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Date ../� %- 4 h......
TOWN OF NORTH
PERMIT FOR GAS JASTALLATION
This certifies that .........
has permission for gas installation . .... ............
in the buildings of .....''.... ��d'L z�• .............. .
at . l ..�� �? �: '�-! .. l .\.. , North Andover, Mass.
FCOq. Lic. No.!�?: . , ` . � ..�..t,.'...... .
r GAS INSPECTOR",
Check #
r
. I11 J 1
T A%ACHUSEITS UNIFORM APPUCATON FOR PERM TO DO GAS FTFI ING
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations ?_' 1"
Permit # a�
Amount $ ® ��
Owner's Name 1410 Oa -&1,2m,
New ❑ Renovation ❑ Replacement 0- Plans Submitted ❑
(Print or type) �� I /, C_hgLk one: Certificate Installing Company
Name l
Corp.
Address Sz /3G k r -6",L r( 5----f —_
Partner.
11) D t C� � L.'-.C'a� L Q
BuSiness Telephone 5 7 1> r. L,, C, tv z f, 19-firm/Co.
Name of Licensed Plumber or Gas Fitter 13 C L 5144 r "4. 1,?
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13-- No 13
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 12- Other type of indemnity 13 Bond 13
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
L _
--y Lally maL "JI kJ, L„U uciaua anu iu1ULLI auUn I nave suomutea dor enterea) in above application are true and accurate to the
hest of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance Yvith all pertinent provisions of the !Massachusetts%state; (,as Code arid' hapter 42 of the eneral Laws.
By:
'Title
City/Town
kPPROVED (OFFICE USE ONLY)
Signature of Licenseii Plumber Or Gas Fitter
umberD --3 C
Gas Fitter tc cnse um
ster
Journeyman
•
•
15TH. FLOOR
(Print or type) �� I /, C_hgLk one: Certificate Installing Company
Name l
Corp.
Address Sz /3G k r -6",L r( 5----f —_
Partner.
11) D t C� � L.'-.C'a� L Q
BuSiness Telephone 5 7 1> r. L,, C, tv z f, 19-firm/Co.
Name of Licensed Plumber or Gas Fitter 13 C L 5144 r "4. 1,?
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13-- No 13
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 12- Other type of indemnity 13 Bond 13
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
L _
--y Lally maL "JI kJ, L„U uciaua anu iu1ULLI auUn I nave suomutea dor enterea) in above application are true and accurate to the
hest of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance Yvith all pertinent provisions of the !Massachusetts%state; (,as Code arid' hapter 42 of the eneral Laws.
By:
'Title
City/Town
kPPROVED (OFFICE USE ONLY)
Signature of Licenseii Plumber Or Gas Fitter
umberD --3 C
Gas Fitter tc cnse um
ster
Journeyman
No j Date ... ..... '........... ..%.......
�.
NORT1t
°f,"`° '•'"° TOWN OF NORTH ANDOVER
'° PERMIT FOR WIRING
41
This certifies that ............................................................................................
has permission to perform ...............
.................................:..............................
wiring in the building of
...................................................................................
at ................................................................... . North Andover, Mass.
r�
r
Fee.• .. �................ Lic. No.. f :....................................................................
ELEcmicAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
7HEC0Mff10NWE4L7710FM4SS G1U,S= Office Use only
DFS NTOFPURUC&IFE'IY Permit No. % G
BOARD OFFIREPREVEN'770NREGM4770NS527CY1R 12-00
Occupancy & Fees Checked
APPLICAT7ONFORPF��IIT TOPERFO"==CAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 521 C&IR 12:00 / p
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /� � '20 — 7
Town of North Andover _ To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. IMAP PARCEL
Location (Street & Number) -r_ 1/
S�
�-)Y t1a
Owner or Tenant
Owner's Address
a
Is this permit. in conjunction with a �uildi
Purpose of Building
- Yesr7 No Qom` (Check Appropriate Box)
Utility Authorization No. -* J 7/36
Existing Service
A u Amps /17 Volts
Overhead Underground �
No. of Meters
New Service
db Amps /aU / a Yu Volts
Overhead Underground
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work �..., �.- �� Sr v✓I c .. t a L 415-
No. of Lighting Outlet
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtmes
Swimming Pool Above
Below
Generators
KVA —'
/ground
ground
No. of Receptacle Outlet
No. of Oil Burners
No. of Emergency Lighting Battery Unit
No. of Switch Outlet
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of ReapsNo.
