnature of Owner or Owner's Agent Owner El Agent ❑ I hereby certify that all of the details and information I have rtted(or ent ed)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations ormed under permit issued for this application A co all Pertinent provisions of the Massachusetts State Plum ng Cod an Ater 2 Gen S. Title Sigaatafie of Ucensed Plumber City/Town Type of License: Master Journeyman ❑ APPROVED OF ICE US ONLY) License Number �g� h` % MASSACHUSETTS UNIFORM APPLICATION-FOR PERMITT0:D0'pLBry4B1n0 'r " (Type or Print) ., , NORTH ANDOVER ,Mass. :l�4: .=Date: Building Location 57`e--Z— 5?,e- Permit 0 w Owners Name New Renovation Replacement [] Plans SVbmitted F T U F i. • z at . z )d ` • .. �,. to • N O O O Z x w Wj P U h to Us Z 4a a ¢ Z 0 z 0 0. ¢ i ¢ as = z O1- W k H ., a ya tri a _ a: r � W to x < a. �, � x v x' o � ¢ W a sa o a to z a a 0. &U Was m ¢ J p W x < YBr 0 z x. 14 a a < to IL LC W '' ~ V > t•• O x ° � N � z 0 Yt x x W t- O 0 X • :.; < �• < < Z N N a a o a -a < ¢ ac ac < O < ►- Y -A J 3 x t- N 1L O O a < '1c ao O • ' S11131-18SMT. BASEMENT 1ST FLOOR 2N0 FLOOR 3R0 FLOOR b A 4TH FLOOR STN FLOOR 6TH FLOOR 7TH FLOOR ' 8TH FLOOR • t (Print or Type) Check one: Certificate Installing Company Name Corp. ,.• , Address yy / cyP S7` L� Partner.______ /y/-P /v PGv G19 C'j Firm/Co.�� Business Telephone Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the i , appropriate box: Liability insurance policy '-Other type ,of indemnity 0 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 coverages. •• . Signature of owner/agent of property Owner AgeneN i I beaebr cutifp dial all of We details and in(ornation 1 t4a•c submiUcd lot entacd)in alwi.e appliolion lite live 4:844 to dw btN of w I ...• ftssowkdp and that all plumbing work and installations loci fnrmcd under retnait issued for that applicstiort will be Ick W ratio"pop,# v1siow of&be Mamaditswils Slate Plumbing Code and Qupter 142 of the Genual Laws. By Title • Signature of 'Licensed Plumber Type of Plumbing License City/Town: Iii 174 — r, _ Date. 4" 3628 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . . . . . . . . . . . . . . . . . . has permission to perform 4 jrm�d? . plumbing in the buildings of . r.. . . . . . . . . . . . . . at. . . �- '^.0° s 4k- .4 . . North Andover Mass. Fee , .40 Lic. No.. . . . . . . . . PLUMBING INSPECTOR C 48/18/48 08:58 25.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 0 3YJ 01 Location , o,h*r3l� No. Date pORTIy TOWN OF NORTH ANDOVER Of «ae , 1ti p Certificate of Occupancy $ Building/Frame Permit Fee $ sA�MUs(� tlF ou karti�o/n Permit Fee $ ; — C Nefmit Fee $ a Sewer Connection Fee $ Water Connection Fee $ w TOTAL �� Building Inspector - - � Z/�4 10:45 25.00 RAID A�0 7302 " Div. Public Works . .'1:'.i-ra'1. tiJ.�...,.. ..... r' / 4w 'y- � r.q`.wa-y♦-� rY �- .... _. _ .. LQication. 0��0� ��- f��.-� �'(' J No. s2 Date -2Z -,' 3' i i NaRTh TOWN OF NORTH ANDOVER • �O Certificate of Occupancy $ Building/Frame Permit Fee $ 0 ,d v �,�•°' •''��' Foundation Permit Fee $ ��d ssACHU _ J Other Permit Fee $ Sewer Connection Fee '$ i Water Connection Fee $ ����y y� TOTAL 14 uilding Inspector RAID �. /93 6815 Div. Public Works Location 4) No. >� Date 3 , ,aOR77y TOWN OF NORTH ANDOVER 4mi-amad-&��, Certificate of Occupancy $ j /i.ri c) Building/Frame Permit Fee $ Foundation Permit Fee $ //l ii• ) s'CHuse Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ /,5 i1.iJ r) / fi' Building Inspector W1 `I l9'3- :43 150.09 RAIL` - 674s 1 � Div. Public Works Location' I ZZ L4me,>S 01- ��l{ r� 35 _ f No. 2 Date .4, Rr" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ ` Building/Frame Permit Fee $ s i • no♦Aq°� ,SSACHUSEt Foundation Permit Fee $ Other Permit Fee $ 4b C z4;- Sewer Connection Fee $ /,-Z� Aln 32 - t Water Connection Fee $ lc�C� TOTAL $ r- _ /� ' �/ ,��, ✓ .S � _11WIding rinspi.Rec,�tortiIIUc i .