HomeMy WebLinkAboutMiscellaneous - 17 QUAIL RUN LANE 4/30/2018 !,
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Date..................................
i NORTH,
3:;•t;,`" :"�o� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4 i ^ •
,SSACMUS�
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This certifies that ........ .:.T.. .....T...... ............................
has permission to perform ...A.G....... ....................
wiring in the building of........... .�,.V�
at......0.......�-?Q4(e...R...................................,, ' orth Andover,Mass.
'
..
Fee...YS...�. Lic.No. .. ...... ...... .....
.
/ ELECTRICAL INSPECTOR
Check # 1 L.
'l 0865
a
- Commonwealth of Massachusettts Official Use Only -
a
Department of Fire Servlces Perm"o.
BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked
[Rev.1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
M work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT NINK OR TYPE ALL INFORMATION) Date: J,?O
City or Town of. NORTH ANDOVER 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) � - P
Owner or Tenant If Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No Et (Check Appropriate Box)
Purpose of Building VC_L€ FA 16% ,b W EZZ Z1ti 4 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:
C0__Y_#:__o the ollowin table maybe 3valvedhv theInspector o Wires.
No.of Receised Luminaires No.of Cell:Susp.(Paddle)Fans 0.01 Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency-Lighting
Lyrnd rnd. 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
Devices '
No.of Ranges No,of Air Cond. To-taTons Initiating
No.of Alerting Devices
No.of Waste Disposers 7Space1A
umber Tons * KW No.of Self-Contained
____.. _.._._._ ._.___._........__
�� Detection/Alertin Devices
No.of Dishwashers eating KW Local❑Municipal ❑ Other
Connection
1 No.of Dryers ances KW Security Systems:*.
FNo.
fWater No.of Devices or E uivalent
Heaters KW No.of No.of Data Wiring:
Signs Ballasts No.of Devices or E uivalent
ydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices ox E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: (5 '3) ')'L 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 thu�s-.ins andpevalties ofperjury,that the information on this application,is true and cop,p-ete.
J FIRM NAME:ZtA h �Ov 1J L ice-t 3zC LTC.NO.:._tS 40 15 -
Licensee: AYE. ® y�� Sign "� LIC.NO.:
(Ifapplicable enter"e empt'a in the Itc num be ine.)
Address: o 4 V LL �yt� � �� Bus.Tel.No.• -W
0 TI Z L- $ Alt.Tel.No.:
'PerM.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$
FILE
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rx. ecTON;
. l;'�sset�-•-[ �� �+'aileB--j 1 �e-xuspeetzoxtxequixecT(��O.OQ)�j �
Inspectors,comments: -
i �.lr !.1^•. • S. •
(r'nsp Wore Signature••no�fpjtials) Date
2.�'11� �c�zoz�; •
Passed- Failed--j ) Ae xnspeetion required($50.00)•-[
xnv eeto;e'e wMents:
(X 4actors'Oignature••7a z Date
r3.�UNDIAIR ��OM)N�'NTION:
omments. ,
Clnspectoxs'signatuxe-•?ao initials) Date
.ITSFAMON—SES►ICE.-
DATE,CAr T A-0 M a+O.i AL G319-131 : NA16�1 :• "
Passed.-- Re inspection required($50.00)
Inspeetbxs'comm.eits:
(Xusp ectors'Signature-xzo Wtials) Date
�.:iN�Jt'EC'z`XOIaT-•OTI�+S�c" '
'assed [ ) vAllerf•-•j '?ate-luspection xequfxed 050.00)-1 1
aspectore conim.ents:
�1n sZ1 ectors'signature xzo initials} Date
DDOff,TA.G,5.AM TO 13B��'�L"QED OUTAND XRFT ON RITE IF THE.APXA TO BE WSTECTUD 19 NOT
ACCESSIBLE.AND RE WRECTIONOF$50.00IN TO BY MMGED. r .
a .
CX The Commonwealth ofMassachusetts07 -
Department oflndustriglAccidents
Office of Investigations
Uf 600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name(Business/Organization/Individual): C _OOME:s )KO V'YO V f)7 :j-MN,
Address:
City/State/Zip: � s�m �rg 0 �A.01�l� Phone M '�6Q -s c�_/a,
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(fall and/or part-time)* have hired the sub-contractors
2.J'I am a sole proprietor or partner- listed on the attached sheet.? 7. ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.E1 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13.❑Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site
information.
Insurance Company Name%
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certto under flee pains anInenaldes ofperjury that the information provided above is true and correct. -
Simturw-::: �� GJ Date:
Phone#: ' 7 G O- -S) ) C-�,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other - - -
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required"
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to cavy workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filied out each
year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance.for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Co onwoalt� of mossachusetts
Depaftent of ladustrial Accidents
Office of Investigations
600 Washington Stroa
Boston}MA.02111
W,#617-727-4900 oat 406 or 1-87TMA.SS.AFB
Revised 5-26-05 Fax#617727;7749
www.znass,govfdia
Date. .-3/7, G.L... ....
HORTM
pf „ao ,°11.0
oTOWN OF NORTH ANDOVER
� n
' PERMIT FOR GAS INSTALLATION
t� SACMUSEtS
This certifies that . . ! .!'.!?-. .. . . ....r.�. .�'. . . . . . . . . . . . . . . .
has permission for gas installation . . . .`. . . . . . . . . .
in the buildings of . ^ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . . j 7 . . �,�'� .�: �. . . . . . . , North Andover, Mass.
i
Fee.).?. . . . . Lic. No.. 3. . . . . . . . . . . ,. . ...- . ,a---_. . . . . .
GAS INSPECTOR
Check#
MASS APPROVAL ,, 6z✓ 1OU,5- ' 3s �,)
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO W GASFITTING
Olrint ar Typel _
Av boozfz ,Mass. iJate0,3/97/-4 ..r Permit,tt _
BuBding Location /7 wp% )eunJ owrle:'s Name Je�1 Gr k C,l 1�
Type of OccuPancY �S!�i�) t� L
New p Rervation e"' Replacement 0 Plans Submitted: Yes No
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ave—asatT.
BASEME14T
IST FLOOR
G1 I
2ND FLOOR
a 3RD FLOOR
4TN FLOOR
5TH•FLOOR
4TN FLOOR
7TK FLOOR
`TH FLOOR
Installing Company Name YANKEE GAS Check one: Certificate
Address 140 SOUTH MAIN STREET Q Corporation 1010
MIDDLETON, MA 01949 [. Partnership
Business Telephone 978-774=2760 L Frm/Co.
Name of Ucenwl Plumber or.Gas t=itter WILLIAM R. HARRTS
INSURANCE COVERAGE:
I have a cu enYesntt liabilfly Insurance
a 2
u ce policy or Its substantial equivalent which meets the requirements of MGL Ch. 14
No 11
9 you have.checked yam, please Indicate the type coverage by checking the appropriate box
A liability Insurance policy (Z Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER:1 am aware that the licensee does nct 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 Owrw.=1 Agent 0
1 hereby certify that all of the details and information t have submitted(or entered)in above appicaticn are true and accurate to the best of my
•knowledge and that all plumbing work and installations performed under the permit isumd for this rpa'' will be" no with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the �'/
8y T of License:
Plumber gnalure m0er Or mer
e G
Titlasfitter
aster License Nurnbes 3785
Oty/rown Journeyman
I
Location
No. U � Date �1
gORT,y TOWN OF NORTH ANDOVER
Oft..o �1ti
A Certificate of Occupancy $ ! U J
} Building/Frame Permit Fee $ //7. 9 r)
►,ti0 N" ¢
ssACHU ,youndation Permit Fee $ `=
Permit Fee $
EjN bnnection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
;'
7047 Div. Public Works
PERJIIT NO. 0,2J APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGIE 1
MAP KJO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE
ZONE SUB DIV. LOT NO.
LOCATION 17 au,41e-- Xvhf 1 PURPOSE OF BUILDING
OWNER'S NAME Am e=s /4l',0.PON*-</ NO.� NO. OF STORIES SIZE
OWNER'S ADDRESS /7 l�y� BASEMENT OR SLAB _
ARCHITECT'S NAME �+f SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME /0'7Jk-e AV 710o A.) G,.//��/ �&I"S'7" SPAN GCX457-1w 6
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS �by'_f
DISTANCE FROM STREET POSTS car
DISTANCE FROM LOT LINES — SIDES REAR GIRDER 1A.,0 SUS w�QF�
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION 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 EST. BLDG. COST
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
Z PAGE 2 FILL OUT SECTIONS 1 - 12
EST. BLDG. COST PER ROOM 17
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 ���u- l /
BOARD OF HEALTH
SIGN jI O O N AGENT
FEE O
—7
��fJ PLANNING BOARD
D'
PERMIT GRANTE
19
BOARD OF SELECTMEN
OWNER TEL.# 7-v f�
: CONTR.TEL.# (-59-6272 1
c�2zU CONTR.LIC.# O� S
Y4y
���6 s p BUI ING INSPECTOR
� D y7
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION —I 8 INTERIOR FINISH
CONCRETE d 2 13
CONCRETE BL K. PINE
BRICK OR STONE HARDW D _
PIERS PLASTER _
_ DRY WALL _
UNFIN
3 BASEMENT
AREA FULL FIN. BM'T AREA _
114 1/1 '/. FIN. ATTIC AREA _
N_O B MT FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE ��_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDVJ D _
ASBESTOS SIDING COMMON
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK N MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I__� POOR
11 ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLEHIP 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 t
lst 13rd NO HEATING A,
s
S Phone & Fax: (508) 688-6272
Y
CONSTRUCTION
14 Bearse Ave., Methuen, Massachusetts 01844
"FINISH CARPENTRYAT ITS FINEST. "
PROPOSAL
... .
No.383 Sheet 1 of 1 Date: 02/18/94 File: MORONEYI
SUBMITTED TO WORK TO BE PERFORMED AT
Mr.&Mrs.James Moroney
17 Quail Run Same
No.Andover,Ma.01845
682-7598
WE HEREBY PROPOSE TO FURNISH ALL LABOR AND MATERIALS NECESSARY TO COMPLETE THE FOLLOWING:
•Will frame basement similar to diagram provided by Mrs.Moroney,providing a NEW insulated door at existing bulkhead and provide
doors per layout shown.Will also have a door to boiler area and at existing electrical service.Doors will be six panel solid core molded,
paint grade with 2 1/2"colonial casing.
'Will frame perimeter,as well as closet area,with 2x4's 16"on center,insulating all exterior partitions not already insulated.2x on floor
will be pressure treated to prevent decay or moisture problems.Will also frame walls at all]ally columns.
Will provide blueboard with skimcoat plaster on all wall surfaces.
s Finish trim will be paint grade and will consist of one piece baseboard moulding,trim around existing window and door and capping
knee walls at short foundation walls.Will apply plywood treads&risers at stairs ready to accept carpet.Will provide shelves for closets.
s Will provide a 3/4 bath in area next to the existing water main,which will include a Y x 3'shower,Eljer or equal,(no door),a power flush
water closet,Gerber or equal,and an allowance for a vanity and top of S 400.00.You may chose from whit,bone or silver gray for color.
'Will provide two(2)additional central vac outlets off existing system in locations you specify.
'Will install a suspended ceiling with white grid work using Armstrong's ceiling tile.This file is a non"3 D"tile.Bath will have a rust resistant grid.
'Electrical will include the permit fee Fluorescent lights as agreed,wiring for the new zone of heat,TV and phone jack,one light for bedroom,
wiring for vanity light as well as a fan light combination provided by my company and moving any cables that are in the way.Price might vary slightly
due to partitions created by lally columns.
'Will provide a new zone of heat off existing boiler.
•Will remove all related construction debris from site.
•Price does not include any painting of woodwork,any floor finishes or permit fee for general construction or plumbing for future wet bar.
ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORT:TO BE PERFORMED IN ACCORDANCE
WITH SPECS SUBMITTED FOR THE ABOVE WORK& COMPLETED FOR THE SUM OF:
Seventeen thousand nine hundred ninety five dollars ($17,995.00).
WITH PAYMENT AS FOLLOWS: !�
$3,000.00 to start �w�9 6' p,:, PLEASE INITIAL
$2,000.00 upon completion of framing. $1,000.00 ANW lm I.Ro-A PAYMENT SCHEDULE:
$3,000.00 when doors are delivered $1,000.00 dw ke
$5,688.00 cash for plumber and electrician half upon completion of their rough.-�, X
$2,500.00 upon completion of plastering.51,000,00 -
%1,807.00 upon day of completion.$1,000.00~
ANY ALTERATION OR DEVIATION FROM ABOVE SPECS INVOLVING EXTRA COSTS,WILL BE EXECUTED ONLY UPON
WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE. OWNER TO CARRY
FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND
GENERAL CONTRACTORS LIABILITY INSURANCE ON ABOVE WORK TO BE TAKEN OUT BY:
.. .
MICHAEL J.ANTOON DBA
MIKE ANTOON CONSTRUCTION
_. _
NOTE: THIS PROPOSAL MAY BE WITHDRAWN BY THIS CONSTRUCTION COMPANY IF NOT ACCEPTED IN 7 DAYS.
ACCEPTANCE OF PROPOSAL
THE ABOVE PRICES,SPECS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.YOU ARE
AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE.
ACCEPTED: SIGNATURE:
02/18/94
DATE: SIGNATURE: ✓e� G' ,
}
p F-
CLOS FT �'IVVE
r �
. S %u OY
y i
ya
Town of d
L
m
No. 05 �- :,YNR:,; .
�.
Ado dover, Mass.,
19py
011� C-
0/'ATE
MSC ME WICK
A0/'ATED P'9�x' (`,
.9`
'-If BOARD OF HEALTH
PERMIT TO Food/Kitchen
Septic System
THIS CERTIFIES THAT...........��.���...... 40.#4 BUILDING INSPECTOR
':.�...................................................... Foundation
has permission to erect. ir�40I buildings on Rough
g
tobe occupied as.....f�../ �5. ..... � ...................................................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms 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
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR
•
Rough
.... ....... ... . .... ..... ..... .. .............. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Ocatpy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
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
V� (�!�P (�ummonwettltl� ofI� s�e>t�u�etts Office Use Only
Department of Public Safety Permit No. �v
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Occupancy & Fee Checked
3/90 (leave blank) V
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 INFORMATI N) Date
City or Town of � V V To the Inspector of Wires)
The undersigned,applies fora permit to Rerform the electrical work described below.
Location (Street & Number) L] m/I i // n I I,:) Pa3d
Owner or Tenant Mr A T)0?Z
Owner's Address /
Is this permit in conjunction with a building pefrm�it:�y Yes No' (Check Appropriate Box)
Purpose of Building _f�j ��( �!/��, Utility Authorization No. _
Existing Service Amps al i /Jq-&Volts Overhead E] 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 AJ / f A/�1k �( A J
TOTAL
No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA
Above. In-
No. of Lighting Fixtures SwimmingPool rnd. ❑ rnd. ❑ Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets No. of Oil Burners Battery Units
No. of Switch Outlets -6 4Wrs Q r FIRE ALARMS No. of Zones
total No. of Detection and
No. of Ranges No. of Air Conditioners Tons Initiating Devices
Heat Total TotalNo. of Sounding Devices.
No. of Disposals No. of Pumps Tons KW No. of Self Contained
No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices
Municipal
No. of Dryers HeatingDevices KW Local F1 Connection ❑Other
No. ot No. of Low Voltage
No. of Water Heaters KW Signs Ballasts Wirin c
Ll
No. Hydro Massage Tubs No. of Motors Total HP „=a _5«.__w.0
OTHER: E' I CCD _ I h I
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES❑ NO O:have submitted valid proof
of same to this office. YES U NO IJ
if you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE M BOND ❑ OTHER❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NA 00N / e LIC. NO �/a
Licensee Si nature _ LIC. NO.
Addres 1 7Bus. Tel. NoL
Alt. Tel. No.
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement..Owner Agent (Please check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
t Date..(..
2840
pOR7p
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
,SSACMUS�
r
t
i
This certifies that ....7q..c& .f�.. 2........ .....................
..... ./...
has permission to perform ,t C- l�c.e1....! '4{'d/. fa................
wiring in the building of fir). 2'
at....L-. ..........',A.R.. . ......R.�A!N.....� .................. .North Andover,Mass.
Fee...p� ............ Lic.Nd�0..5W.............................................................
I �y ELECTRICAL INSPECTOR( p�J IQg o 2/% 11:58 25.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File