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HomeMy WebLinkAboutMiscellaneous - 199 ROSEMONT DRIVE 4/30/2018 199 ROSEMONT DRIVE 210/098.6-0048-0000.0 5 �r. Location �t: No. Date � s t %ORTNI, TOWN OF NORTH ANDOVER O='�.._ .• O� M p Certificate of Occupancy $ �&S 3Y Building/Frame Permit Fee $ .�3 04 Foundation Permit Fee $ _ J Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �;��'_��3 �5 3 Building Inspector 9656 Div.Public Works 1 . Location ' No. Date '` ' TOWN OF NORTH ANDOVER a Certificate of Occupancy $ A * Building/Frame Permit Fee $ Foundation Permit Fee $ ACNUSE Other Permit Fee $ 'M Sewer Connection Fee $ Water Connection Fee $ TOTAL $A5::� 1 Building Inspector c7 657 Div. Public Works i; I y,. ,.-�_ .....� .-: +^w.. .eA6^fes..^` '.'Y`w._ ��-'[ �..iyw rr2�.aF,rtr:W!'n• ,qq to {� Location G. No. 7 g Date NpRTH TOWN OF NORTH ANDOVEI ° asagmdllkp Certificate of Occupancy $ Building/Frame Permit Fee $ i 'ssAC„usE`� Foundation Permit Fee $ Other Permit Fee $ .p. /c" 3( Sewer Connection Fee $ — 0 4Y/t-/�,, Water Connection Fee $ /14 Sa TOTAL' $ d � 7 B biding In ctor J 9035 Div. fjub'lic Works PER:-I,T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. ✓ PAGE 1 r MAP KJO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE _T ✓ ZONE Q SUB DIV. LOT NO. 26 LOCATION�9 �b Q��L� �C?q PURPOSE OF BUILDING v OWNER'S NAME UIKA-]'-k"c L� r ,,,_,,;� n_n F NO. OF STORIES K SIZE OWNER'S ADDRESS 31r)3 qp4/ IT�YCr`�W�Vyv� !w �/��n� EMENT R SLAB ARCHITECT'S NAME Y' SIZE OF FLOOR TIMBERS IST 2ND D 3RD BUILDER'S NAME �// /2n p7]_�S SPAN 1-6-1q DISTANCE TO NEAREST BUILDING •./� DIMENSIONS OF SILLS �/G2 DISTANCE FROM STREET Z2,s(:p r�h��OSTS DISTANCE FROM LOT LINES-SIDES REAR i yg GIRDERS AREA OF LOTIt" 2 FRONTAGE HEIGHT OF FOUNDATION g THICKNESS l0 Ir 15 BUILDING NEW l/� „�jG SIZE OF FOOTING wy X IS BUILDING ADDITION �iR//)/ MATERIAL OF CHIMN Y �WQgm IS BUILDING ALTERATION 1 /00 IS BUILDINGSOLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE / IS BUILDING CONNECTED TO TOWN WATER �5 BOARD OF APPEALS ACTION. IF ANY /(O IS BUILDING CONNECTED TO TOWN SEWER ,l/ IS BUILDING CONNECTED TO NATURAL GAS LINE - INSTRUCTIONS s PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST as,J 105 EST. BLDG. COST PER SQ. FT. a PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM U SEPTIC PERMIT NO. ELECTRIC METEPS MUST OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST E FILED AND APPROVED BY BUILDING INSPECTOR DAT ILED BUILDING INSP[CTOR SIGNATURE- F OWNER OR AUTHOR AGENT 4777- 1 F E E 3. y�J OWNER TEL. / 146 O c -a BLDG. PERM'' "177 T (/. CONTR.TEL.N �U4 6'62—�Q� PERMIT GRANTED 9 LESS- 1 r , 19 < LESS FDA FE .;..._ ( � I- L CONTR.LIC.� DUE FR it S 9 FRAM H.I.C.# PERMIT ER FOR FR aNiE/BUdLQ(NG �f DATES FEE Pa f U:� 3 c ti BUILDING RECORD 1 OCCUPANCY 12 V SINGLE FAMILY RIES - 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 $ INTERIOR FINISH CONCRETE _ d 1 2 13 CONCRETE BL'K. PINE - BRICK OR STONE HARDW D j PIERS PLASTER - _ DRY WALL UNFIN. 3 BASEMENT. AREA FULL FIN. BM'T' AREA _ '4 1/2 '/. FIN. ATTIC AREA NO B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I. 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"✓'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE —{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR ADEQUATE NONE % F 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) Z GAMBREL MANSARD TOILET RM. 12 FIX.) r 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 ti ' WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM a' r STEEL BMS. 8 COLS. _ HOT W'T'R OR VAPOR 1 ✓Ij r�(J# ~ .�� WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL f g'M'T12nd I T ELECTRIC 1st 'f� 3rd NO HEATING 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: , % 1640 ALO Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street �bsll?dx�Z` �r2cyb� St. Number ************************Official Use Only************************ RECO DATI :rl,,l AGENTS: L 4 Date Approved 1 Conservation A ini trator Date Rejected Comments Date Approved 1 Town Planner Date Rejected Comments Date Approved Food Ins ect -Health Date Rejected Date Approved 3 pt c nspector-Health Date Rejected Comments -Public Works - sewer/water connections - driveway permits-� Fire Department ' Received by Building Inspector Date MAR 1 4 (996 ! FROM LAND PLANNING BELLINGHAM PHONE NO. 508 966 5054 P02 370 r j i LOT 25 / s2 ! 1 r r LOT 27 LOT 24t aeo OD \ \~ �J * 15,2 8 t.F,. CL Iv o 3 � CIvL }v! rEQ� s CAR 38�SO ps368 �h �SLAQSg 70 35 5 0 . 7 ,g6� \Nl� � 0 ROSEMON ,p % `364 CLEAN U � a to (50' WD APP. Y) Irvv=ss.42 � a NOTE: ALL UTILITY LOCATIONS ARE TO BE MELD VERIFIED BY THE GRADING / SITE PLAN SITE CONTRACTOR. EATON FEDERAL IACA7'!56 AT LOT 26 SETBACKS: F-20' S-20' S—O' R-20' NORTH ANDOVER ESTATES NORTH ANDOVER; MA PMWAM FOR LAND PLANNING TOLL BROTHERS, INC. ENGINEERING & SURVEY 1800 FEST PARK DRIVE 167 HARTFORD AVENUE, HEUJNGHAMA 02019• wESTBOHO, MA 01581 M, (508) 966-4130 FAX (508) 988-5054 3/13Z95 1"=4O' Id At-26 J NORTH TF ® of over t -1zL r No. <; " +_R- dover, Mass., 19 COCHICHEwICK a A0RATED `-' BOARD OF HEALTH Food/Kitchen Septic System PERMIT TBUILDING INSPECTOR THIS CERTIFIES THAT.... ......�........ .1.. .(. ..��............ .A...1. 4�.......... O..L�' ..��.................................................. Foundation has permission to erect...............O- ...... buildings on ........../....9.. .......� .�.5 .d. T~ Rough tobe occupied as............................. ............. .. ................ .'1..1. --.Y................................................ Chimney provided that the person accepting this permit shall in every respect conform to the ters 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. '�'_j I �PI `01 'N rT , � PLUMBING INSPECTOR I �:,R+�fi .,� �. FO PI of the Zoning or Building Regulations Voids this Permit. ' '°°° # =r.r, S. B.C. Rough PERMIT EXPIRES IN 6 MOQ Final UNLESS CONSTRUCTION S AR - ELECTRICAL INSPECTOR Rough Service B LDING INSPECTOR Final Occupancy Permit Required to 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. Smoke Det. NORTH 0 Town of d ver 0 VIM No. 78 o o dover, Mass., 19 C0'+i C.E-CK A0RATED PPS' `,�5 5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..../.Y/1.........Lt...M.(. to..........k' .eyo..........� .................................................. .undatio has permission to erect.............. .o- ...... buildings on........../..9..?.......� .5 ..�''t.d. l ~.....:(`�.f�.., Rough to be occupied as...................:......................, .././ .. �................ L.�1..1. -,.�.............................................. .. chimney provided that the person accepting this permit shall in every respect conform to the teribs 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. �PDRIi Fp Rough RcGULATE©8RY�0RAIDATION D1V/Ly Final PERMIT EXPIRES IN 6 MON �T S 1 114 8-S. B.C. ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS .;., PAID Rough PERMIT FOR FRAME/3,_,t r,l.,- ....... Service 13 (o� B LDING INSPECTOR Final DATE: Y Occupancy Permit Required to py Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove nallh F No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. NORTH .0�4�7 w k , Y.tgy� j k .. £ 0 over -� i. No%7sz�, J r t :z i _ �"� .'a i A !?v., = qua�w $� 4--.,,+.# i o � y lover Mass. 19Y � .�..� H� �S � � :r ka4 4T * , , r is A D Pa t� ,r RATED MIT J BOARD OF HEALTH fi Food/Kitchen * t 4 Septic System ..� G INSPECTOR BUILDING I i T# IS C IFiES THAT�.. , 1. '.(. ..... A...l`�c7... . o.:R...P.., ......... .......... ........ undatio �-- w / tics' ernti'8l0 to erect , G.7 ...... buildings on....,... 9.. .......��..�.5 ..�`1.d.1u �......(71�., ���w ,ra v L. moi`jam, f 3 't0 be c cc piled � ... ........ . !✓.. .U.". �. C ney. u: pr'ov ded fhat the'person+�ccepting-this permit shall in every respect conform to the ter�hs of the application on file in ,d thin:office,"'and to the provisions of the Codes and By-taws relating to the Inspection, Alteration and Construction of mal Bulldings in.the Town of North An PLUMBt INSPE 4,4f r PSR ^ CT0'�-- VIotATIQith9"lo'ning or 8uildir�g Regulations Voids this Permit. Mlr � au Ui ::� EGU(grED Q p�UNp/iTll�N ina S B C. ELE CAL INSPEAQ RM CTOR s CTI �z{ A UNLESS CON-MUCTION r.. >� Ali , Ro f l y'PERMIT��OR�fR�A�IE/BlJ4l:Cl��v s' a Service' .................................... IN SPECT - B DING OR in ' . ATE y ` FEE PAIdz / U �, <p�, �CCI:� Pe-r it >�('C�Itired t0 �t7y �1.lilding GAS INSPECTOR Rou r f p y a Conspicuous Place on the Premises -- Do Not Remove x n Des 1a' m No Lathing or Dry Wall To Be Done kt` , x �� s FIRE EPARTMENT v Building Inspector. } Until:Inspected and Approved by the Bui d g sp Burner ' Street No. Smoke Det. � ur b:�3 � �l� L t s•F�. N t i ~r i'„H '!' � W��yf tT 'T .. - 9 i, t '�. i Til F t �, _ - ►. �wz�r ry,x*�•,3� {tbj3+��� '”' -Fp i 'tif3a s�1 �` dr a7( yi. 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Pt ti'-. •r...R Y ':.. ! '7 THIS CERTIF THA T � , 1 , Y f!� t ,tp:: h.2.i t �f o5.}„ 1' ''�' "eS' i §':5'. •4 r' �...'U y n ,C "'•6 76a :1 r 1 w .. +, 9i ..�w xis �`'A 14:�! adb �3lnn fi:. ,�• � -T .�. a " THE BITILI?ING I#OCATED ONDRIVE' 1 199 ROSEMONT .L'�� '!.i_r -,q. .,t3.i•, P:. - C s � .x r' �u r: r P - `re tot.. :' s5 t>. ; 5}�- •e .a -x ♦i}r p.. Y L,^• 4 F ?. "1 ��55 r ti i A' SINGLE FAM LY DWELLING':::. r:,, �.g _, • , , ��.•. � t, - MAY BE O,lGC TIED AS. IN A►C R13A,N � , :., n... a.n. - , ;>1i t`r.. �, ! e , c:x.;, +-t'..i•, �'ic`F�� t,:<� �t'3( :,.;-F .:x• FMr°-.a a ��' w,.,v �� 7i 7 WIT : :. : H'THEPROVISIONS OF THE.MASSACHUS.- _ S,STA�,T BU IIVG CODS, . cr w i sUCH..OI'IIER EGULATIONS.AS MAY 'APPLY. .� x X53 4�,} ?1 t, .wP # -F•. �.. 1 �t •yi Y }4 .. 3 lr +i. 7. t 7j }r 1` �.y [ 3 Cds 7s.;rAs: t :. {k, ,{. :. ...✓, a . � i .:; ..,. t a'. ..P 5 r .i� "vl i .r:.. ..3•� p4 1� �` t. :p i -r..� � I tt s7& C ,.�n,',•. + k o .:�t n, f !. :i�+. �z.•.^' r' r '�t.'{' �eia. ,tL»"X { t �.•r}t� `$•Y�j,� ��# � •a s, t ,;�?;, { ry t i { e:, ;, t , �,. +•. a CI,It�II KATE ISSU wD O�, MA Ltd. Land Corp. S y { 1 t �� • { - _ ( ^K.1 1ny� .�Ph1..'�,„ y-� �yp -{ �i'li§ t i} � �'� :S� e�y y 310 S l�.tll�llt �Vi:.�• f' '✓S t* q -°*L � s ,,0:ADDRESS' 4 ,� r ' #V i4 ♦ �,' .r M t'° s s 4S I d;: ly'etYs t '4.;+°'j! t r.; S ft R •. �� } o-.�... ii 4 i1F t t ,�i �rgti,r � .f ,��D�•no�a a}.^a `�, E Ir a"�� �� tS;�o- i+� .. y � * k `i i 9 Y t°'ry{ n.' !_ t- s „e } F x,'x•: Buddl ..Ins Inspector - - ,ta#e t .. is _i.t. !r x:-,rth�}Y .;... .. y,.d ..� o-i "�!'t�i}s .2'f..d •�t tTt, .L� +'�:#. r §.. L. >.�8 ''e. �:. µ�R :� S� f• !1, 4 �:4 54 Y �: t 3' t t;. �:i " �3tt'.,t.c �� � r. k-x', r ,... ' ',',., I � .a., at. ea.. .- ', ?.. ,._ ,,� ,t r 1 r; r.M7.„ ie ,�•s` 1 'i. Tr. ra ? 6i,3a _x <3:a t .,i.F �r, '.a,..:.ct, �a : _ s,r•. .tis, . :. . ,tt n1f t k _ • y i7,:I y';, P ,bio- s e St �.E ( , e f m za i A 3 Fd�w t - ,, Vii•. r 'iia j � - . a t w„ c - .. • • '° �'-_r `'§'k ] a to v,,i� 4 i ;W�• �.. �.., . � j �v .: •'S ..-.:.. .: ,. r ct t s: ,ra }+��rtr.'� tr4� �Yaa 1�1 t; �� : •<':' S , t. ,.:i., ....:: .:. ._:___- . �'.• ;a'.._ _ ra�T u,t:t r.., 'n t �}7, v �• �l,:a'jl tl�', >•;� y�� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date - _ building Location � 4 r G� OS�� � Permit # z (� to Owners Name %w �,,� ,r New Renovation D Replacement Plans Submitted D FIXTUR=1z w v; to aI v z N s Imo. O v m z m cct- d to 0 Y W W O 0. W LU W— cc y Q W " F N Q y W us W W Z < y a us m W 4 Q cc Ulf. us t- X o t- z � f- z t. W W cc C7 O T k f. V .s F.. w z 4 W G a — i Y- 0W 4 cC 4 td ' O Z rz O W z rs z v o x U. t— o SUR—SS MT. BASEMENT IST FLOOR 2ND FLOOR G1 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TK FLOOTR ± s (Print or Type) Check one: Certificate Installing Company Name Corp. Address �o jpq Partner. ✓/,21; -���� e ���L�/lam 5� Firm/Co.- Business irm/Co.Business Telephone: Name of Licensed Plumber or Gas Fitter46:� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity F-1 Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent El i hereby certify that all of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and insaUadons petformi d under'Permit iuced for this application wiU-be-in compliance with all petttnent provisions of the Massachusetts State Cas Code and Chapter 142 of the Cenuai Laws. . By TYPE LICENSE: _ Plumber Title Gasfitter- Signature of Licensed City/Town: Master Plumber or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) Li�nse Number 4XIt"e.— .r I Date: fi I< °; of No oT",ti TOWN OF NORTH ANDOVER { PERMIT FOR GAS INSTALLATION O o �9SSACMUSE� fQQr This certifies that . . P.1 . .{. C. �. . . . . . .f . . ` c p has permission for gas installation . . .A.t° in the buildings of . . . . . . . . at . . f Gi ., f t` . . . . . . , North An` very, Massz_ f Fee. .�r. ' . Lic. No.A Y).7. . . . . . . . . AS INSPECTOR . �m WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:Flleo Office Use Only / gymsm.uhE LIIITIIIIIIIII1IE it I Df 5fic`IL LI-1PttS Permit No. s � Ee{rarimPrrt Qi llubtic �fett2 Occupancy & Fee Checked 3194 (leave blank) SOARO OF FIRE PREVENTION REGULATIONS 527 C, 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 QM or Town of NO TH mn -FE To the Insp ctor f Wires: The udersigned applies for a permit to perform the electrical work described below. X99 l�s�f; Location (Street & Number) / L ""^' / Owrer or Tenant/rUT�h cam( Owner's Address Is this permit in conjunction with a building permit: Yes `� No i_ (Checkroorta aGrx Purocse of Suiidinc eS�J Utility Authorization \2 �D� w Existing Service Amps _J Vcits Overread Undgrnd r No. of Meters New Service Ames -A 01 Vcits Gvernead _ Uncgrnd No. of Meters Numoer of Feeders and Amcacity 0 �� Location and Nature of Prcoosed �iec:rcai :`lcry �� No. at l.ignang Outlets i No. a. ....' 7�cs Ac No. of L.- ting Fixtures i Swimming Pool r a e_ crnc. i No. of Recectacie Outlets No. at Oil Eurners Taiai ! No. of Transformers KVA i Ganerators No. at Emergency Lighting aaaery Units No. at Switch Outlets No. or Gas Eurners Tota! I No. at Ranges I No. ct Air C,.nc. tons "eat Total No. of Disoosais Noaf s :ons K.Vt No. or Disnwasners .- ScaceiArea Heating Na. at ^riers Heatina Dev,ces KLV ` No. ct . No. at No. of `Nater Healers KV/ I Sicns Sailasts No. of Meters Tota: HP OTHER: KVA FIRE .ALARMS No. at Zones No. of ^election ane initiating Devices No. of Scunaing Devices No. of Salt Contained Oetect:aniSounaing Oev ces I Munciaw -Other Local Connection Law Vottage Wir.nc INSURANCE COVERAGE: Pursuant to the recu+rements at Massac-usa-s general 'Laws Its _ I have a current Liaotiity Insurance policy inclucinv YES Ocerancncucoverage orave c.'tecXec YE�S•aleaslB, nuivatent. S et coverage Cy nave suaminea val proof at same to the Office. S _ NO — i cnecxtng the aop anate aox. INSURANCE SONO = OTHER = (Please Scec:ty) (EAnirauan Oatel Est:maceo Value of E! ctncal 'Nary 5 Werx :a Stan inseecaon Oate �;acuestac Signea unser the Penalties at penury: I FIRM NAME �<1.U�Jc`� �2dS i- Inr�-nv "Y Raugn Finai LIC. NO. ! Ic_ NO. 3U�13a Licensee 1OR� �QL S.gnacure /EytS� / /. 2—Ci6o Sus. Tat. Na. ACCress ,1�ll2niJJ i�VC ,tgiUlrf� pog Alt. Tet. No. r' rr insurance coverage or its SuostanUal eaurval8 OWNERS INSURANCE WAIVER: I am aware that tre L:cer!see aces not ❑ave :ns A ente- ctuWrea nv Massacrlusetts General Laws. ane ;hat my signature On :n:s derma aoalication waives this reauirement, ner tP!ease cnecx anel —aiecncna No. PERMIT FE= s <�SSS (Signature at Cwner or Agenti Date ..... A i,J2 414 NORTH p 1 to 6 — 6 TOWN OF NORTH ANDOVER PERMIT FOR WIRING PIMP This certifies that ..... f,/ ... fu. ` A ( ...... .......................................... has permission to perform ....... \./. . t'. 0 WA J ............ I . . ....................... ru wiring in the building of ........ T.0 ... k.A ............ .............................. at...... ............. ... . ....... North Andov�e®rs. . . ....... Fee..33� .... 60 Lic. No..A�'..( ..... . . ........... LECTRICAL IN PS ECTOR WHITE: Applicant CANARY: building Dept. PINK: Treasurer 1 The Commonwealth of Massachusetts once use oniy, �.:..� Department of Pub �gffl 4 lic Safety Permit No. .^ ed BOARD OF FiRE PREVENTION REGULATIONS 527 CMR 12:00 occupancy a Fee Check 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL An work 10W performed In .aaroanC. witll o+e MaaseenueetU tcllrremeal Cods. u7 CMR 1200 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION �j /n ,/ `, Date X City or Town of N!/_' IVA/ty c --P / 'The undersigned for a permit to perform the elecincal work described below. Location (Street 3 Number / 9y �/l ��/y�/f/�►— �p �� a Owner or Tenant _Lz /mP P. To the Inspector of Wires: Owner's Address Is this permit in conjunction with a building permit ,, ry �- yes ❑ no � Purpose of Buildtn"if/�L' 4�t�C�V�[� //Q���//)� Utility Authorization No. (Ch-* Appropriate Box) 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 Nat - *,e of Proposed Electrical Work f" L/0 7'r a -- No. of lighting Outlets No. of Hot Tubs INo, TOTAL No. of Li htln Fixtures Above Swimmin Pool In ❑ ❑ of Transformers KVA rnd. rnd Generators No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting KVA Battery Units No. of Switch Outlets No. of Gas Burners -------- No. of Ranges No. of Air Conditioners No• FIRE ALARMS No. of Zones of Detection and No. of Disoosais HEAT No. of Pumps TO TOT L Initiating Devices No. of Sounding Devices TONAL No. of Self Contained No. of Dishwashers Soace/Area Heatinq KW Detection/Sounding Devices --' No. of D ryers Heating DevicesMunicipal KW Local ❑ Connection ❑ No, of Water Heaters KW Na. of Bof Si ns Ballasts allasts Other low Voltage Winn No. of Hydro Massae Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial - valid YES-❑ NO O I heave submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage b checking the a I IL �. !� , tl y 9 appropriate box:' INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) i i'Q U Iyz)U (Expiration Date) Estimated Va..Iue of Electrical Work S Work to Start inspection Date Requested: Rough ` Signed under the penalties of perjury: Final FIRM NA=MLd & A O Licensee LIC. NO. Address SSiig�n-atur LIC. NO �� � Dir! /z.iQ �� �i%'� Bus. tel. No.il[Q3'.3 .Z' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its ubst ntial equivalent as required Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent e i y (Please check on Telephone No. �C (Signature of Owner or Agent) PERMIT FEE N2 486 Date....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....�s.� °�......... ...................,.................................... has permission to perform . .� `� ` Sy .... ..... ... .... .... wrong in the building of ....... T.k rl... /?d S� FN dj� orth Andove , Fee ... 3. ..�.... Lic. No....* ..................... ...2�...... ..... ......:...... CTRICALINSPECTOR l0/0�09:53 J1 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer