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HomeMy WebLinkAboutMiscellaneous - 15 WEYLAND CIRCLE 4/30/2018'10222 Date.... .....�....��... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........f *%W ........ Q -, %e .... has permission to perform ..........CSU ........S. f� �_ ,� ?..... wiring in the building of........�...,�' ........................................ ................. 1 at ........................... .... .... .......:.......... North Andover, Mass. .................. Lic.N...........Fee......... / . ... CTRICAL INSP UT4 0R Check # — 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 I 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 Y electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be.deemed_by- the ,Inspector_of_Wires abandoned.and_invalid.ifhe—.. _ 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 extending1hrough August 15, 2012. l.ommonwea& of MamacLe Official Use Onl�y-7 Apad..t o1 }ire Serviced Permit No. L._ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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: -1 Lf I ( i City or Town of: N %zr +Wy\ A AeA e, \J e,� 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 z— -T r Qy c.-5 Telephone No. si (o - 5-;k /5-6 Owner's Address 's q Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install residential security system Completion ofthe fnllnwinv fnhle mmi ha wnivod h„ Iho t—.,—mr.,f W;r No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total v Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency Lighting Battery 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. Total Tons No. of Alertin Devices g No. of Waste Disposers Heat Pum Totals Number ""' ' ' """' ""' Tons """"""""" KW " '' """' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kms, Security Systems:* No. of Devices or Equivalent No. of Water Kms, Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �-(d� (When required by municipal policy.) Work to Start: 3 p 1 1 ( Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRMNAME: Nightwatch Protection, Inc. LIC. NO.: 7 0 2 4 C Licensee: Paul DelSignor Signature LIC. NO.: 7024C (If applicable, enter "exempt " in the license number line) us. Tel. No. • 888-722-9282 Address: 22 Briarwood Drive, Westford, MA 01886 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SSC00000969 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 No. PERMIT FEE: $ r . Lx Office Use Only q / uhe Cf ommoniuenith of f tt000thlmett5 Permit No. 13t�lt rtmtrit t7f Public tlafttq Occupancy A Fee Checker -1 3190 (leave blank) a BOARD OF FIRE PREVENTION REGULATIONS 521 MR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 0 A6 (%* or Town of NORTH ANDOVER To the Inspector of `hires: The udersigned applies for a permit to perform the electrical work described be( ,J c Location (Street & Number) Owner or Tenant 64 kIAoc.,[� C-0 is' Cwner's Address 22-33 -IL,=& 1 n I ke-- no- s 4— i X2 , -C ' r ;t !s :his permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purocse of ?uiiding 2 (�� Utilitv Authorization No. 4506 S7.2- Existing Service Amps —J `dolts CVer.n.ead _ Unagrnd — No. of Meters New Service 4236D Amps 120 aQ VOit` Cvernead — Undgrnd No. of Meters �— Number of Feeders and Ampacity Location, and Nature of Prccosed E!ecmcaf 'Nor,( Tc:at No. of U nc Cutlets No. :f Hct T.:cs No. of Transformers gr, K`,'A Atcve— 'n - No. of Llgnt!ng Fixtures Swimming Pcoi g.•r.c. _ -rr.c. — Generators K`+A i No. of Emergency Lighting No. of Recectacie Cutlets No. of Cil Burners Sattery units No. of Switcn Cutlets No. of Gas Surners � FIREALARMS No. of Zones No. of Ranges 9 .-ata, Air onc. No. cf AC ;ons I No. of Detection and Initiating Devices No. of Disocsais -eat ';tai --:-, Nc.v Pumcs Tons C.v No. of Sounding Devices No. Sart Contained No. of Cishwasners ScaceiArea Heaur.c C.'J ' Doted: on/Sounding Devices a No. of Orvers seating Devices — Municmai Conrec::dn _ Other No. of Nc. cf I Low Voltage No. of Water Heaters KW Sicns ?a:'as:s Wirin g No. Hvaro Massace Tubs I No. of Motors Totzi -+P i CTHE'. INSURANCE CCVERAGE: Pursuant to the recwrements or Massacn"etts ger.erai Laws ! .^.ave a current Liae:iity Insurance Policy irc.ucir.c Corr^:e c Ccerat:cns Coverage or its sucstantial ecuivaient. YES NO = i nave suomttted vaii proof of same to the Office. YE -5 CNO = f you nave cnecxea YES. ;:lease indicate :he type of coverage ny checxing the aap O .are box. INSURANCE BOND = OTHER = ;Please Scec:h:; - (Exoirauon Patel Estimated aluegof Eiec:/ al Wdrx 5 g � // � // .vorx :o Start // �� Inscec.:cn pare Racues:ec: Roti n l( (( r nal Signed under :n Penalties of perjury: r / FiF".1 NAM U , LIC. NO. Licensee Signature NO. Bus. ei. No. - S$�/( All. Tai. No. Address C*.NER'S INSURANCE WA VER: I am aware that the L.censee does not have :he insurance coverage or is sugstantial equivalent as re- cuirea ov Massachusetts General Laws. and :Mat -:v signature on :.^.:s zermit aDplicarcdn 'Naives this requirement_ Owner p� Anent ,:Pteasa cnacx cret 1 'e;ecrone No. PERMIT FEE 3 (J� (Signature of Owner cr Agents �ie:s�:cti.,:,,..,r^-- ,., .o;- Y_-1�„�s.�-...-,.1y.«:�"T�-+"�.i:,��-•+ca,-- =t= a� Date ..... ..... %.. ... �x 462 t N� o7M '1 TOWN OF NORTH ANDOVER0. A PERMIT FOR WIRING ff ,Ss^CHUSE'� - r This certifies that ... ...., ................................... has permission to perform ... � .. N.................. wiring in the building -o€ ..J . ir,r .... ...... .. ........... ....................A T ri at .......:. ..................... . North Andover, Mass- Fee.2:... ..�... Lic. No..�. �? ,t ...... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location ��;�__ No,. Date 12 b 1c, x TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 2 Foundation Permit Fee $ �. Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Z Building Inspector t� 12/111/95 13:39 1,239.00 PAID T� 94-36 Div. Public Works as #r^,_ :� ..w .-...�,.w,•.��. .. -,- _ _'K _ .fir -R � _S 'rr2-ti y//:q��R. _ _�j9v ..._ _ r �1 Wcation AT Date aRT„ Of TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ SS�cMusEt Foundation Permit Fee $ Other Permit Fee $ - Q Z Sewer Connection Fee $ /� Water. Connection Fee $ 1/9?7. TOTAL $ 70 J'b 'r�41/t5e11000.00 � �Duild'ri`g Ins ;tor I, 000.00 PAID f `8965u A l 6ivl ,OutAlc works 414 Location 5 Atm C tL . No , " 5 Date " NORTN TOWN OF NORTH ANDOVER p , . Certificate of Occupancy $ -Building/Frame Permit Fee $ 1�404us�"h Foundation Permit Fee $co Other Permit Fee $ _< Sewer Connection Fee $ < Water Connection Fee $ TOTAL Building Inspector .i/09/95 13;56.. 