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HomeMy WebLinkAboutMiscellaneous - 134 ROSEMONT DRIVE 4/30/2018 134 ROSEMONT DRIVE 21-0/098.B-0034-0000.0 0 Aorth Andover Health Department I ORTil � 1� �.TLED ib 1600 Osgood Street Letter of Transmittal 0" g�,- � �� �� bild'ang 20, Suite 2-36 North Andover, MA 01845 ; 978.688.9540 - Phone Page / of 9cat rim 978.688.8476 — Fax S-S 64US�� 'ealthdept(CDtownofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: DATE: COMPANY: FROM: Pamela DelleChiaie,Health Department Assistant Phone: / � RE: Fax: c/z•�GGL� � G� .0 t1i� �h We are seeding you: O Copy of letter O Plans Oat4r(fill in below) These are transmitted as checked below: L74p vadarAb d > Orrgg vmi > Ofim" wpivfiar (d.4sl 4t� > OkrRevi6va imm off OAvRbfAh d > Or r rowt* y OSub70 mpi fordo REMARKS: COPY TO: I COPY TO: -a COPY TO: SIGNED: % " i ('commonbltd(tb of Adggacbtwtttg ��- STATE RECLAMATION BOARD . ,. . �. W alt er G.Montgomery *�� Drrycior j NORTHEAST MASSACHUSETTSAND MOSQUITO CONTROL WETLANDS MANAGEMENT DISTRICT 261 Northern Boulevard,Plum Island,MA 01950 I Tel:(978)463-6630 Fax:(978)463-6631 { I r•, Location 1 3 y No. t l rl �l s 1. Date pORT/y.- TOWN OF NORTH ANDOVER •3 p:t��au ,a 1ti0 . . A Certificate of Occupancy $ Building/Frame Permit Fee $ Zg rag Foundation Permit Fee $ skMust Other Permit Fee $ 8 Sewer Connection Fee $ Water Connection Fee $ N >p TOTAL $ Building Inspector aO 104- 43 Div.Public Works ....r+.-`a�."4�-�-••--*.:w--..e.'r»ra....�...-_'�,,.,.,.;,,�v�., ..,.. . ti+4�,T, ,,,. �-::.!":moi-,;..r..,.., —.rte.. l r� I Location f ,/fes/ � TO N .O f- ND AA DOVER O? � 6On p Certifica ofpa C$ x Building/ e Permit Re $, • - �� Foundation rmit Fee CHUS Other Permit F $ 4 o 95Z Sewer Connection Fee $ �0C Water Connection Fee $ 4 • w A hoz TOTAL $ 2 t 3 � V7 ' Buildin Ins o 11000.00 aai -- &9 2 9'. Div. PSbyE Works 0 Location . ` �S�Iti�MT 0. . No. ! - Date 1ab NORTH `TOWN OF NORTH ANDOVER C °f >..Q? Off' „ Certificate of Occupancy $ ` ? " ' '4 -7 ; • `Building/Frame Permit Fee $ e�� .Foundation Permit Fee $ 34 MS Other Permit Fee $ Sewer Connection Fee $ ..Water Connection Fee $ TOTAL $ - h � 16Td -i4e34 150.E PAID Inspector k, ,N- 8891 , Div. Public Works PEW%frr NO. �14' APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4d0. LOT NO. 12 RECORD OF OWNERSHIP iD /3 �OOK PAGE — ZONE Z I SUB DIV. LOT NO. G� l LOCATION P,� PURPOSE OF BUILDING '" OWNER'S NAME v{JlasdG�J` NO. OF STORIES � SIZE ..`/4��Q W �r X&VNER'S ADDRESS AS ME LAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST ':� /Q 2ND Pjje`Q 3RD BUILDER'S NAME /� SPAN DISTANCE TO NEAREST BUILDING[ V DIMENSIONS OF SILLS c6 _ DISTANCE FROM STREET zy^' POSTS �Y DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT S' �C FRONTAGE HEIGHT OF FOUNDATION fQ rr V THICKNESS /Q IS BUILDINEW SIZE OF FOOTING �� x Y K l-lG IS BUILDING ADDITION /��j MATER:AL OF CHIMNEY ` erQ 7 IS BUILDING ALTERATION /w f IS BUILDING O OLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODEyyC 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 LAND COST j SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY EST. BLDG. COST PAGE 1 FILL OUT SECTIONS t - 3 REGULATED BY PARA. 114.8-S. B.C. EST. BLDG. COST PER SQ. 7 V6_5 - PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROO DAT[C, to4 E PAID I� SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING Sb4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AN PPRO ED BY BUILDING INSPECTOR DATE FILED iU1LDIN0 INiP[CTOR 3 SIGNATURE OF OW R AUTHORIZEqIRPENT F E E �S3 - RMIT FOR FRAME/BUILDING owNERTEI.# b�o�68Z- Ig�f PERMIT GRANTEDB (v " CONTR.TEL.# DATE: �'�FEE PAID�6� — r CONTR.LIC.# CZ� • H.I.C.# Fl � 4 OCT '1 3 1995 I ! sm Fm ,lISv w .- lea s _ BUILDING RECORD T 1 OCCU ANCY 12 (� SINGLE FAMILYS-0RIEs 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 3 1 2 (3 KP'INE CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER .� _ DRY WALL UNFIN. 44 3 BASEMENT , AREA FULL V FIN. B M AREA _ -• - °s - '/. '/, s/. FIN. ATTIC AREA - NO B M T FIRE PLACES - 3 HEAD ROOM ` ' _ MODERN KITCHEN _ 4 WALLS I 9 FLO S CLAPBOARDS 1 2 3 DROP SIDING CONCRETE , WOOD SHINGLES EARTH ASPHALT SIDING .HARD+✓'D - ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME. I BRICK ON 'MASONRY• ATTIC STRS. 8 FLOOR _ ,,,!; E i I,•� fi4..a.� ... t 13 BRICK ON FRAME"'' I .J. . CONC. OR CINDER BLK. •j Ja `?°t`'L `I" v STONE ON MASONRY WIRt G ST041E ON FRAME— ' I -2p UPERIOR POOR _ ADEQUATE NONE 5 OF 10 PLUMBING •�'� �� i GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET v _ ASPHALT SHINGLES LAVATORY \ WOOD SHINGES, KITCHEN SINK Z SLATE 1 NO PLUMBING )- TAR LUMBING)_TAR 8 GRAVEL STALL SHOWER' ROLL ROOFING MODERN FIXTURES TILE FLOOR c TILE DADO 6 FRAMING y 11 HEATING WOOD JOIST PIPELESS FURNACE + joOFORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM - STEEL BMS. 6 COLS. _ HOT W'T'R OR VAPOR _ _.., �.� ... ..,tJ WOOD RA IR CONDITIONING f r RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st 13rd-- I`- NO HEATING+ � l NORTH own of 41 6 Andover 0 Yr No. 51 ori �` dover, Mass. © oa t(0 19gc °� IANC ' > > CCI HIC Ht WICK C, BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ` BUILDING INSPECTOR THIS CERTIFIES THAT... SS......htnll ..7�4�2t1'�ttr���-1rl. ...................................................... Foundation has permission to erect. ...fibl4a... buildings on ....3�..... ......OQUA.......� . IZ� Rough to be occupied as2L P(&. ...'�i. 41.1. U).*A x..0).46........ ..... ... R,..... 1 .... .y .. Chimney provided that the persoh accepting this pernfit shall in every respect con rm 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 Inspfi � 1Md-C t' n of Buildings In the Town of North Andover. REGULATED BY PARA. 114.8-S. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MC�I�{T`I' FEE PAID Final UNLESS CONSTR CTI ELECTRICAL INSPECTOR . _ Rough ;C> =GZ........................ Service BUILDING INSPECTOR ' Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner I PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT �� �� . . t I FORM U - IAT R=ASF FORM r INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction i- have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: hW, 4B4-aj Wk // Cggp' Phone 662-222& 7-2 LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) 17- Street i (5se4fp� de'-I'e St. Number l34 ************************Official Use Only************************ RECOMMENDATI OF TOWN AGENTS: Date Arrroved r Cons e zat-on Administrator Date Rejected Comments k Date Approved A Town Planner Date Rejected Comments Date Approved Food inspector- ealth C�.� Date Rejected CP " iV7k-41-1 Date Apprcved eptic Inspector-Health Date Rejected Com,::enzs Pu:,l_c Wcr::s - sewer/water connections - driveway perm. it 3c) -`: Fire Denartment Received by Xilng I spector Date OCT 13 1995 FROM LAND PLANNING BELLINGHAM PHONE NO. 508 966 5054 9$'y,p �P01 a k ! LOT I I ,! L,a T j S ►t4 / JS, 6 seR� , LOT fN �� ` T 13 F � 01 s �++ ZX of a a Tc = 346.sot MOR�utAN 'I�. GAR.=34S_-To to a a s. SGABs 337 70 iq O�MATt JAY` NOTE: ALL UTILITY LOCATIONS ARE TO BE FIELD VERIFIED BY THE GRADUM ! SITE PIAN SITE CONTRACTOR. fpC41l� at D O V E FZ F I—Dc= F,L I I LOT I Z, S ETPAC KS: ': A0 � S- 0 � 13 = ZO N MM AMVU ESTATES ANDOVER, MA mono m LAND PLANNING TOLL BROTHERS, INC. 314MR&MG & SURM UM 11 M PAR MU 197 TdAItY'FORD AVEN[JX. BXt1�iGMK MA OM9 v=ST80T�0. Ju 01641 =) gee--41� 1rAX (Dos) 9es-06419-2-7-7--31 I" = 4- W AE 17- ? 3530JO + NORTH 1 315. 55 - 1 351 •35 e Andover No: 4 0 dover, Mass.,3c6a+y t(o 1911c LOC n IC MEw cK A RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...171ASS ``..... 4A)l'tV_t'..��RIr ,J� ........................:..........................:.......... Foundation has permission to erect...... ... ... buildings on ...13:1.....1?. ,i T t ,t 1� " �2) Rough to he occupied asSl .64.E . i !?F�.l.. �� 'RJU,. !f�.4�........W�1�-. a...CAOL....��4+A+ .... T ..41� Chimney provided that the persoh accepting this permit shall in every respect conm 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 Ins u�ti n of P Y 9 Pi � l����NIY Buildings in the Town of North Andover. REGULATED BY PARA 114.8-5. B.G. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough `SFEE PAID I C'0 w Final. PERMIT EXPIRES IN 6M(3 c -v, �v . ESS CONSTR CTI ELECTRICAL INSPECTOR T FOR FRAME/BUIL _ Rough PERMS w -bbl �� 8�� ..... x......... ...... .... ... ...... ............................ Service `W�Kq•S • BUILDING INSPECTOR r 3 f FEE PAID: "t�-5 5% Final 4ATE. Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To -Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT - - A�•.� . � w-mow: CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 514 1995) Date December 13, 1996 THIS CERTIFIES THAT THE BUILDING LOCATED ON 134 Rosemont Dr. (.Lot 12) I�Me B MAY BE OCCUPIED AS Si ngl e Fami 1 y Dwel l i ngwf3_car Garage IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SU(_'" OTHER REGULATIONS AS MAY APPLY. gORTq °;,. •_ ..'�o CERTIFICATE ISSUED TO Mass.Ltd. Partnership 3103 Philmont Ave. ADDRESS Huntington al e ;t SACNU u' n for Town of 6Andover � F , 11% No. 1 --rte � o dover, Mass.,OC66M 19q� COCMICMEWfCK ADRATED P' �� 1 S `BOARD OF HEALTH P.. ERMIT T D Food/Kitchen Septic System \ BUILDING INSPECTOR 1:.W THIS CERTIFIES THAT... A ......1^.4A11`�;�.,��It�,����...................................... .......................... Foundation has peg mission to erect. . ... [..... buildings on .. . ..::..� '9Ort "... .......6 to be o.,j cupied asSL . .6..�.�c....�.loM.l. ..�N. ........'4?..... ...CAIL ..!�4W. we . ' ..Q� Chimney;. provided that the persoh accepting this perrritt shall in every respect con rm to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Insp f W A%fiN u Vn of 'n Buildings in the Town of North Andover. REGULATED BY PARA. 114.8-SS.nB..C. PL iGING INS VIOLATION of the Zoning or Building Regulations Voids this Permit. o Cir" 6��` G��—•_. PERMIT EXPIRES IN 6 Md T �0 6 SFEEPAID i�' �1rI �% Q -V ELECTRICAL INSPEC �T "ESS CONSTR CTT PERMIT FOR FRAME/BU{L �u w V� ..... ......... ......... ...... :.. ... ............................ Service TE: 8�5y FEE PAID: - BUILDING INSPECTOR Fi Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough c'7 Display in a Conspicuous Place on the Premises — Do Not Remove a z� . No Lathan or D Wall To Be Done � Lathing FIRt DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. ©K-d,4.1z�`I Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT rte- 0 -�'�; '•�.,��„�.r-frustI I Zi UNIFORM APPLICATION FOR PERMIT T ( O DO t3ASFITTINQ Print or Type) NORTH ANDOVER , Maas. Date Building Permit # a 31 ? Locatlon,OY ,(,1 6Owner's Name New ! Renovation ❑ Replacement p Plana Submitted:. Yea ❑ No p 'n - a a u aC X h at N w aC 0 h a�t M tl J h W h Ud Z 0 w h < Z 0 h w h a7 d v r Z X s M J Z h w w 0 IL J ' 0 aae •ue—sak�T. • • •A119141EHT taT FLOOn ' IND FLOOR l SRO FLOOR 4TH FLOOR $THFLOOR STH FLOOR r 7TH FLOOR t , ?TH FLOOR Mr ' Check one: Certificate Installing Co pany Na e PY4� ye Corp. Address Q Partnership ,gip/�5� ❑ Firm/Co. Business Telephone �f'a Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: Chec one I have a current IlabAfty Insurance policy or its substantial equivalent. Yea � No p If you have checked yea, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy O Other type of Indamnfty D 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: %nature of Owner or Owners Agent Owner ❑ Agent C I hereby certify that all of the details and Information i have submitted(or entered)In above plicatio are true a rate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issu f this plicatio II co Ilance with sit pertinent provisions of the Massachusetts State Gas Code and Chapter 112 01 the � Tup of License: Plumber Title urs of ase met or as er Gasfltter Cty/'Town Master License Number D Journeyman - AT1110'VED(OFFICE USE ONLY) s ..�,-�.R °.--v+y„y`�.yr,,.,n•i..�-..,,rw.w:,:d�°vy,,,egy,,,�s y�•-+:i+.d�"+�g-".,*13i�7Y.d+.�;�y- :""�"- -•:'-^a� n±�; 23 .'7 Date. ag .,,ORTH TOWN OF NORTH ANDOVER E PERMIT FOR GAS INSTALLATION �9Sg4CHU5ES 4j - 0 This certifies that . . ., ./.�:.l.G'.�. . . . a!•.. has permission for gas installation in the buildings of . at !o. z . . . NQrth Andover, Mass. Fee. Lic. No. . F. AS INSPECT= f ; t' WHITE:Applicant CANARY: Building Dept. PINK:Treasurer . GOLD.file . t ' �},. Office Use Onty T' uhl' L: mm�an�Et�ilil �3�azilu3��1L2 'Permit-No., C �, It3�3 Bepa'tmr tIf t1IIltL sfP12j Occupancy E,Fee Checked r ' 3l90 (leave blank) 1(03 t BOARD OF FIRE PREVENTION REGULATIONS 527 C'dA 12.00 APPLiCAT'10N FOR PERMIT T4 PERFORM ELECTR`1CAL WORK ; + All work,to be'performed in-accocdant:e:with the :Massacnusetts Etecutcal Cade 527 CMR J :00 ,: (PLEASc 'PRINT 1N INK OR'TYPE ALL INFORMATION) Oate ; j .ar Town of "ANnQVFR To the Ins ec r. of wires The udersigried appiles'fora permit'.to pe'rfor' the eiectncal work described below f h _4 L (Street..& NumberY, t ., Owner or.Tenant: -.4 t _ 16 .l 5F Owner's Address. i'es' No �.:'_ ( eek Appraonace 9oxl i' isthis perp - t .In can urlc.lan tth u�l¢tng perm t t ,1 r( x r °urocse of Bwidlna M! Utility AuttYan tion Na r Existing, UC+,S ;OVerr edd ' Undgrnd '_' fV0 OT GletelS v.; e� Jarvice , ry ,vT�Volts Overread Un±ac, -Yc r:No of tiierers r ns^ NeN Seryico /C/...Amos'. - :F`. ''�.. ^` ytaN } Numoer of'F-eders aria ,?,mcaclty i Lccaticn arc Nature of,P�ocosea �lec.r;c�l crc u r + .3r ; Total No.. f:ranstormers�c_ .KVA • ��'rr t- a.. c s nt - NO_ des u tr �, } 4. r t No:;at Lighting;'r,xtutes as Sw,mming �yar tnn 'grne Ceneratpr$ r KVA F : `: g her ncy.Ltghbng.. L f r No. of ^,i6 sur. 3atzeryU"riffs $ No.`at =ecectacie out m r ' ,R� AIA,�MS 'No of -Ones> < «« �. No r'Co-.as rrerss t No: at Switch Outlets i rr,�krra Nc. C.•rc: NM,nat rete atv ces�6 #� �"� al ,Na. at Ranges tens k9 w , _ .. t Deaf wtat otai = ' i r x ; of pisoosals ..No.af NC f Scunamg ryev,ces r. i k . ,ra Vo or �a+f Containea " + rain Devices- k% "+ nr. u SoacerArea rJeaurg.-' 0 — Muntcoat y Other ( ti * rt I Hea.:nc.Cev;ces C`N �ccat Connec.on _. ' vo. at Dryers - -. Law voltage NO,,- O of ^aSigns3aiias s ' <'Nie:na t ; `. : v rieate rs- KVV - , �. �lo. of .voce" f� A6 - No of Mote"S' Ofal !,P' {M No. :Hvoro Massage jugs` b s h INSURANCE COVERAGE:-Pursuant o-thereau,rements ot_ Yassacr sa s'yerterai '3ws - 'c: r of Ltaatiit. Fnstsrance Pat,c/'jnc:uctniy C n:et aerations caverace or ts. sues ansa! eaugva+ent YES f F t,nave a:cur e Y vc NC it cu •aIye.cr+ecxea Ea7:Pfease ,naicace tte:tvea ot:cov�rage cyt nave suam,ttea Volta pr of ct same ro.the Otfice.'. ._� r a a , checxing:the appro gate qox _ $ JYVSURANC� 3ONO:t OTHER _ tP ease cee'yl (Exo,r--anon Jatel F t k ty i CS tmatea`Value of E! c.ric Y Norti 5 t a, 3 Q Ynscec:on tpate,.r,ect.es;ec Rough v� r_ 4 dna+ Signea unser Rhe P n ire f.. r>ury d ,No h. 5' e • t g._ Nc) p Licensee. .:; Sus •ei: o .�" N r . - AYF tis "lo. [ 1 1% ACCfesS+' . A' ort i > OWNER'S iNSUfaANCE WAIVER: l am aware that the c ones not nave tris insurance coverage or us suostannai eau,valent as e au,rea.ay Massacnusetts•"General laws•,ane ;hat my's,gra urs �ci .5 Cor-ntt,aoP++canon.,.carves this reau,remenf..Qw++er-.,'ii t:P?ease cnecx ones etecnone vo., PERM Fc- 4 (Signature of Owner or Agentt Date.........509 yE f N�o7M 1 :°•t:�``" "°o TOWN OF NORTH ANDOVER o PERMIT FOR WIRING us� This certifies that . .......0.. .. ... .L.;. has permission to perform ............ ... ....................... wiring in the building of.........1. ..... / �-rl. . .......................... o.. x 1�V....�.....:... . i. .�. ,North Andover,Mass. at...... . at.? Fee.��S... - Lic.4-.J:l:g.A............................................................ ELECTRICAL INSPECTOR kAA- L ,v '� WHITE:Applicant CAN " uilding Dept. PINK:Treasurer ` I The Commonwealth of Massachusetts office Use only ' �:�.� •� Department of Public Safety Fem,a No. l� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 occupancy s Fee Check i7 3M (leave blank) APPLICATION FOR PERMIT° TO PERFORM ELECTRICAL All work to b.performed In acc roan wrtn meMasswnus@ns a acm"i Code.1 27 CMR WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date_ City or Town of �the D /•The undersigned applies for a permit to perforctrical work described below. To the Inspector of Wires: Location (Street & Number),! � Owner or Tenant Owner's Address Is this permit in conjunction with a buildingpermit yes C3no JK (Ch�•:k Appropriate Purpose of Buildings . /�/( 4 Utility Authorization No. ppro nate Box) Existing Service Amps I__V°Its Overhead ❑ Undgrd ❑ No. of Meters New Service Amps J Volts Overhead ❑ Undgrd C3 No. of Meters Number of Feeders and Ampacity _ Location and Nat**,e of Proposed Electrical Wor No, of lighting Outlets No. of Hot Tubs TOTAL INo. of Transformers KVA No. of Li htin Fixtures Above In Swimming Pool rnd.❑ rnd❑ Generators Na. of Receotacle Outlets No. No. of Emergency LigKVA Of Oil Burners Battery Units hting No, of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ran es TOTAL No. of Detection and No. of Air Conditioners TONS Initiating Devices No. of DisoosalsHEAT TOTAL TOTAL No. of Sounding Devices No. of Pumps TONS KW No. of Self Contained No. of Dishwashers Soace/Area Heating KW Detection/Sounding Devices —' No. of Dryers Heatin DevicesKW Municipal �— Local ❑ No. of WataConnection ❑Otherr Heaters KW N°• of No. of Low Voltage Si ns Ballasts Wiring No.of Hydro Mn-,,. a Tubs No. of Motors Total HP OTHER: T INSURANCE COVERAGE: Pursuant..to the.requirements of Massachusetts General Laws ~{ 1 have a current Liability Insurance Polity including Completed O valid proof of same to this office. YES ❑ NO ❑ Operations Coverage or its substantial equivalent.YES ❑ NO❑ 1 haave submitted If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S (Expiration Date) Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: Final FIRM NAME ,(i(1& L0 0 Licensee LIQ3 C. NO. .D Signatur Address/- t� �t,� 3O #3 ���� n�RK• LIC. NO. i4MPJ'7'.� A6, H- d3 8.Z fv bus. tel. No.& -3;7z- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not,have theinsurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check Telephone No. �� (Signature of Owner or Agent) PEHMtT FEE Date...ly �� J.. r10RT►� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHUS� This certifies that,,,::... .. .`R.'. ....�.J..°`e2:.................. has permission to perform .......5 ..........��. .5....................... ` wiring in the building of.... TU.L�........ ................................ at..... ....J..' .....1!.(�.`1 E.`}!I vet - ,North Andover,Mass. .....OR................... p I ``�� � Fee...'J�.:00..... tic.No.../. ..)... . .................. .; << 1A��j ' ELECTRICAL INSPECTOR i/T1 --07 35.00 PAID S WHITE:Applicant CANARY: Building Dept. PINK:Treasurer