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HomeMy WebLinkAboutMiscellaneous - 170 ROSEMONT DRIVE 4/30/2018 `- -_ �.m--=- _ � 170 ROSEMONT DRIVE ! � 210/098__B_0039.0000.0 i tell.- .; - - --- .-f.sr.- -ks- ---:x-tom•=zt-a..,.--.°Y- n.�, -., ...a...n; Location �-1U EKNUhAt Ute. No. (ca Date n. NaR*h TOWN OF NORTH ANDOVER - �, Certificate of Occupancy $ + ; ; Building/Frame Permit Fee $ " 'Ss„CHU c�' Foundation Permit Fee $ so Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ h TOTAL / $ Building Inspector .. "� 7718 i � Div. Public Works Location -O P Nl � No. ta'4 ro Date V►CRo - TOWN OF NORTH ANDOVER t " A Certificate of Occupancy - + "s s Building/Frame Permit,Fee $ Foundation Permit Fee $ Other Permit Fee $ ==` Sewer Connection Fee $ Water Connection Fee $ TOTAL $ I 0 f Building.lnspector '* Div. Public Works t Location t No. Date, TOWN OF NORTH ANDOVER Certificate of Occupancy $ d Building/Frame Permit Fee $ �s''^ EtA Foundation Permit Fee $ • � sACHUs ° Other Permit Fee $ Sewer'Connection Fee $ Gd03 Water Connection Fee TOTAL $- Buil In, I pe mor 8435 T� s� Di . Wblit Works V r� 'rt3tlT Ivo. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE. 2 I SUB DIV. LOT NO. t� F- ) LOCATIONG PURPOSE OF BUILDING e RbSg--:n�loNcG- P -q�;y-�� _ S L • >�-,�a+k.�Z OWNER'S NAME iO// ��3�11/37 f NO. F TORIES SIZE ` !OWNER'S ADDRESS O3 Pk�L �` �(6 , *_vim// `7 ASEMENT R SLAB ARCHITECT'S NAME S�7k7fNfJ�— ��+K �( I OF FLOOR TIMBERS 15T���'V 2ND 'Cato 3RD - BUILDER'S NAME �R// 7Zp.wl to L SPAN IS" •/' �G.� { `DISTANCE TO NEAREST BBUIILDINIG�Rx�6.�Af!e DIMENSIONS OF SILLS DISTANCE FROM STREET -,d " POSTS /i{•N /o I DISTANCE FROM LOT LINES-SIDES ']l (J2 REAR 11 GIRDERS WB .-tg I AREA OF LOT ;2^ sor�l 77 FRONTAGE HEIGHT OF FOUNDATION p �O THICKNESS `Q . IS BUILDING NEW `,of SIZE OF FOOTING l�.��/�tt X I It IS BUILDING ADDITION 77��ii �iq MATERIAL OF CHIMNEY IS BUILDING ALTERATION om0 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE {,/,p� IS BUILDING CONNECTED TO TOWN WATER n BOARD OF APPEALS ACTION. IF ANY FJ.l• IS BUILDING CONNECTED TO TOWN SEWER ye IS BUILDING CONNECTED TO NATURAL GAS LINE Ye 5 INSTRUCTIONSPERMIT FOR FOUNDATION ONLY 3 1PROPERTY INFORMATION REGULATED BY PARA. 114.8-S. B. LAND COST SEE BOTH SIDES EST. BLDG. COST 7�^1' ^7G1r`•-. PAGE 1 FILL OUT SECTIONS 1 - 3 PA EST. BLDG. COST PER SQ. FT. DATE FEE PAID � - BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 p SEPTIC PERMIT NO. f , ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING PERP,.OT FOR FRAtEIDUiLDB APPROVED BY ` ATTACHED GARAGES MUST CONFORM TO STATE FIRE RE ATIONS - PLANS MUST BE FILED AND APPROVED BY BUILDI INSPEC_TQ@,E. EEE PAID. DATE FILED (JkdL� UUPPAA11T1i{ BUILDING INSPRCTOR SIGNATURE OF OWNER OR AUTHORIZED AG F E E OWNER TEL.# PERMIT GRANT CONTR.TEL.# 19q4CONTR.LIC.#. ®lUC H G(O sm ifS.i m f �pp H.I.C.# DUE�RA.ME Famrr$ ! 1 o I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY RIES THIS SECTION MUST SHOW EXACT DIMENSION SPF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES _- LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH` PORCHES. GA- ` APARTMENTS I I RAGES. ETC. SUPER IMPOSED.-T,HIS•REP LAC ES,PLOT.PLAN. CONSTRUCTION 2 FOUNDATION8 INTERIOR FINISH S CONCRETE 3 • 1 2 -I3 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WAII _ UNFIN. 3 BASEMENT _ AREA FULL FIN: B M T AREA _ FIN. ATTIC AREA MO B M T FIRE PLACES - HEAD ROOM MODERN KITCHEN 4 WALLS 1, 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH —y� ASPHALT SIDING HARDW D •� r -t e ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE "Ci �,.F; t jt- •4 r 1 STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAMEI •T CONC. OR CINDER BLK. ti -•_ I STONE ON MASONRY WIRING STONE ON FRAME Wo SUPERIORPOOR _ 11 ADEQUATE (V I NONE 'S 5 OF 10 PLUMBING GABLEHIP BATH (3 FIX.) of 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 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 - - ale UNIT HEATERS l g sir q 7 NO. OF ROOMS GAS OIL y LUG(� T — 2nd I ELECTRIC - 'S +'sem• 't tds111 1st fj 3rd NO HEATING Pt f PP Town ® "off over 0 . No. 546 ' A o dover, Mass., l�lo�lem�� l co 19 g4 r COCHICNEwICI q-- oqq PP c 'T0 , 9 `C%, Esq ®` BOARD OF HEALTH Food/Kitchen PERMIT Septic System r BUILDING INSPECTOR. O 'to`t> .R� CoRKEv� .... THISCERTIFIES THAT....1.... .... ..l........................ .................................................. ............... ........ Foundation has permission to erect.V..M....R!4►ty L...... buildings on ...VIC> aSr..(ftQKT..�.......... 1 '...«• ••••••• Rough to be occupied as.%t014's...%M1%� ..lru�04n6k.....w.j..3 G'�4e_..4A"iE.................................................. chimney provided that the person accepting this�ermit 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 Inspectio�E� �11�� tL Buildings in the Town of North Andover. 5REGULATED BY PARA. 114.8-S. B. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MOI\?AT (4 qA FEE PAID LL ' Final UNLESS CON I�Rt 1 ELECTRICAL INSPECTOR Rough - Service BUILDIN ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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 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***************** APPLICANT: 73RV7— e_vt,S Phone LOCATION: Assessor' s Map Number Parcel SubdivisionLot (s) Street St. Number 1. 7z6 ************************Official Use Only************************ RECO NDATIONS O TOWN AGENTS: JJ( Date Approved Cons vation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspectt�or-Health Date Rejected _ Z�J � � Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 7—J Le) - driveway permit Fire Department ') Receiv d by uilding Injector Date 1 44 411 0 Ar h.• 1• ` l t�) + • _� i� �J,,.., � JCS .t�,i_ . � 1 k-IL A'-L UTILM' LC�CkMONS ARE TO BE FlEt-D VERIFIED BY THE C.tkAl)11�1Ct I .sm; PIAN S TF, l~nt:Ti;F G� W6Al�D AT IAT (1 c.: r,' E L L- c tr c .....: NORTH ANDOVER ESTATES LAND PLANNING TOLL BROTHERS, INC. ET:GLf�'EERII:G k QUFYL'1• iRoc, vrl*,T Pel' fiFl?%lr a _ •N 1 �r -07 d 2 z Bos' LoT J Lor �g t cp A Lr �V.V,p OD �C de 29p' AF BERWO L 40 MUNRO$A. 40 ST&Q• r yt'ty FOUNDATION AS--BUELT UXAM AT I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED LOT /7 ON THE LOT AS SHOWN ON THIS PLAN AND THE NORTH ANDOVER ESTATES LOCATION DOES CONFORM WITH THE FRONT, SIDE, NORTH ANDOVER, HA AND REAR SETBACK REQUIREMENTS SET FORTH IN SWAM F= THE T'OWN'S ZONING BYLAWS AT THE TIME OF TOLL BROTHERS INC. CONSTRUCTION. I FURTHER CERTIFY THAT THE 1000 TM PARK DRiV6 STRUCTURE IS NOT LOCATED IN THE SPECIAL TgrBORD, HA 01581 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT LAND PLANNING TO BE USED FOR THE ESTABLISHMENT OF PROPERTY a � �Y LINES, ERECTION OF FENCES, OR CONSTRUCTION OF pm ADDITIONAL STRUCTURES ON THE LOT. °.wi;;o_Gor MAP NO.acwac COM NO. Z'70016 DATE: Co -7Z-7,3 L 77A 4_ dover Town of v4i No. 546 0 J v' laUcl�m� 16 19R4 dower, Mass., o Aor COCK CnEwKn 0''ATEE F? �, BOARD OF HEALTH Food/Kitchen `i Septic System PERMIT T BUILDING INSPECTOR �i ............""..."". O(tK THIS CERTIFIES THAT 1O1•�... ".1L.O��t�.... ... •••••"'••'•••••••• oundation y—1Z1%4�LQ has permission to erect.V4.00...F.M( L...... buildings on ...V.10 ...••...• Rough • •., Chimney to be occupied as.%.. 4% ,.. 1. . ...D.14 ..�nc .....w.j..&ci9►e_-4A(�i�Kw E.................................................. provided that the person accepting this rmit 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 InspectioPERMWBOtl Buildings in the Town of North Andover.F REGULATED BY PARA. 114.8-S. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 00, Rough l FEE PAID Final PERMIT EXPIRES IN 6 MOI`•Q�iT sL— ELECTRICAL INSPECTOR UNSS CON TRt 1 T1 ") T� Rough PERMIT FOR FRAME/BUILDINGService . . ........ ..... ... . . ... ... ....... ,� BUILDIN ECTOR . _.l FEE PAID:_LSft'-i--�-. Final 1 DATA, 10 Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing Dr Wall To Be Done � 9 or y 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 ovm Of roti over 0 No. 546 IK l� '^Ortd over, Mass., lANFEMSEAL l co 19 g4 • •f��(�Un/1T ED AP A\7 s i.. BOARD OF HEALTH g ( /Kitchen PERMIT T UILD Septic System BUILDING INS E OR O '20�t�1�8.a CORKED i .... t — ole cz� 7 q�4- ,I THIS CERTIFIES THAT....1.... ......................... !!> . ................................................... ............................................ Foundanon(3lz c vq has permission to erect.u404....P�?�4�lylL...... buildings on ..I�0..