Loading...
HomeMy WebLinkAboutMiscellaneous - 128 MILL ROAD 4/30/2018 128 MILL ROAD 210/107.0-00140000.0 ....._................ ............._._....................... ..........................__........... .......................................... _...........................__........ ......................................... ..........................................................................................................._..................................................................................................I.................................................. , ... ......_.. ........... A`' A7 SPECIFICATIONS'CONSTRUCTION BUILT ON INTEGRITY 8,TRUST SINCE 1959 www.AvatarConstructionlnc.com BBB. Salem,NH Office:603.513.2878 Cambridge,MA Office:617.714.5773 Josh Bonenfant Direct:603.769.1833 Email:JoshPAvatarConstructioninc.com Nazar Vincent Direct:603.440.3967 Email:Nazar@AvatarConstructionlnc.com TO: Stella Chistyakov 128 Mill Rd North Andover,MA 01845 Phone:978.257.0476 Emai!LA.—s-c±i-s—tY@gmaii.com Exhibit A JOB RE80111 IOM k 2 Car Garage CODEG728 AMOUNT;: Garage: Ball area with fill to create level and buildable ground as much as possible as well as cost affective Install frost walls and footing as specified in the plan dated 5/8/16 Pour 3/4"aggregate fiber reinforced 4,000 PSI 4"concrete slab as floor of garage(stress cut slab to prevent cracking) Install all framing to 2009 IRC code and design.Plywood attic floor with 3/4"Subfloor Install(2)Simonton windows or equal Install brick veneer on(3)sides with brick coins at corners-bring will match existing home brick type and color/design.Brick type:Blended 920926 BLDEN Install vinyl siding on(1)side(back side as shown on drawings).Install asphalt shingle roofing.Color TBD. Install pulldown ladder for entry/exit to unfinished attic Install insulation,drywall,compound,tape and sand walls and ceiling for a finished product Apply(2)coats Sherwin Williams paint Install standard trim around interior of windows.Install exterior white soffit dental and facia trim to match existing house and as shown in Exhibit C Install(2)quality insulated garage doors with automatic openers-design to match as provided by Owner.Provide brand of Doors to Owner prior to door order or install. Note:Paving is not a part of this estimate Option: $4,244.00 Install mini split electric heating system(wall mounted unit)at 7,000 BTU General Contractor(Avatar)to provide and install the unit with electrical to be connected to the unit by Owner hired Electrical Contractor Option: $1,555.00 Install(2)Coats of Epoxy on concrete slab floor Note:All electrical and electrical fixtures are NOT a part of this estimate.Owner will be responsible for electrical work and will hire and manage electrical contract r Note:All allowances are at contractor's cost at contractor's suppliers and not at retail pricing level MA Tax: All Supplies and Materials only Start of Project: The day all materials arrive or near that time Duration: Project to be completed in 90 days. The intent of the Owner and Contractor to have the project completed in 60 days,however an additional 30 days is provided as a completion buffer and not an additional time to complete the scope of work listed above Permitting Fees and Processing: $450.00 Building permit fees allowance Mobilization: $425.00 Set-up cost,delivery of equipment and delivery fees of materials and supplies Disposal Fee: $488.00 Remove and dispose of all debris specifically pertaining to listed above scope of work.Dumpster to e a Additional Discount: 4 ttrs�rr.°Advice± pgp�, All work and material is guaranteed to be as specified. MA taxis to apply to all supplies and purchases. ar ir/ P3 Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. T � Josh Bonenfant 311117• PREPARED BY DATE Nazar Vincent 6112117 REVIEWED BY DATE ACCEPTED BY � DATE Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. ` Y Josh Bonenfant 311117 PREPARED BY DATE Nazar Vincent 6112117 REVIEWED BY DATE ACCEPTED BY DATE x � . •...^',� Vii: - 7. til Barit - "t`�gtm "3fi ���I�iw �PokNJ i '��� 9 aC �,-� 1 "�--n•.^� 1 c l c � oy�a-" x �.. �`�"^' •� •fir• , � zY`���"'"+c� „�p,.t 4 r-x um x.�sw � ° >z.L 4 �' � r � w 4�'' .„,y Mi`�pr a.•ww,�4+� Yw'" .«»�.r.,x'�' ,�,�w+a„r r�„�:�, .., .r a'�`'.,.. �'.�.�' ''�a° ` 3°"-.:4:�a��Y y �„# ` �.arY"- -`„ �s" a"'"�"'"" :„. A.�h.;�'.�yU'� 'Y.1"��� •�..ST ^��t3�"`�'a ��;,.�.• , . .:^( �; '°"'-:.^�,"'�.""'x '^ '6 z'�'ksafr.y�. �i -y,a � .r ""t>',.y+� �,,t �w*•"�,G �* � +a< e�; w,,.� C� «�'°^�..j .f,^°S �'�• �ryy �,., „�.. m U O I I I i 22'-0" 16'_0• '-0" 16'-0" 4'_10" 5'-0" ,r. ---- ------ ---I I 72X80 SURER ' , I I I I I a © I I I , � I• I � N D FIDA I I I I w i I g I N • I as "_ � I04 8 k l ';I S �`$E g k b � 1 I0.+ "'d o �n 1..'• I, I 8; I I "az K g; i , o �.+ n X n o Li , I I I � t•. I V g usyO� l_—____.____---_--_J I 72%605UOER L_____-- � 1z' S'-o" a'-1 • I i 26,-0, { --------------------------------- k I __ u I I I , I I , lol I I f o � I a o I I m l I c °• r! I $ I a � I I S I �oia x o I I b • I —, m , I I I I @ Iq 1 , . i� I S I � � I• I O I I I I I J T L_---------------------- — J I - � ? 24X36 20 6 6'-0" Construction Drawings:9\2\16 seat ,faEoaR Ch ked JDs Project Name: Chistyakov Poolhouse and Garage ��W: RC Silverwatch Architects, LLC Prepared For: Roman and Stella Chistyakov sc Architecture'Engineering'Design•Land Planning o $ nHa 1,9 xxx 128 Mill Road Scale: �1r2"=1'-0", NHProject Address: North Andover Massachusetts 155 Londonderry Road Windham,New Hampshire 03087 e� W Oi Mbgb Date: 51806 603.694.4450 WWW.SILVERWATCH.COM - Project No.: sA-24 1G Sheet Title: Floor\Foundation Plans i 1 Cy ' it I m R � ro o 73 17 7 m � i N� N a 5-4 I aN m I N 2 -- HMO . \\\\ � pAAV;.,,�0 N m ��waN Ng x:Xy Sp ' ° n % ryA ". 2. 2Q� am ��SRlyaE°�g �O A {�Sa 2 2111 R� D)mj 48 °°p R m� CCg'^1p 'F V SRS �R m(7 O E Gm O ° Z Z R ° ° k � k � Z Construction Drawings:9\2\16 9 e seal Drawn: JDS Project Name: Chistyakov Poolhouse and Garage Checked:aeo y ecked:- JDS 6��WALL ��� A roved: RCSilverwatch Architects, LLC ' sc Prepared For: Roman and Stella Chistyakov Architecture Engineering•Design.Land Planning vnN° XXX 128 Mill Road WNH State: 1/2"=1'4" Project Address: North Andover Massachusetts 155 Londonderry Road Windham,New Hampshire 03087 M Of Date: 518\i6 603.694.4450 WWW.SILVERWATCtf.COM ftiectNo,: SA-24-16 Sheet Title: Framing Plans\Building Sections r • I2X8 RAFIERS 0 16'OC 2X8 TAILS 0 16'OC II � Ii II � i I I ♦ I' x fl - 1 I I � j it It � 1 1 f I BEAM AF-1 I ( f i 1( ' I I1 ( ( ING I I I 4 3-2X12 - 3-2X12 STEEL ANGLE OVER FOR BRICK STEEL ANGLE OVER FOR BRICK 1.75'X I I.88'LVL HIPS(TYP Garage Attic Floor Framing Garage Roof Fr iSCALE: Ile-I'-0' SCALE: General Notes: 1.ALL CONSTRUCTION METHOM MATERIALS AND TECHNIQUES TO CONFORM WNH THE FOLL(MMO RESIDENTIAL CONSTRUCTION CODES AND REGULATIONS: A THE INTERNATIONAL RESIDENTIAL CODE 209 B. THE INTERNATIONAL ENERGY CONSERVATION COD 2009 C. THE INTERNATIONAL MECHANICAL CODE 2004 D. THE INTERNATIONAL PLUMBMG CODE 2009 E_ THE NATl0t1AL EUECTRICAL CODE 2D14 2.CONTRACTOR OR SUBCONTRACTOR TO VERMY ALL DIMENSIONS IN HELD AND REPORT ANY DISCREPENCIES IN THE DRAWINGS TO THE ARCHITECT 3.CONCRETE TO BE 3000 PSI AT 28 DAT STRENGTH 4.ALL MAHING LUMBER TO BE SPRUCE-PINE-nR OR BETTER STRUCTURAL OUALRY(Fb>1.1) 5,ALL CONCRETE I'DDTP.NGS FOR STRUCTURES TO BE PLACED ON UNDISTURBED EARTH OR ENGINES FILA-3000 PSF BEARING CAPACITY S.ALL SUBCONTRACTORS TO PROVIDE A LAYOUT OF PROPOSED SYSTEMS THAT ARE TO SE INSTALLED 10 GENERAL CONTRACTOR 7.CONTRACTOR TO VERIFY THAT SOILS WILL SUPPORT 3000 PSF BEARING CAPACUY - 1.75'X 11.88-LVL MPS(TYP ( -----------------------------( it !I II Ir 1� I I I 11 -8 COLLARS 01 16-OC 0 12'-O'AFF! II !