�� i _ Di Pub/16 Works I v - APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 t--rvIAP �i�0. LOT N0. 5' 2 RECORD OF OWNERSHIP JDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. � LOCATION PURPOSE OF BUILDING27 / OWNER'S NAME NO. OF STORIES Simi n OWNER'S ADDRES / ! / / - _ BASEMENT OR SLAB /1 -04- yam ARCHITECT'S NAME f) SIZE OF FLOOR TIMBER/S9' IST „ ,� <� 2ND y3RD v p^ BUILDER'S NAME SPAN / /1� DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS ` a •� a X 6 <_!_ DISTANCE FROM STREET , / POSTS DISTANCE FROM LOT LINES-SIDES �J� REAR GIRDERS ����/J•D AREA OF LOT n J FRONTAGE O/f sa, HEIGHT OF FOUNDATION a / THICKNESS c IS BUILDING NEW SIZE OF FOOTING X ` IS BUILDING ADDITION,*' MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FI LED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY e IS BUILDING CONNECTED TO TOWN SEWER , '��F� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES 8111/ rGllttli �/� 1 d r OLK PUMP* =� O EST. BLDG. COST 3� 7 o'Fo PAGE 1 FILL OUT SECTIONS 1 - 3 lfil I m ICRA ��d O RAEST. BLDG. COST PER SQ. FT. ii 1F P/AGE EST. BLDG. COST PER ROOM 2 FILL OUT SECTIONS 1 - 12 G U SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR iDATE FILED / BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT F E r �D.d OWNER TEL # 2J�``- " q PLANNING COARD PERMIT GRANTED CONTR.TEL,# Y 19 CONTR.LIC.# BOARD OF SELECTMEN 12�zeezl BJILIDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY Y STORIES 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 1 ' a 1 2 3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL G FIN. B M'T' AREA _ 1/4 1/2 l/. FIN. ATTIC AREA - N_O 8 M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 J 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ~ ASPHALT SIDING HARDI!J'D ASBESTOS SIDING _ COMMCN G _ VERT. SIDING ASPH.TILE k STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MAS N Y ATTIC STRS. & FLOOR _ w %'t'• 4.4�,{ tl j { BRICK ON FRAME I '^'" -' '.3 CONC. OR CINDER BLK. STONE ON MASONRY WIRING " STONE ON FRAME _ A SUPERIOR ADI� POOR EQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP C., BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. -- TIMBER BMS. 6 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B•M'T 2nd ELECTRIC Ist 13rd I NO HEATING J f f4 T}.n CERTIFICATE OF USE & OCCUPANCY . ?f Town of North Andover . Building Permit Number 557 (1993) Date MAY 31, 1994 r F THIS CERTIFIES THAT THE BUILDING LOCATED ON 122 LANCASTER ROAD (Lot #35) MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/22 CAR GARAGE IN ACCORDANCE a & SUNROOM WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Oq CERTIFICATE ISSUED TO A. J. Maillet Construction , 9 h �: •° 3 Wescott Rd. ADDRESS Andover, MA Building Inspector AORTK Tovm .of Andove 0 No. $57 A � dover, Mass., IVO V •.I�y 199' COCHICnELJ EwICK i 7 RATED AP -J V -� BOARD OF HEALTH [ Food/Kitchen v Septic System ., -. . PERMIT T D ,. BUILDINGINSPECTOR L THIS CERTIFIES THAT.......A .�....& ` r...... ............. ........ h- �L �... F6iindatio� .has permission to erect�ll�.�P/.�tA.l .0.. buildings on . �.�. , .�, ji s�... i� Rough h�� a -�'�! 