�.`...�*rX1wT...�Z......•.•:(L&...0• ....... Rough ����n Chimney to be occupied as.�1t.16.w.�4!n�. . ...11................ ....wj..&C'Ae_.�A(ti4 vr................................................... provided that the person accepting this�ermit 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 InspectioPEN R MOA WKLY Buildings in the Town of North Andover. PLUMBING INSPECTOR REGULATED BY PARA. 114.8-S. B:C. 1 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough AT u �' �Q FEE PAID Final PERMIT EXPIRES IN 6 I40 T J -� szz v UNLESS CON "FRU 1 �� ELECTRICAL INSPECTOR �XAA � Rough ....... ... Service BUIL DIN ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR I Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final F No Lathing or Dry Wall To Be Done FIRE DEPARTMENT pn i Until Inspected and Approved by the Building Inspector. Burner # PLANNING FINAL CONSERVATION FINAL Street No. l Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT r' _if3L v. Apr. t_it- 1'_957 11:c1AM FO Apr. MEC"HIANICAL, CO. c . Ualu•icl a Dr:, aaai i� Mkw, 1906 Tel.-617.211,-201:6. a `�a, s ��.j1•r [l' F 1 � py 'it 't re 4�'��U��c+aQrr;'�,it Jar: ov n pger�, _.A3 r i {{ f G' 1 e�r.c�a��conversation i T. u r,a,ante ttia� <;e r storage P a on th s inorn�ns, d nd to use the� pa fc� at. ,� rr�y f�ah►rP t Pfil6 nk.P llwte.d,Fit o v e. w� 46 V A -0 t i �^f "�§ � �b a ,c ti ✓ k " ,.. -....... Wf T r - �S All. y f RIP IR > �a .'R', �AORTH Town of _ 4Andover . 0 Y No. 546 `' - j0 = crtlEmSEA. l 19C(4 LA E bre dover, Mass., t COCHICHEWICK AD"?ATED P? \ "\C, H BOARD OF HEALTH : Food/KitchenPERMIT T D ' Septic System ~" 0 a BUILDING INSPECTOR } THIS CERTIFIES THAT....k!t4w.�C ................... ...... " oundatto }� 1Z1�4�tj Q has permission.to erect.W. OOP....FM(A c....... buildings o 1 la. ...P;K.MQK.r.�.........(L&..11)....... 41&,[c(,F � wj 4mA Z ^� -CJS (V— to to be occupied as...4#.(.4w.%Mj.%. ...1�.u1!Ak.n..k....W1 ..3..'Ae_.4A"1E......................... . .......... ....... imney j thprovided that the person accepting this Armit shall in every re pact conform to the terms of the application on file in' ►na is'oNice, and to the provisions of the Codes and By-Laws relating to the InspectioPERR ftfiffftiffiLY l Buildings in the Town of North Andover.s REGULATED BY PARA. 114.8•S. B.C. PLUM ING SPECTo� VIOLATION of the Zoning or Building Regulations Voids this Permit. U t 44 FEE PAID ____ i p ` t PERMIT EXPIRES IN 6 MO r,- ELECTR C INSP '' UNLESS CON TR T I PERMIT FOR FRAMUBUILDING R°° h .. ... Service 2 LL DATE: FEE PAID:_ BUILDIN ECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR ' Rou d 1' Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FIRErp 0ARTMEN Until Inspected and Approved by the Building Inspectot//r. Burner l PLANNING INAL CONSERVATION FINAL Street No. ��?1�te– SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT 6/J Smoke yet. rf���C" �' ­v-� -1r, Q,S� CERTIFICATE OF- USE & OCCUPANCYt a F . Town of North Andover P' "Building Permit Number R4 - s4 ca Date 1A F .�.x .t f rk I 4 - THIS CERTIFIES THAT �` t• 11`� �� �� THE BUILDING LOCATED ON Zx $ MAY BE OCCUPIED ASJ" �'�• � 'N ACCORDANCE3 ''4 ,r aye y #� 4.;g, �#5y +'�) (# # t 7 1 3" '..:,!"; ''! }.n _'.:�. ..�. � - ._s�y '. ', ,. - .. . � ��1,"' It WITH THE PROVISION5 OF THE MASSACHUSE S STATE BUILDING CODE AND , 1 r, t xEC SUCH OTHER REGULATIONS AS MAY APPLY. Cea�i� r l } sy r Mo•TM 1 :..A; y�/�1 y i 5�, � #,ig`'`'e^'�' inA0 111 � s �o•,,. .ae CERTIFICATE ISSUED TO ip' 'ADD s,a 33 f - [ ♦ ti••w•✓'ate ^ . 8# 'kl����i�'.'a"s.a. 7t �,CN�S url 'ng InspectoIN rxikY° x ` A +111,.,:-` i i � i Location No Date 110RTly - TOWN OF NORTH ANDOVER . A Certificate of Occupancy $ • # Building/Frame Permit Fee $ g ��s ^°'•th Foundation Permit Fee $ SACNUSE Other.Permit Fee $ Sewer Connection Fee $ i Water Connection Fee $ �. ' TOTAL $ # c+ cc Building Inspector � 10990 Div.Public Works. ..YYP�4 :.w •:. MIT NO. APPLICATION FOR PERMIT .TO BUILD — NORTH ANDOVER, MASS. PAGE MAP 4-40jq�g6 LOT NO. 7 2 RECORD OF OWNERSHIP DATEBOOK 'PAGE ZONE SUB DIV. LOT NO.� 7 CAooce �-��9S I f 33� 7� LOCATIONRf OS uPosc oBUILDING z=C,_ OWNER'S NAME n�T. / • NO. OF STORIES- ZL SIZE OWNER'S-ADD S S6-T lam, levS�. --/ BASEMENT OR SLAB' ARCHITECT'S NAME SIZE OF FLOOR TIMBERS NIST/'`.,vl 2ND 2R0 Al BUILDER'S NAME (f(P�6f�4'Xi' SPAN 9A/o- /Z,/_y�, DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS Yj_ IJ DISTANCE FROM STREET POSTS .� DISTANCE FROM LOT LINES -SIDES REAR - GIRDERS - - AREA OF LOT 7 Z/ FRONTAGE HEIGHT OF FOUNDATION ON . THICKNESS IS BUILDING NEW l (�V SIZE OF FOOTING x IS BUILDING ADDITION Ab a i,V-(. P, 1)&-C JC MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yc-„ IB BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IB BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE I FILL OUT SECTIONS I - 7 EST. BLDG. COST P[ BQ. 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 /L_ PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR •�� DATE FILED ------ NUILDINO INBP[CTOR SIGNATURE OF R AUTHORIZED AGENT F E E OWNER TEL if �- PERMIT GRANTED > CONTR.TEL/ CONTR.LIC.f H.I.C.I 'I+,� -r`'WJ'•a' .- +1-t-'=z i:s a.eS -,$:s'*4t�d'�3`.4".�as,•Rr-r.r^% •.ha {.. ... r ..r,"i ° £-� s'+S .. BUILDING RECORD 1 , OCCUPANCY , SINGLE FAMILY STORIES - - - MULTI. FAMILY THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM — OFFICES APARTMENTS LOT LINES AND EXACT DIMENSIONS OF BUILDINGS' WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION H INTERIOR FINISH COFICRETE CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAII UNFIN. - 3 RASEMENT AREA FULL FIN. B M"T' AREA _ FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN - - 4 WALLS I 9 FLOORS CLAPBOARDS 8 -L3 7 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING COM/ACN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICKATTIC SIRS.3 FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRUPERIORAME ADEQUATE I-1 POOR 3 ROOF 10 PLUMBING GABLE HIP BATH IJ FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.1 IA " FT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR A GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS.6 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" BMT ( 2 _ ELECTRIC n d INO HEATING �a 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. ****************Applicant fills out this section***************** APPLICANT: 4e Phone S _-/a i3 LOCATION: Assessor's Map Number Parcel 6029 Subdivision iflvni l f )IN 7a u Lot(s) 7 Streetvs C, o "r 7 St. Number 17 ********************** *Official Use Only************************ REM ID C AGENTS: Date Approved onservation Administrator Date Rejected Comments �N S f tAS 1 Date Approved ° .i Frown Planner Date Rejected C � omments 0 HJT Q rJ R0 Food Inspector-Health Date Approved Date Rejected Date Approved Septic Inspector-Health , Date Rejected Comments I Public works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date .� 12 u C C i 'C �S r 1�E7VC - • -AUG 18 '95 09: 17 -- 1 �.2 \S ~ll 1 179,65 1 �s ( L0717 ` A . 22,803.s s1 t 10 PROP111 170 3 4 1 9 oo, � ROSEMONT DRIVE THIS MORTGAGE INSPECTION PLOT PLAN HAS BEEN PREPARED FOR MORTGAGE PURPOSES ONLY I HEREBY CERTIFY THAT THE BUILDING(S) SHOWN ON THIS PLAN ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND CONFORM WITH MORTGAGE INSPECTION PLOT PLAN THE DIMENSIONAL REQUIREMENTS OF THE ZONING LAWS, AT THE TIME OF CONSTRUCTION, OF THE TOWN OF NOR7HANDOVER MASS. IN ALL Y 1 S I BLE-EASEMENTS-AND ENCROACHMENTS ARE SHOWN HEREON. NORTH ANDOVER -::MASS OAi2 ueen�vc� AUG 16 195 09: 17 �--- U, 2 1 ,1 _ 179,65 1 LOT 17 A . 22,605:if 17-7-71- 10 m 170 2©_ 9 00, ROSEMONT DRIVE THIS MORTGAGE INSPECTION PLOT PLAN HAS BEEN PREPARED FOR MORTGAGE PURPOSES ONLY HEREBY CERTIFY THAT THE BUILDING(S) SHOWN ON THIS PLAN ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND CONFORM WITH MORTGAGE INSPECTION.PLOT PLAN THE DIMENSIONAL REQUIREMENTS OF THE ZONING LAWS, AT THE TIME OF CONSTRUCTION, OF THE TOWN OF NORTH ANDOVER MASS. IN ALL VISIBLE EASEMENTS AND ENCROACHMENTS ARE SHOWN HEREON. - NORTH ANDOVER SASS . I FURTHER CERTIFY THAT THE ABOVE SHOWN LOT(S) ARE NOT.LOCATED IN A FEDERALLY DESIGNATED FLOOD HAZARD AREA AS DEFINED ON THE'' alit OF k,� SCALE40 FLOOD INSURANCE RATE MAP FOR THE TOWN OF NORTH ANDOVE> ,5, ppm. THIS INSPECTION HAS BEEN PERF ORID IN ACCORDANCE i1 I TH THEf ` R �DIiAKE 7l5SOCIATES X110. TECHNICAL AND PROCEDURAL STANDARDS FOR MORTGAGE LOAN , INSPECTIONS (250 CMR 6.05), IN THE ABSENCE OF MOINUMENTATtON a q W" 5,??0 +GROVE g APPARENT LOT LINES AS EVIDENCED BY LINES OF OCCUPATION, VHICM . - �t N u;p g {� RAMJNGHAM . PROVIDE SUFFICIENTACCURACY FOR THIS CERT I F 1 CATION, HAVE BEEN HELD. :. x s r 1• ,� �� 6.ri A t �� IA nil SIGNED L h{Ps - . DATE 1'y 1\1 ,1:1:1 .,, .'•.`.\ �,`.. �rrrr tr , \,•�\l`\`\`\`\t,tl\ t`l\:.t\ 1`t'l1`lTI,'/:4- t\\\1N 1\1\\1 \\\\ •` \ t t i2tA�� N\�r " 1`� \\ iw - -W Design Works (R), Somerville Lumber, # 173, Phone # 623-28OU Wed Jun 0412:27:19 1997 Plan ID: CQ0970 Post Layout for Deck 1 iyOUst 23' t3 �N. 1 9, !6� i ---------------------------------------- ----- -------- _ ------------------------ ---------•------- - 20 2. 23 30' s s See the Specification Sheet for More Details •c BEAM LAYOUT CUSTOMER -- DATE OG/02/97 REF SJ LA r - , I BEAM BEAM POST POST LABEL LENGTH COUNT SPACING 4 , (�„ 4 q �a Post spacing is measured center-to-center. Depth of concrete footers --- 36 inches. RILL OF MATERIALS --- LUMBER CUSTOMER: DATE: 06/02/97 REF: SJ SALESMAN # KEN --------------------------------------------------------------------------- COMPONENT --------------------------------------------------------------------------- DECKING 2001899 9 EA 5/4X6 12' PT PINE DECKING 2106284 70 EA 5/4X6 16' PT PINE APRON FRAME 2106300 7 EA 2X4 16' PT PINE APRON FRAME 2001626 3 EA 2X4 12' PT PINE APRON FRAME 2001618 3 EA 2X4 10' PT PINE RAIL CAP 2106326 1 EA 2X6 16' PT PINE RAIL CAP 2001634 6 EA 2X6 8' PT PINE HORIZONTAL RAILS 2106300 10 EA 2X4 16' PT PTNF ?= RT7.ONTAT, RATT,S 2001600 1 FA 2X4 8' PT PTNF VFRTTC`AT, RATT.S 9.14'127q 17 F.A 1X4 19.1 PT PTNF RATT, POST 2001535 6 FA 4X4 16' PT PTNF STATR POST 2001493 1 FA 4X4 8' PT PTNF STATR STRTNGFR 2001 451 1 FA 2X1 ? 12" PT PTNF STATR TREAD 2001899 2 FA 5/4X6 12' PT PTNF REAMS 2001378 4 FA 2X8 16' PT PTNF. REAMS 2001352 4 EA 2X8 12' PT PINE BEAMS 2001345 2 EA 2X8 10' PT PINE JOISTS 2001345 16 EA 2X8 10' PT PINE J-SPLICE 2001378 1 EA 2X8 16' PT PINE JOISTS 2001378 15 EA 2X8 16' PT PINE FASCIA 2001378 1 EA 2X8 16' PT PINE FASCIA 2001352 2 EA 2X8 12' PT PINE FASCIA 2001345 3 EA 2X8 10' PT PINE FASCIA 2001337 1 EA 2X8 8' PT PINE LEDGER 2001378 3 EA 2X8 16' PT PINE LEDGER 2001345 4 EA 2X8 10' PT PINE LEDGER 2001352 1 EA 2X8 12' PT PINE STAIR HANDRAIT,/^A.T « - TAIR RAILS 2106300 1 EA 2X4 16' PT PINE VERT_ STATR RATT.fi 21 4'1279 7 PA 1 X4 1 21 PT PTNF GROUND POSTS 2.001501 3 FA 4X4 10' PT PTNF. --------------------------------------------------------------------------- I r BILL OF MATERIALS --- OTHER MATERIAL..S CUSTOMER: DATE: 06/02/97 REF: S SALESMAN # KEN --------------------------------------------------------------------------- __— ___ ;'r T IrV DESCRIPTION --------------------------------------------------------------------------- - -— - w Z� «=s�; L_- <XI1_ _h EA u:: FOIST HANGER !'1w_n iv; ►c�n1`u M 1• 2. )m.r, 6 A �,:_'):.. iil_1_1• i-.io n�C_. " JS\iS_1411 _ L-AG ._CREW 4164414 16 FIA I //. 1C 6 GAL LAG SCREW WA'rit"N 4i63911 236 EA 1 /2" WASHER F—D(sE;I-R-' ST-RAF, 202026 I I 02 GA TIF L)(`_lWly .JR, v•I• a1,7.f-_iry i7,TI.'' iiliil i i -- -Si i __o nil`-- --7 -- r;� r.....i,r:r : :.. . I.A'I"I'1 l:F: 2XM 2046787 1 I F;A l.AM I,A'I"I'I( F: RAII.I-9G OT.I'.MIN 4164331 _)l) 'F.A 1 /2 X M CAIN iVi T.T RUT 4163g7M 110 R A 1 /2" NUT ANCHOR BOLT 4055943 15 EA 811 — _: niiia•i•Trl"ni ►avu•i•_,i-y j, iil i < i <il 3 ., wn 4xii ut=i`i' pRr_Hr_)u ►4pvw K M'91V1 i-cr_lI;•!' S!�v �,i c34 i i " !-•!! N:A ! ! X ?4 rt .2k pn Fcr_)i;•�• ti[_lNl) '1'IIFSN: 111111 h I y 1 J N.A O111 [_'K'I'1_IFSN: 17X4?i f;C) FiA(j�i ?il) NA I I.ti I I.Fiti 4"_l. ill i il_I 2 R iF) NA 1 I.ti I F.Kti 1_i[_)X I hl_) NA 1 I.ti Itil.Ftti 4l il)44'/ I 1 h1_) NAI I. 1 PSI) NA i 1 ht_) NA T i.ti til,Fiti 4J i[)4'1 C) 1 h:A 1 fel) IVA 1 I.ti I.Fiti ti[_)X f;F) -N A T I.ti 1 I.kc; 4'_l.1l)4l 1 '_l. N.A 1 hl) NA 1 I.ti I I.Fiti ►e[_!v _ + ti(_:KN:Wti hl.Fiti 4!•_864O 1 M.A J_ ti" ti('KM:Wti hl.fiti FSl)X M:Wti I I.liti 41676-i7' N:A --------------------------------------------------------------------------- c. .. r. �I�I RECOMMENDED MAXIMUM SPANS FOR FLOOR JOISZ,S 60 PSF LIVE LOAD PLUS 10 PSF DEAD LOAD Normal Load Duration Fb = 1000 psi E = 11300,000 psi Typical values for Southern Yellow Pine #2 (Pressure Treated Exterior usee. . decks use (e.g. ) Joist Size Joist Spacing 2x6 2x8 2x10 2x12 12 8-6 11-7 14- 17-4 16�� 7-4 10- 12-4 - '20 6-7 8-11 11-0 13-5 24" 6_0 8_2 10-1 12-3 Design Criteria: Strength: - Live load of 60 psf plus Dead load of 10 psf produces bending stress of 1000 psi at spans shown. Note: Design values adjusted for normal duration loading. g i T40RT . ^ - - Tovm - of _ - over No. * . i . �.K dover, Mass., (D 19P, '9 -CO CMICHEWICK 'Y'�• 0qE D vS BOARD OF HEALTH PER. M IT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........................................................... ... ....4...o u. .C../................................................... Foundation has permission to erect.............! .. /.C.. buildings on.......1.2,2)... ,.... ........ Rough tobe occupied as............................... ... .^Z................ ..� t....... ...................................................... 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 • ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ART Rough ................ .............. ..... ...... ... ....................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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 Street No. Smoke Det. Office Use Onlyo, / 04c Tiammi Inturttlo of lfflassar4useli,U Permit No. iz.==a %partmetit ofuhlit afietg Occupancy& Fee Checked` also (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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 4 f/, 9 c (XK or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a/permit to perform the electrical work described below. Location (Street & NNumber) Owner or Tenant— 7�,/ `��s Owner's Address �� Y USt' ow "t/- U4 z Is this permit in conjunction with a building permit: Yes 2f� No ❑ (Check Appropriate Box) Purpose of Building,. »"C Utility Authorization No. Existing Service Amps -Volts Overhead r❑ Undgrnd ❑ No. of Meters New Service d Amps/ � 67-Volts Overhead 1. Undgrnd No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA U� No. of Lighting Fixtures Swimming Pool Above de^ gond I Generators KVA ® 1' No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners / Battery Units tl/No. of Switch Outlets I No. of Gas Burners / FIRE ALARMS No. of Zones ) Total No. of Detection and �No. of Ranges I No. of Air Cond. / tons Initiating Devices Heat Total Total No. of Disposals I No.of Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municioai No. of Dryers I Heating Devices KW Local I Connection __I Other No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the rea.utrements of Massacnusetts general Laws _ _ I have a current Liability Insurance Policy including�prnoieteo Operations Coverage or its substantial equivalent. YES _ NO _ I have submitted valid proof of same to the Offi YE)t - NO — If you have checked YES. please indicate the type of coverage by (��ue 'appropriate box. - BOND = OTHER - (Please Soec,fyj (Expiration Date) o;Elect_ ric?I.Work 5 Work to Start r-�''�(�'� Inspection Date aecuested: Rough Final Signed under the Penalties doff perjury: LIC. NO3 6FIRM NAME �S� J 4 �7��v.,�/'l,✓7G�� LIC. NO-3-4 �� Licensee _—'Pa 'a �/�'� V, LIC.'gigSignaturr­- .rte 7 �L'Of y� /�J us. Tei. No. — J /��,� ol/! ��LJ �w Alt. Tel. No. /� Address �� OWNER'S INSURANCE WAIVER: I am aware that the Licensee coes not have the insurance coverage or its substantial equivalent as re- OWNER'S by Massachusetts General Laws, and that my signature on this permit application waives this regwrement. Owner Agent (Please check one) Teleohone No. PERMIT FEE 3 (Signature or Owner or Agenq s-5565 Date.... . `......! ..t........�.. rµ 2it5 pORT/, TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACHUS� This certifies that ..../ �'•• •...:..... ` Z has permission to perform ...4(/,t°f-cl....A :................................... wiring in the building of.:...../.GJI .....eeS.:............................................. .. ` at .. ... .. ,North Andover, Fee ..........:. Lic.No. .. �............ ............ � � . ..... ........................ ELECTRICAL INSPECTOR 7 U2/17/95 12e47,1 244>00` PAID -- WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) C NORTH ANDOVER Mass. Date tuilding Location �Z) �( eS� y��T DJC' Permit # �� •� Owners Name 'i ? New Renovation Replacement Plans Submitted FIXTUP=� C� W � til N 14 z as N ao 0 a F, � :2 x G1 . ` Z to 0 4-' < G a0 O � © � 1- Q W .4 W W F. yf a C 4 N z (� W V7 s( Q 0 C1 > W W W Orf < %� � C Q W W I' �" Cf G L7 F. 2 J H F W W O O ? U. t-. tu = q ul G C •• F' Y- ttt O O N < t:t > C W O < G < < O O W O W I t— a a al -410 > a a I•- Of SU$—BS264T. BASEMEUT IST FLOOR 2KOFLOOR ` 3RD FLOOR I 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TK FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name/44->-5 Corp. Address�C7c{�/�,� Q Partner. ''W 'Iy -S E�irm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [2---Other type of indemnity Q Bond Q Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Q Agent Q I hereby certify that all of the dctails and information I have submitted (or entered)in above application are true and a best of my knowledge and Mat all plumbing wort and wcALlations perfornad under'Permit issued for this application will-be in cc wi s4i pertinent Provisions of tho Massachusetts State Gas Cede and Csapta I4:of use General Laws. By TYPE LICENSE: Plumber Title Gasfitter- Signature of Licensed City/Town- Master Plum er or Gasfitter Journeyman �C�7 APPROVED (OFFICE use ONLY) License Number +� Date.. NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION S y This certifies that E has permission for gas installation . . . . . in the buildings �of t . . . . . . . . . . . . . . . . . . . . Andover, Mass.at 4/. North Fee.,'-�.�. r-' Lic. No.. Bt.' J 95 1w'23' rQRS 1040cTOR � . r � WHITE:Appllca� � 'GA A f.--Building Dept. PINK:Treasurer GOLD:File 011ie (14111tmm](11raftli 0 flflasnarlitl ett kvv Office Use Only I'rri.(ir $o%efy Penni) No._ j QOARD )F FIRE PRFVI_N1l( )N REGIJI.ATIONS527 C NIR 12:00 Occupancy & Fee Checked -_L I L 3/90 (leave blank) 4= APPLICATION FOR PERMIT T(vl - All wurk to I,,• pertnrr„c•,I in �,nnidance will'llle&1,4�;E:m rrl.tRll 52ELECTRICAL R12:00 WORK - (PLEASE PRINT IN INK OR TYPE AL1. INI ORMA11(if 4) Date_ City or Town of The undersigned applies for a permit to�pelforrn the electrical work described b(,low. --// - ---- To the Inspector of Wires> Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a buildir g peanut: Yes o i � -�---N -`-'�}----_------ (Check Appropriate Box) Purpose of Building (1 --- --- - ---`-=�'----------------------_.lJtility Authorization No. Existing Service AnrpsJ_---_---- -_- Volts Overhead ❑ Undgrd ❑ No. of Meters New Service _--.-Amps _----_------J- --- Vohs Overhead ❑ Und rd B ❑ No. of Meters Number of Feeders end Anipacily Location and Nature of Proposed Electrical Work -_-__54E ZL(— S�✓/,jr�' No. of Lighting pullets No. of lint TubsTOTAL No, of Transformers KVA Axl <e In- No, of Lighting fixtures _- Swinnnin fool �rnd. ❑ md. L J Generators KVA No. of Receptacle OutletsNo. o Emergency Lighting —Nu. of Oil Boaters Batter Units No, of Switch Outlets No. of Gas Burners — Tota FIRE ALARMS No, of Zones No, of Ranges No. of Air ConditioneTons No. of Detection.and rs Ifi•al s Tota Initiating Devices No. of Disposals No. of Purls Ions KW No. of Sounding Devices. No. of Self Contained No. of Dishwashers Space/Aw,i I Iealing KW Detection/Sounding Devices -” Municipal No. of Dryers I lealin Devices KW Local[], Connection 11 Other No. of Water Healers No. o — No, or— Low Voltage KW SiL,ns Ballasts Wirin No. Hydro Massage Tubs No. of Motors Total Iill OTf IER: INSURANCE COVERAGE: Pursuant to the requirements of Massachumes General Laws _ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES O NO O 1 have submitted valid proof of same to this office. YES f I NO 1-1 If you have ch (e Jcked YES, please indicate the type of coverage by checking the appropriate box. ck INSURANCE IC!�J BOND ❑ 0IIiERL-1 IPIc•asc Spe(ify) "_--------.-------.------------------- Estimated Value of Electrical Work $10—aQ-_ (Expiration Date) Work to Start __—...- Inspection Date Requested: Rough — Final Signed under the penalties of perjury: ---- FIRM NAME ��_fW fy E D `) —" LIC. NO. Licensee `�.tra�tvr�Lie�[��L--- Signature Address - � f'� - LIC. NO. r " Bus. Tel. No. f Ib/ 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 s gives this requirement. Owner Agent (Please check one) __.—...—_—_—" — -___-._.___-. Tr•Ir1IN)nc` No, PLRAAIT C['C t � r , Date....>` .. ........ 2291 NORTH TOWN OF NORTH ANDOVER ° ' PERMIT FOR WIRING SSACMUSE s This certifies that . Vit...;. t� ; ..,r. .. .. ,i' ::.... .......a° .' .. has permission to perform . � .r. 't.:..1 {. . l tr.{. wiring in the building of:...« x- 4 ro 4 at... . ... :... !✓c`.. . :.'. ......................... Y North Andover,Mass; ' LD Fee.... ..E.... Lic.No. .....:.. . ............................................................ ELECTRICAL INSPECTOR z WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Y Date 1�.:��:..r..�............ '. NORTH °`, :°•'"� TOWN OF NORTH ANDOVER I. p PERMIT FOR WIRING CHUS Thiscertifies that ....................................................4�......................................... T has permission to perform . .........................,,1............................................. lwiring in the building of......:` . ......................................... / tl...... ... ................ .North Andover,Mass. G..�`�� . ��. .1`u� Fee..................... Lic.N ............. ................................................................. ELECTRICAL INSPECTOR Check # 55U8 Commonwealth of MassaJAN Official Use Only Department of Fire SePermit No. `S`�O 8 4 t WWI BOARD OF FIRE PREVENTION ROccupancy and Fee Checked [Rev. 11/99] leave blank APPLICATION FOR PERMIT M ELECTRICAL WORK All work to be performed in accordance with thctrical Code(MEC),5 7 CMR 12.00 (PLEASE PRINT IN INK OR E LL INFO TIate: e a /® City or Town of: (3 o the Inspector of Wires: By this application the undersigned gives notice f his or her intentio to rform the electrical work described below. Location(Street&Number) (� Owner or Tenant n Telephone No. 1 Owner's Address Is this permit in conjunction with a building permit? yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / _Volts Overhead EJUnd t;td❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meter-s Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion of the fibilowin table may be waived by the Inspector of Wires. Fo. f Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No. of Total Transformers KVA f Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o mergency ig ing rnd. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No.of Switches No. of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total i o Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No. of Self-Contained Totals: Detection/Alerting Devices } No.of Dishwashers Space/Area Heating KW Loc Municipal ( tion ❑ Other No. of Dryers Heating Appliances KW Security Systems: No. of Water No.of s or Equivalent Heaters KW No. of Data Wiring: Si ns Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs' No. of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. 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: INSURANCEV BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical/Work: (Wh (Expiration Date) en required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.. I certify, under the paint and penalties ofperjury,that the information on this application is true and complete. FIRM NA _ LIC. NO.: SSCLicensee: "Signature ^ (If applicable, enter -eyem t"in the lic nse number lin ) LIC.NO.: �O Occ7Z Address: �' Bus.Tel No.:�7 `S701r�i� OWNER'S INSURANCE WAIVER: I am aware that the icens 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: S r r HOME SECURITY® Brink's Home Security,Inc.•155 West Street,Suite 6•Wilmington,MA 01887 978-657-0443 Brinks Home Security 155 West Street Suite 6 Wilmington, MA 01887 978-657-0443 978-657-5367 FAX fi December 28, 2004 To the Inspector of Wires: The address listed on this permit is ready for inspection. If you would like, we can help arrange a time and date for you with the customer for inspection. Also, some towns and cities are letting us write on the electrical permits that a site is ready for inspection. If writing on the permit is acceptable or you would like us to arrange an inspection with our customer, please contact Krista Taylor at 978-657-0443. S i cerely, ohn Tanner Technical Manager