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HomeMy WebLinkAboutMiscellaneous - 147 JOHNNY CAKE STREET 4/30/2018 (2) J 711407�JOHNNYCAKE STREET 107.A-0188-0000.0 Date.................................. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4CHUS This certifies that ............... .......... ......... .............................................. has permission to perform .......41(017 ................................ A wiring in the building of..............0 v� ...... )........................................ at.....P-1.7.!�,;V e,,f.A�......./2D.....:.eVorth Andover,Mass. Fee..J/—.... '."—T .c.No..149 -JjW...... .. .-I... .. .—.. . Check # 10785 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed 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,firrn 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 ofongoing construction activity,and may be.deemed-by the.inspector_of_Wires abandoned-and-invalidif_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,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. ule 8—Permit/Date Closed: ***Note Reapply for new per ❑Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusettsofficial Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MLC),527 CMR 12.00 (PLEASE P)WT.ININK OR TYPEALL INFORMATION) Date: y 0 l• City or Town of: NORTH ANDOVER 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 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes B---No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service`x-d Amps (2-0/Z-J'dolts Overhead 0— Undgrd❑ No.of Meters New Service APs / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letfon o the ollowin table 7nay be waived b'the Ins ector o Wires. No.of Receised Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig mg nd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No,of Ranges No.of Air Cond. TonsTota)taNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons _KW _ No.ofSelf-Contained Totals: ___ Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances , Security Systems.. No.of Water , N. of No.of Devices or E uivalent Heaters No.of Data Wiring: Si ns Ballasts No.of Devices ort uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring; OTHER: No.of Devices or E uivalent Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: ,S'?J� (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 cerfify,under the p - and penalties ofperjnry,that the inform do on this application is true and conn: leie FIRM NAME: LIC.NO.: Z2 ( J/1- Licensee: (Ifapplicable,enter"exem t"in the license nu ber�tt'ne.) LIC.NO.: Address: p a}C ala / Eli f.y �/ D�o7 Bus. R o.• *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt. Lic.No. 3 1d 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/Agent ❑owner's agent. Signature Telephone No. PERMIT FEE.- 7- 3 Z-, E +C7[ d]CCA�Ct WSPE.IPTOR _ MIMI . �'�ssec�--• _ - S'ailefl•-[ � �e-ins�eetion xequzz'ec�($�'O.OD)�[ j �nspectpxs'c mmex�fs: - - ' ectoxs' ature ni€fials) Date Passed—[ ) +ailed--[ ) . ate-xnspectio�azequixed($50.00)- [ 3Cn5�iectoxs'comments: (t tactorsRignature-.no infflals) Date 3,7J.ie DAR CRODM IMPACTION. ] l:+'ailed--j ) 7�te-anspectzor,xeguire�($�OAO)�[ ] Lns.Vectoxs'comments: [.tnspectoxs Signature•-ttoimtials) Date DWAM Passed--[ ) Failed--[ Re-xnspectionxeq*ed($50.U0)-[ I Thspectaxs'commeph: . (nspectoxs'Signature o xnifials) Date ' I �.DeI'aPEC�'x0�1�7-•O�`13ERr" ' 'assed--[ ) +ailed--[ )- Zte xnsp ection xequired($50.0 D) [ - asp eC OW colnm.ents: , �t;�sp ectoxs'Signature no initials) Date B 0O TAGS.ARE TO BE FILLED OUT AND IEFT ON SATE IF THE.AP"XA TO 3E WSTE.CM IN NOT .A CCE981BLE AND A MURECTION OF$50,00 fS TO IN CkTARGED. 't The Commonwealth oflMlassachusetts - Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 69 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ �• C� !M. �(C C%'fir Address: City/State/Zip:_ A/y o 3--7 Phone#: `I-7 cl Y A e yo n employer?Check the appropriate box: Type of project(required): 1 1 am a employer with [ 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. ?• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.)t employees.