150.00 IIID ) r3'3 cP Div. Public Works r f PER31IT NO. '. L 7 7� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. Z PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO.--, -p L-OCATION—' ---+� I PURPOSE OF BUILDING OMI,NER'S NAM E¢—� NO. OF STORIES SIZE OWNER'S ADDRESS 3 3 C BASEMENT OR ARCHITECT'S NAME /U e7 BUILDER'S NAME /�/ _! G• t ) ? SIZE OF FLOOR TIMBERS 1ST 1N/ /g 2ND v [� V 3RD SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS 3 //,;;L v DISTANCE FROM STREET n _ DISTANCE FROM LOT LINES -/SIDES /J l REAR f% '� GIRDERS AREA OF LOT 7 /] /fy�7 6 FRONTAGE /� HEIGHT OF FOUNDATION i1 THICKNESS 7S IS BUILDING NEW j/�v�vV Y' SIZE OF FOOTING ,� x a( ? IS BUILDING ADDITION �/ �� �I.A MATERIAL OF CHIMNEY IS BUILDING ALTERATION J IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ,L/� IS BUILDING CONNECTED TO TOWN WATER S BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 4r- __f IS BUILDING CONNECTED TO NATURAL GAS LINE 41-1-F SEEBOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 INSTRUCTIONS 3• PROPERTY INFORMATION LAND COST 1> t^ �..,1 PERMIT FOR FOUNDATION ONLY EST. BLDG. COST J (/ REGULATED BY PARA. 114.8-S. B.C. EST. BLDG. COST PER SQ. N V PAGE 2 FILL OUT SECTIONS 1 - 12 • ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDINGDATE W FEE PAID--� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR /`7 •DATE FILED GNATURE OF OWNER OR F E E ►33 PERMIT FOR FRAME/BUILDING PERMIT GRANTED L6 71 19 DATE: z- EE PAID -6.? MAPERM LW FVA WIEFRUIE PERMIT $..... .,� ... I EST. BLDG. COST PER ROOM /7) SEPTIC PERMIT NO. 4 APPROVED BY �. ..sem :. ���► • 671>— / CONTR. LIC.# 1990 H.I.C. # � (o� ot, — z� - v *i z. A BUILDING RECORD 1 OCCUPANCY SINGLE FAMILYSTORIES 12 _ THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT'AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS 6F, BUILDINGS. WITH PORCHES. GA - RAGES, ETC. SUPERIMPOSED. THIS -REPLACES PLOT PLAN. \ ' , f 7 L s' ' ,4 - _ -\ ry �s ;• a •- \ , j , - SPH - MULTI. FAMILY OFFICES _- APARTMENTS _ CONSTRUCTION - 2 ` FOUNDATION 8 INTERIOR FINISH CONCRETE 'xi •PINE 3 t 2 13 CONCRETE BL'K. BRICK OR STONE HA DW D PIERS . PLASTER `.""� DRY WALL UNFIN.• 3 BASEMENT AREA FULL FIN. B'M'T'-AREA V. '/o 1/1 FIN. ATTIC AREA _ NO B M T HEAD ROOM - FIRE PLACES , _ _ MODERN KITCHEN 4 WAILS9 FLOORS CLAPBOARDS CONCRETE EARTH B 1 2 �_ �— 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW'D COMMCN ASPH. TILE STUGCO ON`MASONRY' STUCCO{iN-FRAME -BRICK 5N MASONRY - BRICK ON FRAME ATTIC STRS. & FLOOR I i CONC. OR CINDER ELK. WIRING STONE ON MASONRY STONE ON -FRAME SUPERIORPOOR _ ADEQUATE I NONE I 10 PLUMBING BATH 13 FIX.) TOILET RM. 12 FIX.) 5 ROOF GABLE HIP GAMBREL MANSARD FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE - NO PLUMBING TAR & GRAVEL STALL SHOWER ROIL 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 _ 7 NO. OF ROOMS B'M'T 2nd _ 1st '� 13rd I RADIANT H'T'G UNIT HEATERS GAS OIL ELECTRIC, NO HEATING I Al _lw. —44 1 VW V 1;i'Stjj L CN r .. 12 H O O i tr` w w z ^2 w �/-1 i YY11 Z� � i -i F C�" W C4 z ►M z e u 1+1 a Z A W j� cn o a _ �� 7 a z � w° n C U n cQnc cn° cA ujY Q z E d L O 2 O 0 F. y y .CD L O co C3 !d CA O O O CL y O cc cc fl. CA rte, i 0 y C CT C m m 0+ t dM - N3 cr 9 CJ tr` m C6 :o w0¢ '- m cm O J� N J �o w v co) dE= o m C., rj0 0 :: co C m m i N C_ — m = m � � c N p N m m o H O p as o c O ccCi-;C,;, > Z o .� a Q y O C m cool t. � E W v ca cm V .� CDN _ R =�a,m � E d L O 2 O 0 F. y y .CD L O co C3 !d CA O O O CL y O cc cc fl. CA rte, i 0 y C CT C m m 0+ t dM - N3 cr 9 . FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. **************j***Applicant fills out this section******************* APPLICANT: X 0 0 y 6z/�tio 1TV 6 rY� Phone a11 1 d LOCATION: Assessor's Map Number Parcel Subdivision �LQ X 1A ) 6 O G/ Lots) q Street `if/ -2U /8 N ��! i^C �e St. Number ( 7 ************************Official Use Only************************ RECONII4ENDAT ON OF . TOIWAGENTS : i' d Conservation Administrator Comments r �L s tL ,_p Q a Town Planner "4 Comments 10114 - Food Inspector -Health Septic Inspector -Health Comments Date Approved v /� Date Rejected Date Approved Q l Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections `IT 14) - driveway permit ---(-Z7-L0 l D-/�o - �,�T Fire Dep tment, ��- A -VR eived by Bui] N e ��Xt � ts'«x, %.Aa+ri "t.; tkS�y.,.n"-cl�mF�r Asa ,i« c :F�.-r.caxic�T ?» '.c•. :'.rc ar - a r�" x �` m.�*4-'y...__....-r__•..._ i �"°� "` �'Tds�'�"'.'-�t�- M s';�.*.34.a.a ; fiaa,. � i .o>! ePF �r c : +^ d. y �.. ..F t. E c� �'.: � �'�„s• �*.4.»•.a�`i.`�y� R�� ,�P <� lP•O�y -im �'� T' 'k� t rs f u. ;:.JM � '`:. L4,-0 � •6 n .N. rvx'4'-.. r r �£- "'C. r F '+'" x -� ";�X.. ""3^ � ¢`-rI"`�`" +�'�`r�,�ayx �;y-y* � 'yt•xt�->..u�Y� � '.�tA.:«'un �..,:.y ^c'i- i, 4wr�.d�,txf� S h .�t� s«. ^a +r.',�--s �w--t-t"5a r � .;-et „� F.r 'r a-6�.'�ra. v.�;u� y �'�. '�.� w'd�R:k'�4 �,�'�-+� � tom. ss ��.:. � ars - w .y. •" � .. , is +- * ,' w-9e ww � Jnr r.: `� s. r= .:. a -t � ; s *a4�a Y� «t`ia—My s. - Afw�l.$W B X5 3Z4xa Zz �� � o Qp 6 3 s6 \ \ t S i/EPf BY CECT/Fy TO TyE T/T(_E /,</SU.P0.�.4,t/O T?% Ti/E BA.V.r T.ygT T//EOA✓ELG/.tK /S COCATEO O.V T,yE caT.lS .ssniry A.vo T,�ivT/T oafs cvvFae.�! JY/Tip/ T.S/E 7acr.�/ OFN• �o,�oor6�, ZON/.vG ,c�E6vLATib,�Cs' .�6.I.eO/.KS .SETQ.IC.t'.S' FG0�11 ST�PEc�TS � LGT L/HES. "' 1' FU.�Tif�C.0 CE.�T/FY TiViOT T.fU.S OiY'ECL/NB /s' �t/OT LOG4TE0 /N THE FEG�.�,P,4G fiCAOO f/AZA.�O A.PE.4. SHawK O/V FfMA' CO��It/�//TY P,�NGL '� Z 5 ao 98 0007C GA E e,=I- or 74/pfs%�/Oo�E.e/ IV6V.../7 /ASS �E��/�A�X E.vG/.tiEE.P/l/6 SE.P/i/lES 6G �q.P,(� ST.rEET ANOOYE.� /y14SS.4Gf/!/SETTS O/8/O 1 g 77; • CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number_ Date tA -� THIS CERTIFIES THAT THE BUILDING LOCATED ON 14 0j 9 C e MAY BE OCCUPIED AS �'/w C' L E- 4::;0qw• i ly IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO b X Q d d Q R6X 17— ADDRESS ui! ing Inspector r i a1) O FM4 W a4 a .O z x V coo GOO a - iQj • W � '2 cn or a : acc \\J 1 w° cn 0 w 0 U a o c: 'o v; o q. O FM4 xa ,, oCD v W rw i e.r Z. C� C, r4 CL LLJ L m a � �,; (tel C C co CL CO2 COD co r O m U ca O O+ J� i co0 y. cm a - N ev m y - m 3 CD c> �.. .." m 0cc C2 , Q: y C� m CLC.3 CID CD CA w ,b, m ` m .j �.." o 1. cj Z O ! C AtM ly 1 CL O N � o � C N z WCA W b- V m V G � "= CO) a. CD. �= z a`�,.� c 0.. .O z xa ,, oCD v W rw i e.r Z. C� C, r4 CL LLJ L m a � �,; (tel C C co CL CO2 COD co r O m U ca O O+ J� i co0 y. cm a - N ev m y - m 3 CD c> �.. .." m 0cc C2 , Q: y C� m CLC.3 CID CD CA w ,b, m ` m .j �.." o 1. cj Z O ! C AtM ly 1 CL O N � o � C N z WCA W b- V m V G � "= CO) a. CD. �= z a`�,.� c 0.. 3390 Date ... _.... `........ . R NORTH TOWN OF NORTH ANDOVER py`t..o ,e 1tip` p PERMIT FOR GAS INSTALLATION Tois certifies that :. /� :-e- ............. . h is permission for gas installation f...... tri the buildings of . ,�--�- .................. at...... � .. .. .... -- . , forth Andover, Mass. Feed. Lic. No.�?�'�... �. .......... li/ 1ti21 1 G GAS I OR ''' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MAP PARCEL MASSACHUSETTS UNIFORM APPUCATON FOR P01MIT TO DO GAS FITTING or print) NORTH ANDOVER, Building Locations 1/1 A Owner's Name NewRl Renovation ❑ Replacement ❑ Date � 0. —�) 19 c Permit # Amount $ ,j ) M Plans Submitted ❑ N Name of Licensed Plumber or Gas Fitter Tl ➢ lk one: Certificate Installing Company .� '�- - ❑ Corp. ❑ Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes EM No ❑ Myou have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ i "er'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 ❑ I hereby certify that all of the details and information 1 best of my knowledge and that all plumbing work and i compliance with all pertinent provisions of the Massacl (OFFICE USE ONLY) Pmitted (or tered) in above application are true and accurate to the tions perfo&ld underrmt Issued for this application will be in State e andter L42 of the General Laws. Signature of 1 Plumber ❑ Gas Fitter ® Master ❑ Journeyman F z Z C z c a ° z 9 W d x w ° E ° °" a W >. U d W d Ir F > p W > Ci a w Z Q 5. a VOj d O O W G O > o a E✓ O \\JJ SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6T H. F L O O R 7TH. FLOOR # # 8TH. FLOOR N Name of Licensed Plumber or Gas Fitter Tl ➢ lk one: Certificate Installing Company .� '�- - ❑ Corp. ❑ Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes EM No ❑ Myou have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ i "er'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 ❑ I hereby certify that all of the details and information 1 best of my knowledge and that all plumbing work and i compliance with all pertinent provisions of the Massacl (OFFICE USE ONLY) Pmitted (or tered) in above application are true and accurate to the tions perfo&ld underrmt Issued for this application will be in State e andter L42 of the General Laws. 3ed4flumber Or Gas Fitter Icenseum er Signature of 1 Plumber ❑ Gas Fitter ® Master ❑ Journeyman 3ed4flumber Or Gas Fitter Icenseum er N2 2296 Date ...... TOWN OF NORTH ANDOVER 0 #- pPERMIT FOR WIRING k ........ t 15 t�-- ( -f C iA (' C' Thiscertifies that ..... ............................................. has permission to perform .......... f. wiring in the building of ..... .......................................... at ..... ......... ....... North Andover,$ -Mass. 1 Fee ...... Lic. No. .... .. ......... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use only 44 DEPARTM1JVT0FPVBL1C&4FETY Permit No. BOAMOFMEPREVEMONRWULATIONS527CMR120 Occupancy & Fees Checked uq",-�APPUCATION FOR PERW TO PEUOR ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datg.�,,�� a „� Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street A Owner or Tenant To the Inspector of Wires: Owner's Address ���III�r•.. ��� .��� I�II.MI�elY�l1 ■ A 1�.1�.11 Is this permit in conjunction with a building permit: Yes [Z] No © (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service AmpsVolts Overhead Underground No. of Meters Number of Feeders and Ampacity A1,. k Location and Nature of Proposed Electrical Work 'e r9 M G �+°» ° ►� 1 • ,�, �l No. of Lighting Outlets i3 No. of Hot Tubs No. of Transformers Total VA No. of Lighting Fixtures Swimming Pool AboveBelow Generators KVA ground 0 ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Sips Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER • ..�_ Irst>r�IoeCo Raslla<dt�thetegtritat�t>Ss�(.ral�'allaws ItmeawwtLiatnlilyIrom oePbli-'itrdudmgCon �ft i Coveragorits WYUMet}nvalat YES NO 1tmee%lbm1edvdhdptoofof%nle1oftOffD-- YES MNO n ff}(ut sedtedcedYES,pleaseir thetypeofwvaWbydtedmgtbe �CE M BOND p o R]IR p ) IIi�l1�.1 E11VAr Wak $ WakiDS., ,.I....,,....� D.*Ra*xsW e�0' ...r_I��.I� FvW vs2 a !S,fit ricI;o eNa d 7 G S Lioam N d15f k c� . m I l d' >✓ Lioa>seNo q n ff � a,I �_'� �1 , eInb°' A1tTeLNa ......�.�...r11.�® OWNEWSINSURANCE' (Please check one) Owner Agent n /) �"--'+ Telephone No. PERMIT FEE v Location 4-6— No. a� Date 3 Do TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ga' �-- Foundation Permit Fee Other Permit Fee TOTAL Check # 137?9 Building Inspector SIGNATURE: e Buildin Commissionerfl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 15 wGYLAN D CAaCLE 1.2 Assessors Map and Parcel Map Number Number: a3 Parcel Number C.lnf 9 ) N • AN Drp V E:� _ M A . O 1 � � � 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided 1.7 Water, ty M.G.L.C.40. 54) Public Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone 1.8 Municipal Se a Disposal System: On Site Disposal System 0 SECTION 2 - PRUPERTY OWNERSHIP/AUTHORIZED AGENT r 2.1 Owner of Record Lc-- 14, WMAOC GR_cLE N. AtvoWV!(z NM �- Sal Telephone 2.2 Owner of Record: Address for Service : Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ MAP-WMAJ ✓ 8V ILDI N.4 1& 'DE514N Licensed Construction Supervisor: I lSc,-SE. X OAgD ;* TLIW4SM g0 I M A • License Number dress Z 8 • �o� � " 8 rJ% Ci Expiration Date s / Telephone w 2 3.2 Registered Home Improvement Contractor 14ARLOUNI , SV 1 LUl N �j ' TaES tCa R� Company Name - `r' i N4S8t20 . Ah A . 01 - Not O °f r Registration Num'be�e�1td..> 8 130 J00 Expiration Date A I SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... )' No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ,� Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: F N1S1-% EyiSrIN4 3ASEMEN ► AS PSE R ?l A14S � SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Completed by permit applicant 151000.06 FICIAL _x. _ , (a) Building Permit Fee Multiplier USE O1�ILY ...... 5� 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing 018 Building Permit fee (a) X (b) 1 . 4 Mechanical HVAC 1000. ou 5 Fire Protection �- 6 Total 1+2+3+4+5 OGe7 -Op Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property He y authorize MAPRoWre SII. O 1D�eS1c�fV to act on My behalf in all matters relative to work authorized by this building permit application. Signature opeVier Date SECTIO 7V OWNER/AUTH RIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property - Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N e 3�25'd0 Si a ure of Owner/A nt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR ITABERS Or 2ND 3RD SPAN DR\, ENSION$-OE SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I pphh�n d d� --------------------------- ----------------- ---------- a a �%a .UIZIiCI � m 0 •D i u iA W e e ----- -------- ---------------------- ------------------------ -------- jT D. m O � a sn r V _ E19 - T r .9x -Eu - o, to I U I Z C> Z pl O O — I U ►— C7 c - _ I C CD O cA 1-- O O W OU v O cn etc o• t aN N U \ 1D CcoC7 W G OD Z — W O Z =19 K ... = W rr O O ' S ¢ GJ X c ? 