/
of Air Cond. Total
(0 1%Q!4A
I I -
Tons
No. of Detection and
_
No. of Disposals •
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Connections
F -1
--
Other
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Sims
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTH5R. -
no • • :r...: • :a :u t• t :• u:u:•w • +.m ::ati :•:
�. • <u a n.� .u• •RWOMAII WINut r •• r.:u ••:. r�•. r :.,. • i, - i•,ri a :• •
- � u ous• a i• • •r r �:� ra- i• t • •iu- 5► � • • - a:•r.• •:c•• i••i•sr i - r • •• _• • • :•a .. i -
MA!
.�•. ••tsar w
It a uo•..• ••:
�•:• •: t •a u • •:
1• I MIA
LicerneNo 7 F.3 If
Alf? -Mlle, A1tTelNa
OWNER'S INSURANCE WAIVER. IamawarethattrLiar-BedcesnAK-nvtheMY= critsst)b > aleqmakelasmgxcdbyN>assa�CXYMIlLaws
arrlthatmysignah>remtinspeartii a�itiortwmiws this tai ttttzr�rt.
(Please check one) Owner Agent PERMIT FEE $
Telephone No.
Jtamarure o Twner or «cnt
AN° 1 1 i 8? /.7 ��
Date ...............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .. .! t �.4! . r.1 � `.... .�.c........
has permission to perform .......,X.q : A' ..........................
wiring in the building of . :y ,. i.........��.�
at ....... r/. Vl a ► uy� U �.✓�. ...................... orth Andover, ass.
........... ..............
Fee ... 3.S 0 Lic. No,,- ...�.I00.J.............„ . .. .>.... .. .. ` .....
ELECTRICAL IN§PECTOR
C d S 07/22/49 13:23 35.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
filie Commonw�lfh ofAk�wchu RWARD office, oldy
Department of Public Safety —
BOARD OF THE FIRE PREVENTION REGULATIONS 527CMR 1200 Palm, No.�?
Ooarpancy &Fee Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 3o 0"" )
All work to be performed In accordance with the Massachusetts Electrical Code 627 CMR 1200
TOWN OF kj
(A FIRE ALARM PERMIT MUST BE OBTAINED FORM THE FIRE DEPARTMENT)
doo7 DATE %
To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. MAP
Location (Street & Number)_ I � Li ( ) A r m C IN.I4 I --V4*
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permft:
Purpose of Building L<0' / U( �Q/Zj. fi 4A
E?dsting Service Amps /
/V1 C- '--�r
Yes ❑ No 9 (Check Appropriate Box)
Uttffty Autftorizatlon No.
Volts Overhead ❑ Undgrd ❑ No. Of Meters
New Service Amps / Vcfts Overhead ❑ Undgrd ❑ No. Of Meters
Number of Feeders and Ampacity
Nature of Proposed Electrical Work cJ EC, U Q. 111 S Y S T r` irT- I)'V5 "C/9 f.,L A T 1 O N
No. Of Lighting Outlets l No. Of Hot Tubs
NO. Ut Lighting Fixtures
No. Of Receptacles
No. Of Switch Outlets
No. Of Ranges
Swimming Pool - Above gmd. ❑ Ingmd. ❑
No. Of Oil Burners
No. Of Gas Burners
No. Of Air Cond. Total Tons
Of Disposals 1 No. Of Heat Pumps Total Tons 'Total
No. Of Dishwashers
No. Of Dryers
No. Of Water
No. Of Motors
Space/Area Heating -----RW'
Heating Devices KW
KW No. Of Signs No. of Ballast
Total HP No. Of Emergency Lighting
No. Of Transformers Total KVA
Generators KVA
Fire Alarms Permit Required
FIRE ALARMS No. Of Zones
No. of Detection & Initiating Devices
No. of Sounding Devices
No. Of Self Contained Detection/Sounding
Devices
Local Municipal Connection
Other
LOW Voltage Wiring
No. Of Hydro Massage Tubs
Battery Units
U 1 HER: 15 A/n E
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ® NO n
I have submitted valid proof of same to this office. YESLEg NO 0
If you have checked YES, Please indicate the type of coverage by checking the appropriate box
INSURANCE BOND [::j OTHER 0 (Please Specify)
c, Exp. Date:
Estimated Value of Electrical Work S�_ Work to Start J L - I INSPECTION NOTICES:: MUST CALL
Signed under the penalties of perjury: (PRINT) Licensee NEM EN S KY E"C/—R 1 C LIC NO A 1039 EZ 56 8 6
Address S -Y E06EW006 2d. SOUTHCOX0 MA 01772 Phone 508-418Y- 5718
Signature: Date; I1- Tel P OR - � - In 6
OWNER'S I rVER: I am aware that the licensee DOES NOT HAVE the Insurance coverage or Its substantial equivalent as
required b a s. Gaws, and that my signature on this permit application waives this requirement. OWNER AGENT
(Please Check One)
Tel: Permit Fees 3
(Signature of Owner or Agent)
< TOWN OF NORTH ANDOVER
o+,e .... hoc
� O 9
PERMIT FOR PLUMBING
7
This certifies that
has permission to perform .....Pc.: /-I-. c'.� .tit fJ.� i�� ............
