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Home My WebLink AboutMiscellaneous - 16 Grafton Street (2) 0'0000-£S00-O'eZ0/OkZ 13381S N013H J N of 7 I i I I i Claims Processing - Arnica Scan Center Toll Free: 1-800-59-AMICA 1 PO Box 9690 (1-800-592-6422) ` Lam°5 Providence, RI 02940-9690 Fax: 1-866-759-3140 {AUTO HOME LIFE I 4 June 9, 2015 Town of North Andover 120 Main St. North Andover, MA 01845 File Number: 60002041673 Date of Loss: 02/08/2015 Owner/ Insured: Edward A. Boughan Street: 16 Grafton Ln Town: North Andover Type of Loss: Freeze To Whom This May Concern: Please be advised that we insure the above named individual(s). A claim has been made for Damage to Real Property and as the insurer, we are presently in the process of adjusting the loss. We are mandated to comply with Massachusetts General Laws, Chapter 139 and as such, if there are any present liens on the above property, please notify us within 10 days of receipt of this letter. If we do not hear from you, we will be under no obligation to pay you any portion of this claim. Sincerely, Ci��'��Zf1 � Cie222P�t/G6 Cristina S. Carreiro Claims Department 800-592-6422 x47029 CCARREIRO@AMICA.COM I AMICA MUTUAL INSURANCE COMPANY AMICA LIFE INSURANCE COMPANY AMICA PROPERTY AND CASUALTY INSURANCE COMPANY AMICA LLOYD'S OF TEXAS AMICA GENERAL AGENCY.LLC. WEB SITE:WWW.AMICA.COM • � � The Commonwealth of Massachusetts zr - = Perri[ b: (l:t icc Use Onl Department of Public Safety Occupancy 6 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) 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 --),r/ 7 City or Town of /".`q 1ndy<`2 To the Inspector if Wires: The undersigned applies for a permit to perform perform the electrical work described below. Location (Street & Number) v C5 /��F TO S Owner or Tenant 1'f-'- Ei.C Owner's Address v, 4 Is this permit in conjunction with a building permit: Yes No L__I (Check Appropriate Box) � I Purpose of Building Utility Authorization NO. Existing Service /620 Amps l / `l 0 Volts Overhead ❑ Undgrd❑ No. of Meters A New Service 'Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- 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 Heat Total Total No. of Sounding Devices p Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Y g Connection No. of Water Heaters KW No, of No. o Low Voltage Si ns Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: O C ✓} / T!� �/ 2 PC 7—d 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 ❑ -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) �Y/ C. P t/ Expiration Date Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: 7 / 7 /J FIRM NAME ) LIC. N0. �/ ( 7' ( 1 Licensee 1�abg t'; C �`/e/C-r � Signature � 1 LIC. NO. Address 8 Q t"'4I)C Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stan 1 equivalent as r quired by Massachusetts General Laws, and that my signature on this permit app is tion wai his /qu cement. Owner Agent (Please check one) Telephone No.CSr �,�`S (3 �j PERMIT FEE S Signature of Owner or Agent M Do Not Write In Here 3 D N For Electrical Inspector Only M r M ' ll Street and No. n DName .....................:..................................... Z Electrician .................................................... PermitNo. .................................................... Comments .................................................... 'Q. -v+.c^-y,.�4:+Y.I�a...--��:, .S•�r^`i „?•eIt-�""^—�.^.^.«y,a--�-.+ s- _ _ t -- Date...... .. . j..%.. z ► 978 NOR71, 3?°;<�``°.:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACNUS� This certifies that ...&1 rf?t.... .�u.�t.. 't:......................................... has permission to perform ...... .......... .�ta..�Z�LP ............. wiring in the building of.....4 C.�. .r..f.. ................................................. at....../!....0 r .,,..Cf rz f1.....(� ........................ Orth Andov r, /� Fee. ..:.dl�?.... Lic.No. ............. �i✓ LECTRICALINSPECTOR C . 