[No workers' -131JOther comp.insurance required.) *Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. T Homeowners who submit this affidavit indicating they sire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. .1 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 requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certo under the pains and penalties ofperjury that the information provided above is true and correct. _ Signature: Date: Phone#: 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#: t l 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. lir anLLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox 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. Anew 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 burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massar�l usetts - Department of Industrial,A.ccidents Office ofInvestigations 60 Washingtoxa Street Boston,MA,02111 Tel.#617-727-4900 ext 406 or 1-877MASSAFB Revised 5-26-05 Bax#617;,727-7749 www.mEtss.gov/dia 9380 Date. . „aR'N TOWN OF NORTH ANDOVER O� ..go PERMIT FOR PLUMBING J � r ,SSACNUS� This certifies that .STE'... . . �!��'!�? r' ./. . . . . . . .h M has permission to perform ' . . . . . . . . !' . . . . . . . . . . . . . . .. plumbing in the buildings of . . .C47ae?.ZL2 at. . /Y.�. . n!? �. . . . . . / . orth Ando v,�j�, Mass. Fee. . ...l...'...L No.. . . . . . . . . Cl . z.,V. , ��bs"T?� . . . . . . PLUMBING INSPECTOR Check # �S/ ✓0 -C-\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 1 0AX a4 NtWj^/' MA. DATE LA' I t-I L PERMIT# JOBSITE ADDRESS_ l ��c ��v Cc.C-�-t OWNER'S NAME 5i`04�1 POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO ❑ FIXTURES Z FLOOR— BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB Z CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN1;77 SHOWER STALL ( " SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER,HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes R No IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE BOX ONLY: OWNER El AGENT E]Si nature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Cha ter 142 the General Laws. PLUMBERNAME STtPtfIFO C Ggt_(0GK+f SIGNATURE LIC#} 103 ti 2 MP 0' JP❑ CORPORATION [(# 319 h PARTNERSHIP ❑# LLC (]/} COMPANY NAME 6AL113SKY PLuMOIiUb *- NV1TjI.1% ADDRESS: P.r7• 134X 001 CITY HA VCIZKIL-L STATE rAA- ZIP 01831 EMAIL Www, mrply mbeggpol . Covj TEL 4'7V-32q- 12H 3 CELL •'SD$_ 50cI-5g0H FAX__ ,2'715-57,21-'4131 ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES l Yes No /2 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I r" Date. ... ...... . NORTp TOWN OF NORTH ANDOVER PERMIT FOR WIRING cHuB�� This certifies that .......6,4A.R.a.5 �L� C`/ .Cb 1 has permission to perform ....... ,. wiring in the building of..... � . �7-/`�7� ...................................... e �! 7..�.b..Aj� �� �L . North An Mass. at............ ... E... , 0 Fee...< ©'"'. .. Lic.No. T ELECT RICALINSPEClOR F Check # �SY 0 / 5: 3 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 6 7-5-,P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 eave 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 W INK OR TYPE ALL INFORMATION) Date: Co-A 0 Co City or Town of 0 Q, (A Oy;.;Q_C 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) � .� Q A Owner or Tenant L' P\ Telephone No. Owner's Address Is this permit in conjunction with a bu'ding permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amp / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: LJ )LQ af OA 2W410ArA ' r' Com letion of the foliowin table mty 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 '5140KVA No.of Lighting Fixtures Swimming Pool d.Above ❑ -rnd. o.omergency gng ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump umber Tons [R-W- No.of Self-Contained Totals:I I 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 Equivalent No.of Water KW of o.of Data Wiring: Heaters Signs Ballasts No.of Devices orE uivalent ns No.Hydromassage Bathtubs No.of Motors Total HP elecommunicatioMug: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of R'ires_ 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 I 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 Electrical 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 and penalties of perjury,that the informatto n this a lication is true and complete. FIRM NAME: Q 4A CO �-k ec4f I C i Inc, • LIC.NO.: Licensee: ,�hl(� ( ( Q S Signature LIC.NO.: C y (If applicable,enter "exempt"in the icensenumberline.) Bus.Tel.No.• y Address: e ( Alt.Tel.No.: 2162- OWNER'S INSURANCE WAIVER: I am aware that thensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this equirement. I am the(check one)❑owner ❑owner's agent Owner/Agent PERMIT FEE. $ Signature Tele hone No. U >� P F. 5 Date. � . .