HomeMy WebLinkAboutMiscellaneous - 155 WATER STREET 4/30/2018i.
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o� 1go TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that -e ....................
X~
has permission for gas installation ....?.Y..� 1.? ...............
in the buildings of .........................
at North Andover, Mass.
Fee. .n'.C- Lic. No.. �'........
GAS INSPECTOR
Check #
5544
,%%SSACHCSE M UNIFORM APPI�ICATON FOR PER'�IlT TO DO GAS PTCI'ING
(Type or print)
Date Z -2 /Q
NORTH ANDOVER, MASSACHUSETTS
Building Locations I S,—r � ��� � — Permit k . S J�yy
Amount 9; Ac-
Owner's
cOwner's Name C�v
New ❑ Renovation ❑ Replacement ❑� Plans Submitted ❑
SUB-BASEM EN
B_ASErtENT
]ST.
FLOOR
2ND.
FLOOR
3RD.
FLOOR
4TH.
FLOOR
5 T H.
F L O O R
6TH.
FLOOR
7TH.
FLOOR
8TH.
FLOOR
(Print or type)
Name
Address
stness
i
Zdx royL—�
//a- 1,104 G J -C
�6-H
i
C one: Certificate Installing Company
Corp.
❑ Partner.
0-Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE • Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Q---- No ❑ ,
If you have checked yes, please indicate the type coverage by checking the appropriate box. EJ
insurance policy 13 ---Other type of indemnity 1:1 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 ❑
" hereby certify that all of the details and information l nav
hest of my knowledge and that ,dl plumbing .kork an instal
'cinpliance with ,ill pertinent provisions of the ala, achuset
By:
Tale
CitviTewn
APPROVED ,CFFICE r:SE
ttea (or entereu) in aoove appncauon are true ana accurate to me
P�jformed and Permit Iss for this application will be in
;,(jas Code ar>hapter Wof the General Laws.
Si nature of Licensed Plumber Or Gas Fitter
Plumber
oCas Fitter Ltc—t�G"u�err
. taster
Journetiman
6941
HOR7M
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
.......
has permission td
performs
plumbing in the buildings
of v�!.� - f- - .................
at .......... ...... :. ":.... ,North Andover, Mass.
4i Fee :'..... Lic.
No........
...........
PLUMBIN INSPECTOR
Check # C91i1
6941
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date , l'
Building Location /—�a— 1407r?'� _ 5 Permit is 9i//
Owner fCleh l -W ���C �/Q Amount <?d
New Renovation Replacement El Plans Submitted Yes No
FIXTURES
i
.:
P.
_. •
• M
■ . . ••
(Print or type) l
Installing Company Name t%d�7�✓S
Address " �� •��
Check one: Certificate
19 Corp.? 3
E] Partner.
E] Firm/Co.
Name of Licensed Plumber: /W�/
Insurance Coverage: Indicate the tvpe of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity D Bond D
Insurance Waiver: I, the'undersigned, have been made aware that the licensee of this application does not have any one of the above
4� three insurance
Signature Owner El Agent 1-1
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 installati s performed and ermit Issued for this application will be in
compliance with all pertinent provisions of the Massachuse S to Plubing d and Chapter 142 of the General Laws.
By Signature 34-Licensea riurnocr
Type of Plumbing License
Title - Z
City/Town icense Mumoer Master Journeyman D
APPROVED (OFFICE USE ONLY
�TOWN OF NORTH ANDOVER
-a PERMIT FOR GAS INSTALLATION
This certifies that ... .........................
has permission for gas installation ...'? .Y - �............... .
.�.-f
in the buildings of . P `; !ze! C. ................
at ../.:. a!Sr.? ..�> !- ............ North Andover, Mass.
Fee. Lic. No../?? . 3.`�..... . •..... .
iAS INSPECTOR
Check # / ) / t
5143
.. MASSACHUSETTS
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
New ❑ Renovation ❑
s Name
Replacement n
PERNff TO DO GAS Ff 1TNG
Date 6 _
Plans Submitted ❑
Permit # s / y 3
Amount $ 3 o —
(Print or type) Chh c cpne: Certificate Installing Company
Name �Cc/ %`/s4 �enry Corp,
Addresses x `� ❑ Partner.
Business Telephone j'� �- -( s'Z� -S �I--2 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitters i/jOG c 3
INSURANCE COVERAGE k.necx un
I have a current liability Insurance.p icy or it's substantial equivalent. Yes No
If you have checked Les, please in tate the type coverage by checking the appropriate box. ❑
Liability insurance policy Other type of indemnity ❑ Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 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 ana tnrormauon 1 nave suvnuucu kUL V,._�,�-) --- —11 w.- .. -- •-••- -
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State,�ads Code and Chapter 142 of the General Laws.
(OFFICE USE ONLY)
Signature of Lic2 sed Plumber Or Gas Fitter
❑ Plumber /„?03-
❑ Gas Fitter License Number
Master
❑ Journeyman
4TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOjR
(Print or type) Chh c cpne: Certificate Installing Company
Name �Cc/ %`/s4 �enry Corp,
Addresses x `� ❑ Partner.
Business Telephone j'� �- -( s'Z� -S �I--2 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitters i/jOG c 3
INSURANCE COVERAGE k.necx un
I have a current liability Insurance.p icy or it's substantial equivalent. Yes No
If you have checked Les, please in tate the type coverage by checking the appropriate box. ❑
Liability insurance policy Other type of indemnity ❑ Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 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 ana tnrormauon 1 nave suvnuucu kUL V,._�,�-) --- —11 w.- .. -- •-••- -
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State,�ads Code and Chapter 142 of the General Laws.
(OFFICE USE ONLY)
Signature of Lic2 sed Plumber Or Gas Fitter
❑ Plumber /„?03-
❑ Gas Fitter License Number
Master
❑ Journeyman
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
?.
This certifies that ...P.`' L"-. . .. 1. .1.
5 . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perform ... R C.P), 0 ,, M{ -f ................
plumbing in the buildings of . P< -A t1. !�r. .<,6 ............
at. ............. North Andover, Mass.
Q -
Fee. Lic. No../ 2.c).-7 y . ........ .
PLUMBING INSi;YE'CTOR
JMB
Check#
MASSACHUSETTS UNIFORM
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location
k
of
New M Renovation FVJ Replacement
F]EXTURES
'LI ATION FOR PERMIT TO DO PLUMBING
/ Date
Permit
Amount
Plans Submitted Yesa No
(Print or type)C.hec °ne: Certificate
Installing Company Name �y li/ NA �� W Corp. ef
0 Partner.
0 Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the a 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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massach mitts State P bing Code and Chapter 142 of the General Laws.
ar ,�
By: Signature of 9censedum r
Type of -Plumbing License
Title fl�V
City/Townicel se Nuuni er Master 3" Journeyman ❑
APPROVED (OFFICE USE ONLY
1
Y
Locationx-,;:�6- X117 t/jA� 1/ -/-
No. %3.r?, Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
d�
TOTAL $ -1- f
Check # C�;9,-�,
182289
Building`Iraspector
�-' TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT ELM& RENOVAOR DW MOWSH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: .—Ji 4A.&L..
Building Conunissioner or of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Numbs:
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dons:
Lel Arm Frontage(ft)
1.6 WELDING SETBACKS A
Front Yard Side Yard Rear Yard
Reqwred Provide Required Provided Required Provided
1
1.7 Wow supply NCCLL.C.40. 34) 1.3. Rood Zone h&nnstion: 1.1 Seweap Disposal system;
Public ❑ Private 0 zose Outside Flood Zone ❑ Mmicipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1t: Ui8tnct: Yes r.h
2.1 Owner of Record
Ne nt) / �Address for Service : `
�I �J 02-?/
Signa re Telephone
2.2 Owner of Record:
Name Print Address for Service:
Si tore Telephone
SECTION 3 - CONSTRUCTION SERVICES 44
3.1 Licensed Construction Supervisor.
Licensed Construction Supervisor.
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature____ Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 121
Workers Compensation Insurance affidavit must be completed and submitted
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No ....... 0
SECTION 5 Description of Propond Work check an appscabb
New Construction 0 Existing Building ❑ Repair(s) ❑
Y
with this application. Failure to provide this affidavit will
Alterations(s) 0 1 Addition ❑
Accessory Bldg. 0 Demolition ❑ 1 Other ❑ Specify
Brief Description of Proposed Work.
y I LD f�vl1,�/ I N row �iSZ c c�/�
I U 1Q rt> I L c i i ut/ t w I T- �-f P- S J A[ .� .
14ZVVTTON A - RATrMATRi1 VnNe1rD1rTr-r1r^W r ruv rc
Item
Estimated Cost (Dollar) to be
-Com pleted by permit applicant
OPFICIAL USE ONLY
1.
Building
(a) Building Permit Fee
Multiplier
2
Electrical
(b) Estimated Total Cost of
Construction .
3
Phunbing
Building Permit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total f 1+2+3+4+5 (���
CII!`TinN 7. nWrJVn ATT'r[iA1E0*7 A qrV u
Check Number
...... VVr=rJ
OWNERS AGENT OR CONTRACTOR APPLIES FOR
BUR DE% PERMIT
I, C• ` �'RlAeQ z "` tip' , as Owner/Authorized Agent of subject property '
e �
Hereby authorize to act on
Mylf, ' ma ative w work authorized this building uig permit application.50
�L
Si atf Owner Date
SECTIO%N� 7bOW AUTHORIZED AGENT DRC LARAIlTION
//
I, GMS 9 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
C-6 (\ UR.')V,a 1 r
NO. OF STORIES
SIZE OF FLOOR TI>VIBF.RS 1 2N U ,RD I
DMNSIONS OF SILLS
DIMENSIONS OF POSTS
DIJENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
1S BUILDING ON SOLID OR FILLED LAND
IS BUILD IIJG CONNECTED TO NATURAL Gaq T rKw
,j
D. Robert Nicetta,
Building Commissioner
Please print
DATE:"rU NQS
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
Telephone (978) 688-95454
Fax (978)688-9542
JOB LOCATION: I_Z2�-15-9 "Ier
Number Street Address Map/Lot
HOMEOWNER
/,C 6/'?.37ff, C,//04.Ckt/n
Nam6 Home Phone
PRESENT MAILING ADDRESS
N
Work Phone
U1` K) SUi,iy-2-
0 �) 0'�1
Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the
owner acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended
to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and at he/she will comply with said procedures and
requirements. /_1) j47
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
f30.UD OF APPEALS 688-9541 CONSERVATION 6R8-9530 I ]EM, 111 688-9540 PLANNING 688-9535
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Date........:....... �... .. ....
., f NORTH 1
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSACMUSE� i
i
This certifies that ......... .. .......... ...............
has permission to perform-,-- ', /.. ? .:.4 ... �..... ..: .. Z .............
wiring in the building of ........
ll jf
at!.. .., �.... ....-.... North Andover, Mass,.
Fee��-.i�". Lic. No�( .. ��W..���
~ELECTRICAL INSPECTOR %
Check # /
5 b 5
�\ C.ommonw�a�� o� ///aiiacliwel�
1JrParinunl o��ira �irvicoi
BOARD OF FiRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PE
All -work to he perl'ornicd in accordance with the htassachc
(PLErf,SE PRINT ItV IIVK Ott TY{'G :l _L 1VF02.VA770N)
Citv or l'oNN-n of:
By this application tite undersigned gives police 0-17 his r her i it . tioi
Location (Street & Number) -
0 NY I I e r
umber)Owner or Tenant PV"10 C , /'O,G) "f
Owner's Address
Permit No,
Official Use O y
cupancy and Fee Cltceked
kev. 11/99] (lege blank)
ORM ELECTRICAL WORK
rlectrical Cade ( IE -Q. 527 Alt` E) no
Date: . 6 q 200.E
To the Ins/ ecto - o Wiles:
crfornt the clecn ical work described below_
Telephone No. G-2 3
Is this permit in cotijunc uti with a building permit? Yes � No v .
❑ (Ghee(: Appropriate Box)
Purpose of Building_ kevde� Ce- Utility Aulliorizalion No. 2
Existing Service 60 Anips 12O / 2 Colts Ovenccad�Rr Undgrd ❑ No. of Meters
New Service -?op Anips /20 12 ` 0vwts Ovcrhe.ad-�r Undord ❑ No. of deters
Number of Feeders and Antpacity
Lgcntiouand Nature of Proposed Elecirical Work: �„rf; j(D_ /' ®M G�P.� t 1 t�W) %inti n C'/.
No. of Recessed Fixtures
No. of Ccil.-Susp. (Paddle) Fa.ltstVo-
.•«,r vc ,.cu.ru ar clic rrrs error of trlrYs.
of `Total
I'rattsfonucrs - KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Sivinnuiltg foul Above
grnd. !
grad.
g
o.o niergency g uut
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
t o. of getection anti ..
IF.itlntina'D^_: ces
No. of Ranges
No. of Air Cond.. Total
Tons
No. of Alerting Devices
No. of \Vaste Disposers . :..
Heat Yump
Totals:
.[Number __'ons
1•IDetectioit/Alertific
. of Sclf-Contained
Devices
Nu. oC Dish+vaslters
S act/Area Heatin K�V
g
cal h_unicipalp
ConnectionOther
No. of Dryers
Heating Appliances I{\y
urity Systems:
No. of Devices or Equivalent
No. of WaterK\`,
Healers
t\o. of tVo. of
Slaps Ballasts
Data \Viring:
No. of lleviccs or Ecluivalellt
No. H� dromassage Bathtubs
No. of (Motors Total hIP
1'ciccommarncations �\ firing:
No. of Devices or E uivalent
OTHER:
ittaciia(iattiottoi acitrit y aesrrea. oras rcgtiired by ilic hisFecYor of [vires.
