The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 148 BRIDLE PATH 4/30/2018 (2) \\ � ��.+ R1Dl.EpA� j / 210�104�� "'` i� I I, J!: I 4 �l i1 '� i 1 �� II � I ,'i +, I I I t a Date/:.:2- .'47.— .7....... HOR7N `'° 'e1"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SStCHU This certifies that .................................................ae .............................. .............. -- --�', has permission to perform ............................................................................... wiring in the building of........................ ....................................................... at...lA/.f�.'...... ................... .. ...... ,North Andover,Mass. Fee&. e1. ........... Lic.NA�F.............. �/(,/ . . 'AL�MiCAL:INS�CTOR' v Check # i 7854 Official Use Only Commonwealth of MassachusettsMoslem j� Department of Fire Services Permit No. Occupancy and Fee Checked 'Ok� GO:- BOARD OF FIRE PREVENTION REGULATIONS ev.9/OS] (leave blank-) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /l�,?b'�0-7 City or Town of: /(/� /nJpt/c To the Inspector of Wires. By this application the undersigned gives notice of his orr/her intention to perform the electrical work described below. Location(Street&Number) /Y? 1641,01 L /�i4t Owner or Tenant � -}�e-," Telephone Na 97,p- (or(" - �J Owner's Address 110 Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building 1e,St J4�4r Utility Authorization No. Existing Service ' ) Amps /d 1 &uO 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: �yt� 1 Wt.t r G �ti arc ✓ /fo � Completion o thefollowingtable may be waived by the Ins ctor o Wires. No.of Recessed Luminaires Na of Ceil.-Susp.(Paddle)Fans Na clad Transformers KVA No.of Luminaire Outlets Na of Hot Tubs / Generators KVA Above ❑ In- Na of Luminaires Swimming Pool ❑ o.o Emergency grnd. d. Bette Units Units Na of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones Na I of Switches No.of Gas Burners o. action and nitiatin Devices Na of Ranges Na of Air Cond. Total Tons Na of Alerting Devices No.of Waste Disposers Heat Pump I Ru--mber ons_ W Na o el-Contain Totals:I i -� Detection/Alerting Devices No.of Dishwashers S ce/Area HeatingKW Local❑ Municipal ❑ �� Connection No.of Dryers Heating Appliances KW Security of Devices or Equivalent No.o ater , No.of a o Data Wiring. Heaters Signs Ballasts Na of Devices or uivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNevicer uivagl Y ssage Na of Devices or Equivalent OTHER: ` Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: �s0. 00 (When required by municipal policy.) Work to start: // o"7 Inspections to be requested in accordance with NEC 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 Q BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penal ies of perjury,that the inforn ation on this application is true and contptde. FIRM NAME: J M^4#-TT _.L,"re ui LIC.NO.: /f 16-91 .11 Licensee: 65-1 e -e-rr- Signature LIC.NO.: 4 /S 7/ 9 (If applicable,en r"exempt"in the license numberji 1 Bus.Tel.No.- '1 7,r-617-Y770 Aaare�s: �0- ,ebl 79V �1?7c'P1�71YJ � 0 9yg Alt.Tel.NO.: 1 -V7d'- 4IvA *Security System Contractor License required for this work;if applicable,enter the license number here: slifu� 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 Signature Telephone Na PERMIT FEE:$`/5 i?O Date. .!j . j. • 7 No TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAC MUSE I~ i 'J J iw �T This certifies that . . . . . . . . . . . . . . . . . . fhas permission to perform . . .. ... ... . . . . . . . . . . . . . . . . . I plumbing in the buildings of- I . . . . . . . .. North Andover, Mass. I Fee-00 . . . . . .Lic. No.. . . . . . . . . �..,,Ik�'�✓.�. . . . . . . . . . . . . . f / PL INSPECTOR INSPECTOR / Check # e�" 2— i I WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ^ � ii.. '' -� Building Location in �f `, Owners Name l�Q., W Permit#� f Type of Occupancy Amount New Renovation d Replacement ZPlans Submitted Yes No FIXTURES z d H a O z E~ w 3 W o a w a w A a �' a a w W x H H 3 3 0 04 d x x a H o U x 3 a x a A a 3 x F w a 3 a o BE ELOCR 3M HJOCR 41(H ROM 5HI haat M haat 7]H HDM 81H H JDCR (Print or type) Check one: Certificate Installing Company Name Corp. Adc�ess �- Partner. S Qs0 Business Telephone ' �(J; - ? Firm/Co. Name of Licensed Plumber: iL Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I 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' sta ations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass c S P bin ode d Cha ter 142 of the General Laws. By: 61gnftTUre 01 LlCenSeClum er Type of Plumbing License Title 3 City/Town License NumDer Master Journeyman a APPROVED(OFFICE USE ONLY Location No. � ~ S Date i 401tT4 TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ s ; Building/Frame Permit Fee $ AcMU E<� Foundation Permit Fee $ Js r r Other Permit Fee $ a, Sewer Connection Fee $ RECEIVED PA ' O-6onnection Fee $ TOTAL $ NOV 1'. 1991A. Building Inspector No. Andover Collector Div. Public Works PERJLiT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE i MAP d40. I LOT NO. 12 RECORD OF OWNERSHIP DATE (BOOK !PAGE — ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING 7 OWNER"S NAME NO. OF STORIES SIZE F _ O ER'S ADDRESS BASEMENT OR SLAB CHITECT'S NAME „�� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME " SPAN -- DISTANCE TO NEAREST-BUILDING NM• DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS I I IS BUILDING NEW (, p� SIZE OF FOOTING x IS BUILDING ADDITION Ili l 0 MATERIAL OF CHIMNEY Y IS BUILDING ALTERATION NC, e--7IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /� S IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY .,�-� r IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST ! 18 /'�� PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY A,'FTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGEN I FEE CONTR.TEL.# CONTR.LIC.# _sa L_J_. PLANNING BOARD PERMIT GRANTED 19 BOARD OF SELECTMEN BUILDING INS CTOR 1 BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY STORIES 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 —I 8 INTERIOR FINISH CONCRETE _ B t 2 13 � � �l�•t l`C�J CONCRETE BL'K. PINE _ BRICK OR STONE H RDW—D PIERS PLASTER _ DRY—WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ V, '/x V/ FIN. ATTIC AREA _ N_O B M FIRE. PLACES _ HEAD ROOM, MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS_ B 1 2 3 DROP SIDIN CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDY✓'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE ---{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ - BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX. GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM ' STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS o'L B'M'T 2nd ELECTRIC 1st 13rd NO HEATING O ,4O"TM OFFICES OF: . �? om Town of 120 Main Street APPEALS n North Andover, 'r NORTH ANDOVER BUILDING ;, :i::;^• ,a Mi ISS;WI I I ISCI tS 0 184 5 ! CONSE'RVA•1•ION SS,°"�°`5 DIVISION OF (61 7)G85-4775 HEAL'I•H ' PLANNING PLANNING & COMMUNITY DEVELOPMENT f KAREN H.P. NELSON, DIREC•COR t is i In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number 4( rS is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: 14-16lq 130p (Location of Facility) C Signature of Permit Applicant Date '1 NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. F F 11`4 A Town of 6 n over 483 S . _T$k� T ,r G's A C HEIT wICK\ e , Mass, OR QP- SS BOARD OF HEALTH PER ,MIT T 0 THIS CERTIFIES,T ,,,,,,,Ini „ ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ��' ...�� BUILDING INSPECTOR has permission to ereLORGuildings on ...... Rough e occupied as....... ...................................... Chimney r?-W(W/Asii14- w................... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this mit PERMIT EXPIRES I 6 ONTHS ELECTRICAL INSPECTOR Rough UNLESS CONST UC T TART Service Final ... .. BUILDIN � .,•.,' ECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises ' Do Not Remove Burner FIRE DEPT. No Lathingto Be Done Until Inspected and Approved by MEET K, P PP 1 Smoke Det. Building Inspector 2 5 9 Date...... N . .... 1".� t � NORTIi� TOWN OF NORTH ANDOVER o PERMIT FOR WIRING SSACMUS� �� 2vlc '� Thiscertifies that ..... ...................................-.................... .... ....................... *has permission to perform /'t � ' +' v� . ....................................................................... 1 wiring in the building of... ..!`.�.�e S L at...... ..Y. ... r .'.....ql..�,�f JJ�� ,,¢¢ ....................... .North AndOer,Mass. Fede. X.v�... Lic.No%�.3-7;.(......�;� ��(................ ELECTRICALINSPECTOR Check # �/ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer l.o�nmonwea[lh o�///adeac�itc�e� Official Usc Only y c� cc77 Permit No. �( oL.JePart`menf o�.}ire serviczd BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 11,99 [ 1.] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Clectrical Code(mEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE• ALL IlYrOl iVA7'ION) Date:_ .7 y/ City or Town of: /��, f�/�/, c V& P To the Inspector of IYires: By this application the undersigned gives notice 01-his or her intention torform the electrical work described below. Location (Street & Nulilbcr) �) )4 Owner or Tenant �&V6tv a,®e Telephone No. Owner's Address Isthisperinit ill collju�nqoli with a b lldin'*permit? Yes No ❑ (Check Appropriate Boz) 1'urliose of Building /�/Ito& - —,wl i r 0 Utility Autllorizatiun No. Existing Service Amps / 1ta s Overhead Existing ❑ Undgrd ❑ No.of illeters . New'Service Anlps / Volts Overhead❑ Undgrd ❑ No.of itileters: Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f IMP 0 1 Com lesion of the folloivinQ table may be waived by Clic h ector of wires. No.of Recessed FixturesNo.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting OutletsNo.of I•lot Tubs Generators KVA No.of Li kiting,Fixtures Swimnlina Pool Above ❑ In- ❑ o.o mergency Lighting Lighting, b arnd. arnd. BatteryUnits No.of Receptacle Outlets No.of Oil Burners FIRE ALARiIIS TP'o.of Zones No.of Switches 0 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges f No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers HentftNumber "Tons KW No.of Self-Contained Totals: i —� Detectiotl/Alertina Devices No.of Dishwashers Space/Area Heating K`V Local ❑ tilwlicipal El Other Connection No.of Dryers Heating AppliancesK\V Security Systems: No.of Nater No.of NO. of No.o�Devices or Equivalent KW Data Wiring:Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP I eleconlnluaications Wiring: f No.of Devices or Equivalent OTHER: - /V / � n 1Pre7v Attach additional detail if desired,or as required by 111dInspecior 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 Electrical Work: (When required by municipal policy.) Work to Start: - (�p Inspections to be requested in accordance tvitlt iVIEC Rule 10,and upon completion. I certify, under the pains and penalties of perjttq•,that the information on this application is true and complete. _ FIIZII NAME: L7 ' Li LIC.NO.: 1 Licensee: . 0 Signature LIC.NO. (If applicable,enter "e-empi"in the license,um+ber ne.) -7-�� I Bus.Tel.No.: Address: 1 �� 49 , j. AMe . ��9i Alt.Tel.No.: OWNER'S INSUV-A CE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. 13y my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PI:R411T FEE: 5 Date.///.!I . .. . . . . r- No . r 5 6 �_ of,",°�':�tia TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING •�,� "tis SSACMUS� �• i This certifies that . . . . . . . . . . . ... . . . . . ... . has permission to perform-: . . . . . . : . ...-. . . A plumbing in the buildings of :7, . . . . . . . . . . . . . at North Andover, Mass. Fee-``? . . . . . .Lic. No/�.9. 1'.�. . . . � ✓�.�-G.-;�� . . . . . . . . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING , go (Print or Type) ,MA Date ' 20 00 Receipt# / Permit# Building Location��g�rl Owner's Name Map: Lot: Zone: T e of Occupancy ms's 1 New Renovation ❑ Replacemen Plans Submitted: Yes❑ No ❑ Fee: N w ¢ y Y W ¢ y N N N U z } ¢ W Or O U F' = 0) Z J N W f' } m 2 ¢ Q o W a ¢ ¢ z n o Z w ¢ m ur t- W W Co O a w a N ¢ O W R = z y 0 > W UJ W 0) J ? Q = 2 M CW7 ¢4 W F W U S W ¢ O f' Z J F Z F W W O > LL F- W J F W Z Q W _ Q CC f- } N m z O 2 O y Z Q W > M W z Z Q ¢ Q Q O O W _ O W � ¢ = O C7 S LL 7 3 o C7 J U ¢ > O a 1- O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name EASTERN PROPANE & OIL, INC. Checkone: Certificate Address 131 WATER ST DANVERS MA 01923 Corporation Estimate Valueof Work: ❑ Partnership y Business Telephone 800-322-6628 0 Firm/Co. NameofLicensed Plumber orGasFitter �e INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have checked /des, please indicate the type coverage by checking the appropriate box. 1 A 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: w Owner L3 AgentO Signature of Owner or Owner's Agent I 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 thatall plumbing work and installations performed underthe permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the�eral Laws�Laws. By Type of License: Plumber Signature of Licensed PlygbeG�Fitter Title Gasfitter C./� Master License Number City/Town RJourneyman APPROVED (OFFICE USE ONLY) Revised 05/17/00 r BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME& TYPE OF BULIDING LOCATION OF BULIDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GASINSPECTOR Date. ........... NORTH °f< :• '"° TOWN OF NORTH ANDOVER R v FO . P PERMIT FOR WIRING �,SSACNUS� This certifies that E c has permission to perform .........�.... r. .....!. .........I...... ......................... wiring in the building of....... . '.� h ................................................................. at...... ... .{.................... ......... .North Andover,Mass. Fee...... .....:.... Lic.No./a!-s.?. , ELECTkICAL INSPE R Check # a ConmwnweaA o`Va6w" Official Use Only �eparfinant o�fire�ervricee Permit No. �L Occupancy and Fee Checked Jam= BOARD OF FIRE PREVENTION REGULATIONS gey. iw] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /I .- - p - efty-or Town of: y P,4t Dae To the Inspector of fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 5 a Aln Owner or Tenant Telephone No. 9 Owner's Address Is this permit in conjunction with a build' g permit? Yes ❑ No [V (Check Appropriate Box) Purpose of Building Utility Authorization No. 7 c=Z —7 762 Existing Service _S u nu d Amps 1::10/-aw oVolts verhead ❑ Undgrd M" No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters A Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I 4 Completion of the ollowin table TjM be waived by the Ins ctor of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans NO.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool A ve ❑ n- 1:1o.o Emergency g grrid. d. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1`l0.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiatin Devices .I No.of Ranges No.of Air Cond. oons No.of Alerting Devices No.of Waste Disposers eat ump um er ons ;o on t Totals: etctionl .n'YDevices No.of Dishwashers Space/Area Heating KW Local t con; or [3 Other No.of Dryers Heating Appliances KW arity stems: Nam.of ices or E ui alen No.ofater , No.of No.of Data 'rig: Heaters signs Ballasts N of Devices or E ni. al t; No.Hydromassage Bathtubs No.of Motors Total HP a No int trona irrp No,,of Devices tr°E ttia stir OTHER: 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:&�//G- L L Inspections to be requested in accordance with NEC 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 [I BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the inj madon on this application is true and complete. FIRM NAME: 7 LIC.NO.: 6 Licensee: �R -D,' ��,,q p Signature LIC.NO.: (Ifapplicable,enter "exempt"in the license number line.) Bus.Tel.No.• Address: ,L,. r�-�Ze;p� gzlt 4, ell qzN Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Pudic Safety"S"License: Lim 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 a ent. Owner/Agent Signature Telephone No. q PERMIT FEE: $ /� Zoe/ r