•. ,ORTM pf °p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION gs9SSAC MUSEtt is . F This certifies that —N�t�q: (. �. . ��•�.-�/�c �L'. . . . . . . . . has permission for gas installation . y.-� �. �.4'�. . . . . . . . . in the buildings of . �- !`�? .. �. . . . . . . . . . . . . . . . . . . . . . . . . at . .,1 ft . . :�.�.�. ::. . . . . . . . ., North Andover, Mass. Fee. 0 . . . . Lic. No../.?Y. � . . �� c . . . . :S. /GAS INSPECTOR Check# t ) W I 5638 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,Mass. Date—L ���20 Permit# p Building Location/Y/7 mu Owner's Name Owner Tel# Type of Occupancy pm New ❑ Renovation ❑ Replacement o Plan Submitted: Yes ❑ No ❑ FIXTURES w Z w a w ` O z o � w F z z o H Q m H o o Z o z H c" w F. w x w w to n: rn 0 U x y z a o r z 0U' IW— z W Q x w w tW7 0 w z Q W J! Q �� t:" F �+ �n m Z O z O x w = O S w 3 A c¢7 .aa U a > A R ~ O w BASEMENT 1 sT FLOOR 2ND FLOOR k 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8T"FLOOR ti Installing Company Name �_ tva l { :W11A Check one: Certificate Address 3 SC-6o 1 r0}V� F4 ❑Corporation �10d I R"1-VPv M A Q;--1�-o ❑Partnership Business Telephone# 5 q62- 13Firm/Co. ^ Name of Licensed Plumber or Gas Fitter �,/ona I a p"'�y e-- � C)V\ INSURANCE COVERAGE: I have a currens liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes t� No ❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. A liability Insurance policy ta/ 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 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all rtinent provisions of the Massachusetts State Gas Code and Chapter 142 oft General Laws. By Type of License: r 077�L- -•-Plumber Sitifiature of Licensed umber or Fitter Title •-Gas fitter •-Master License Number-AP-4. /9/14 City/Town •Journeyman APPROVED(OFFICE USE ONLY) Commonwealth of Massachusetts Division of Registration Board of Plumbing Examiners DONALD`& FR�16N = Y-- 43 SCHOOL HROOK FALL RiVEIR,IW--4-27-f6-- Master A 42720-Master Plurriber = _` PL15114-M 05/012008 '" 001507 License No. Expiration Date. Serial No. i amu+ DRIVER'S LICENSE 486643925 UTC _ MM FW e=rr SO 07.06-1955 D 8 5-W M SMES it 07-06-2009 METREJO[V DONALD S 43 SCHOOL BROOK RD FALL RIVER,MA a 4; 02720 q.._..s.J IAA G li d,4 Otftco Uso Only - � • Pormit No. 35, 01 4e &iumv una1tj of RW.SeffS occtrpar v& Fee Checked wp (leave blank) \ -0CPSCtMttTt of f ltblic *afttg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 `arid Area n D APPLICATION *FOR PERMIT TO PERFORM EL�ECTRICALoWORK All work to be performed in accordance with the Massachusetts Electnca � � O CM (PLEASE:PRINT IN INK OR TYPE ALL INFORMATION) Date —Tgn T ! To the Inspector of Wires: M City or Town of l f N �d� O 0 The undersigned applies for a permit to rformthe electrical work described below. < Location (Street & Number) u�AJ 6F5U Owner or Tenant �EtSt1gc��� Owner's Address � ❑ l Is this permit in conjunction with a building permit' Yes ❑' N (� Appropriate Box) z Utility Authorization No. m Purpose of Building C) Volts Overhead ❑ Undgmd ❑ No.of Meters o Existing Service Amps—J s Vofts Overhead ❑ Undgrnd ❑ No.of Meters t^ New Service Amps_J o Number of Feeders and Ampacity -` Location and Nature of Proposed Electrical Work Installation of a arm Svatem Total No.01 Hot Tubs No.of TransformersA rT No.of Lighting Outlets I Above In- �A c No.of lighting Futtures Swimming Pool Bind• _❑ Generators No.of Emergent►Lighting J\ Battery Units No.of Receptacle Outlets No.of Oil Burners < No.of Switch Outlets No.of Gas Somers FIRE ALARMS No.of Zones Total No.of Detection and/4 No.of Ranges No.of Air Cond. tons Initiating Devices < I Heat Total Total No.of Disposals No.ofPurn Tons INV No.of Sounding Devices No.of Sell Contained No.of Dishwashers Space,'�sea Heating KIN OetecliortlSOunding Devices Municipal No. of Dryers Heating Devices KW LOBI Connecti//o''nf Other No.of No.of ow voltage (},//b la f lr I C No.of Water Heaters KW Signs Ballasts Wiring p� No. Hydro Massage Tubs No.of Motors Total HP _ OTHER: tri n nor" tNSURANCE covERAGE Pursuwa to the requlrerneMs of massael-sem General taws 1 have a current liability Insurance Policy W+ek�' ing Cpnpleted Operations Coverage a its suhstanttal equivalent.YES O r NO"`p rl,have.submitted valid proof of same to the Office. YES O NO O M you have checked YES.please• dicate the type of coverage-by cl+ecking-�appropriate box. inco INSURANCE W BOND O OTHER (Please Specify) (Expiration Date) Estimated Value of rival Work S Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of Perjury: 1 UC. NO. FIRM NAME Licensee Signature LIC. NO. Bus.Tel•No.617-431-587 J Address 60--William S t /Well esslt`y, A ()?181 Alt•Tel.No. t as OWNf "S e�JRANCE 111t71f1/E'i'tr 1 ant -waft 11110 the licensee does not 1+_w the kaurartoe ooworage or its Substantial equivalen �.gttlrad by asetd General Lxwa.arta!fret OW on this pent oppa=,don waives age"RtrimmeriL Owner Ams %=• 3r. ":.•.' • _lreleohons fMrrFF..Es_— _.:.._�i�1L'.r:��'7c1�•K:S�'>•1�:?.2?�.i�aTtr'rl.•sic..•r...... .. -------- - NO` Date.... oaf 388 TOWN OF NORTH ANDOVER PERMIT FOR WIRING �OtArno SSCMUS� 4 Y: This certifies that ... ....: ...1........... .e. 2,.f. .....S..IY .h?..... ' has permission to perform .......t.c.........A..(.C4 .(u......... �..:.......... wiring in theb;uilding of...... ......41.1............................ ..........:..::..... ..'��j. `.:�.. u,fi... ....� ............. ,North Andover,Mass. Fee .�./:v� Lic.Nol J�C 48l1319b1:I6 35.00 PAID WHITE:Applicant CANARY:,Building Dept. PINK:Treasurer TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD f DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION 1 tJ�0 (example: left front of house) i. bzA- &e DATE OF PUMPING: T`1-6_06'k, QUANTITY PUMPEDL SQ(�) GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES —Z NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Tc�a COMMENTS: i CONTENTS TRANSFERRED TO: -� ` Location I t-f -7 No. .36GDate N011T1y TOWN OF NORTH ANDOVER O?O:�«•o .•'�.y0 AL n Certificate of Occupancy $ Building/Frame Permit Fee $ 6)0 ,SSACMUSE�� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL {CriJ I/L r Building Inspector 12 TaT98 08:41 5-00 PAII► Div. Public Works Location ) ) , , , r r C It J No. � � Date f,&AK ^T� TOWN OF NORTH ANDOVER o� Certificate of Occupancy $ 41 Building/Frame Permit Fee $ -y� 610 Its" Foundation Permit Fee $ MusE Other Permit Fee $ t Sewer Connection Fee $ Water Connection Fee $ TOTAL ` Building Inspector 1270 4/og/98 mm 25.00 PAID Div. Public Works u PI?r'MIT NO. ��� APPLICATION FOR PERMIT TO 13 ILD********NOIZTI-I ANDOVER, MA MAP NO. LOI',NO, 2. HECORDOFON'NwRSUB' DATE BOOK PAGE ZONE SUB DIV. LOI'NU. . LOCA"IION /�� �j�,(/�/� j �y P11H1'()SF<k Bllll.l)ING �� ���" 1 OWNER'S NAME G� v/v�t NO.Of:S TORIES SIZE OWNER'S ADDRESS BASFMENI'OR SLAB ST ND RD ARCI III ECI'S NAME SIZE OF FLOOR TIMBERS I 2 3 BUILDER'S NAME SPAN I)IS'I'ANCF:TONEARES'f HUII.DIN(i v DIMENSIONS Of SILLS DIS I'ANCE FROM STREE i' DIMENSIONS OF I'OB'I S DIsTANCEFROM LOT LINES-SIDES REAR DIMENSIONS OFGIRDERS AREA OF LOT FRONTAGE IlliwaIT OF FOUNDATI(N! THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDI ZION MATERIAL OF CI IIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO RFQUIREMENTS OF CODE IS BUILDING CONNECTED"1'O TOWN WATER BOARD OF APPEALS ACTION,IF ANY IS BUILDING CONNECIED'TO'rOWN SEWER IS BUILDING CONNECTED TO NATURAL_GAS LINE INSTUCTIONS 3. PROPERTY INFORRIATION LAND COST EST. BLDG.COST PAGE 1 FILL cu r SECTIONS 1-3 EST.BLDG.COST PER SQ.FT. EST. 131.06.COS 11'ER ROOM EI ECTRIC MEI ERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. A 1-1 ACHED GARAGES MUST CONFORM TO STATE FIRE REGULA MONIS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY Bt 111-DING INSPECroR BUILDING INSPECTOR DA'I'F FILED Pa OWNERS TELA C(WI'RAr-t.# �J c(NJTR.LIC9 11GN,\ftlHiilN l)\VNI:RtN2AU'I'1ItN21'Lli AG- 1' I'IRMIT(A(AN I H) ZZ7 19 G/ �.►ORT/y Town of And No. 3 Y 1 * - i � dower, Mass., O'DA_COCNICNE WICK ti'y',�• E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... /'.t.-rnevot..'L......................................................................... Foundation 9 q? �./ .!�l!1.. ... IG 4......R�[.......... Rough has permission to erect...��.l.�t��J.F......... buildings on ..... ..... .............. .. to be occupied as........�I.`t ��......FR.,wtR./..� Chimney . . . . .. .. . . .. . . . .. . . . . .. . . . . ....... . .. . .... ... . . .... ......................................................... provided that the person accepting this permit shat m 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU O TARTS ELECTRICAL INSPECTOR Rough .......... ...................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Roughn Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing. or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det.