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CERTIFICATE OF LIABILITY INSURANCE 061°101999 PRpDUOER TMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Palmer Goodell Ins. Agcy, Inc. ONLY ' AND CONFSiS NO RIGHTS UPON THE CEFrMCATE HOLDER, THIS CEFMnCATE DOES NOT AMEND, EXTEND OR 2077 Roosevelt Avenue ALTER TM COVERAGE AFFORDED BY THE POUCIES BELOW. EACH OCCURRENCE S PO Box 9040 Springfield, MA 01102 INSURERS AFFORDING COVERAGE INSURED uvsuRERaI Norman -Spencer McKernan, Inc . ACCuservice Corp. INSURER 6: --._ 186 High Street INSURER C: Windsor, CT 06095 IN"ERG; _ I NSLRIF.R e INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POEJCY PERIOD INDICATED. NOTWITHSTANDING THE POUCIES OF ANY REOUIREMENT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERRN IS SIAWEOT TO ALL THE TERMS, S=USIONS AND OONDITIONS OF SUCH POUCIM AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. pd�c�► N TYPE OF INSURANCE PORGY NULLBER ew cr - ewtti LIMfiS GENOUL UABILrrV EACH OCCURRENCE S CCU MERCIALGENERALLWBILRY MEDAMAGE (Any amfim) S MED IW (Any one Oman) 8 CLNMS MADE n OCCUR PERSONAL & ADV INJURY S GENERAL AGGREGATE 3 OENI.AOMSRECIATELIMITAPPLIESPER' PRODUCTS-0W1OPA130 5 pOUCy JET LOC CT AUTOMOBN.E U IASIU1Y OWERN50SINGLE LIMIT g ANY AUTO ALL OWNED AUTOS ILINJURY _ $ _ (Par - --- -SCHEDULED AUiUS--- ----- --_ HIRED AUTOS BOOL.Y INJURY g NON-OMED AUTOS– _ — PRDPEFITYDAMAW S (Per accusal) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO CnLr. ACV. S EXCESS LIASRM EACH OCCURRENCE I S_ _ OCCUR CLA6MS MAGE AGGREGATE S DEDUCTIBLE S RETENTION S A IQI AN wORKEm coMPENSATD B INDERI2 0 0 4 8 0 5/ 31 / 9 9 0 5/ 31 / 0 0 DTH• So _. TORY LIMITS EB.. EaR'LOYBRa• LR18 u" EL EAC14 ACCIDENT j$100,000 E.L DISEASE - EA EMPLOYEE Sl Q Q , 0 0 0 _ - - - EL OISIJLSE - POLICY OMIT I SS O O O O Q 015WRIPTION OF OPERATICNGR=ATMMrmHCLESfEMCLUWAM ADDS BY = To Show Evidence of Workers' Compensation CERTIFICATE MUL.DEfl 1 1 ADDITR>17ALW5UM ll:W:5UMrwL -11r �.w�v-_ • ,w n� SHOULD ANLYOFTNE ABOVE DESCRIBED POUCIESBE CANCELLED BRFOIETH! OPM74I + Marlowe Building & Design DAMTKE3iAF. TILEISSURLB INSURER VLLENDEAVOR TOLWL-40—DAYSwRRTEN 404 Middlesex Road #1 NDRCETOTHE CERiRFICATE HOLDERNATAEDTOTMELEFT, SUTFAILURE TiODOGOSMALL Tyngsborc, MA 01879 IMPOSE NOOBUGATIONORUARKMOPANYwnDUpon THE INSUREnnsAGENT$OR FIRDEeffAlm AU 7H01i1= FEPRCOWATPA 7M l of 2 #S 2 7 51 i iv,27 5 0 DMQ ® ACORD CORPORATION 7986 r"' � �''y"��.x�'.�s ,4 ,v. m+�"f y, ? ''i } v x "- ' � k � � F u''"a,-�'`� ��w�- i'-3�5' •�����.��" ^�7 - - y;E DEPARTMENT OF PUBLIC SAFETY 210426 ONE ASHBURTON PLACE, RM 1301 — BOS T N �A 62108-1618 CONSTRUCTION SUPERVISOR LICENSE c Number: Expires: Bi -r to la b CS 014685 06/19/2000t__��95 -_1m` --� 1,=. - - -L__ ; z# 3�! PETER D MARLOWE 108 NORRIS RO+'`' rg TYNOSBORO, MA 01879�UN� ✓fze VOWMmomawmu HOME IMP.RO/.EMENTi Cot 3oard' - ofBu%]dng` .Rei 0r�e Aii bdrton P' — PRIVATE°'CORPORATSt MARLOWE BUILDING & DESIGN INC PETER D. MARLOWE 404 MIDDLESEX RD. #1 TYNGSBORO.MA 01879 ,rid S+; �4 �ol Keep top for receipt .and change of address notification. 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