9�� (� t0 be occupied as.NW ASAWN.O. .. .. � 0 l .. & Chimney e i permit sh 11 in eve res ect conform tot a terms of thea lication on file in provided that the person accepting this pe it a ry p pp �? this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final �Q �,tJ C .. °i Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING I SPECT¢R r �, , REGULATED BY PARA. 114.&S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. ou <l� 'D - .00A na Y/S PERMIT EXPIRES IN 6 MOTs y e.�..FEE PAID . �. 1-11*­111-1­11 er .d U ELECT` CA�PIMPECTOR UNLESS CONSTRUCTION STARTS Roughc Service FOR FRAME/BUILDING ..... . ....... .. ....... . i rl BUILDING INSPECTOR Final DATE:fd�FEE P u cy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough } S y No Lathing or Dry Wall To Be Done ` FI DEPARTME T +E --.. Inspect �id a d Approved by the Building mi�t , �� Burner PLANNI CONSERVATIO Street No. � Smoke Det. rSEWER -jA� F NAL DRIVEWAY EN ��� NORTH ANDOVE It Iit111.1NN(i ';t-.: �' t.l:i�: :�i Ini x II':�►ifi•I (J)Ntil:I iVATION �`"� I iIVINH IN 1 I I1 I 71 fill! .17 Illii�l:l'll ' Iir�NNINc; 1'1,-ANN1N(;. (;O111[�11IN1'i'1' 1)1'sYl;l,OL'l1Il N'l' ' I:: HWN' l 1.1 '. NJ:I tit )N. I Illtl:(:'i( )It CHIMNEY APPLICATION ANO I'L1311I' 'ATEr- 1 L1tM11. # )CATION LINER'S NAME: 1ILDER'S NAME: SON'S NAME: „ ,L kSON'S ADDRESS: ISON'S TELEPHONE: JERIAL OF CHIMNEY: IFERIOR CHIMNEY: EXIERIOR CHIMNEY: 11%WER AND SIZE OF FLUES: IICKNESS OF HEARTH: ' ,,U cl biney al. (iAenCace con(anm to .tl(Q acqu-0(eme►I•ts uO .the cu11e (11111 have :ince.: alld .grl,Ca .ioiL5 been aeee.suect: .TE: ' .GNATURE OF MASON: :RMIT GRANTED: FLE o-/37 'BERT NICETTA �`Y� 'ILDING INSPECTOR SPECTEU: _ :MARKS: _ SOLID BLOCKlt�( UIItED 1 THIS PERMIT I,IIISF GE UISPLAyCU 014 INE I RUAISLS (v1 ��l'I.�p �''��.� .,, 1' i r f Location `LNo. Date / �F Gt l 3 NORTH TOWN OF NORTH ANDOVER p Certificate-of Occupancy $ 6 »• Building/Frame Permit Fee $ � '"°''�� Foundation Permit Fee $ s�cMust �. Other Permit Fee $ �� p, Sewer Connection Fee $ Water Connection Fee $ ' w TOTAL $ a cq /I s) Building Inspector 6r�2 f Div. Public Works 'Est39:rto. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. MAP ti�0. LOT NO. PAGE 1 ZONE 2 RECORD OF OWNERSHIP DATE SUB DIV. LOT NO. �IBOOK ;PAGE LOCATION `�-� OWNEq'f NAME /� PURPOSE OF BUILDING f-�•/►"s !h t' /4✓IT��hd NO. OFfTOR1EM SIZE OWNER'! ADDRESS //1 �n CX} p, ARCHITECT'S NAME d S e2 /K1� BASEMENT OR SLAB _ N(Dov SIZE OF FLOOR TIMBERS IST BUILDER'S NAME �1 ZND TRO �LLen pn /YJG ( V`/v SPAN DISTANCE TO NEAREST BUILDING -�- DIMENSIONS OF SILLS DISTANCE FROM STREET OISTA NCE FROM LOT LINES - SIDES - POSTS --- REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION IS BUILDING NEW THICKNESS I9 BUILDING ADDITION SIZE OF FOOTING X IS BUILDING ALTERATION MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION r SEE BOTH SIDES LAND COST PAGE 1 FILL OUT SECTIONS 1 - 3 EMT. BLDG. COST `-. . DG. � PAGE 2 FILL OUT SECTIONS t - 12 ESTBLCOBT PER SQ. FT. ElT. BLDG. COST PER ROOM ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4 APPROVED BY PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �^ / 7- [ O ^ /. ' lIGNATURE OF OWNEROR AUTHORIZED AGENT I BNI INO INfPiCTOR FEE ������ ! OWNER TEL/ PERMIT GRANTED c� / CONTR.TEL 0 19 CONTR.LIC..I __D� Cf H.I.C.I l O cf 7Y� f OR Town of over M No..3'? -7 dover, Mass-,_-z-'// 19 COCHICNEWICK 0 rED BOARD OF HEALTH Food/Kitchen PF. MK0kM1T T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................................... .................co U .t.A.!V.t. 0.......................................... Foundation has permission to emcL...... ........ buildings on ........ .........A..AjfqC.A.Slxl .................... Rough tobe occupied as.................................................F/ .................CT ........................... 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 By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough ................................................. Service UILDING 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. Smoke Det. .�wrr - U4t Q'I uwnweullh at �fim#Stmf'ettnit NO. 'r Etpartmcttt of Public $nfrtti2 Omponq A Fee CMCMd_.._.. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 0e"""A APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed n accordance with the Massacnusetts Electrical Code. 527 CAUR 12;pp ,U (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -1 - /o�- G�IK/ or Town of NORTH NDOVFR To the InspeeWr of Wine: The udersigned applies for a permit to perform the electrical work described below. Location (Street b Number) L �ti C s Owner or Tenant Owner's Address - C la this permit in conjunction with a building permit: Yes �',NO CI (Check Appropriate Box) Purpose of Building �� �4 'bo6 Utility Authorization No. Existing Servicell�,!::> Amps .c V a i I s Overhead Undgrnd No. of Meters •' New Service Amps _� Vous Overnead Unagrna [ No. of Meters Number of Feeders ana Ampaclry Location and Nature of Proposed Electrical W01K i No. of Lighting Outlets I No. Ct yol -__s I Tata No. of Transformers , KVA No. of Lighting Fixtures i Sw-mm.ng P:O, Aocve.— ;n• r , Srro _ crno I Generators KVA No. of Receotacte Outlets /2:�) I No. of 01I curnars I No. of Emergencyu Lpnung Sanery �. No. 01 Swticn Outlets I No. of Gas =::rrers FIRE ALARMS No. of Zones No. of Ranges I No. CI Air C„rC. 'Oldi No. of Oetection and Cns Initiating Oevtcea No. of Discosals I No.ol Hedf °:a' -otat Pur-=S N0. of Sounding Devic" No. at Self Contained No. of Oianwasners SoacerArea '4eanrQ K.v 0/1/ctloniSounoing Games No. of Dryers I Healing Cevices KW Local i—, Munruoal ^Other Connection No. of Low Voltage ; No. of Wath Healers KW I Signs °a Ias:s Wiring No. Hydro Massage Tuos I No. of -toicrs ,alai HP OTHER. c INSURANCE COVERAGE. Pursuant to the re0wrements ,:t '.tassac%sers ;eneral taws I have a current Ltaodtfy Insurance Policy inctuotng Czr,c eiec Ccerauons Coverage or its suostantial equivalent. YIgS NO t have suomtnea valid proof of same to the Ontce. YES = v0 = It you nave cnecnsa YES. ptaase Indicate the type att Coverage N r enecxtng the aoproonate oox. INSURANCE = aONO = OTHER = tPlease Scec...,I Estimated Value of E!ectncal Work s L-�v,<;ZZ Ittaotration 0awl . jWork to $tart —� —� Insoec:ton pate ;;ac�as:ec: Rough Final i Signed under the les of perjury. Jf FIRM NAME J�\ Licensee ' S•g-a:.:re Li UC- iBus. Tel. No. oi-41,L Address _f y . , C Dy�.cl%2� �iL /V, ill zb l�,�j All. Tel. ltd. OWNER'S INSURANCE WAIVER: 1 am aware that tn• t:tenses ^.ees not nave tree insurance coverage 8r its sypaynum uwemm lee rw aurreo oy Mass"nusalls General Laws, ano inai my signature on :nis _ermn aopttcation waives this requitement. Aqw (Plea"cmKx OMI• iieonons No. PERMIT FE$ I � l .gi+atura OI Owner or Ageno i N° 1 4 4 G Date. .. ../. Z. ♦ A H NOR71{ °� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;,SSACHUS� O This certifies that .. . E'. �:J�..>........ . �, ............................ . .. ........... C" has permission to perform �y1 P '`y P<� ....tf..'....... ..... ....!�/� . ....