'r-k . I I.I 06/03/97 14:28 25.00 RAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer NORTR 3?04. ,,1tiDOt Town Of North Andover A Plan • Building Department , " : Review I 508-688-9545 ,SSACH�St1 � I 146 Main St. Town Hall Annex APPLICANT: DATE: Zoning District: Use Code : Title of Plans and Docume Request : Q_A 61�/ Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violationof Height Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Open Space Insufficient Lot Frontage Sin requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By-Law Use requires permits prior to Building Permit Other Other Remedy for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign-offs Copy of Recorded Variance Information indicating Non-conforming status Copyof Recorded Special Permit Variance for Sin Other Plan RevleW The plans and documentation submitted have the following inadequacies : I 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, '4. Infoymation is incorrect. 5.All of the above. - # oundation Plan PlumbingPlans IF ubsurface investigation ertified Plot Plan with proposed structure —Construction Plans 127 Affidavit ! hanical Plans and or details Plans Stamped b proper discipline lectrical Plans and or details FramingPlan ire Sprinkler and Alarm Plan Roofing ootin Plan Plans to scale tilities Site Plan ater Su I Sewa a Dis osal aste Dis osal Other DA and or AAB re uirements Other Administration The documentation submitted has the following inadequacies : I 1.Information Is not provided,2.Requires additional information,3.Information requires more clarification, 4. Information is incorrect. 5.All of the above. # I # Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other -777771Other The above review and attached explanation of such Is based on the plans and Information submitted. No definitive review and or advice,by the Building Department,shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL.Any inaccuracies, misleading Information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled`Plan Review Narrative"shall be attached hereto and incorporated herein b reference. The building department will retain all plans and document on forthe orpo Y above file.You m de a building permit application form and or requ for pl review to receive ap oval. I Buildi a art t Ictal Signature Infor ation Received Deni d If Faxed Denial Sent If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety.Requirements for detailed plans are necessary to ensure that there Is enough information through plans and specifications to show that code requirements will be met. dation &2 li No,, Date �� f N011Th'1 TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s�cHus � - Other Permit Fee $ • Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 0_— Building Inspector i ? 10908 05/22/97 11:17. 78:68---PAR Div. Public Works PER311T NO._z !s7_ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP 4-40. Z 3 LOT NO. <3 2 RECORD OF OWNERSHIP JDATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. I II LOCATION �� i.�.9/-�Z� L/.✓� PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES ✓/Y SIZE OWNER'S ADDRESS ��/1 /.' �:C�� L �./� BASEMENT OR SLAB � �5✓j"��f�L ARCHITECT'S NAME �7�✓ SIZE OF FLOOR TIMBERS tSTZ,(/Q 2ND 3RD BUILDER'S NAME QN �� y� SPAN ��! DISTANCE TO NEAREST BUILDING` �� DIMENSIONS OF SILLS .2 X DISTANCE FROM STREET �7 Q POSTS Zx DISTANCE FROM LOT LINES—SIDES ® ! REAR ! " GIRDERS `� Y 3 AREA OF LOT L!, OUp FRONTAGE / HEIGHT OF FOUNDATION y / /1 THICKNESS w !� IS BUILDING NEW ! 119 SIZE OF FOOTING 7 `) �I X . ,9 E' IS BUILDING ADDITION f✓ S MATERIAL OF CHIMNEY G IS BUILDING ALTERATION/ �`S T IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF r:ODE 7�`•j IS BUILDING CONNECTED TO TOWN WATER `e'' BOARD OF APPEALS ACTION. IF ANY i/� IS BUILDING CONNECTED TO TOWN SEWER /va IS BUILDING CONNECTED TO NATURAL'GAS LINE t/ ` INSTRUC, 3 PROPERTY" INFORMATION -- LAND COST ` SEE BOTH SIDES EST. BLDG. COST /YZ,' (>�✓ , FT COST PER SQ BLDG. . . PAGE / FILL OUT SECTIONS 1 - 3 EST. EST. BLDG. COST PER ROOM /Oa PAGE 2 FILL OUT SECTIONS 1 - 12 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 e 64i� •UILDING INSPECTOR 2i� SIGNATURE OF OWNER OR AUTHORIZED AGENT amp FEE //�V '-d�/-�J/_►`/, OWNER TEL.