HomeMy WebLinkAboutMiscellaneous - 19 UPLAND STREET 4/30/2018Date. (5 .....................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
............. .................. ...............
I V.
has permission for gas installationy%1,,,,,,,,,,,,,,,,,
in the buildins .. of ........ —.D...c...--Wro
......
at ...... �..( ............... .... . e ....North Andover, Mass.
Fee.��O� ..... Lic. No -J!5 H-6 ........................................................
GASINSPECTOR
Check #1312
0 9 8 8 3)
G
TYPE OR
PRINT
CLEARLY
APPLIANCES Z
BOILER
BOOSTER
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-CIT-Y'MA DATE
JOBSITE ADDRESS OWNER'S NAME
OWNER ADDRESS TEL FAX
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
NEW: [jRENOVATION: D
FL --I`
-BSM' I.....1
OORS—►
RNER
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
GENERATOR
GRILLE
INFRARED HEATER ,
LABORATORY COCKS
MAKEUPAIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
UNI'r HEATER
UNVENTED ROOM HEATER
WATER HEATER
REPLACEMENT: 19-
2 1 3 1 4 1 5 1 6
PLANS SUBMITTED: YES F—] NOR -
7 1 8 1 9 1 10 1 11 1 12 1 13 1 14
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [31V0
1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ( OTHER TYPE INDEMNITY ® BOND r j
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ® AGENT O
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the bes of rrm knowledge.
and that all plumbing work and Installations performed under the permit issued for this application will be in complianc th erti an ro ' of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ]LICENSE # iS6y Si6NATURE
MP aMGF ®I JP ® JGF E( LPGI ® CORPORATION ..�(�( PARTNERSHIP 0#�� LLC
COMPANY NAME: ee gro g[S SE2,, e ADDRESS
CITY �a�-�� _ STATE' M ZIP Z (2 2 TEL
FAX CELL s°� �d6-IRQq EMAILeeNr Gro C4
1
.,e
Date ...`.. "..... ..... .
/.io ,e'rye
y` TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
,�ro
This certifies that .... .... ........... . .
z
has permission for gas installation .................
s_ in the buildings of -.... - :.. .......... .
at �... "..... :}.., orthAndover, Mass.
Fee` s� .. Lic. No.....................
.
� f GAS I •PECAOR
Check #�
4668
MASSACHUSETTS UNIFORMAPPUCATONFORPFRIVIIT TO DO GAS FPITID NG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations 7 - Permit #
Amount $
Owner's Naive A,�
New F1 Renovation Replacement ❑ Plans Submitted ❑
VY
i (Print or t /f Check
❑ ertificate Installing Company
Name l l it'1 a.�. , / 2f / �- Corp.rp.
Address crl S ❑ Partner.
Business Telep one CQFirm/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 ❑ No ❑
If you have checked yes, please indicate 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.
o. Check one:
t Signature of Owner or Owner's Agent Owner p Agent ❑
I hereby certify that all of the details and informati I have submi ted (or entered) in above ap ation are true and accurate to the
best of my knowledge and that all plumbing wor and installation performed der rmit ed r this application will be in
compliance with all pertinent provisions of the assachusets to G n Ch pie 4e General Laws.
Y 1
IAPPROVED (OFFICE USE ONLY)
Signature of Li ensed P mber Or Gas Fitter
Plumber 1626 /
Gas Fitter License Number
Master
Journeyman
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SUB-BASEM ENT
BASEMENT
1ST. FLOOR
r
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. F L O O R
7TH. FLOOR
8 T H. F L O O R
i (Print or t /f Check
❑ ertificate Installing Company
Name l l it'1 a.�. , / 2f / �- Corp.rp.
Address crl S ❑ Partner.
Business Telep one CQFirm/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 ❑ No ❑
If you have checked yes, please indicate 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.
o. Check one:
t Signature of Owner or Owner's Agent Owner p Agent ❑
I hereby certify that all of the details and informati I have submi ted (or entered) in above ap ation are true and accurate to the
best of my knowledge and that all plumbing wor and installation performed der rmit ed r this application will be in
compliance with all pertinent provisions of the assachusets to G n Ch pie 4e General Laws.
Y 1
IAPPROVED (OFFICE USE ONLY)
Signature of Li ensed P mber Or Gas Fitter
Plumber 1626 /
Gas Fitter License Number
Master
Journeyman
A
Location-
115
ocation
c��li�� 115-11U
No. Date
40RTM TOWN OF NORTH ANDOVER
3? : o�
� s
# Certificate of Occupancy $
s i
,SSACNUSEt Building/Frame Permit Fee $
.-A Foundation Permit Fee $
Other Permit Fee $
' TOTAL $�
Check # /a 8
16818
G,� `Building Inspec,r�
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/1tor 16flBuitdings Date
SECTION I- SITE INFORMATION I
1.1 Property Address:
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic District: Yes NO ✓
1.2 Assessors Map and Parcel Number:
2.1 Owner of Record
�'( .7
Map Number
L
Parcel Number
?A,49ea--X
N4, 40 /,P'/ S
igaature Telephone
2.2 Owner of Record:
—410,
1.3 Zoning Information:
1.4 Property Dimensions:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Zoning District Proposed
Use
Licensed Construction Supervisor:
Lot Area (sf)
Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard
Side Yard
AddrvP
44
Rear Yard
Required
Provide Required
Expiration Date
Provided
Required
Provided
'3
1.7 Water C.40..
M.G.L'C.40.
54) 1.5.
Flood Zone Information:
Outside Flood Zone ZQ
1.8
Municipal
Sewerage Disposal System:
On Site Disposal System ❑
Public fir'y
Private 0
Zone
1
00
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic District: Yes NO ✓
2.1 Owner of Record
Name (Print) Address for Service
igaature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
Licensed Construction Supervisor:
G S 0 72. 'Y P7
License Number
AddrvP
44
Expiration Date
ignature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Tel hone
00
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Pro osed Work(check au applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Additionl
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
sfd- iN9 coat
'er'rr'(N:7 5'0e
�D�% s�5/�X aa! � t>/j�/aG! l�iT/! G,yrrG /%���1 /�/jo✓cam
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed b permit a licant
1. Building
soj �p°� '
OICtAiJ+()Ngy�
(a) Building Permit Fee
Multiplier
��
s,
2 Electrical
&I
(b) Estimated Total Cost of
Construction
a a S oDD
3 Plumbing ppp, --
Building Permit fee (a) x (b)
o2J p� 8
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 —
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, 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
Print Name
Si ature of Owner/Agent Date
I=11,21— MAM
NO. OF STORIES a ISIZE ;I VX 73
BASEMENT OR SLAB
SIZE OF FLOOR T MBERS P1! 2ND d2 /p 3 ;tie/,o `
SPAN /
DMIENSIONS OF SILLS 6
DIMENSIONS OF POSTS
DM ENSIONS OF GIRDERS )0 X
HEIGHT OF FOUNDATION ° s �d;S J.uG ' 6-ot; w 4ii THICKNESS `
SIZE OF FOOTING a�'X /�a s' X
MATERIAL OF CHIMNEY -�
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
V
i�•e
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/peri-nits fron
Boards and Departments having jurisdiction have been obtained. This does not relievE
the applicant and/or landowner from compliance with any applicable or requirements.
APPLICANTS ATr �? �3r�ro,,i� PHONE?ZS-- & 8,5-- a9St
LOCATION: Assessor's Map Number 'a& i PARCEL
<621
SUBDIVISION LOT (S) s y
STREET C1 P t ✓v0 f j , ST. NUMBER
OFFICIAL USE ONL *�*,►�
Lt]
TOWN AGENTS:
DATE APPROVED
DATE REJECTED
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE -REJECTED
'UBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
'RE DEPARTMENT
CEIVED BY BUILDING INSPECTO
✓ised 9W jm
TE
i
' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation .insurance Affidavit
[—Name = Please Print
Name: 114 free—, Z2zS &Yv,✓Q
Location: / UPe A!,g Jf
City Phone #
I am a homeowner performing all work myself.
d1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for nTy employees working on this job
Comaanv name:
Address
City: Phone*
Insurance Co. Policy
Comnanv name:
Address
City `
Phone*
Failure to secure coverage as required: under Section 25A or MGL 152 can lead to,the irnpcsgm of aimikW penaWes cf a.fine u43 to $1,?
andlor one years' imprisonment -as vmg-as-ciW penatiesinlbol m-d�a-STDPYiOM_ORQERAXI-af m -it ($1D.L ),3A1agr,-galnst.xm
understand that a.copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verificMoh.
t do hereby certify mdar thus and penalties of pedwy that the iMarrnatian provided above is tare and correct.
Print
Official use onlydo not write in this area to be completed by city or town ofticiar
City or Town Permn/Licensing.
Buiftng Del
❑Check I immediate response is required ❑ Licensing &
❑ Selectman's
Contact person: Phone # ❑ Health Depai
❑ Other
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-954
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in properly
licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A.
The debris will be disposed of in:
(Location of Facility)
Si ture of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
.... � /i// I Nair /l .. /f ✓L
REScheck Compliance Certificate
1995 MEC
REScheckSoftware Version 3.5 Release Id
Data filename: Untitled.rck
PROJECT TITLE: PLAN NO.5117
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: Single Family
DATE: 10/03/03
DATE OF PLANS: 10-3-03
PROJECT DESCRIPTION:
ADDITION TO EXISTING HOUSE
GARAGE AND BEDROOMS
DESIGNER/CONTRACTOR:
BRUNO ASSOC.
28 BERKELEY ROAD
N. ANDOVER, MA 01845
COMPLIANCE: Passes
Maximum UA = 232
Your Home UA = 221
4.7% Better Than Code (UA)
Ceiling 1: Flat Ceiling or Scissor Truss
Wall 1: Wood Frame, 16" o.c.
Window 1:
Metal Frame with Thermal Break:Triple Pane with Low -E
Door 1: Solid
Basement Wall 1: Solid Concrete or Masonry
Wall height: 8.0'
Depth below grade: 7.0'
Insulation depth: 4.0'
Permit Number
Checked By/Date
Gross
Glazing
Area or
Cavity
Cont.
or Door
Perimeter R -Value
R -Value
U -Factor
UA
828
30.0
0.0
29
1616
13.0
0.0
119
144
0.330
48
21
0.330
7
252
19.0
0.0
18
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,
and other calculations submitted with the permit application. The proposed building has been designed to meet the 1995 MEC
requirements in RES checkVersion 3.5 Release Id (formerly MECchecl and to comply with the mandatory requirements listed in
the RES checklnspection Checklist.
Builder/Designer Date a— "2 is 5
REScheck Inspection Checklist
1995 MEC
RES checkSoftware Version 3.5 Release I
DATE: 10/03/03
PROJECT TITLE: PLAN NO.5117
Bldg.
Dept.
Use
I
[lI
Ceilings:
1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation
Comments:
Above -Grade Walls:
1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation
Comments:
Basement Walls:
1. Basement Wall 1: Solid Concrete or Masony, 8.0' ht/7.0' bg/4.0' insul,
R-19.0 cavity insulation
Comments:
Windows:
1. Window 1: Metal Frame with Thermal Break:Triple Pane with Low -E, U -factor: 0.330
For windows without labeled U -factors, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments:
Doors:
1. Door 1: Solid, U -factor: 0.330
Comments:
Air Leakage:
Joints, penetrations, and all other such openings in the building envelope that are sources of air
leakage must be sealed.
Recessed lights must be 1) Type IC rated, or 2) installed inside an appropriate air -tight assembly
with a 0.5" clearance from combustible materials. If non -IC rated, the fixture must be installed with a
3" clearance from insulation.
Vapor Retarder:
Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors.
Materials Identification:
[ ] Materials and equipment must be identified so that compliance can be determined.
[ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
[ ] Insulation R -values and glazing U -factors must be clearly marked on the building plans or specifications.
Duct Insulation:
[ ] Ducts in unconditioned spaces must be insulated to R-5.
Ducts outside the building must be insulated to R-6.5.
I
Duct Construction:
[ ] I All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used
for fibrous ducts. Duct tape is not permitted.
The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
[ ] ( Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
I
Circulating Hot Water Systems:
[ ] I Insulate circulating hot water pipes to the levels in Table 1.
I
Swimming Pools:
[ ] ( All heated swimming pools must have an on/off heater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
Heating and Cooling Piping Insulation:
[ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the
levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp.
Insulation Thickness in
Inches by Pipe Sizes
Heated Water
Non -Circulating Runouts
Circulating
Mains and Runouts
Temperature ( F)
Up to 1„
Up to 1.25"
1.5" to 2.0"
Over 2"
170-180
0.5
1.0
1.5
2.0
140-160
0.5
0.5
1.0
1.5
100-130
0.5
0.5
0.5
1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
NOTES TO FIELD (Building Department Use Only)
Fluid Temp.
Insulation Thickness in Inches by
Pipe Sizes
Piping System Types
Range F
2" Runouts
1" and Less
1.25"
to 2" 2.5" to 4"
Heating Systems
Low Pressure/Temperature
201-250
1.0
1.5
1.5
2.0
Low Temperature
120-200
0.5
1.0
1.0
1.5
Steam Condensate (for feed water)
Any
1.0
1.0
1.5
2.0
Cooling Systems
Chilled Water, Refrigerant,
40-55
0.5
0.5
0.75
1.0
and Brine
Below 40
1.0
1.0
1.5
1.5
NOTES TO FIELD (Building Department Use Only)
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NOTE.•
THIS PLAN IS NOT TO BE CONSIDERED AN ALTA/ACSM
LAND TITLE SURVEY, NOR IS IT TO BE USED FOR
RETRACEMENT OF PROPERTY LINES.
ASSESSORS:
MAP 67, LOT 54
zmime,'
RESIDENCE 4
REFERENCES.,
DEED BOOK 7245, PAGE 84
N
0
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2
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2
C N/F
33 UPLAND ST.
a CONDOMINIUM
(— PLAN #13357 N/F
FRAN SHEA DORA
D
PLAN #326
100.00' 00
N/F w cn L4 COR. BDR
USE I. KNAKKERGAARD g
BD. 10.7
STEPHEN E. HYLAN � o � i v EXISTING
PLAN #326 rr► OSHED
m y o (30 MIN) -t -
z m 31 24'
ORJ (30'MIN)Fn tv
D �, r ' A6fTION o
C4 N/F Ui
rti q _ f"" -G ' 00 N/F
�-H•R FRANCIS & DORA
COPPETA REALTY TRUST 0 31 ,� ,j (30'MIN) SHEA
PLAN #326 p -� 30'MIN 44.9' PLAN #326
COR.
17.2' EXISTING 2 STORY = SHINGLE
COR. WOOD FRAME
HINGLE DWELLING/
EXISTING
N /F ) 19.2' DECK
12 UPLAND STREET
IRREVOCABLE TRUST SHINGLE ; AREA=12,500± S.F.
PLAN #326 � \
100.00' N/F
N/F HENRY J., VIOLA G. &
CURRIER FAMILY TRUST MARYLOU LIBBEY
PLAN #123
PLAN #123
I CERTIFY TO THE NORTH ANDOVER BUILDING
INSPECTOR THAT THE EXISTING STRUCTURES
SHOWN HEREON ARE LOCATED ON THE
GROUND AS SHOWN.
0' "9
rDE
icONALD y N
MOND, JR.
No. 31722
LAND
L LAND SUR
PLOT PLAN
OF LAND /N
NORTH ANDOVER, MA
PREPARED FOR
MATTHEW & BEATRICE DESMOND
SCALE. I" = 30' OCTOBER 3, 2003
0 15 30 60 120
HSAHANCOCK SURVEY ASSOCIATES, /NC.
235 NEWBURY STREET, DANVERS, MASSACHUSETTS 019238-77
CALC. BY- CHECKED VO/CE 978-777-3050e
78-777-3050 ;FAX ",'§74-7816
www, honcockgssoclvts com
SRJ almeldwgI m8pp.dwq ar w 2vw - Ya•i2 am
Date ..//--,-2/,�,3
...............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
.................................
This certifies that .........................................
has permission to perform
wiring in the building oft -/-1(24-5... ..... ... ............................................. at ........................................................................ North Andover, Mass.
111� U
Fee?�........... Lic. No ..............
L ECrRICAL INSPECTOR
Check# 16
4871
Of 4P TommonwratO of Mniiscar4itsrtts Official Use Only
mom 0Department of Fire Services Permit No. ��
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: IVd4Z % y A/(.i
To the Inspector of Wires:
By this application of the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) _ s7 -
Owner or Tenant /V] A-7/# LES- DEY, 1, (Q/yZ? Telephone No. yTV49f-�gpfl
Owner's Address
Is this permit in conjunction with a building permit? %Yes El No (Check Appropriate Box) /
Purpose of Building �'//1%�L� 1=.�� L y 46Q � Utility Authorization No. //'
Existing Service 1459a Amps a2'�(% / lZaVolts Overhead Undgrd ❑ No. of Meters 01YE
New Service 100 Amps &0 / !2(, -Volts Overhead ❑ Undgrd�}R No. of Meters . a -
Number of Feeders and Ampacity
LocationRd Nature of Proposed Electrical Work:
Completion of the following table may be waived by the Inspector of Wires
No. of Recessed Fixtures / S
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets ;Z
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above In-
No. of Emergency Lighting
/
grnd. grnd.
Battery Units
No. of Receptacle OutletsNo.
of Oil Burners
FIRE ALARMS %
No. of Zones
No. of Switches
No. of Gas BurnersUr N�
No. of Detection and
Initiating Devices
No. of Ranges 1
No. of Air Cond. oTotal
ns 3
No. of Alerting Devices 7'
No. of'Waste Disposers
Heat Pump
No. of Self -Contained
Totals:
Detection/Alerting Devices
F
No. o114Dishwashers
Space/Area Heating KW
Local EJ Municipal F-1 Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Water
No.
No. of Devices or Equivalent
Heaters KW
of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. of Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner. co permit for the performance of electrical work may be issued unless the licensee pro-
vides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov-
erage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE EX BOND ❑ OTHER ❑ (Specify:) 9Z161 ti
Estimated Value of Electrical Work: (When required by municipal policy.) xpira (o ate)
Work to Start: IInspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: CONTINO ELECTRIC LIC. NO.:
A I 19 �Bz,
Licensee: LOUIS CONT I NO Signature LIC. NO.: E 2 8 7 8 8
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-363-5420
Address: 1 T)nNl)rant nRTVPt WY -ST NEWRURY,—MA 01985 Alt. Tel. 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: $
FORM F.P. 11 HOBBS & WARREN - BOSTON (REV. 11/991