} f I I 1 f 11 it 1 11 I � I 1 — 1� L —� LJ C=—_Jl � f It i ♦ v if SI � 1LJ i Nm LJ x8 fS� f I 01 N a � tw it J L J 3-zxlz Tqr It's ....aT( NGI'O01575 0 16.Oc ot AM ` us attic Floor Framing Poolhouse Roof _ SCALE:1/4-=1'-O" SCALE- 1/4--1'-0- U Ca I 22'-0" 18'-" '-0• 16'-0" •P- .,r. ..--- ------ ---I i 72X80 SLIOER I J I �i o I I 1� o m I Q .• C4 �Xp I O x r1A�.� b 10 / 0 I �, I I i iia cep r I ' I 1 OD O b I LJ L—...-- L..-----.-.---.— -----J 72X80 SLIDER I I I N 26'— --------------------------------- --------- I I I I I l o l I I I b ISI I.' I z �M• R b o o j ot N u I I 8mo I I e o m I I of n o I I X O I I b N I � I n I• I m � m I 1 Mme! I I E I I I Mh�r I I p I I __� • I I I I w I a —J ' I p 24X38 24%36 --------------------------------- 26'-0'26'—' Construction Drawings:9\2\16 Seal 'MsChecked: JIProject Name: Chistyakov Poolhouse and Garage Approved: R s Pr aced For: Roman and Stella Chis akov Silverwatch Architects, LLC sc maty Architecture"Engineering'Design•Land Planning NRAe, xxx 128 Mill Road tiNH s'd Scale: ]r2"tel'-0" Project Address: North Andover,Massachusetts 155 Londonderry Road Windham,New Hampshire 03087 r^' Date: 5\$\i6 603.894.4450 WWW.SILVERWATCH.COM rrD'ect ND.: sA-z4-16 Sheet Title: Floor\Foundation Plans I Date.... ............... f O�NORTIy,� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING s`SACHUS� This certifies that ,... h c 'jam . .................................. ................................................................. has permission to perform . � _ at2 Gd✓I . ............................................................................. wiring in the building of............ ..... ..........................f�YAiu✓ / .................... ............................................. at /. .. �/ y..�:� .......r'. . . . ............................ .North Andover,Mass. Fee.... .:...........Lic. No. ELECTRICAL INSPECTOR Check# �av 1 8 9 2 -l � -,7 --611- "A H Commonwealth of Massachusetts Official Use Only Permit No. 6q07—/ Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),52 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: j I City or Town of: NORTH ANDOVER To the InspectJr of fres: By this application the undersigned gives notice o s or h r intention to perform the electrical work described below. Location(Street&Number) a (Ae Owner or Tenant Telephone No. Owner's Address Is this permit in conj unction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building i-4Atl 9069 *Y bY)'a Utility Authorization No. - Existing Service ( Amps ��U/ (molts 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 Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets `3 No.of Hot Tubs Generators KVA Above Ei In- o.ol Emergency Lighting t No.of Luminaires Swimming Pool rnd. grnd. Battery Units 1 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices TotNo.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alertin Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal E] other P g Connection No.of Dryers Heating Appliances KW Security Systems:Y y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent 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 WZres. Estimated Value o lec"ical Work: S ��. (When required by municipal policy.) Work to Start: I S Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: 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 cove e 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 andpef talties offgerfuly,that the info r nation on this application is true and complete. FIRM N LIC.NO.: ((57 Licensee, Signature LIC.NO.