plumbing in the buildings of ../> C�.�s!`f/��! G. "` ...........
at ...% ?. Z.... �Gt. G �... �.' ...,:.. ,�-Noorrth Andover, Mass.
Fee.Lic. No.. �7s. .. .. ....... : �..J.!�.:..... .
LUMBING INSP &TOR
Check #-
61'14
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
(2l 0K-% i ,0 kt/ J7' Owners Name w
of
New Renovation Replacement
FIXTURES
r Date 1� I -
J .
L(/ Permit Permit #_Y
Amount
Plans Submitted Yes No ❑
r
(Print or type)t t Check one: Certificate
Installing Company NameQ" r 4 Corp.
Address Panner.
K1, VQ I V qU
Business Telephone ff,^,,A, Firm/Co.
Name of Licensed Plumber: I I� I 1 W1 V YI S:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 1 Other type of indemnity D Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner n Agent n
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massh7tts mate ing Code an C ter Z o the �� al Laws.
OVED (OFFICE USE ONLY
Ty eo f Plumbing License
cense um er Master P/Journeyman ❑
Location az\ V N l0-fj �
No. Date
-1-a8- 0 Lf
NORTol
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
'�sJuMus
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
cQ
TOTAL
$
Check # 3
17•.3
r Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: / DATE ISSUED: 7
c
SIGNATURE: zw (—ocA�
Buildingtommissionerff2Txtor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number
Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (sf)
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Required Provide
ReqWred Provided
Re
red Provided
1.7 Water Supply M.G.L.C.40. 54)
1.5. Flood Zane Information:
1.8
Sewerage Disposal System:
Public ❑ Private ❑ Zone
Outside Flood Zone 0
Municipal
0 On Site Disposal System ❑
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 1' 1 iJ i i t, u 1 a u Ki. i c5 i v
2.1 Owner of Record
Prin Address for Service
.Ct e a
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
1
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Consfn ction Supervisor: _ 3
r— License Number
Addr s zi
Expiration Date
Signature Telephone
3 2'SRegistered Home Im�pr�/(j/\]y/jement Contractor l 1/y/ey� l Not Applicable ❑
Company Name y'
` y ` i Registration Number
Add ss
l51 Expiration to
re
Telephone
00
rn
X
Z
O
I
IN
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 it.
Signed affidavit Attached Yes .......❑ No ....... 0
SECTION 5 Description of Proposed Work check all
applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
T751—tion ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Dfscyption of Proposed Work: , I
1-0
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building
O
(a) Building Permit Fee
Multi Tier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
Y D �-
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number 3
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Si ature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS iST2ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIlvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
North Andover Building Department
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 gf-facility
Signature of Permit Applicant
o�
ate
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
I
✓!ze 1°o�rvinooecUealt/ r�'✓�iiaaa(zc�euoeda
} BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR +
Number: CS 023365
Birthdate: 12/04/1957 I
Expires: 12/04/2005 Tr. no: 12107
Restricted: 00
DAVID REITANO
56 PLEASANT STREET
METHUEN, MA 01844 Actingo miss ner
,p� ✓/ee �aiyurn�aurea// o��/ar/zuaeii'
�-\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 108782
Expiration: 8/25/2004 a
Type: Private Corporation
DAVID REITANO REMODEL & BUI
bavid Reitano
56 Pleasant St C
Methuen, MA 01844
Adtoinia±rater
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print I
-ic- \leC
r C
I nratinn �� �- 1� /~ 9 1 ?`2 . Uvk` C
City O' �� •-), -.)I u ,. Phone # 7 0 7 L {
F -1
I am a homeowner performing all work myself.
F-1 I am a sole proprietor and have no one working in any capacity
F-1 I am an employer providing workers' compensation for my empl<71 oy s working on this job.
Company name: e
Address
Company name:
Address
City: Phone #:
Insurance Co. ___ Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00
and/or one years' imprisonment_as.wtell as.civil..penaltiesinfhefband-a STOP WORK_ORDER..and..a fine ..of_(.$100..00)_a day.against.me. I
understand that a�copy at hi statement maforvv�arded to the Office of Investigations of the DIA for coverage verification.
t do hereby erti(y unde pars and penal r s of R egury that the information provided above is true and correct.
Signature
" -
Print name N- -�, c=-- %,--- " k C- -
Date'2
Official use only do not write in this area to be completed by city or town official'
# tq-V�l'3641 '1?a�
City or Town Permit/Licensing
❑ Building Dept
❑Check if immediate response is required ❑ Licensing Board
❑ Selectman's Office
Contact person: Phone #: ❑ Health Department
❑ Other
David Reitano Remodeling & Building
56 Pleasant Street
Methuen, MA 01844 1.
Phone/Fax: 978-688-3944
Company Email: Davidikeitanofcomcast.net
NumbalContractor@hotmail.com
Proposal
Date: June 1, 2004
Submitted To: Mr. & Mrs. John McCarron
75 Sterling Lane
North Andover, MA 01845
Home No: 978 -
Job Description: Windows and Bathrooms - Union Stre4 North Andover
We hereby submit specifications and estimates for.
*Proposed bathrooms located on first and second floor of property will involve converting existing bedrooms
(partial) to accommodate full bath/study sitting room.
*Framing modifications include wall partitions framed with 2 x 4's, 16" O.C., to accommodate bath space which
includes a full three piece fiberglass tub unit, toilet and pedestal sink (?), as well as entry. Framing also includes
creating an opening between to (2) existing bedrooms for additional entry, as discussed.
*Existing sheetrock located in proposed bathroom will be removed to expose all framing.
*AO electrical in this area will be relocated, as necessary, to meet Mass Code requirements. Wiring includes GFI
receptacle, fan/light combination properly switched independently and an over head light in sink area.
*Plumbing will include water supplies, drains, vents, shutoffs, etc. to accommodate two (2) bathrooms, stacked
on bop of each other, first and second floor. Drains, water tines, penetrating into basement area will be properly
blended into existing finish work and tied into existing sewer lines. All areas disturbed during construction will
be properly reassembled to compliment existing as closely as possible.
*AII areas disturbed during construction will be re -insulated where necessary. Walls including existing and new
framework as well as ceiling will be resurfaced with %ff bluboard and plastered in preparation for paint supplied
by Contractor.
*Existing floor will be surfaced in preparation for tile - allowances outlined below.
*Finished work to include new trim around windows, doors, baseboards to compliment main house as closely as
possible, including door style. Finish work will also blend into existing areas disturbed during construction.
Finish also includes mirror size to be confirmed.
*All debris will be removed from job site.
*Price includes all fixtures - allowances included outlined below.
*Contractor will supply dumpster - dumpster location to be determined prior to construction.
�IJI!7T7tL7---JPal
Two (2) Three (43) piece fiberglass tub:
Toilets/Two (2) - $150.00:
$ 300.00 each
Faucets/Two(2).....................................................................$
200.00 each
Valves/Two(2)........................................................................$
175.00
Two (2) Pedestal sinks or
Two (2) 30" Vanity/countertop/drop in sink: ..............................