>.............. . fk�� ��� a wiring in the building of..... ............................................................... L;e(... .. `f S .... ........................... .North Andover,Mass. Fee...... Lic.No..`??�. �/.14.. ....... ...... ........................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Of&m Use Only 014t Liam Iunwealth of _qUodpnifts Permit No._;L252= _ z :' Ee>pmttntnt of Public $afztq Otxupancy d Fee Ch3190 � BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 peeve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK r; 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 -97 9�i}ir or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. a. Location Street & Number j2— n)6 0_,4S'7_&-??— L /4' & Owner or Tenant !�?LG h(f��'l- LE S L t_ry SK LA tL.. Owner's Address : n Is this permit in conjunction with a building permit: Yes _ No C (Check Appropriate Box) Puroose of Building Utility Authorization No. ' '.,.. Existing Service Amps Volts Overhead U Undgrnd C No. of Meters „I New Service Amps _J Volts Overhead ' Undgrnof r No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Wl/1 ( /w�S� 15,4<cw'kc,,5`T No. of Lighting Outlets I No. of Hot ucs ( No. of Transformers Total 9 9 KVA •' No. of Lighting Fixtures Swimming P_oi Above— In- 020 grr.o. _ grno. — Generators KVA No. of Emergency Lighting. R•, No. of Recectacie Outlets �� I No. of Oil Eurners Battery Units No. of Switch Outlets 6 I No. or Gas Surr.ers FIRE ALARMS No. of Zones 5;, I' & No. of Ranges I No. cf Air C.:r.c. Total No. of Detection and :cns Initiating Devices :. w No.of Heat To:ai Total No, of pisposats I Pur:sps :ons K�V No. of Sounding Oevtces s i, No. of Self Containedr (` .fic No. of Dishwashers I SoaceiArea eatir.a KW Oetection/Sounaing Oevtees H . No. of Dryers Heating Devices KW Local — Municioaae'i1' Other Connection ^ ` No. of NO. at Low Voltage f' No. of Water Heaters KW I Signs Bairasts Wiring No. H aro Massa a Tubs I No. of Motcrs Total HP y g OTHER: INSURANCE COVERAGE: Pursuant to the reouirements of Massacnusers general Laws I have a current Liaotiity Insurance Policy incluaing Comp,.eiec Ocerations Coverage or its substantial equivalent. YES = NO have suomittea valid proof of same to the Office. YES = No = If you have checKea YES. please moicam the type of coverage cy,,' checking the appropriate box. INSURANCE = BONO = OTHER = (Please Spec:!,?,) - (Exoiration Oate) s; Estimated Value of Eiectncal Work 5 r � /LL �f1LZ " Work to Start '/-7 Insoec:ion pate Recues:ec: Rough W Final Signeo untler:he Penalties of perjury: FIRM NAME UC. NO. Licensee /rn�L� Sign`ature i LIC. NO.L= s7i 2— wig /��U //V�� r /(/��)l).ild�J��� BA t. Tel. No.? - f�f�p timed S . Address Til. No. ��� � OWNER'S INSURANCE WAIVER: I am aware that the Licensee cues not nave the insurance coverage or its suostan tial equivalent as re- qu,rea by Massachusetts General Laws. ane that my signature on Ns permit application waives this requirement. Owner Agent ` (Please cheCK onel' ^" Titteonone No. PERMIT FEES (Signature of Owner or Agent) rj t I x9S83'�t,r 70 H92 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SAC This certifies .. . .. . . ....................... that .... ........... ............ has permission to perform, .... .. ................................... wiring in the buil ng of ............ ..................... .North Andover,Mass. Fee;45. ............ Lic.Nd?.9L.?...............................................................Iii ELECTRICAL INSPECTOR ru WHITE:Applicant CANARY:Building Dept. PINK:Treasurer