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HomeMy WebLinkAboutMiscellaneous - 1542 SALEM STREET 4/30/2018 I 71542 SALEM STREET - J 210/106.6-0053-0000.0 ` Date../I/ 1.�............ 11468 of"fpr"'ti TOWN OF NORTH ANDOVER ° n PERMIT FOR PLUMBING �SsgCHU5�t R ~'4 � �' This certifies that......................�...c':........�-�.................,......!✓�.tJn...............::................ _ has permission to perform..... plumbing in the buildings of......... . .:/ ..................... - ......................................................... at.......L.6a...7...•7.... -&.�...... ............ North Andover, Mass. Fee.....��..P..........Lic. Noo�Coa 3.7... ................................................................................. PLUMBING INSPECTOR Check# MP3 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITyl.)oT/[n ANdove� MA DATE ///Z//S— PERMIT#f 1� JOBSITE ADDRESS OWNER'S NAME ��ex ✓moi✓/. jr OWNER ADDRESS L��aZ $9-/f'''► Sf TEL 403 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL, PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT- PLANS SUBMITTED: YES❑ NOX FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER 1/7 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER F INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESA NO E] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ry 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 ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information 1 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 :E� wit all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C l 112 PLUMBER'S NAME LICENSE#a6 S3 1 SIGNATURE MP❑ JP CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME RI V&S RL,, t f/eahvj ADDRESS CITY AJSTATE /I09 ZIP TEL FAX CELL`I 'V 'el0-? 12(aO EMAIL MI - e- Ar 4"O T OWN OF ANDOVER MASSACHUSETTS BELOW FOR OFFICE USE ONLY _ _ PLUMBING/ GAS _ _ _ _ _ _ ____ PLUMBING/ GAS PLAN REVIEW NOTES INSPECTION NOTES INSPECTION NOTES FEE: $ PERMIT # ROUGH FINAL J P, Date.... .......................... 3? 07 TOWN OF NORTH ANDOVER * � PERMIT FOR GAS INSTALLATION #�o = 1s`SACHUS�� z This certifies that ..........1......l..!....................... ... E-t 5.................................... has permission for gas installation .... �,.......................... in -thebuidings of...... � .................................... at_... 5 ................ .�.....6 ................ North Andover, Mass. Fee.. ....:.::-w-..... Lic. NoeZ4?..�...�.....q.... ................................................................ GAS INSPECTOR Check# 1 0212 � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FIT TING WORI< CITY/t��G�/�l 4AJdY✓ef MA DATE _`�jo��lS PEP,MIT# q ='F JOBSITE ADDRESS lS /o?, J¢}�C s OWNER'S NAME MeX 67V'-4�t/ OWNER ADDRESS`5S TEL6,03 –� OV FAX TYPEPRINTR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMEfJT:.X PLANS SUBMITTED: YES❑ NO APPLIANCES I FLOORS-- BSM 2 3 4 5 6 7 8 9 to 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE X DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE — INFRARED HEATER I LABORATORY COCKS j f� MAKEUP AIR UNIT �— OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT I i TEST UNIT HEATER - UhJVENTEDROOM HEATEP. WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPP.IATE BOX BELOW I LIABILITY INSURANCE POLICY X OTHER TYPE 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 ONLY: OWNER ❑ AGENT E] OF OWNER OR AGENT I hereby certify that all of the details and information I have submilled 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 appfication will be in compliance vrith II Pertinent provision of the Massachusetts Stale Plumbing Code and Chapter 742 of the Gc-neral Laws PLUMBER-GASFITTER 14AME LICENSE-i SIGNATURE MP❑ MGF[:1 JP❑ JGF ❑ LPGI ❑ CORPORATION J El r; PARTNERSHIP E]# LLC❑# 1 COMPANY NAME /VerSflea 77 _ - -- ADDRESS_ jC' (,I \, �S CITY _ ra✓� STATE �lP= el8'1D__--- TEL FAX — _ CELL y7 YO9_/�!(cd -- E14Ailfyli�e ��> Jr,• l Q ,,, ROUGH GAS INSPECT'iON NOTES THIS PAGE FOR INSPECTOR USE ONLY' FINAL INSPECTION NOTES `fes No k" THIS APPLICATION SERVES AS THE PERMIT ❑ FEE: PERMIT n PLAN IZEVIE1-1' NOTES I - i i i T z3COMMONWEALTH OF MASSACHUSETTS, B©ARD O PLUMBERS AND GASFITTE,RS ISSUES THE FOLLOWING L1'CENSE # LICENSED A5 A JOURNEYMAN PLUMBER r©f MICHAEL C RIVERS`�` �i 8 FOXH I LL ROAD RiVDQ'E . MA 01810-1611 2653 05/01/16 203784 March 20, 2015 Inspector Of Buildings Town Of North Andover 1600 Osgood Street North Andover MA 1845 Claim Number: 033551916 Policy Number: 72179400004 Company Name: Arbella Mutual Insurance Company Date of Loss: 2/26/2015 Insured: Pryor, Sheryl Property Location: 1542 Salem Street North Andover,MA01845 To Whom It May Concern: Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Verytruly ours, Y Y Thomas Gollatz Crawford&Company 204 Second Ave Waltham,MA 02451 CC: North Andover Fire Department North Andover Heath Department Arbella Mutual Insurance Company i I Location No. Date ' f „°RT" TOWN OF NORTH ANDOVA Certificate of Occupancy $ �� '. . �• }�, - ;; Building/Frame Permit Fee $ 47S Foundation Permit Fee $ Other Permit Fee $ CU `U Sewer Connection Fee $ on_ Water Connection Fee --�-L�— � TOTAL $ "� Iwo Building Inspector T- 8683 Div. Public Works PER11IT NO. 914- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. �I LOCATION C PURPOSE OF BUILDING �bWNER'S NAME �• V O NO. OF STORIES b F G• SIZE ���✓��( OWNER'S ADDRESS /�� �� a BASEMENT OR SLAB r ARCHITECT'S NAME 1`J FYI/ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME C e ,' C� 1 � SPAN s DISTANCE TO NEAREST BUILDING`•J DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS (4j AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION Gr THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY - IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES (/,.�- 6�. b(i!+/ D"� `--f�•�•� EST. BLDG. COST 1 a�O,O PAGE 1 FILL OUT SECTIONS 1 - 3 o t 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED A BUILDING INSPBCTOR SIGNATURE OF OWNER OR AUTHORIZED AdENf FEE — OWNERTEL.# co 2-3 1)(9 PERMIT GRANTED CONTR.TEL.# 6 Z3-7`7 0`e / ` 19 CONTR.LIC.N H.I.C.# 3 0 1995 BUILDING RECORD r 1 OCCUPANCY 12 SINGLE FAMILY SiOR1ES 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 I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HA DW D — PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/. 1/2 % FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD\N'D _ ASBESTOS SIDING COMI.ACN VERT. SIDING ASPH. TILE 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 HIP BATH (3 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 OIL B'M'T 2nd _ ELECTRIC � 15t 13rd NO HEATING ..max ■ ORT aTownof 31 `z y _ rt �( dover, Mass., LAKE T COCHICHEWICK ��- a ADR TED P'P \ y A E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.. ......................................................................................................... Foundation has permission to erect..�� ......MAP.. buildings on..I T'41.......�4.Qrm.......�T................................ Rough to be occupied aPUk&4ft �.......�...rA0..... 14 . � .�hl,Ql� Chimney .... ..... ....... provided that the person accepting this permit shall in every respect.....c..onfor to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXP ONTHS ELECTRICAL INSPECTOR UNLESS CONS U S Rough . ... . ..................... Service BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove R Rounal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER —FINAL DRIVEWAY ENTRY PERMIT b , 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. ****************Applicant fills out this section***************** PLICANT: 44 K _( DPhone (0'94 LOCATION: Assessor's Map Number Parcel Subdivision ' / l Lot(s) G�eet J�/T� ST ` St. Number ' ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driv way permit re Department Received by Building Inspector Date 3 0 f995 M _ The Commonwealth of Massachusens - - Department of Industrial Accidents y' 5 AzkV d RYSS9 s ' r 600 Washington Street Boston,31ass. 02111 Workers' Compensation Insurance Affidavit locationi =i No AFFFF,d,,jel ) AA& phone# I am a homeowner performing all work myself. r7 I am a sole proprietor and have no one workins in any capacity CJ I am an employer providing workers compensation for my empiovees working on this job. SomFanv-name:.., address• city: - Qhone#. _.. insurance co. p olicv# I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: compan^name si—= 'mob address - _. . city phone#r insurance co . . policy 4 - .,.__ comRanv name: address- City- phone 4- insurance co nolicv#�JLfficlrl on s ee aecessa Failure to secure coverage as required under Section..SA of NIGL 15:can lead to the imposition of criminal penalties of a fine up to SI-500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify nder t pains a d p allies of pet�urm v th=the information provided above is true and corrects ASignatureDate ��30J Print name �' Phone 4 official use only do not write in this area to be completed by city or tower official LC'. y or town: permit/license# tiBuilding Department aLieensing Board cheek if immediate response is required OSelectmen's Office C]Health Department ntact person: phone d; nOther (M,ts d 31"PIA) e T. FLYNtV' y, LO Y 80 }hIV P. '1 t r di SEPH r ? N v a 13 , tJ2�ON Au MP Fou l'tN� ,u t N QAT ' SC-PTI;C M f LOCATED 1 t�1 29—oe 3$,_11xi SCALE I'=4_c? DP�'C E; . Nov. t e, Irni _ -22 -p�� •• ?' ri✓..[_.C.i�t�'S {�\� v �i i J e� T',' w;',;, ry 1�'lAr-STa `JTi LAWREW__r_ t lid c ri A5FHAI-T SHINGI-E5 TO MATGH EXISTING - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- - -- - - - - - --------------- ---t- - -- -------------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - = L- I L-N6 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .......... ..... ... ...... .... ........ q'\X/IPE X 7'HT, q '\Yll[)E X 7'HT. OVERHEAD POOK OVERHEAD DOOR GONGKCTE TKEATED TKEA ,, 6 X (I �)I IA- ,:j -- L, EVAT I ON 1 0 EX I- GKETE FOUNDATION u EX I ST I NU DWELL. I NG TRIM TO MATCH. EXISTING P.H, WINDOW / MATGH EXIST GUTTER . DAI�NDOAKP :.... 51DING . . . . . . . . . . . FIN. Gf EXISTING FOUNDAT I ON \GOWKi T06WTEL - - - - - -- - - - (� I CHT I IDE E L. E V4J I ON A5FHAL-T 5H I NGL-E5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- DAKNDOAKP I q NEW FA5'7 POOK TODNKKEL- EX 1 '�)T I NG FOUNDATION COLLAR TIES \ �,� 2 X 8 RAFTERS AT AT 32' 0/G 16° 0/G / I /2" GPX ROOF SHEATHING OUTLINE OF� \ ASPHALT SHINGLES EXISTING TO MATCH EXISTING / STIZUGTURE DEYOND 5/6" TYPE X. GWD MATCH EXISTING AT WALL ADUTTING / EAVE PETAIL5 DWELL I NG SFAC.E aUTTER` 2 X 8 GEILING JO15T5 AT 1 6" 0 G X 1 O NEW WOOP NAILER HEADER I DOOR I DOLTED TO TO STEEL DM STEEL DEAN TYI' IGAL EXTERIOR WALL; (SUFFORTED DARNDOARD 51PING (I 0' ) `o I I AT EA. END ORZWY I TYFAR DUILDING WRAF )E X 7 ' HT, 2 X 4 AT 1 60/G 1EAD POOR SOL TREATED 2 X 4 51LL EXISTING GONGRETE 5LAD � FINISH GRADE 111111=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III=III= — c —� 1=III_III_III_III_III_III_III=III=III_III_III=III_III=III-III_III=III-III_III_III-111_111=III=111_i11=111_111=III III ISI III III I�I III 111 III III ISI III ill IIl 111 �' EXISTING FOUREP� TODNXGTI CONGRETE FOUND- ATIONS TYF I GAL GFA'�)c�) SEAT 1 Affil SGALLE 1 1 /4 " = I - 0 ' C. U LL - ya S , X �Z � ��So L/ M= yq6 S = M r Date.........�. ."�o.....�..J a 2542 NORTH °t<�``�.:•�"° TOWN OF NORTH ANDOVER e 10 . PERMIT FOR WIRING This certifies that ...... i ��' >�..... :. .. ..t_.. has permission to perform~% f... :....... wiring in the buildin f.. �J/ 'r. . '�'... ... . ......... ....... at./,.-A..... .f�.f�. . ... ................... .North over,Mass. //�� Fee fj. ..� Lic.Nd�l.�.I.I.M ...........1: LECTRICAL INSPIrCTOR , 09/21/95 09:53 20.00 RAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File w ��• The Commonwealth.of Massachusetts Permit P4.. Office Use Onh Department of Public Safety 3/90 & k iCheck� BOARD OF 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 INFORMATION) Date (? L City or Town of /V. A A00 L0 Z To the Inspector'of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ` i SALEM S l Owner or Tenant r 6` ! t✓ , �� ` � f C Ya ALE Owner's Address bfAl'A` Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of BuildingCr!-1dZA lTE A121>1 TlGey Utility Authorization NO. Existing Service Amps / 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 W 74- al No. of Lighting Outlets No. of Hot Tubs No. of Transformers TKVA1 No. of Lighting Fixtures Swimmin Above In- g Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of oil Burners No. of Emergency LightingBattery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No_ of Disposals No. of pumps TTons Total No. of Sounding Devices No. of Dishwashers S ace/Area Heating KW No. of Self Contained Space/Area Detection/Sounding Devices Municipal No. of Dryers Heating Devices KW Local❑ ❑Other Connection No. of Water Heaters KW No, of No. of Low Voltage Signs Ballasts lWiring No. 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. YES(@ NO C] I have submitted valid proof of same to this office. YES❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER ❑ (Please Specify) 9/16/95 (Exp raEion Date Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME CONTINO ELECTRIC & CABLE INC. LIC. Nl%A11983 Licensee LOUIS. CONT I NO Signatur LIC. NO.E 2 o 7 8 8 Address 1 DONOVAN DR. WEST NEWBURY, 019 8_n Bus. Tel. No. 0 8 ) - Alt. Tel. No. 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) OJ Telephone No. PERMIT FEE S cT©s d 0 Signature of Owner or Agent