$450.W
Tile Floor/Material:...................................................................$350.00
Mirrors/Two (2) or medicine cabinets.........................................$175.00""
*Removal of seven (7) double hung windows and one (1) picture window located on first and second floor of
property to be replaced with Harvey windows to compliment existing, including 7/8 insulated Low E glass.
*All debris will be removed from job site.
*Complete perimeter will be insulated with fiberglass insulation.
*Prior to window installation, window opening will also be sealed with silicone type material.
Window will be re -sealed and insulated after installation as well as side stops reinstalled.
TOTAL PRICE: $ 34,850.00 -� c� t �i �. L • 5 ~
c i(100-00
*Contractor is responsible for allowances mentioned, anything that exceeds these allowances -
Homeowner is responsible for.
*Contractor does not include paint or stain, unless mentioned otherwise.
*Please review this proposal carefully for any items which may be missing. Contractor is not responsible for
items not mentioned herein.
*Please do not hesitate to contact us if you have any
Thank you for considering us for this project -
Workmanship Completely Guaranteed/Sullivan insurance
(Please sign and return one copy)
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Date..�—�.;............— O.....L/
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that ........Y..D .10.. .C. %?.....F.....I..:e .c—
....................................
has permission to perform ...... 3 A--ttA ........ .................
.... ........... .... ... ..... ..
wiring in the building of ...... f:� (..( A r P p r,)
.. . ................................................................
at ....... .......... '................... . North dover, Mass.
5
Fee ...... 3,3 —... Lic. No....PGo ......
ELECTRICAL INS ECTOR
Check# 3
1; -4 0 1;
77ECOMMONWEALTH OFMMSSACHUSETT S Office Use only
DEPAR739MOFPVBLJCSAFM Permit No. 63 g;��
BOAROOFFSEPREVEMONRECGULWONSR7 12.E Z
Occupancy &Fees Checked
APPLICATTONFOR PERMIT TO PERFO LECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS EL , ICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover
The undersigned applies for a permit to perform the electrical work described
Location (Street & Number)
Owner or Tenant
Owner's Address -
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes IM No E3 (Check Appropriate Box)
Purpose of Building AXlr/I� (=� Utility Authorization No.
Existing Service Amps /��Volts Overhead Underground a No. of Meters 6 --
New Service G AmpVolts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No: of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
round
ground
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
a
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
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INSURANCE BOND a OTHER D (Please Sp>Iy)
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FiRMNAME
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(Please check one) Owner M Agent
signature of Owner or Agent
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11Date�D�..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that ......[.............. ................... ...................
has permission to perform . ............
wiring in the building of ::..... .J1- c 1....... Y... _ :. .....!........
at/ l../1��.��..-5! ................... .North Andover, Mass.
Fee�T. . .. Lic. No/0(?............. .......... ...........................
ELECTRICAL INSPECTOR
`,Check # v �!
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`� Commonwealth of Massachuse S Official Use Only
I Permit No.�
Department of Fire Service
,
Occupancy and Fee Checked
' BOARD OF FIRE PREVENTIONJEG ATIONS [Rev. 11/99] leave blank
APPLICATION FOR PERMIT ;T' PERFORM ELECTRICAL WORK
All work to be performed in accordance withihe assachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK ORA FO AT N) Date:
City or Town of: , To the Inspector of Wires:
By this application the undersigned ives ice o is or her inte i n to perform the electrical work described below.
Location (Street & Num er) ,
Owner or Tenant Telephone No.
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 El No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Security system
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Liahtino,Fixtures
b b
Swimming Pool Above ElIn- ❑
b grnd. grnd.
i o. o Emergency Lighting
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
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alertin Devices
No. of Dishwashers
Space/Area Heating KW
Local 7-1 Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
SecurityNo. ystems Devices or Equivalent
No. of Water KW
No. of No. o
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
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:)
(Expiration Date)
Estimated Value of E ectrica Wo (When required by municipal policy.)
Work to Start: VL1ffl6 Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certify, under th pains and penalties ofperjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.: 1q11(,
Licensee: John S. Bassett Signature LIC. NO.: 1533C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 60.1 _ 594 5928
Address: Alt. Tel. No.: '
OWNER'S INSURANCE WAIVER: I am aware that the Lid, see 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: $
Signature Telephone No.