• 7- (If (If applicable,ent "e�es2pt"in the license z� berI'Meyfl d Bus.Tel.No.: / Address: 7 - Alt.Tel.No.• *Per M.G.L c. 147,s.57-61,security work requires Departmerif 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. I am the(check one)❑owner ❑owner's agent. Owner/AgentPEZMIT FEE: �� Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the q permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed ., t 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 may be 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,p s,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 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass F?] Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS ECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECT N: �b Pass M V Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: _z�9 Inspectors Signature: Date: — 'L DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com t' r The Commonwealth ofMassachusetts M Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information I Please Print Legib Name(Business/Organization/Individual): Address: - City/State/Zip: i/1i ll'i A Phone#:�7i 7—,)k,) Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a gmployer with employees(full and/or part-time).* 7. ❑New construction 2. �am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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-contraciors have employ ees,'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: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa' penalties o,fper1*!u!U that the information provided abov is true nd correct. /Si nature: Date: J y / Phone#• 4 -0 �lO 7 Z r.) 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#: K a 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=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 foi•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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia r COMMONWEALTH OF MAS ►CHUSETTS I' ,::BOARD Qf ELt-tTR I C I ANSA ISSUES THE FOLLOWING iI'CENSE € j ASA REG :JOURNEYMAN ELECTR'1'C.IAN ! M9GHAEL J BALLOU 6 JAN I CE RDr. j( �r�a .z afLLERICA. ;; ;1A 01821-0 .1 11519 B 07/31/16 56667 ' Date..... G.7..... HORTM °1A,° TOWN OF NORTH ANDOVER ov PERMIT FOR WIRING �,SSACMUS� This certifies that ............: f}................................................................. has permission toperform�f. /..... -....!-*rte-.............. wiring in the building of .............................................. at... ........................... .North Andover,Mass. 6 Fee3./,-I d-r��' .. ...... Lic.No . ............. ELECTRICAL INSPE R Check 7865 (�onvnorswaa[tfe o� a�arhusaffs Official Use Only „ c7�� cc77 Permit No. . _`Uaparbna,ef o�..J�ira�arvieas Occupancy and Fee Checked — BOARD,OF FIRE PREVENTION REGULATIONS (Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5;7 CM 12.0 - (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �CM 12.0?- City or Town of: kJp V A-?\ A-N &47V- -4 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) Owner or Tenant Su. C rr:_ ti OLA Telephone No. q7f 7�q-17?7 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No n (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Seryice Amps / Volts Overhead❑ Undgrd U No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: J��-a t l CZ`T t o» o ec U,r t p r t t� �t t t� f Sgs7en Completion of the followingtable m�2 be waived by the Ins ector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA A oven- o.o Emergency Lighting No.of Luminaires Swimming Poole rnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners lNo.oetection and 1;-tinting Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices Disposers eat um um er ons o.oSell-Contained No.of Waste Dis P Totals _.......___......_....................__. . ........-- Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipaln ❑ Other No.of Dryers Heating Appliances KW curl stems:* ry es or E uivalent No.o titer o.o o.o Data Wiring: 1. !eaters KW Signs Ballasts No.of Devices er E uiv:lent No. Hydromassage Bathtubs No.of Motors Total HP a ecommunicat►.ons Wiring: No.of Devices'or Equivalent OTHER: 7DX 76 Qcq Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE 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 andpenalties ofperjury,that the information on this application is true and complete- FIRM ompleteFIRM NAME: 'T Se.(2_Urt-rcJ 2 rULCes LIC.NO.: 1533 Licensee: pt Si nature LIC:NO.: -� (ifappl/coble,enter "ese p("in the lice—�s numlLer e.) , / Bus.Tel.No.: Address: ' _ L_I NrLm /fes (S , 'UH a`�°`�9 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires"Department of Public Safety"S"License: Lic.No. CG' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent [PERMIT FEE: $ Signature Telephone No. gxe -06147z'�� Department of Public Safety _ One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CERTIFICATE OF CLEARANCE Number: SS CC 001975 Expires: 10/09/2009 Restricted To: 00 KENNY WONG 18 CLINTON DR HOLLIS, NH 03049 S! Tr.no: 439.0 Keep top for receipt and change of ada,A« DPS-CAI 0 SOM•07/07•PCO490 comrdlCN•!\VE:ALT.. Cir IdiASS ACHU:E I 1 /,c G%on,.,,ronrxal!/r o�'..��aaurc/uacltl - "LEC ,•'IA-'•1 y 1� DEPARTMENT OF PUBLIC SAFETY REGISTERED SYSTEM TECHNICIAN i--. • CERTIFICATE OF CLEARANCE UcS El ISE TO Number: SS CC 001975 Q� Expires: 10/09/2009 Tr, no: 439.0 a KENNY Q WONG li (i S-License: ADT SECURITY 22 FIELDSTONE DRIVE r+ KENNY WONG BURLINGTON MA 01803-42-13 18 CLINTON DR i HOLLIS, NH 03049 DIG SAFE CALL CENTER: (888)344-7233 5966 D 07/31/10 284072 Commissioner •4-pi< , i/- NUMBER DRIVER'S LICENSE �- ,.� Ju2919181 NEIGNT SFJ( . DATE OF BIRTH CUSS AW5-OT M ? - 10-09-1969 D I EXPIRES 110-09-2009 vv0NG - KENNY QIU 22 FIELDSTONE DR BURLINGTON,MA 011103 42131%�r tAJ V , C� G ~151 Date.. . . .. .. .. . . . . . Z RTk TOWN ORTH ANDOVER 41 • PERMIT FOR GAS INSTALLATION T-Ms certifies that . . . . . . . . . . . . . . . . . . . . has permission for gas installation .. . . . . . . . .. .. .. . . . . . . . . . . . . V in the buildings of . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . at A-)S * ' * *;& ' ' * * * * * * ' * . * * * . . . ... . . .. North Andover, Mass. Fe A. . . . . . Lic. No GAS Check# WiPECTOR 6766 MASSACHUSETTS UNIFORM A.PPLICATON FOR PERMIT TO DO GAS fff nNG (Type or print) . NORTH ANDOVER, MASSACHUSETTS Date Z Building L •,� ocations Permit# �o�o _ Owner's Name Amount$ New Renovation D Replacement Plans Submitted c v� W cL U vi Z ' G a EW+ F inn F Z c F . Ga U U W s w a C w F Z z e w �' m d o F z z x a w w E-' C � F Z 0 F W '� W W o x w 3 0 2 . > a a W o KTH .�F ASEM ENT MENTFLOORFLOORFLOORLOOR TH . FL00R 6TH . FLOOR 7TH . FLOOR. 8TH . FLOOR (Print or type) Name / Check one: Certificate Installing g Company Address b ��� (.LJ Corp. Ij W99� Partner. usmess e e Pone 2. FimmlCo. Name of.Licensed Plumber'or Gas Fitter W INSURANCE COVERAGE 1 have a current liability Insurance,policy or it's substantial equivalent Check one: If you have checked es please indicate the a cove Yes No� Liability insurance otic �'p coverage by checking the appropriate box. policy Other type of indemnity D-- Bond Owner's Insurance Waiver. JAM aware that the licensee doesnot the Insurance coverage required b Cha Mass. General Laws,and that my signature on this permit Y ter 142 of p apphcatmon waives this P the requirement. Signature of Owner or Owner's Agent Check one: t hereby certify that all of the details and information I have submitted(or entered)in above appent lication best of my knowledge and that all plumbing work and installations performed un r Permit Issued for this application will be in PP a true and accurate to the compliance with all pertinent provisions of the Massachuse State G ode an hapter I42 of the General Laws. itl ie of Licensed Plumber Or Gas Fitter Title Plumber City/Town; _n z-q Gas Fitter 1 incen1. se gum er 0 Master APPROVED(OFFICE USE ONLY) Journeyman f Date.....1.......... .... .. 7 r10RTM TOWN OF NORTH ANDOVER mom p PERMIT FOR WIRING .,S US This certifies that .................. ..7.................................................................... has permission to performS G .!�.!.�..`�� ..Z j?t......... ../7 ......................... .... wiring in the building of...................... .¢. ! L 7ev.0....................... at.......... ..23.....114.1.L�.......5.J`....................... .North Andover,Mass. �oc9 l533C Fee.... ........... Lic.No. ............. ...................... �� -� -� i 5"9e 66 ELE RICALINSPECTOR Check # _ e pT�q :J 7869 Convnonwaa o�///as�achwalfs Official Use Only �'7 Permit No. -7 NEW .L'aParfir+.arcf o�}ins�arvicas Occupancy and Fee Checked BOARD,OF FIRE PREVENTION REGULATIONS (Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AlI wor(c`to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT X INK OR TYP ALL INFORMATION) Date: I c —le)- ,62 City or Town of: dle T/4 ,t 4),-Doilet— 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) 72,G S Owner or Tenant 15R > T44g1 v Telephone No. —/7k7 ' Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead LJ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: y} �� 0,�-t en o jeC.ur t dr trt t.a�t� Ae Completion of the following toble may be waived by the lns eetor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 0.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA g Pool. Above ❑ n- ❑ o.o Emergency Lighting No.of Luminaires Swimmin rnd. grnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners INo.of Detection an ':itiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers eat Pump _um er _ ons_ o.oSelf-Contained P Totals: ' Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Loc r l ❑ Other .- Connecda No.of Dryers Heating Appliances Ktiy Security stems:* ry es or Equivalent No.of ater KW No.o o.o Data Wiring: Neaters Signs Ballast, .of Devices c:E uivslert No.Hydromassage Bathtubs No.of Motors Total HP a ecommunicationsWiring: No.of Devices'or Equivalent J OTHER: 7e 909gF A1 (19. Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: _ (When required by municipal policy.) `;,Iork to Start: e--tle Inspections to be requested in accordance with MEC Rule 10,and upon completion. .NSURANCE 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 substar:tial equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: ScrV(Ces LIC.NO.: /f33 (Z- Licensee: Licensee- It y1,Ow� ^Signature j"�""—}_. LIC.NO.: Ijapplicab/e,enter"exec pt"in the licerts�num er line.) Bus.Tel.No.:�.� 59� Address: i [?L I; T6� t e_ l5 Alta Te}.No. `Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.�s. Ce 00 19 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurancf 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 Signature Telephone No. PERIL i FEE: $�; ' Department of Public Safety _ One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CERTIFICATE OF CLEARANCE Number: SS CC;: 001975 Expires: 10/09/2009 Restricted To: 00 KENNY .WONG 18'CLINTON DR -- HOLLIS,: NH, 03049 -fr. no: 439.0 Keep top for receipt and change of ad,4—- CJ\�E�LTE' CCiUE� IPS-CAI 0 5OM-07/07-PC8490 Co!atS ✓/c ;�AINf/FO7IrIM.ltlll o/',.I�afinc/rulel.�d ` -LEC IA _ DEPARTMENT OF PUBLIC SAFETY. REGISTERED SYSTEM TECHI41CiAN CERTIFICATE OF CLEARANCE Number: SS CC 001975 Expires: 10/09/2009 Tr. no: 439.0 KENNY Q W 0 N G S-.License: ADT SECURITY 22 FIELDSTONE DRIVE l KENNY WONG BURLINGTON MA-AJ803-42-13 18 CLINTON DR / - I HOLLIS, NH 03049_ �^"" DIG SAFE CALL CENTER: (888)344-7233 5966 D 07/31/10 284072 Commissioner ' .. r F NUMBER DRIVER'S LICENSE �— • ,629191 bi i(voM SFX ` • ) '' •j DATE OF B,RTH C{.ASS REST 5-07 10-09-196EXPIRES 9 � M >i 0-09-2009 OCING , KENNY OIU t .2 F!Tr ST'S dE DR ,p0}1K9 r:. --- — BURUNG"'ON.MA -� O?yb7 425 ([ s• V Vj 0'`C) Office Use Only Permit No. hilt CtIImmafl= 4 of s*u ttto Occupancy&Fee Checiced llugt J)cpartznwt of-public $r;if-etg 3190 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12.00 ward Area APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work,to be performed in accordance with the Massachusetts Electical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date !//,p /F6 City or Town of NotnJ4 A Ill btwE2 To the Inspector of Wires_ The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) /.74? ^'//L L Pt 64 D Owner or Tenant 11O.PE/VA /Y. Y ✓e fYA/ 7". WILL/A/43 Owner's Address SAM E c5-Ice) 6V83' 9 Is this permit in conjunction with a building permit- Yes ❑ No ❑ (Check Appropriate Box) purpose of Building Utility Authorization No. Existing Service Amps_J Volts Overhead ❑ Undgmd ❑ No. of Meters New Service Amps_� Vohs Ove head ❑ Undgrnd ❑ No. of Meters Number of Feedecs and Ampaciry Location and Nature of Proposed Electrical Work Installation of alarm system ' Tota! No.of Lighting Outlets No.of Hot Tubs No.of Transformers Lal No.of Lighting 1=ixtunes Swimmirx) Pool Above In- Wnd_ ❑ 9nd- ❑ Generators KVA No.of Emergency Lighting No.of Receptacle Outlets No.of Oil Burners fiery Units No. of Switch Outlets No.of Gas Burners FIRE ALARMS No_of Zones Total No.of Detection and No. of Ranges No.of Pic Gond. tons Initiating Devices Heat Total Total No.of Disposals No.ofPumpsTons KW No.of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW 0etec2kxVSounding Devices Municipal Other Local No.of Dryers Healing Devices KW ❑ Connection ❑ No. of No. of Low Voltage No.of Water Heaters KW Signs Ballasts Wy_ tje me . eE ALAgm No. Hydro Massage Tubs No.of Motors Total HP OTHER. (Z) $M6 k.E DI TECT-OIK AFP 2 R lCa INSURANCE COVERAGE:Pursuant to the requkements of Massachusetts General Laws 1 have a current liability Insurance Policy inciud- ing Completed Operations Coverage or fts substantlal equ ivatenL YES O NO O 1 have submitted valid proof of same to the Office. YES O NO O h you have checked YES.please indicate the type of coverage by checking the appropriate box_ INSURANCE n BOND O OTHER O (Please Specify) O0 (Expiration Date) Estimated Value of Electrical Work S 630 Work to Start 9/2a /96 Inspection Date Requested: Rough Final Signed under the Penalties of Perjury: F1RA1 NAME L1C. NO. ) 2 Licensee Signature ✓ UC. NO. ems_TeL No.617-4 31-5 0 Q J Address 60 William St./Wei 1 P_ I sley. MA 071 R1 A, Tel.No.b'i7�' 8-47 OwrfER'31NSLAANCS VWUVEft:I am-was that the Lioet does not have#W kourranos tooveral)e Or its substantial equivaWA as re" :.qulfed by tlfpalb 6anaal taw*.and dot OW*%pnallt"an i111.t' peaoil.app>ieatioo w+f��' K'Ovrner •.!t !-i +ixii'+M «:S' 'xt'�17t :lita..r`z." .s {n't�e{ephOjlbllt7�^ 4 x < Y i s Date......7 .. 51X i TO 464 NORTH 04 ,40 tt"'° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHUS {� :-r.`.mss � �..+�f..l. .y..... �. ...... This certifies that ....... ........ .....1�..t. has permission to perform,........ .......... .......................... wiring in the building of....... ?.. ......................................... at....... .........VVI+..AA.::...... ...................North Andover, Fee. . : .U.. Lic.No..�.°�3 . 1C............. ELECTRICAL INSPEC'' C WHITE:Applicant CANARY:Building0 t K:Treasurer 09/25/%-16:18 �p 00 PRT Date.................................. t? NORTI� Of't�aD �61M0 TOWN OF NORTH ANDOVER �e PERMIT FOR WIRING �7SgACMUSE� This certifies that ff has permission to perform-._-,..---� : -'<"2n!� wiring in the building of....../• ..t"1,-�........(/............................................. at............................................................ ........... .. .North Andover,Mass. 1 Fee..��............. Lic.No/5 .... s:,...... ..... ..........�: ................... ECTRICALINSPECTOR Check # Q 2 Z(�' Lzf �' Commonwealth of Massachusetts Official Use Only Permit No. v� y Department of Fire Services ��� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 MR 12.00 (PLEASE PRINT W INK OR TYP A L IN ORMATION) Date: 1 Q City or Town of: naoytr To the Insp ctor of Wires: By this application the undersigned gives notice of his orh i tention to perform the electrical work described below. Location(Street&Number) /J4? i Owner or Tenant 40E= 4t Telephone No. — �5 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion qf the ollowin 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 AboveIn- o.o mergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. E] Batte Units a b 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 No.of Alerting Devices Tons No.of Waste Disposers Hear tap Number Tons KW No.of Self-Contained ' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sec Noyof ritDevices or Equivalent No.of Water Kms, No.of No.of Data Wiring: t Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage 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 El ctricJ Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the Pains 6ndpenalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: lire Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.- 603 594 5928 Address Alt.Tel.No.- OWNER'S INSURANCE WAIVER: I am aware that the Li*see 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. Date........ ........ ... NORT" ° OL TOWN OF NORTH ANDOVER 3? a�, ....• p PERMIT FOR WIRING SSACMUS This certifies that............ ...... ..�.......... ,. .......... ..........�.......... has permission to perfrimn ...... iri...... wiring in the building of:....... �..... ................. at.... e,7 <f �.. 1.. ... ..... �..... ,North Andover ass. Fee.`Lfes'„ Lic.No..11,.�,,5-e............ �,. AL.!�.4..T�- �....... ELE6141CINSPECTOR Check # /, 7 r 5502 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked E` BOARD OF FIRE PREVENTION REGU TIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT T ERFORM ELECTRICAL WORK All work to be performed in accordance with th M'assachusetts Electrical Code(MEC),527 C R 12. 0 (PLEASE PRINT IN INK O P A INF RMATI ) Date: City or Town of: To the Inspector ol Wires: By this application the undersigne i s tic of his r h in ntion to perform the electrical work described below. 3 Location(Street&Num ) , Owner or Tenant OA A 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❑ 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 followin table maybe 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 Lighting Fixtures Swimming Pool above ❑ In- ❑ o.o mergency Lighting rnd. grnd. Battery Units No.-of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 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 Equi alent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TeleN of Dev ces or E communicaonslu valent i 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 El ctrical Work: J61 (When required by municipal policy.) Work to Start: D Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the Jains dndpenalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC.NO.: U31_ Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.: 603 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic.9hsee 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 ' Signature Telephone No. PERMIT FEE: S h