INSU"NCE COVEIL-\GE: Unless .waived by the owner, no permit for the performance of electrical work may issue unless
}
the licensee provides proof of iiabiliiy insurance ri clud:n,` "con;pit:iCd vj.cr,^.tion- covcrzw;c of its substantial equivaiciit. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSUi -LANCE ❑ BOND ❑ UITIER ❑ (Specify:)
(Expiration Date)
Estimated Valuc of Electrical Work: (When required by municipal policy.)
Wort: to Start: lnspcctions to be requested iAall ) t Rule 10, and upon comole[ion.
I cerrifj•, itNdc•r the!rains aitd pell allies of perjury-, [(gill the inforplica un is true alld complete.
FlIL•\I ��AME: ROBERT PRIZIO ELECTRICIA LIC.NO.: #16156A
Robert Pr;zio SignatureLIC.NO.: R�F
(ifapplica 1 ,emu "�:r;u, in rite lie ice ntaab rune.) Bus. Tel. No.: � �754-9637
14 Orton. treet Ext.., 10rcester, -
!;AJJress. Alt. Tel. No.: 1242 cell
-O\\�NER'S-INSURANCE WAIVER: l arts awarcthat the-Liceluee does rtor have the liability insurance eoveragc norma v
required by taw. Eli• my signature below, thereby waive this requirement. 1 ant tilt (check omc) ❑ owilcr ❑ o.rticr's agent. �
Owner/Avert[. _...... .. _ .- .
Signature Telc hone Nu. Pj.: i111T FLT: S �S
aw 0 t S (--,,
w1v )hc 00a 0 ofog op 01! 3.
Date ... �0's .....
�to ,eye O
TOWN OF NORTH ANDOVER
PERMIT. FOR GAS INSTALLATION
This certifies that ............ ' ✓ ...............
has permission for gas -installation ... ......... .
in the buildings of ... L ... .
at ..�'"� ......... North Andover, Mass.
!� Fee>".. Lic.�
<.r tt ........ .
IN�PEviOH..
Check #
515
MASSACHUSEI'IS UNIFORM APPUCATON FOR PERMPr TO DO GAS FrrnNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date .1 - v S
Building Locations /,---74,` cPermit # v ��
Amount $
/�P�c�es - Jrus L -L C7 • Owner's Name �a-le 17- LSC' .
New (� Renovation Replacement S Plans Submitted ❑
I.�J
Check Certificate Installing Company
N 13f W ��c ��, f Wclorp. C 3S %3
ame
Address �7 . Dc, 7 `. /.2 % ❑ Partner.
usiness Telephone 3v fs-& O- s 3 ya I (le. 0 ❑ Firm/Co
(Print or type)
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE uiecx Un
I have a current liability Insurance licy or it's substantial equivalent. Yes No ❑
If you have checked yes, please i icate the type coverage by checking the appropriate box. ❑
Liability insurance policy Other type of indemnity ❑ Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 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 mtormanon i nave suormueu kUr UXILUMU) UI auvvc djJF %,auun am uuc ai,u Qa.—ai w x.11
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts St to Gas Coded Chapter 142 of the General Laws.
APPROVED (OFFICE USE ONLY)
Signature 6T Licensed Plumber Or Gas Fitter
❑ Plumber lao3.1
❑ Gas Fitter License Number
�Iaster
❑ Journeyman
•
,SUB-BASEM ENT
2ND. FLOOR
,5TH. FLOOR
7TH. FLOOR
Check Certificate Installing Company
N 13f W ��c ��, f Wclorp. C 3S %3
ame
Address �7 . Dc, 7 `. /.2 % ❑ Partner.
usiness Telephone 3v fs-& O- s 3 ya I (le. 0 ❑ Firm/Co
(Print or type)
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE uiecx Un
I have a current liability Insurance licy or it's substantial equivalent. Yes No ❑
If you have checked yes, please i icate the type coverage by checking the appropriate box. ❑
Liability insurance policy Other type of indemnity ❑ Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 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 mtormanon i nave suormueu kUr UXILUMU) UI auvvc djJF %,auun am uuc ai,u Qa.—ai w x.11
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts St to Gas Coded Chapter 142 of the General Laws.
APPROVED (OFFICE USE ONLY)
Signature 6T Licensed Plumber Or Gas Fitter
❑ Plumber lao3.1
❑ Gas Fitter License Number
�Iaster
❑ Journeyman
C .rnmonwea& of /r/aidacIt"elLf
_ ,parinunl Siraic+e
BOARD OF FiRE PREVENTION REGULATIONS
0 APPLICATION FOR PERMIT TO PE
All wurk to he performed in aceotdanee with the Massachi
(PLE:I.SE PRINT !tV liVK OR TY'E .,I .L l W('ORA .17/ON)
City or'1'own of:
44 ak
By this application the undersigned Lives Volice of his dr her i 11136t' 0
u. do
Location (Street C Nutttber) I -5 IS Q
Owner or Tenant
Owner's Address
011-1621 UsnM
Permit No,
cupancy and Fee Checked
tev. 11/991 (Icavc blank)
ORM ELECTRICAL WORK
lsleetrieal code ( flit). S27 nt 12.00
Dale: 6 2.00's-,
To the Inst ector of Ryes:
ierform the elecn-ical work described below. r' t
_ Telephone Na. sc 2 3
Is this permit in conn
juc 'uti with anbuilding perntit? Yes � No ❑ (Check Appropriate Box)
Purpose of Iluilditig (d e,( Ce- Utility Aulhoriznliun No. 2-1
Existing Service �Do* Amps QQ l � colts Overhead Undord ❑ No. of deters
Nest• Scrvice 200 Antis 120 0t' A`olts Ovcnccad-�T Underd ❑ . No. of Meters
Number of Feeders and Ampacity
L cation and Nature of Proposed Elertrical NYork: ( ' 1 D c S
J a on- )' AO I,Ith-A d IDOi G
I V ContRetion ofthe follouine table may be traived by rhe lnsnermr of 11?res_
No. of Recessed Fixtures
No. o(Ccil: Susp. (Paddle) Fans
NO. of 'Total
fransfortucrs KV A
No. of Licyhlino Outlets
No. u! iiut Tubs
Generators' hVA
No. of Liahtin� Fixtures
o b
S�vimmnino Pool Above ❑ In- ❑
a �rnd. rod.
o. o mergeucy tg lung
Battc Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zoites
No. of SwitchesNo.
of Cas Burners
ction
t o. of London and
Ir.;tiatin e:ccs
No. of Ranges
Total
No. of Air Cond. 'Pons
No. of Alerting Devices
No. ofWaste Disposers
P
Cleat Pumtp
Totals:
Number 'Pons
V _
No. of Self -Contained
Detect ionlAlertino Devices
No. of DishwashersSpace/Area
Heating KW
Local C]Nlul icipal C] Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of water
Heaters KNV
N0-0 1 tNo. of
Sins Ballasts
baln Wiring:
No. of Devices or Equivalent
No. Hvdrontassaoe Bathtubs
V
No. of Motors "Total HP
Telecommunications �\icing:
No. of Devices or E ui�alent .
OTHER:
tr
co -s
g IDDM
I&(�F,4.
Ul/,
ope p %'(t
Attach odditiorrol derail if desired. or as required by the Inspector of Wires.
iSUR �iNCE COVE ILA G E- Unless waived by the o,.%ncr, no permit for the performance of electrical work may issue unless
t licensee provides proof of liability insurauce including "eompicted ofcratioit" coverage oc its substantial cquivalemt. 1'h:
idersigncd certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
HECK ONE: INSUR:\NCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Ezpirnion Dace)
stintatcd Value of Electrical work: (When required by municipal policy.)
fork to Stan: Inspections to be requested in accordance 7th t Rule 10, and upon completion.
cerdfy, under rhe 'nils and penalties of perjaq•, that the infonnatioa or his rplica un is tree oral complete.
LIC. NO.: 4� 16156A
IIUM TAME: ROBERT PRIZIO ELECTRICIA c _
icenscc: Robert Pr; pie _ Signature LIC. NO.
applica f eu er "e a in the lic vee numb rLuc.) Bus. TeL No.: � „`e-9637
ddres a U beton treet �Xt • e �lorcester, 01604 Alt. Tel. No.: ].242 cell
\\ NER'S 1NSURAvCE WAIVER: 1 am aware that the Licensee dots not have the liability insurance eo�eragc norma v
quircd by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑puma ❑ oier's agent. 0
vucr/Agent Pi'Rti11T FE•E: S
nature Telephone Nu.
SQmAcQ &C. U�A Q. 55
WH 2110 rf0l;V tY4 W)AM + 'lir I'i 6A 1-1 Cl al-rl I D I-JOAY 11hP 101V
1- 'c F T u X11/6ak v
20-05
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