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HomeMy WebLinkAboutMiscellaneous - 190 FARNUM STREET 4/30/2018 (2) 190 FARNUM STREET 210/107.A-0103-0000.0 � � i r' Date... .......f�...... o... a AORTH °f ' TOWN OF NORTH ANDOVER 1 p PERMIT FOR WIRING # i # ;�SS�caUSE� This certifies .....-� !:'... has permission to perform ....? - !:.:. !:. -.'..., - wiring in the building of:....... ? ...cry!'.............................................. at �/( . North Andover,Mass. d Fee . ' Lic.Nod! ................ ..... I. j LECTRICALINSPECCo Check # 8005 Official Use Only Commonwealth of Massachusetts Department of Fire Services Permit No: Occupancy and Fee Checked -3i � BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] 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 ININK OR TYPE ALL INFORMATION Date: Q2 Z Z.d f1 City or Town of: . 41d Lo ye,t To the Inspector oJ Wires: By this application the undersigned gives notice of.his or her intention to perform the electrical work described below. Location(Street&Number) 120 A �( S 19� - ' Owner or Tenant �/1'( / /10 V S 6-7/2 G,– Telephone No.yv'fY7J-2, Owner's Address- ��- Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Boa) Purpose of Building 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: ' lj &14 Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E] No.of Emergency ig g rnd. grnd. 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. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number. Tons KW No.of elf-Contained *� Totals: Detection/Alerting Devices $ No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of ater , No.of No.of HatwWiring: Heaters signs Ballasts No.of Devices or Equivalent No.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. Estimated Value of Electri al Work: (When required by municipal policy.) Work to Start: L�� 6V Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO GE: 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. fi CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I I certify,under the pains and penalties of perju ,that the information on this application isntrue and complete. FIRM NAME:. J�j /�L�t�A � LIC.NO. Licensee: Signature LIC.NO.: (If applicable,ent p-"i th license number line) Bus:Tel.No.: .S r 26 Address: L/' /��` Alt.Tel.No. *Security System Contractor License required for this work;if applicable,enter the license number here: 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: All The Commonwealth of Massackusetts y Department of Industrial Accidents �.� Office of Investigations 600 Mishington Street r r` Boston, MA 02111 f: www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information n Please Print T�es?ib Name(Business/Organization/Individual): S/11 I'R Ay(9v J Address: 779 CUr �/1- �/V(/M S 4z City/State/Zip: Phone.#: Are you an employer?Check tate appropriate box: Type of project(required): 1.❑ I am a employer with_ ;, 4. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I ama:sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 7 Demolition working for me in any capacity. employees and have workers' [No workers' comp,insurance comp. insurance.4 9• ❑Building•addition required.] 5. We are a corporation and its 10.❑,Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised,their A 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.[1 Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who subnnit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatir.-such. $Contractors that check this box must attache e d an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractorshave employees,they must provide their workers'comp;policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:' 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 required under Section 25A of MGL c: 152 can lead t othe ' . osition of ' fine up to$1,500.00 and/or one-year � p � criminal penalties of a y 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. I do hereby certify under the pains and pen s of perjury that the information provided above is true and correct Si ature ®Z 2 O Date: Phone#: I. Officutt•.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 ldmg De partment 3.City/Town Clerk 4.Elec 6.Other trical Ins - pector 5.Plumbing Inspector 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." i 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 apart3nents 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,operstte�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, §25CO)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 carry 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 for 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 laworif 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. A new affidavit must be filled 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 burn 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 Commonwealth of Massachusetts Department Qf Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext.40,6 or 1-877-MASSAFE ` Revised 11-.22-06 Fax# 617-727-7749 - www.mass.gov/dia LAWRENCE H. OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fax 978—352-2858 pager 978-502-5921 March 12, 2008 Mr. Sergi Smimova 190 Farnum Street North Andover MA. 01845 RE: Smirnova Residence, 190 Farnum Street,North Andover,MA. 01845 Dear Mr. Smirnova As you are aware I designed the framing for the above project as shown on sheet 4 of plans, prepared by Martha Macinnis, certification date 10/3/07. As you requested I visited the site 1/10/08,to review the framing in the field. At that visit many items were not constructed as shown on the plan. I revisited the site 2/16/08 to discuss with you various repairs required to bring the framing into compliance with the design. These revisions are shown on R-1,R-2, SK-1, SK-2 and SK-3 dated 2/18/08. I revisited the site 3/12/08 to review the corrections as shown on the above sketches, these corrections have been made satisfactorily, except for the footing in the basement required to support the post from above. The original drawings called for a square footing, a 10" sono-tube was used. This can be corrected as shown on the attached sketch SK-4 dated 3/12/08.. With the above correction based on my visit I can certify that to the best of my knowledge the engineered lumber used in the structure are acceptable and meet the loading conditions required by the Massachusetts State Building Code. Please call me when the work is complete, or should you have any questions. Yours truly, " OF 4 9 LA RENCB �y 'D Lawrence H. Ogden ,P.E. Structural 27765 7765 5�ONAL ESA. Rap,; % " t , - . t- IN ,�T e. LAWRENCE H.OGDEN.P.E. 198 EAST MAINSTREET GEORGETOWN,MA.01833 978-352-8318,cell-978-502-5921 •. J DA lP_D ,� • a SSG OJ+.! RAME FOR PULLDOWN STAIR - Fo t. )NNER TO DETERMINE FINAL � C .OGATION T 4 11`� >OUeLE E I 3.S x 7,i •ONNEGT TOGETHER PER IANWAGTUREI VERSA !R R'S ,EGOMMENDATIONS 8015E G SGADE 6GI I6'� Po S r ro 1105 2.0 ® OG P u,W q t:=gin/ g L0(,,Y �c `F WNT4 Cac.LA IZ L T%E 1wRCN ako 3 Z gLOCK_e o T (�DJq.cF."'T C 01.(..4dre -i Ir -ugF- $Imp$o COLVMtJ 6,AP 3.2x4 psi' 'BC, R i M -BOA Rg Q a'----- ,� ____q'------ W1714 _WITt4 {- (.?5 x t 6"€-u t_ w► T�h 5►J,.P$,.A, $cx A01Sr R�c.E C� ITT'416 M SC ,st f 5 r-E wPD TO Me eT" 4 ROOF G F O/AETR Y � L 1 s�X 1 " v 15 Q SP>CiAL b 2 c E I? I TIVF m Rpt. ow 2.175„ 9-s T,nv 3 L Ut, µeA A e!' � QJ2f RnriN�j�1J I K _ !!t t VA I-L e-q g LSSUQ tO t•?S x tl '�G" UL ENGINEER: LAHRENCE H. OODEN FE I Q5 EA5T MAIN 5TREET OEOROETONN, MA. 01533 q78-352-8318, ce 119?5-502-sq2 i 2.118 to sp SJR- REPAr I ILS FR ATTIC-, FLOOR FRAMIN0 Ov LO NOTE: 3 5 f DG NEW ATTIC FLOOR FRAMING 5HALL BE CC INSTALLED ON TOP OF EXI5TIN6 P50N HAN6ER M'4 CEILING JOISTS. -`-I--�_I I pl�' 1361HEADER I" BCI RIM BOARD AROUND PERIMETER. 3 Tot� 2 n i O t /" 0c pA-,-t-s:.cis WIT4 2.n6 Cc)(-LA(,' T1-eS-e INSTALL 5IMP50N HIO HURRICANE CLIP AT END OF EACH RAFTER J T� �T '(" rn k ITEnM 2, X N S K-- N N 21 z x a 10 MARTHA MAGIN-N15 Pj�OPOSED. NEN ATTIC FLDOF BRADFORD, REGENT AME.ADFORD, MA. 01835 SM I RNOMA RAS(DF=NC E (Q78�3�4-8 I10 FARNUM 5TS EET NORTH ANDOVER, MA. 9'0 hJ J!''! ST R e e-'r NTIA +cCte— ' 4 F—E�T, � Q e iii M S S n1 la 4-AJ4 F-K M 5 G1 . l N4,.; S ee ��e��►ate �ff 4a l �� Squa LOCr- S 0 W L;A/0 6-� t Svcs W►T4 OAK, W&W E Cvr TOP r r 5t� PA g 5 � °'h� F- VSA Gs � 3 ee L.0 S ��„�4 gin► � 4A4 a F F, t r P� - � $ • zI131 M t;L � �:PF-4 CF. 95 YL 113,C2 PA An Vrxcer 4y C.-L t �' AT a ` LOC . Sot-lip ���" • fti, t nNta t/I 3 l t�5 $ o +t fi t 'fi t we w l.v L. VA to r NEW i C.,� 4e NORTH T oo6 Andover wn f No. 3 C3 _*r;V7 7 over, Mass., C) 0 LAK It. COCHICHEWICK 0'4:?ATED J"V S WARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THATFoundation ... .......................................................................................................................... has permission to erect .......................... buildings on /�15) /�rl IrAJ S' Rough .............................................................................................. to be occupied asqChimney ...................................................................................................... ...4-le". provided that the person accepting this permit shall iryevery 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS .CONSTRUC7TI!! STARTSx1_ Rough ...... Service .............................. .......... ........ ........ BUILDING INS CTUFt- Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises ---;-Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until ' Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date.... VORTH 4`° '•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACHUS This certifies that . .:. ................... ........ has permission to perform .... .. i .... r .. ... � ur .... wiring in the building of .............................:.................................................... at./f.:.........`�..�. s ���;,: .....:.:........:�.�........ ,North Andover,Mass. .......... �� �/ �-� Fee..................... Lic.No�........ . ELECTRICAL INSPECTOR Check # P / {1/ 6r icial Us-—co,Onl _ C.ontrnonwealtli ol/�/a9]ac�tu9eiif Permit No. I '( - ''I �LJC/JU II/)tBAI O�JI/Q �8fV1[1] t 9s Occupancy and l=ee Checked t 1 BOARD OF FIRE PREVENTION REGULATIONS lte�. 1,99 J fle l a, blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AN ��orl, to be pertitnucd in accutd:urce�Oi!i the :\tassjchusctts 1:Iccmcal laude(`iEC), 527 LAIR 12.00 (PLEJSE PR11VT 1.V 1/VK OR TYPZL-lLL INI,'ORM,MOV) Date: i City 01- Town of: /0, A oua L To Me 111.ymor of'IVires: Lav this application the undersigned rives notice ofhis or her intention to perform the clecnical work described below. i j Location (Street & Number) ( t7 i Owner or Tenant � k-,Q e j rn.1 f2 fVQQ Telephone No. Owner's Address Is this permit in conjunction with a building permit'.' Yes ❑ No [ (Check Appropriate Bos) Purpose of Building Utility Authorization No. Existing Service Antps / Potts Overhead ❑ Undgrd ❑ No.of tP,tcters New Service Amps / Vults Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical (fork: tA,r k a 5_e4)-;-V— Completion V—Coln lerion of the f<d1mving ruble mall be n•aived by the Inspector of(t'il'es. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Falls No. of Total 'rransforuers KVA No. of Lighting Outlets No.of Ilot Tubs Generators KVA No.of Lighting Above III Igo.—Of Emergency tg tang bhting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones of Detection and } No.of Switches No.of Gas Burners No. Initiating Devices i Total No. of Ranges No.of Air Cond. Tons No. of Alerting Devices I No. of Waste Disposers Heat Punnp Number '('ons KW No. of Self-Contained Totals: Detection/Alerting Devices No. �f Dishwashers S pace/AHeating Municipal 1 rea g KW Local ❑ Connection Other N11t Dryers Heating Appliances KW Security Systems: `' _ ' No.of Devices or Equivalent No.o. "rater KWN0.of No. of luta 7Virillg. Heaters sins Ballasts No.of Devices or Equivalent No. Hydrumassa�e Bathtubs No. of Motors Total Iii' Telecommunications Wiring: b No.of Devices or Equivalent OTHER: l itac•h additional derail if desired, or as required by the Inspector of{Vires. INSURANCE COVEIUkGE: Unless waived by the o%vner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"covera,e or its substantial equivalent. "l he { undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: IN'SUR.,\NCE R BOND ❑ OTIiER ❑ (Specify:) (Expiration Date) ' Estimated Value of Electrical %fork: i Z OCA (When required by municipal policy.) Work to Start: 2 2(=0 Z inspections to be requested in accordance with NIEC Rule 10,and upon completion. 1 certif', tender the punas arrd penalties of p1erjuu,that the information oil this application is true and complete. F1101 NAME: - 1 S `eS e t LIC.NO.: Licensee: JELL_. �K l„e�SS�--- Sibttatwe LIC.NO.: r 73 (If applicable, enter``�"e.r. opt"in the licence number line.) Bus.Tel.No.:7Ss'/-y�'0-(- r Address: 2oca /°* v "'-' <,�— C0,1•�-t &t�_ Alt.Tel.No.:_f>Y-&I-7-5S)6(� ONVNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my si�-natmc below, I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent Pi- F-E—: 5 Signature Telephone No. Of NORTH,M ��``° '• o TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,S3 CHUSEt Q This certifies that . awl A ... !.:... r ..:. has permission to perform ...... ........ wiring in the building of......; . .......: ..................................................... +� at... v*��....... ,North Andover,Mass. Fee ���.. .... Lic.No,�/ 4 �,r. .\ ..1...!. ..;,t�......�� r j"--&i TRICAL INSPECTOR J Check # 4_ 5615 Office use only 1 HE(,ULVMU1V VVP AE!H UIQ AZ4,,,iEi(HU6E11 J DF.PAUMENTOFPUBUICS Permit No. BOARD OFFIREPREVF1VH0N ONSR702120 of Occupancy&Fees Checked APPLICATTONFORP�TOP ORMELECTRIGALWORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MA ACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date O-z Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrica wor described below.. lmLocation(Street&Number) / K/ V V 4Y/_1 Owner or Tenant 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 Underground F-1 No.of Meters New Service 77F— Amps 2f40/ /24OVolts Overhead Underground r--J 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 KVA No.of Lighting Fixtures Swimming Pool AboveBelow Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units Vo.of Switch Outlets 2 No.of Gas Burners 1Vo.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER-- hVnr=GDWraW- Rttst><vt6othetegritar�s�GalaalIaws Ih,; aamailiabl7ityl»SurPoticyinch>dagCanple>E eisb;�tiagrialY YES NO IhawIbrrwmdvatidptoofofsametntheOfflce YES ffyouhaNediatlWYES,pleaseirdcaiethetypeofmvsag�bj, dr&aglhe box ET INSMANCE \/ BOND MIR � (P1ea9eSpec�y) Estirr*dValteofl~7oc"Wodc$ WodcloStalt kEPecbMD&Recbd Rough Fiml SignadundArFbMkesafpecjtuy. 1, FIRMNAME ��` Lioa�eNC, Os.5p7 4 Lioerwe Signahne Li�eNo m l✓� >! � /y4• .. (,SPX l BtuulessTelNa ar Bl `�/AILTdNa yZ;E 3VS.RdVSz OWNER'SINSURANCEWAIVER;Iamaw=dmt&Lxawdoesnothavvetheir>sura=oDwWorzsub�egtrivalagasWlkedby,MassadlEsC=Ed aws and that my signahue on this pern-d applicMcn wain this legtrilanat (Please check one) Owner 1:3 Agent M o Telephone No. PERMIT FEE Signature ot Uwner or Agent i 111E(.ULV1MUlV WL'AUH U1',1VLA1NN1(HUNK1I J Office Use only _ DF.PA1aNE T0FPUBUCSAFEP--, Permit No. n�O/�3� BOARDOFFREPREVEMON ONS527CMR12.w ti Occupancy&Fees Checked ApPLICATTONFOR PERNRT TO P ORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MA ACHUSSTS ELECTRICAL CODE,527 CMR 12:00 0 rp ©S (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date !J Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform �the /ellecctri�ca wor described below. C�x et&Number) + P/Y V /'1`` :Y° ` " /�� j , -� , 1 ,::Location(Stye c + « 1-s� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes m No .� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service - Amp �Volts Overhead Underground No.of Meters New Service %mps%zy©�1)Volts Overhead =3 Underground No.of Meters Number of Pee�aad Aafpacty Location Md��+ofProposed Electrical Work No of CMieM1 No.of Hot Tubs No.of Transformers Total KVA No o[ Swimming Pool Above Below Generators KVA round round o Outlets No.of Oil Burners No.of Emergency Lighting Battery Units ;a Nu rpt6 Outlets No.of Gas Burners '`(Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones _ Tons No:of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices o.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices o.of Dryers Heating Devices KW Local Municipal Other Connections o.of Water Heaters KW No.of No.of Signs Bailasis Hydro Massage Tubs No.of Motors Total HP ER - --- - - _ - Coveraga.R=Mtbthetegt*MXI so Ma=dU9eMGff=WLaws ' ama1Liabtlrty1M=xePb1Ly=kdngCxnp Covtxils tialt�quivala�t YES NO validpwdofsanrlotheOffim YES r IfyvuhaN•edrdodYES,plea9eirtdicalethetype0fooMrVby BOND OTHER Q (Please*City) E0natad VahleofDectacalW "k�" "cdc$ hq)eW lD*FffPest0d Ro* Final FUMkies0fpedW �. LiceWNa Sigrmlle IdoatseNo 'i BuskmTelNa C- 1 l/���� /v©• l7'Lc o��P✓r /� �l�j�S�Alt.TdM. INSURW1(EWAIVER;Iamawarethattheli=wdoesnothavetheir>staa=cowWoritsaksLi&g&ialtasnjgtri byMmmbiTZC=aalLaws #grlatiueon thisparrltappliratiaiwai�s this laquitanat. ck.one) Owner Agent 3✓ Telephone No. PERMIT FEE =� signature or Owner or Agent FILE COMMENTS Name: Comments: 190 Farnum Street Date: 3-9-2007 Bateson Brothers did the system. Osgood did the design. Raised system with a retaining wall. The wall fell over from multiple burrowing animals next to the brick wall. The D-Box has water covering it. Batson pumped tank. They have constant running water into the tank. Batson advised the homeowner to fix plumbing problem. They also advised them to removed their garbage disposal. Bateson checked their water usage with DPW. Their using 100 gal. More per day. i i L Commonwealth. of Massachus s Cit. own of System Pumping Record 3ti. Form 4 Y DEP has provided this form for use by local Boards of Health. The System ftm ing=Recorlmmust be submitted to the local Board of Health or other approving authority EU�y� A. Facility Information MAR 0 5 2007 Important: When filling out 1: System Location: fors on the `r WN OF NOR--ANDOVER computer,use r "" ��� HEALTH DEf-,%RTMENT only the tab key Address to move your l y+ � y\U�� �— cursor-do not City/Town / 1 use the return Sta Zip Code key. 2. System Owner V\,& Name Address(if different from location) Cityffown Sta Zip Code' 17. 7 Telephone Namber B. Pumping Record fi: .Date.of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system ❑ Cesspool(s) ❑ Septic Tank- ❑ Tight Tank ❑ Other.(describe), 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of.System: . ��__�X_j 6: Systerr� Pufnped By :`Name Vehicle License Number Company an Y 7. L.ocatio where contents were^used:. Sign u f a e— Date http://www.mass:gov/deplwa#er�apptovals/t5forms htni#inspect t5for4.doc•06/03 System Pumping Record•Page 1 of 1