HomeMy WebLinkAboutMiscellaneous - 126 LACY STREET 4/30/2018 j 126 LACY STREET
f 210/105.D-0046-0000.0
David L. McLellan
Attorney-aiaw
One Elm Square Tel. 978,470,4600
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` ! Andover, MA 01810 Fax. 978,475,8880
Email: dlmclellan@earthlink.net
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Food/Kitchen
PEROM IT D Septic System
THIS CERTIFIES THAT............ .4o..(.d....... ...... ... ... BUILDING INSPECTOR
ate. i6**__*****_*....*""*"**
........................................ Foundation
has permission to ere ... buildings on ...P&......... ......fit.................... Rough
..to be occupied I as...... As- Chimney
q.)o ... F77�!.%.................. .. ....................................
i in every respect conform to the terms of the application on file in
provided that the perso ccep mg E 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
a� PERMIT EXPIRES IN 6 MONTHS I ELECTRICAL INSPECTOR
UNLESS CONSTRU TTT S
Rough
...................................... Service
BUILDING IN ECTOR
Final
Occupancy Permit Required to Owtpy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
David L. McLellan
Attorney-ataw
One Elm Square Tel. 978 470 4600
1 Andover, MA 01810 Fax. 978,475,8880
Email: dlmclellan@earthlink.net
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David L. McLellan
Attorney-att-Law
One Elm Square Tel. 978,470,4600
Andover, MA 01810 Fax. 978,475,8880
Email: dlmclellan@earthlink.net
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.............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that .... .......... ..................
. ...................
has permission to perform 07..................................................
wiring in the building of................. .................... .......................
at.......................
..,....... ........... ......... .
North Andover Mass.
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............... Lic.
ELECTRICA-L,1*N*,S*P**E,C*,T*O,*R**,
Check #
Commonwealth of Massachusetts
Official Use Only
Permit No.
Department of Fire Services
' Occupancy and Fee Checked& �
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99) leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12 00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: O c�
City or Town of: /01 d ,f— To the InspectIr ofWires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street&Number)
Owner or Tenant J Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No [0"*' (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service /(It) 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:
a
Completion ofthefollovidng table may be waived by the Inspector o wires.
No.of Ceil.-Susp.(Paddle)Fans No.of Total
No. of Recessed Fixtures
1 Transformers KVA
No.of Lighting Outlets No. of Hot Tubs Generators KVA
Above Ei In- o. o mergency Lighting
No. of Lighting Fixtures a Swimming Pool rnd. grnd. El Batte Units
No. of Receptacle Outlets 1,40.Vf 0a Burners FIRE ALARMS Nn. of Zones
No. of Switches No.of Gas Burners No. I Detection and
Initiatin Devices
No. of Ranges No.of Air Cond. Tonal No.of Alerting Devices
No.of Waste Dis osers Heat Pump Number Tons KW No.of Self-Contained
P Totals:I Detection/Alerting Devices
No. of Dishwashers S ace/Area Heating KW Local ❑ Municipal
g [IOther
P Connection
Heating Appliances Security Systems:
No.of Dryers g PP Kms' No.of Devices or Equivalent
No.of WaterKms, No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
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 cover ge 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 ectric I Work: 16/00 a_ (When required by municipal policy.)
Work to Start: //7� a' Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, under the pains and penalties of p rju , that the information on this application is true and complete.
FIRM NAME: S (.J e? �Chti J LIC. NO.: � I
Licensee: (}C,J Signature ,✓ i I N0.:3S36 f �=
(If applicable, enter "exempt"//in the license number line.1 Bus.Tel.No.:7R�-£SU4f �C-7
Address: /3 Ber-e'S 4tal->m, cg)- wakIaV4 Al Y GOL y15' Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent.
Owner/Agent PEIwDIt?IT FEE: $
Signature Telephone No.
Receipt # -
APPLICATION FOR ELECTRIC WORK
PERAUT 4C
(DONOT FILL OUT THIS FOLD)
-- S"ia1 No. -- —
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O�tact
Ekc�rku —_
Prf�nir Issrwd
REPORT OF INSPECTOR OF WIRES