# S�® I�� 36-3 ��{{ n PERMIT GRANTED `/� .� CONTR.TEL N 19 CONTR.LIC.t H.I.C.# 4-0 �� -- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYI 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 I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE. BL'K. PINE BRICK OR STONE HARDWD PIERS PIASTER _ DRY WALL _ UNFIN. 3 BASEMENT ll AREA FULL FIN. B'M'T' AREA _ 1/. 1/1 % FIN. ATTIC AREA NO B M'T FIRE PLACES iooF HEAD ROOM MODERN KITCHEN - 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D w, �_ • ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME v BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIORTE NONE I� POOR _ ADEQUA 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT j SHED WATER CLOSET _ ASPHALT SHINGLES iof LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 3 GRAVEL STALL SHOWER p ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. IS, COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G - UNIT.HEATERS 7 NO. OF ROOMS GA OIL B'M'T 2nd ELECTRIC 13,d NO HEATING - - ti Town of North Andover HORT4 OFFICE OF ?O�`•*`�o a,H O - L N �COMMUNITY DEVELOPMEa 146 Main Street r, -<- KENNETH R`-f HOMY North Andover, Massachusetts 01845 �SS4C4UStit� Director (508) 688-9533 C_.MOWN1ER "C-- SE EXEMPTION Please print. DATE /9 JOB LOCATION Number Street address Section of town "'rONIEOW-NTER'• l ,s i /7F°'/P3 Ste_ Name prone Work phone PRESEN+i NfAILING ADDRESS /61 ,U /,,y�✓od�' ��, oil Y� CitvrTown State Zip code The current exernption for "homeowners" was ex:e=ded to include owner-occupied dwellings of six units or less and to ailc:v such aen:eo:v„ers to engage an individual for hire who does not possess a license. provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEF INITION OF HOVfEOWN'.z: Ferson(s) who owns a parcel of ':and on.:vhici ae:sae resides or intends to reside. on which there is. or is intended to be. a one to si-x amil-r d:yelling, attached or detached structures ac- cessory to such use and/or fa_^ s -c:uras. A person who consuacs more than one home in a two-gear period snail not be considered a norreo her . Such "homeowner" shall submit to the Building Official. on a form acceptable to the 3uiiding Official. that he/she shall be responsible for all such wort: performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes for compliance with the State Building Code and other applicable codes. bv-la:vs. ruies and reguiatiors. Tae undersigned "homeowner" ca:.ifies that He:'s a understands the Town of No. Andover Buio -` im T ^ e lam, Depa��aent mrn t._. i:_ -.on prpc..c•.r_s and requirements and that he.she will comply with said procedures and rec,_,4_eme nt.s. HOME-OWti'R'S SIGNATURE2'aw'lLt 't'-�- APPROVAL OF BUILDD G OF. ,CIA Note: Three family dwellings 35.000 cubic feet, or la Ser, will be required to comply with State Building Code Section 1270. Consauction Control. BOARD OF APPEALS 688-9541 Bt1IIAING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Juiie Pwrino D.Robert.N_x a ]fic'saci Howard Sandra Starr Ka Wom Bradley Colweil I FORM U - IAT 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. **************,*'*,Anpplicant fills out this section***************** APPLICANT:APPLICANT: W (�� Phone l9 OS ` 3� LOCATION: Assessor's Map Number 3 Parcel —5:s Subdivision Lot(s) Street C-�4� LCUA St. Number L ** **x****** ********** ficial Use Only************************ =RECOMMMION OF AGENTS: /, Date Approved 7 1 hJ Conservation AdministratorDate Rejected Comments 7(0)1 14m, 3 vQ L4 V411 A 266 , p� a VWN - calve, Date Approved Town Planner Date Rejected Comments Date Approved Food In ector-Health Date Rejected Date Approved ,,,,E-5epeic Inspect r-Health Date Rejected Comments — Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date &IRTGAGE PLOT PLAN lE GRAFTON LANE- SCALE: l" = 40' NORTH ANDOVER, MASSACHUSETTS JULY 20, 1983 BUYER: LAWRENCE AND SUZANNE SCOFIELD D "r 77c5TEFAMO O J �ypA 7�S/STbE� OAF • �SER✓.�1 T/0�1 S LOTS 213 1.u 21,5 �- 21.000 �5 5 n ' AL�XA�ptK � �.GpR• _ � �o'aa' s•4 s 3� 0 1 5TH rR(r"d) / AC I?� ----m er AIS f-Z>'Pon `5478 �N OF NOTE: THIS IS NOT A SURVEY AND IS TO BE USED FOR MORTGAGE •'. PURPOSES ONLY. v N.B.- DO NOT USE OFFSETS FOR ESTABLISHING LOT LINES FOR THE x, 0111 ERECTION OF FENCES, WALLS, HEDGES, FTC. r TEA 1 HEREBY CERTIFY THAT THE BUILDING ON THIS, PROPERTY IS LOCATED AS SHOWN ON PLAN AND COMPLIES WITH THE ZONING SET BACK REQUIREMENTS OF THE TOWN OF NORTH ANDOVER.' `: CYRf;ENCANEERING SERVICES INC. 1 FURTHER CERTIFY THAT THE ABOVE PROPERTY IS NOT LOCATED 300`-'CANAL,STREET;*': IN A FLOOD PLAIN ZONE. ' tAWRENCE MASSACHUSETTS i bk 7-7- .. ..... / � ; ss w - , YYY 4 � FITI 3 / Z F X 2 3 dl g 4 OWF £ LJ_ ........,w.... ,......„. Y.eele �'t�`��i r "'r'�/�r�-�.s�lY/.7 �rrhu� — ,-,as�*�p�:E/ �f/ �� S-��Gfrr/M .��' � ��►�v Sl/ SL/7 Jo S � eZ4 /mss ' .� �, )(alp .7 V //'V4 of x -77 Iry 01,71 /,p ftf // M M - l s✓ ��7Y7nm7 N �'>� l• 1M 01 w o��/ dhni mon 0 n'a}X11 Jcy�l �//c�Ys/-7 , D/ hr�n�/ 7 �! r-7 t > 1 � a r I t r 1 . u�� a� E �. Ir E I 01 p I t9A*l17e- z �_.......,.,.... � .,�._,. ..,....w -W.........w,.. ._...__...,,..._..,.,�_,_....,.��.,..�,�....�..,w,_..,,..,......_...........,�... .w»,.,.,..�._,.5._..,� ...._. . •�y w�wa�;.�a�wvmnYw;vc... ..�, �.<. i p r x A 6 4 N � 7y.! �^M f..� X44. �.� , ,`. a�. 5 :'��.4 � � � .��°va`� �'+y.i � i a Pc. �a`� ��wd• 7 .....,. ..-w««�-...- .,. ...«-,..�...w.«,....... ...... ..a ..,-.:er.o ...:A......» uI.w...l ...>.e. ....,...... ..,.:.. ,.w..euew.+.,.... -.y,.....,,<..a.� e d � 0 7' __. ..._. _.._ ._. . . t . _ f _ . Jv .�a Ica el 9 Y � 3 g9 8 Y _----- ___ f erg.. «....:.....,.....,.,�.�..........,.:..- .T.,o..,.......y .............:........::................. ,�........:.,..., .<...-......w.....>.....:.«......-. ....-...,��.........x.:.-.._:... «„�....,.........,....,.......a....., .:.:,.....:,...«....:.. 3,....m..:�....+..,...,.,tea....... � jj3 1 { F 1 off X4foo F t { ' 4C-:/q,4 d N goox TO le sire / � Rev ' r'. �11��' ! .._ ............... mm. .«-... �. t.... ........_. .. ..... ... ... .... ...... ..... .:n,....„.. .... .. ._.�,..m.,,....�..»..,...n. ......-mow..... .. .r E 1 3 e a 1 i ♦q } { f : 111 �- TT F E i • , 3 3 # } a i s ? d $ TEL: (508) 475-1474 Ir� FAX: (508) 475-5451 I BATESON ENTERPRISES, INC. Excavating-Water & Sewer Lines- Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 1A v 7 , r 3 c. RAt) 1 - ``-(C) SORT Town of over No. 23$ dover, Mass., S 19LAKE MICMEMICK oDAA E S (G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 4%, BUILDING INSPECTOR THIS CERTIFIES THAT.............................. ................��.. .. .. ... D................................................ Foundation has permission to erect......... on......./...�o......... 3 , .F.....T...QIS�.....,(„A./ �...... Rough 1 ,p to be occupied as........................................ .t1�.. . A l�.� .. *4. ..k.�.�... .1 ,.,Nq.,..................... Chimney provided that the person accepting this permit shall in every respect conform to the tefms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. _ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough ............................ Service .... ....... .. ..... . ...................................... DING INSPECTOR Final fancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rte` ' { Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. r Burner Street No. Smoke Det. .. r r.__. z ., ...t_'."Y-vr"k_�-ti...�..�...�_. �. ,..�;.,�..CLi•I'e^,,y_,r-q�,;�...+..i17 Datet, . d� 3987A. �oRT„ TOWN OF NORTH ANDOVER 0�,��•o i•17•C s3? �t,p. -.... •• O O 9 PERMIT FOR PLUMBING ,SSACHU This certifies that —.e. '. . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to performF: ,-, G'v ..��•,,�.�' ,- ,� fi. ` v 3 plumbing int a buildings of .-.. . . . . . . . . at.l�. �.-.- ..� . . . . . . . . . .. North Andover, Mass. Fel4. . t. . .Lic. NoZWII` . . I ... PLUMBING INSPEC 0�� i E_ W 1� Appl�ffnt CAN&iY: N ing Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMI/TDO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date `�� 3 ��QQ _ r / Building Location ,¢ %y h/ 441 ners Name SC� /—rk-, J> Permit# Amount Type of Occupancy New Renovation Replacement r1_1 Plans Submitted Yes El No El FIXTURES z F z H rn 0 >0 O d va �► a x z z a z Cn a a F x a x w x � 0. � �. d � w w x w dF O rxi� r�i� z d Z CA cin A A E- W C7 ►�• A d F4 O SLRESVF. WE"M ISI:Rfm ?Nl Rfm 3M FLOM 4IH FLffR SII-I FLOOR 6II-I FIOCR M Rfm S]H Rom (Print or type) ��0 ..S � Check one: Certificate Installing Company Name 0l [,U / C 122l S ❑ Corp. Address o E9 4,4r 1 cS/ ❑ Partner. / U Business Telephone El Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ElBond 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 ab e a lication are true?6d accurate to the I hereby certify that all of the details and information I have submitte or entered)in pp best of my knowledge and that all plumbing work and installations ermit Issued for this ap m compliance with all pertinent provisions of the Massachusetts mbing Code and Cha 4 ofth a ral Laws. By: S-i-gn—a'?F;7Ticenseaum er Type of Plumbing License Title City/Townicense l um er Master Journeyman AP (OFFICE OFFICE USE ONLY hCX � �(0 lac �aauuoawwlt� ofBs>�s�usrt c,.�.,/I volg Office Use Only /� lDqwtniisse of PubhC Sqr Permit No. / ,lV BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 ,0 Occupancy & Fee Checked 7/90 (leave blank) or APPLICATION wFOR PEk to b@ ptirkinmidRMIT TO PEaccordance wah the RFORM ELECTRICAL WORK etts Electriocal Code, S27 CMR 12:00 (PLEASE PRINT IN INK OR jTYPE�ALL LIINFO&%"T OW {� Q Date-<. / / / City or Town of_� T�L_ / / VeK To the Inspector of Wires The undersigned applies fora permit to pedwA Ilse dscVJc0 work described below. raLocation (Street 6 Number) l rr Owner or Tenant / dl- Owner's Address Is this permit in conjunction with a bui pww"v Yes No' (Check Appropriate Box) r Purpose of Building _ Z Utility Authorization No. Existing Service L(J(/ Amps L2 �IL Volts Overhead Urdgrd ❑ No. of Meter New Service ---Nnps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TOTAL No. of L ighling Outlets No.of Hot Tubs No.of Transformers KVA AboveIn- No. of Lighting Fixtures Swimming Pool gmd. ❑ gind. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No.of Oil Burners Bauer Units No. of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones TotalNo.of Detection and No. of Ranges No.of Air Conditioners Tons Initiating Devices Heat Total Totar- No.of Sounding Devices No. of Disposals No.of Pumps Tons KW No. of Self Contained DtltedtorJSoundmg Devices No. of Dishwashers e/Area Heating KW Municipal No. of Dryers Heatin Devices KW Local❑ Connection ❑Other No.of Low Voltage No. of Water Heaters KW Sians Ballasts Wiring No. Hydro Massae Tubs No. of Motors Tool HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements Of Massachusnes General laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES n NO r_l 1 have submitted valid proof of same to this office. YES U NO LJ If you have checked e typ ES,please Indicate the of e aralle by checking the appropriate box. INSURANCE c7 BOND ❑ OTHER❑ Vlwe Specify) (Expiration Date) Estimated Value of Electrical Work i Work to Start Yrpection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAM17V / LIC. NO. Licensee , SfRnature . .C-1 LIC. NO. _ 1 lddress , O Bus. Tel. No.L� (!/r��f All. Tel. No. DWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts :eneral Laws, and that my signature on this psninit applcation waives this requirement. Owner Agent (Please check one) IA `' Date . ... .. . ! TO �. .. . ... I� ! NOR71{ 3a;�`,�`��•°��°per TOWN OF NORTH ANDOVER A _ p PERMIT FOR WIRING SSACH This certifies that ........ x has permission to perform ... .... ..........� `e— I` e.d.��.................... wiring in the building of......G.C. .c c.S�.�................................................. C at..:.,.(0.... ,North Andover,Mass. I. ............... Fee.019.3.73. Lic.No. .............................................................. ELECTRICAL INSPECTOR It .00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer