HomeMy WebLinkAboutMiscellaneous - 207 ROSEMONT DRIVE 4/30/2018 (2)J
,NW 1619
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
..... .....
This certifies that ....................................................................
--,ot.has permission to perform .....
................
::::«% ..................
'wiring in the building of ..... ............ 1:51, ........................
4 at. c� l ....... ...... '... North Andover, Mass.
Fee.—;6..! ........... Lic. No. y, ELECTRICAL IDISPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Oft lce Use Only.
: � The Commonwealth of Massachuse —�
` Department of Public Safety
OccuMOIer i Fat 010CMd
BOARD OF FIRE PREVENTION REGULATIONS S27 CM 1=W 3/90 (14&-. etank) I
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
NI work to be performed In accordance with the Ma"achusens Eleeuical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPEINFOPM&TION) Date '7 —/ 6- -ff
City or Town of-A,�Q To the Inspector of Wires:.
The undersigned applies for a permit to perform the electrical work described below.
Location
Owner or
Owner's Address
Is this permit in conjunction with a building permit: Yes �❑ (Check Appropriate Box)
Purpose of Building %A>Cl,)c)L)A),9 /`Ji)1) Utility Authorution NO.—
L/
Existing Service 24LL Amps (2c) Volts Overhead ❑ Undgrd g--�No. of Meters
New Service - Amps rf-- volts- Overhead,_ Uadgsd-®---- No. of Meters -
�� Number of Feeders and Ampacity �-
i
0
Z
k
Location and Nature of Proposed Electrical Work
tv(%
// , N ,/ n J , r-
No.
of Lighting Outlets
No. of Hot Tubs
w
iX i
No. of Transformers Total
INA
No.
of Lighting Fixture;
Above
Swimming Pool .grnd.
In -
grad.
Generators RVA
No.
of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting.
Battery Units
No.
of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self ContainedDetection/Sounding Devices
Local 11 Municipal Other
Connection
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
No. of HPus TTonotas . Toil
No. of Dishwashers
Space/Area Heating 1CW
No. of Dryers
Heating Devices EW
No.
of Water Heaters .
No, of o. o
Signs Ballasts
Low Voltage
Wirine
No. Hydro Massage Tubs
No. of Motors Total HP �Z
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current LiabiliInsurance Policy including Completed Operations Coverage or its substantial
equivalent. YES O NO 8 I have submitted valid proof of same to this office. YES ❑ NO
If you have. checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND OTHER C] (Please Specify)
_ (Expiration
ac
Estimated Value of Electrical Work S / 3.ZL9
Work to Start _ Inspection Date Requested: Rough --SIe _ Z 2_ 5,�' Final0 7—
Signed undeT1*'"TEMBiKffCPR1@AL
FIRM NAME SERVICES INC. LIC. N0. ?A�L
152 Licensee Beach,M�-0� � 5l Pee
adereR1�Signature LIC. NO.;�7Z,L
F�
Address ) 289-7Sr FAX 289-8318 % Bus. Tel. No.
Alt. Iel. No.
OWNER'S CE WAIVER: I Wfaware that the Licensee does not have the insurance coverage or ics suo-
scancial equivalent as required by Massachusetts General Laws, and chat my signature on this permit
application waives, this requirement. Owner Agent (Please check one)
Telephone No. FLRMIT FEE S 3S
I `i1 '":t I'IT- .,. • r , i
R FROM : LAND PLANNING BELLINGHAM
Y '
715t
LOT 24 0
N
ROSEMONT
DRIVE
(50' AIDE APP WAY)
PHCNE NO. : 508 966 5054
157.00'
FOUNDATION
ASBUILT 145.,39' TO EXISTING
TC=375.34 48.77' ^
HOUSE ON
a;
^+ LOT 27
LOT 25 LOT 27
24,344 S.F.
N
N
107.00' 1
0
U
LOT 26
N* Of 44'spy.
BEP.NARD ycJ,
oE.
MUNRO,
i No. 34482
SETBACKS: F-20' S-0' R-20' (20' betty. bldgs.)
I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED
ON THE LOT AS SHOWN ON THIS PLAN AND THE
LOCATION DOES CONFORM WITH THE FRONT, SIDE,
AND REAR SETBACK REQUIREMENTS SET FORTH IN
THE TOWN'S ZONING BYLAWS AT THE TIME OF
CONSTRUCTION. I FURTHER CERTIFY THAT THE
STRUCTURE IS NOT LOCATED IN THE SPECIAL
100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT
TO BE USED FOR THE ESTABLISHMENT OF PROPERTY
LINES, ERECTION OF FENCES, OR CONSTRUCTION OF
ADDITIONAL STRUCTURES ON THE LOT.
MAP NO. 0006C COM NO. 250098 DATE: 6/2/93
Z�fi&
FOUNDATION AS -BUILT
MCA= AT
LOT 25
NORTH ANDOVER ESTATES
NORTH ANDOVER, MA
PRPPAKM POR
TOLL BROTHERS, INC.
1800 REST PARK DRIVE
WESTBORO, MA 01581
LAND PLANNING
ENGINEERING & 3URVE7
107ARTIVRD AV=UL SEUINCHAK MA OR019
506) 068-4100 FAX- (500) 988-5054
2/?_'I/9S--1 =4n' NAE -25
i
P02
�5 �.1.'a
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rsa �{
.n`'r;'
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� .fir .s" i --ti k � _� x :,� . �.
�'.t .., .. i.. -.,.
PRODUCER
LAKESIDE INSURANCE AGENCY, INC
88 Stiles Road
Salem NN 03079
INSURED
Andrews Gunite Co Inc
6 Republic Rd
N Billerica MA 01862
DATE (MM/DD/YY)
03/02/98
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
COMPANY
A CNA Insurance Companies
COMPANY
B
COMPANY
C
COMPANY
D
...............
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS .AND CONDITIONS OF SUCH PO ICTS I INAITS SHOWN MAY HAVE BEEN REDUCED 9Y PAID CLAIMS.
CO
ILTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MMlDDM)
LIMITS
A
GENERAL
LIABILITY
110731507
02/20/98
03/01/99
GENERAL AGGREGATE $ 2,000,000 .
PRODUCTS - COMP/OP AGG $ 1,000,000
X
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FK OCCUR
PERSONAL & ADV INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire) $ 50,000
MED EXP (Any one person) $ 5,000
A
AUTOMOBILE LIABILITY
ANY AUTO
SAP1617269
02/20/98
03/01/99
COMBINED SINGLE LIMIT $ 1,000,000 j
BODILY INJURY
(Per person) $
ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
'
I GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
ANY AUTO
$
$ I
A
EXCESS LIABILITY
110731524
02/20/98
03/01/99
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
X UMBRELLA FORM
$
I OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
WC S7iQU- O—ri-
A
EMPLOYERS' LIABILITY
PARTNEOPRRI PROPRIETOR/INCL
120530275
03/01/98
03/01/99
EL EACH ACCIDENT Is 1,000,000
EL DISEASE - POLICY LIMIT is 1,000,000
EL DISEASE - EA EMPLOYEE $ 1,000,000
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF OPERATIONSA.00ATIONSNEHICLESISPECIAL ITEMS
SAMPLE • FOR INFORMATION ONLY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS S OR RNff! Tdi 77
AUTHORRED REPRESENTATIVE _ _
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Locations
No. 4 Date
NORTH TOWN OF NORTH ANDOVER
f ,4.ti
n Certificate of Occupancy 9;
Building/Frame Permit Fee $ —r
Foundation Permit Fee $
SACMUSE PCc 1
Other Permit Fee 01 $ %� r
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
J # 39
tr�'} [[�'' [� nn Building Inspector
Ll�7
03/JG/99 22:46 Div. Public Works
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