HomeMy WebLinkAboutMiscellaneous - 141 CARLTON LANE 4/30/2018 (2) > 141 CARLTON LANE
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5933
Date. ..l... ?7�G 77S�7
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
S"S
S 1cNu5Et
This certifies that ..... ......................... ................
has permission to*perform ............. 7..
wiringin the building of...................................................................................
at...... ..4_1......roft-7PA.-I /&I North Andover,Mass.
........................................ ......
Fee...71,--f.......... Lic.NoI7744.. .........
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Check #
IIm 9.UJVJX1U1Yrvrr1c..tn Ur JVJA%WL112tvac1I L3 �•�~�,� �'
DFPAR7N& IOFPUX1CS4FWY Permit No.
BOARDOFF7REPREVEMONRE1GULA77ONS527a R]Z'W
Occupancy&Fees Checked
APPLICATTONFOR PERNIlT TO PERFORM ELECTRICAL WO
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELEMICAL CODE,527 CMR 12:00 r7 oM
(PLEAS'VRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) -C IVA �.�Q f 1� ,�. r�N a!
Owner or Tenant
Owner's Address S A/H
IE
Is this permit in conjunction with a building permit: Yes[:] Nol;@ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps __�..Volts Overhead Underground M No.of Meters
New Service Amp% I Volts Overhead Underground Q No.of Meters
Number of Feeders and Ampacity a, Ic •
Location and Nature of Proposed Electrical Work W I OIL a MY
No.of Lighting Outlets No_of Hot Tubs No.of Transformers Total
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
and M g..d
ri
No.of Receptacle Outlets No.of Oil Bomers No.of Emergency Lighting Battery Units
No.of Switch Outlets _
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
iOTHER C V
In&==C0ve9W.Pt>t t�tbdtetegmerrtet��Ge�raalIavvs
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(Please check one) Owner 1:3 Agent
Telephone No. PERMIT FEE$
signature of uwner or Agen
I nM 4-ulmrivl r rrrlm ••n yr 1Y1t1JL nr&L-0VM1 1.3 vtnce use oruy
DEPA17NW0FPUNKS4FElM permit No.
BOARDOFFMPREVFVHOIYREGUTAHOMM7C11 ]ZiAI
Occupancy&Fees Checked
APPLICATIONFOR PERIIffTO PERFORM ELECTRICAL WO
ALL WORK TO BE PERFORMED IN ACCORDANCE wrrH THE MASSACHussTs ELECTRICAL CODE,527 CMR 12:00
!LEAS-WRINT IN INK OR TYPE ALL INFORMATION) Date
.Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) IVI C AS.. LT ON 1. AN a�
Owner or Tenant fR r•;- . t-
s 'fi
Owner's Address s q/H
Is this permit in conjunction with a building permit: Yes EJ Nola (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps volts Overhead r7 Underground No.of Meters
New Service Amps Volts Overhead M Underground No.of Meters
Number of Feeders and Ampacity 4b
Location and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transforttters Total
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
ground 11 ground
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW LocalMunicipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
THER• S C Q T I V MQ A I A ftr1
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AeaamatLihT1yhmtrmxPbiCj'i du*glpftConCt ails lt�t}walat YES NO
ahri edvalidpt000fsam oND
the0l�YES � ff}ouhawdrdodYES�plea�eii ic*@etype(fwmWby
>t>e jbL OHr
s
Value Wak$ 900
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underNAAN E&P'trtaltesofpe�tnycTATL C E Lg�1 LLA1• TPJI. LiaenseNo. 19 st 72, A
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.trot my sigrlati>Ie on th's peQrg app5tzriul wanes ltl's ta}merre>t
'lease check one) Owner 1:3 Agent Q
Telephone No. PERMTT FEE$
�
signature of Owner or Agent
rV�'ps n S", @ �x ► o J� ,Worn c
PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. RACE 1
R - MAP 440. \Ub c- I LOT NO. 00 q 3 2 RECORD OF OWNERSHIP 'DATE BOOK ;PAGE
ZONE SUB DIV. LOT NO.
LOCATIONct1 l - PURPOSE OF BUILDING v
OWNER'S NAME \r FI—N NO. OF STORIES SIZE
OWNER'S ADDRESS ` `v �.A� BASEMENT OR SLAB
ARCHITECT'S NAME /• SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDERS NAME l )
V', 1 CO^ SPAN ��•
DISTANCE TO NEAREST BUILDING -] \ DIMENSIONS OF GILLS
DISTANCE FROM STREET oo POSTS
DISTANCE FROM LOT LINES-SIDES REAR - - GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS y y�,\\�
IS BUILDING NEW `/� - - SIZE OF FOOTING 1--� X 1 \\V�J. t
If BUILDING ADDITION MATER:AL OF,.qTW.,El
IS BUILDING ALTERATION IS BUILDING H SOLID
OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CO TED TO TOWN WATER 1
BOARD OF APPEALS ACTION. IF ANY If BUILDING CONNECTED TO TOWN SEWER V
• If BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES 1.1 I , 1 I� �'i EST. BLDG. COST (\
PAGE I FILL OUT SECTIONS 1 - 3 y '-'I^�meg , EST. BLDG. COST PER SQ. FT. �v
'� It'S •+_+„ MT. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS 1 - 12
SEPTIC PERMIT NO.
ELECTRIC METEPG MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FI ED IIND APPROVED BY BUILDING INSPECTOR j
DATE FILED
BUILDING IIttPSCTOII
SIGNATURE OF OWNER
O OWNER TEL/ � y 11"=—
fEE � 74
�/tItIT aRANrcD C� �. ICONTFLTELT --
/ 719 —' ----
- - -
Town of over
No. M
q + 7
dower, Mass., te-Pl- 12. 1qe? ;L
-OC
LAKE Ic"EWICX JCX
Im
A
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..... /... d0A47^0.3Y
........................................I................... Foundation
has permission to erect... ..... btdWim an .....1...+A.... .................. Rough
to be occupied as........ .LA.-.4. (':�P.4........................................................................................... Chimney
........ ... .. ..
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. ?a4z-P^*? Go%% T�dx�cr PLUMBING INSPECTOR
F;
VIOLATION of the Zoning or Building Regulations Voids this Permit. g-Mra7he4 laco aooi�o A/.ro, Rough
Orrk =A"rft_e_Tbe-
PERMIT EXPIRES N 6 MONTHS Final
UNLESS CONSTRUCTION T ELECTRICAL INSPECTOR
Rough
........................... ...............................I.................................. ... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
No Lathing or Dry Wall To Be Done Final FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
cc;are Q 401k Oa-7Q9 1 2_C:P78— Street No.
Smoke Det.
FORK II
- ioT RELEASE FORM
INSTRUCTIONS: This form is used to verif
approvals/permits from Boards and De a e that all necessary
have been obtained. This does not relieve is having jurisdiction
landowner from compliance with any applicabthelocalicanand/or
regulations or requirements. state lav,
****************Applicant fills out this seOtion******
***********
APPLICANT; O�cC�
Phone
LOCATION: Assessor's Map Number
Parcel
Subdivision
Lot(s)
Street
• St. Number
Official Use Only************************
DATONS OF TOWN AGENTS:
Conservation Administrator Date Approved
Comments
Date Rejected
1A I t7
� F
10
;;.
Town Planner Date Approved "
Date Rejected
Comments
Food Inspector-Health Date Approved
Date Rejected
e is Inspector-Health Date Approved
Date Refected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
Date 9
NifT.`y:f1 titi.1 ,1111 .. , _ _ •,, ` Ji�? ` ;
1
d•/1���M'�;�,�'1,.0 ' _ , _ .. S. .� t gyp,.= y{�,�/.
-
r
-00.9.wnawevecrl��
K�'•�}` 1)KPARTHEE17' OF PIIIJLTC SAFETY 4b315 it r'I►�Ii `'A �r�
Sr 1I
•.4tr7 ONE: A,i111311RTON PLACE , RPt 1301 " j�rk��
alsi;�� fY� �u DU;i7'UN , 11A 021(18- 1618 A
CONSTRUCTION SUPERVISOR
Numbers Expirettc tti [t.ItQalot � � �',•„�
;V�l���ajr•:� CS ()27999 03/ 14/ 19913 03/ 14/ 1934
' t
Restricted To 00
r
1) "' , r',. _j�'* ;•tkrr+,.S
,• Y wxJ!) RODNEY P ANDREWS DeLai:b bottow, fold niyn on
I
1Y� , �1F,i� .) 1tj11•) 1idi'f: , aI,d laminate licenBe Card.
.I �.� 1647 LOWEI,I, RD f
CONCORD , HA 01742 Kuelt tot) for receil,t and change
of addIesa n0 tificati0n.
YYY." ii!..(,r..._:f .�...__ -_____ __ ___ _ _ . __ �...��---• _ --—•-••�--- 1".�r�.�n.rrl�r��fir!
BoaOrd off�Building Regulations and Standards
One Ashburton Place - Room 1301
Boston , Massachusetts 02108
i
t
NOME IMPROVEMENT CONTRACTOR
Registration 113772 Expiration 07/15/09
%��r r/•/)))191//.H//MIIIII/�.../I/hkl//I'�I/.M��J
Type -- PRIVATE CORPORATION _
-— HOME IMPROVEMENT CONTRACTOR
j Registration 113772
ANDREWS GUNTTE CO . , INC _ SType - PRIVATE CORPORATION
RODNEY P . ANDREWS o Expiration 07/15/99
6 REPUBLIC RD
N BILL.ERICA MA 01862 I ANDREWS 6UNITE CO., INC.
RODNEY P. ANDREWS
eor4,,RtPUBLIC RD
'�•#
ADMINISTRATOR N BILLERICA MA 01862
s ISSUE DATE (MMDDA^0
vRooucER
3/ 3/1997 -
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
NO RIGHTS UPON THELakeside Insurance Agency Inc. DOESERS NOT AMEND, EXTEND OR ALTER THE TCOVERAGE THIS
BY THE
88 Stiles Road POLICIES BELOW.
_ ......... ............................................ . .
Salem, NH 03079
(603) 893-9450 FAX(603) 89T-9480 COMPANIES AFFORDING COVERAGE
....................................................................... .
LETTERNr A CNA INSURANCE COMPANY
_................. .......—........
..
..................................................._.......
INSURED...................................................................................................................: COMPANY Lm-,71 B
ANDREWS GUNITE COMPANY INC COMPANY ^ _....._...._.................................._.. .......
6 REPUBLIC ROAD LErr>r� l�
NORTH BILLERICA, MA 01862 COMPANY D -....-
LETTER
I
COMPANY ..................._._............_.___...__.I
LETTER E i
CdEiAGES
_.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCUCY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR ,MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
................. 7
_...
.................-
LTAPOLICY NUMBER TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
L : DATE (MMrDDNY) DATE(MMND(M LIMITS
..
A GENERAL LIABILITY _..__
GENERAL AGGREGATE 5 2, 000, 000
X COMMERCIAL GENERAL LIABILITY 110731507 .. EGATE "'
.. PRODUCTS-CCMPICiP AGG S
CLAIMS MAO X OCCUR. : PERSONAL&ADV. NJURY 5
...... ..... '02/20/97 02/20/98: 1, 000, 000
...................
OWNER'S&CCNTRAC CRS PROT. EACH OCCURRENCE
S
..... _...._.......-._.-.:......1, 000, 000
....... .......•...... FIRE DAMAGE(Any one fire) S
50, 000
MED.EXPENSE(Any one person)'S 5, 000
AUTOMOBILE LIABILITY
.""' COMBINED SINGLE
IN
A ANY AUTO 1617269 LIMIT S 11000, 000
..........ALL OWNED AUTOS :02/2
_ ._._..._.._i.........._..-..._......._-.
0 2/2 0/97 0 2/2 0/9 8 BODILY INJURY........_
X SCHEDULED AUTOS w (Per person) S
X HIRED AUTOS .............. .............. _.._ ............
i
X NON-OWNED AUTOS BODILY INJURY
i (Per accident) :S
GARAGELIABILITY ..................... _......:.._._...................._.........
PROPE4TY DAMAGE
S
.. ....................__ __...... . ..
_.... ....... ._.....
wq
........ _. ............. ......EXCESS LIABILITY ...... ......... .........
EACH OCCURRENCE
: S
11000, 000 A XUMBRELLA FORM ......................................
w 110731524 02/20/97 02/20/98 AGGREGATE
$ 1, 000, 000
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION X `..STATUTORY LIMITS
A 120530275 ....................:.... .
AND 02/20/97 02/20/98:EACH ACCIDENT $ 1, 000,000
EMPLOYERS'LIABILTY DISEASE-PCLICY LMR s.-••1, 000, 000
.�••0 0 0, 0 0 0
_...> ...............................................................:. :DISEASE-EACH�IPLOYEE.... : 1, 000, 000
S.
--
OTHER - ......;......__.........................:........................................................................................
....................................
DESCRIPTION OF OPERATIONSRACATIOHSlVEFiICLECLES/SPECIAECIAI ITEMS .....................................
EMS ..... .............:....... ........................... ............... .
COVERING WORK PERFORMED BY THE INSURED.
CERtTFICAT>? HOLIIEA CANCELLATIQN
.. ..... .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
SALESMAN COPY OF COVERAGES LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
R`s> LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
SAMPLE — CERTIFICATE < ;AUTHORrzED REPRESENTATIVE
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Office use Ontc
The Commonwealth of Massachusetts Pernit No-
Oceupanci & dee Checked
Department of Public Safety 3/90 (leave blank)BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
' All umrk to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D2tee./�—��
Cit or Town o£ ��-/� •
Y ®��" ��YL:/` To the Inspector of Wires:
The undersigned applies for a permit to�,41?L7vA)
rform the electrical wo-ck desc,Fibed below.
Location (Street & Number)all /,,.
Owner or Tenant P-1 T-14. A-L
Owner's Address
Is this permit in conjunction with a building permit: Yes, No (Check Appropriate Box)
Purpose of Building SrK 6 1 FA x-L`s' Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. o'_ Y.eters
New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Y,eters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work �(>
No. of Lighting Outlets No. of Hot, TotalNo. of Transfonaers
EVA
u
? Above Q In- '
No. of Lighting Fixtures Swimming Pool`
i grnd, grnd. Generators -VA
a No. of Receptacle Outlets No, of Oil Burners No. of Emergency Lighting
Battery Units
3 No. of Switch' Outlets a No. of Gas Burners FIRE ALARMS No. of Zones
0
o, No.,-of Ranges Total; No. of Detection and
= g No. o Air Cond. :tons. Initiating Devices
W No. of Disposals No. of Heat Total Total
W p PumDS Tons KW No. of Sounding Devices
JNo. of Self Contained
No. of Dishwashers Space/Area Heating Detection/Sounding Devices
No. of Dryers Heating Devices KW Local❑ Municipal1Other
Connecticn
� No. of Water Heaters KW No,.of No. o Low Voltage
g
Signs Ballasts Wiring
o No. Hydro Massage Tubs No. o£'Motors Total HP
U.
OTHER:
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 ❑ I have submitted valid proof of same to this office. YES( NO
If you have ehecked YES, please indicate the,.type of coverage by checking the appropriate box.
INSURANCE `f' BOND ❑ OTHER (Please ecify) r��
Estimated Value of ElectricalExpiration;.Date
n Work $ •. '
Work to Start / Inspection Date Requested: Rough bjj:1,L r+t4 Final
Signed under he penalties of
perjury:
FIRM NAME �II EV_z I //C5 G/-�1:>/ /� LIC, N,).
Licensee Si nature r IC. NO
Address i us. Tel. No.
Alt. Tel. Nod ✓?P.j' ?�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurancelb%Merage 6r—` its su
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone_No.,, PERMIT FEE $_ -3f \
Signature of Owner or Agent ..
INSPECTION RECORD
Date Notes — Remarks Inspector
i
r
I
- i
i-
' i
i
�a �
,....�4'-'b"""�'?'ti'��T.,f`.:-_,S+..tisT.ri"+�.....�:�x�.^«�.,1w._sL✓'!sC^•-+�!^�.�"-""_.. ,_ _. .. _.
` Date... ...
s
. . 1123 L
HORTM
Of,•..eo ,e'�ti0
o= a �-• ,e o� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�,''••,T•e'�6 -
SSACMUS
This certifies that ......... ........... .� ......................
has permission to perform .....U' . .... .......... .ft{�.tP.�t�� s ...: �?.�......
wiring in the building of......../rf:-. ........................................................
[tJ
at 1. ... �� �'� orth Andover s. c
/...........�?.lt.............. a
Fee&c� ,c....
7,.�.... Lic.No.4../5. . ......... ......�.......
LECTRICAL INSPECTOR -
C,I� I t73
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
N° u ti 9 Date.. ..: ..'. ....
4 ,40 1
o .t;"`` a"ao� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
ArIC
SSACNusE�
This certifies that :..................
has permission to perform . t��~*'- ^-r
wiring in the building of...6,L -
.................... .........................................................
.
at....1. ..... ............................. ..'.................,North Andover,Mass.
Fee--;,-.5 Lic.N ...........
a�>/i ...............................................................
ELECTRICAL INSPECTOR
6bl10/98 11:32 25.00 PAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
- Office Use On]
The Com onu)ealth of Massachusetts Peal, Na.
4' epartment of Public Safety Occupanci & Pee Checked
' 3/90 (leave blank)
BOARD FIRE PREVENTION REGULATIONS 527 CMR 1200
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORHATION)
City or Town of'MOak "AitV—, To the Inspector of Wires:
The undersigned applies for a permitrform the electrical wot:k described below.
c
Loation (Street Number) _ to( gj_To Ai A-
,2.
Owner or Tenant P_
Owner's Address A ' ;
Is this permit in conjunction with a building permit: Yes FT No ❑ (Check Appropriate Box) --
Purpose of Building5J;JUeL_Vr Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
r
New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ' i�l?"ti�� C)Iz--
6rAl �.
No. of Lighting Outlets No. of Hot.Tubs. No. of Transformers Total
U, KVA _
Z ` Above In-
No. of of Li iting Fixtures Swimming Poolgrnd. ❑ grnd. ❑ Generators KVA
W
No. of Receptacle Outlets No. of Oil Burners NoBat. of Emergency Lighting
te Units
3 No. of Switch' Outlets
a No. of Gas Burners FIRE ALARMS No. of Zones
a
° Total; No. of Detection and
m No..of Ranges No. of Air Cond.
Ltons. Initiating Devices
m! No. of Disposals No, of Heat Total. Totai ` No. of Sounding Devices
W Pumps Tons KW
D No. of Dishwashers Space/Area Heating KW No. of Self Contained
¢ Detection/Sounding Devices
Municipal
= No. of Dryers Heating Devices KW Local❑ Connection[]Other
LL No. of Water Heaters KW No,:of No. o Low Voltage
Si ns Ballasts Wiring
uNo. Hydro Massage Tubs No. of-Motors Total HP
OTHER:
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. YES2. NO[] I have submitted valid proof of same to this office. YESO NO
If you have ehec}:ed YES, please indicate the type of coverage by checking the appropriate"$ox.
INSURANCE [S BOAR ❑ OTHER ❑ (Please Specify) J`
Estimated Value of Electrical Work $ 3,00-00 00 • Expiration;,Date
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAME 0 LIC. NO. _ 1�
i
Licensee flixc "7_ A tC Signature 2diddLIC. NO.
Address V t /�Qf � `�� 04- Q If,24,-' Bus. Tel. No.
Alt. Tel. No.'917e�'5— 3_9'
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone_No., PERMIT FEE S
Signature of Owner or Agent
INSPECTION RECORD
Date Notes — Remarks Inspector
c'
1 c
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING
k type or print) Date hvy /- 19
NORTH ANDOVER, MASSA HU�fS/EcTTTS
Z�Building Locations �e%� /U� Permit#
Alpd /�,�1 /� Amount$
V�/ Owner's Name /_//
New Renovation Replacement Plans Submitted
NVI r C r
r z z ` F-
n F W C C a C W F
W C z C i
m C y V W m
w W n ,� _ a w x w v 5nC: c. E, W C M Z C r w O w
z a
w :
> C
SUB-BASEMENT
BASEM ENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH . FLOOR
5TH . FLOOR
6T H . F L O O R
7T 11 . FLOOR
ST 11 . FLOGR
(Print or type)<� . `� ,Q� 1�1 �1 , �J\(� Check one: Certificate Installing Company
Name y 1 e n D Corp.
Address D�e— iv '` ❑ Partner.
� �-o►2� 92 I
Business Telephone - js" ElFirm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check o :
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked yes,pl e i dicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe
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 ❑
I hereby certify that all ofthe 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 inst performed under Permit Issued for this application will be in
compliance with all pertinent provisions ofthe ivlassach setts S to Ga CodeChapte 142 ofthe General Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title Plumber
City/Town Gas Fitter License I umber
Master
APPROVED(OFFICE USE ONLY) Journeyman
n
COMMONWEALTH OF MASSACHUSETTS
IN PLUMBERS AND GASFITTERS
LICENSED AS A MASTER PLUMBE(���, j
ISSUES THIS LICENSE TO
JOSEPH R DOYLE
209 MIDDLETON ROAD
BOXFORD MA 01921-252
11821 05/01/00 589161
®®
n�
286 r-
Date U�.... . ..�....
„oR,., TOWN OF NORTH ANDOVER
pFt„t° ,s�1•
3r ' PERMIT FOR GAS INSTALLATION
0 '+
F P
4 •
SACNU5E�
1,
This certifies that::. :.. '. .`:.• • • • . . • • • • • • •
has permission for gas int llation .. . .• • "U
in the buildings of.... . . . .. . . . . . . . . . . . . . .. . .. . u,.
at . . . . ... • • North Andover, M2116-
Fee-.-..:`.., Lic. No../r��/. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer