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HomeMy WebLinkAboutMiscellaneous - 21 SILSBEE ROAD 4/30/2018JAN -10-200.3 17 1? �.I. - NASHUA 9993355 P.01/0.3 MASche X COVPLrANCE REPORT MasadchUBAtts Energy Code MASChrCt SoftwarE Version 2,01. i I Ye :ami t # l i I Chocked by/Date I CITY; north Andover afATE; Maasachusette NIDD: 5322 CONSTAu'-'TToN TyP,t 1 or 2 Family, riatached HEA°T114e SYSTir"M.. TYPE. Other ikon-Eleetzia Rasiatar.Cei DATE! 1-10-2009 DATE OF PLhNal 1/10;03 TITLk:t SINGLE FAMILY ppoJECT INFORMATION; 21 SILSBEE RD N. ANDOVER, PIA COM?ANY INFORMATION: MIKE COLLINS COMPLIANCE,: PASSES Required OA = 3V your Nome = 305 A=ea Or r'avity 4ont. 0lasing/Door Perimeter R -Value R-`'aiuc a -Value UA � r' ,.. - ...,. CEILINGS 835 3G. L' 0.6 29 WALLS: Mood Frame, lo" O.C. 1340 13.0 0,0 14'� GLAZING: Windows or Daars 228 0•'20 �' DOORS 40 Q.500 �G FLo0k3: over unconditioned space 535 19.0 0.0 HVAC e,CLTIPMT ; FurnaCe, 92.0 AFUE r COMPLIANCE STATEMENT Theprvposed building design descrihi4d here is cons9.stent with the building pians, specification&, and other Calculations submitted with the permit application.. The proposed buaidincj ha:, been designed to meet thn requirements of the MA•Ssaohuaette Energy Coda. The heating load for this building, and the cooliyg load if a.ppzon_iate, has been determined using the applicable Standard Design Cunditiony found in the Cade. The. HVAC iaquipmernt selected to heat or c00." the building shall he no greater than 125% c£ the design load as speci.iicd in Sectiuns 760CMP 1310 and J4.4. Bulider/Designer Date 1 RD E C E 0 W E JAN 1 4 2003 BUILDING DEPT. JAN -10-2003 17:19 0.I. - NASHUA ee93385 P.02/03 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 9INOLF FAMILY DATE: 1-10-2003 aidg. I Dept.I Lsa 1 ! CEILINGS: I Comments/Location WALLS - [ ) I 1. Wood Frame, 16" O.0 „ R-13 i Comments/Location i i WINDOWS AND GLASS DOORS: [ ) ; 1, 0 -value: 0.32 For windows without labeled l3 -values, describe ii:atur08 : I I Panes Frame Type Thermal Breahi [ yps [ i No I Comments/Location i DOORS: ( ) 1. U-value.0.5 ( Comments/Location I FLOORS: ( ) I 1, over Unconditioned Space; R-19 { Consents /Location i JVAC EQUIPMENT: 1. Furna,.e, 92.0 AFUE or higher Make and Model Number AT R I.BAM. GE % Joints, penetrarions, and all other such openings in tr-e bU ii,�ing envelope that are sources of air leakage must be sealed. When installed Lft the building envelope, recessed lighting fixtaGes shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixt!re and ceiling cavity and sealed or gasketPd to prevent air leakage into the uncor,diti,vned space. 2. Type IC rated, in accordance with Standard ASTM E 233, with nb more than 2.0 cfm (o.944 'L/s) air movement £xoin the the conditioned space to the ceiling Cavity. The l.iphting fixture shall have been tested at 75 PA or 1.37 lbs/ftz preeaure di,ffarence and shall be labeled, VAPOR riETAROFR: Required or, the warm-in-vrinter side of all non-ven`et framed ceilings, walls, and floors, l MATERIALS TDENTIrICATIQN: [ ) I Materials and equipment must be ident:.fied sv that compliance can a JAN -18-2003 17:19 B.I. - HASHUA 1 be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heatlkng equipment must be 1 provided. Insulation R -values, glaxiAg U -values, aPd hunting ! equipment efficiency must be Clearly marked on the brit-14i.ng plans I or specifications. I I DUCT INSULATION: 1 Ducts shall. be insulated per Table 4.4.1.1. DUCT CONSTRUCTION: All accessible joints, ooama, and Connection$ of surpl.y and return ductwork located outside cintitioned space, including stud hays or joist cavities/spaces used to transport air, shall be sealed using maatic and fibrous backing tape installed acca? ding to the manufacturer's installotion instructions. Mash tape may ne omitted where gaps are Sets than 1/8 inch. Duet 'Cape i;• not permitted. The HVAC system must provide a means fo•: b�lancing air and water systems. TEMPERATUR' CONTROL$: Thermostats are required for each separate HVAC system.. A manual or automatic means to partially restrict or shut otE tha beating and/or cooling input to each _one or floor shall be provided. I HVAC CQUI?MGNT SIZING; I Rated output eaVdcity of the heating/cooling system is 1 not greater than 12c,% of the daaign load as spac.ift,ad in Sections 780CMR 1310 and 34.4. I I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch arld require a cover unless over 20% of tie heating energy is fz,= I non-depl,etable sources. Pool pumps require a time ol.oek. I I RVAC PIPING INSUL&TION: I RVAC piping conveying fluids above 120 E or chiliad fluids I below 55 F must be insulated to the following leve;.s iJ:i.): i I PI?E SIZES !in.) I HIATING SYSTEMS: TEM? (E) 2" RUNOU'iS 0-1" :i . 25-2" 2.5-4" i Low pressure/temp. 201.-250 1.0 i.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 115 I steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYBTEMSt I Chilled water or 40-55 0.5 0.5 01-15 1-0 i roEei;arant below 40 1.0 1.0 1.5 1.5 CIRCULATING 140T WATER SYSTEMS: insulate circulating hot water pipes to the following Levels (in.): I HEATED WATER TEMP (r;: I 170 -IBC } 140-160 PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING 14AINS & RUNOUT$ RUNOUT5 D-1" 1 0-1.25" 1.5-2.0" 2.0+11 015 1 1.0 1.5 2.0 0.5 C 0.5 1..0 8893385 P.03/03 TOTAL F.©' 03/24,12003 09:93 6038981 ,76 C 1'HVc L 4M BER COM gACr'A,x PAGE 01 Job Trues 263154 i 0o 1 W655 0F(Ul TA i t•a0 4.7.3 j I I l� t 1 IFAN' 13 11 aa,�T6t3 ORD, ME. d 5, IBF�i,lelddard6ill di,(iTi iri u�trtas lnc. T ut asp �d 1 W 23:48 2CV'2'page I i I ....._+_._._�+ossa --•+• +se.o �.d�e ,L1, -E 411•@ 4.11 g pyy�tq� 1 Flill!LIMINAIY MATNO NOT FCK Co►,,ML:C'rxON USE •,D.s10 ��—�-i^-�--....,�_---^+�-�---,.,.,,�.�_ 91.0 �.._....__—� _—""•" x- — -- - aINIS LOAoaNc� (pen TOLL 920 11pACING 2•$-0 I Ates increase 1.15 , CSI I TO 0.56 DlFL Vert(LL) In (loc) I/doff .0.65 12-14 >667 PLAT93 Opp RIP � TCDL 10.0 F1CLL 0 0 umber InGreBee i 15 Zap DD 0.81 VeFM) -0.73 12-14 >5p7 07 M112C 1 , I M1119H 1411135 BCDL ^0.0 I S p Straa Incr YES :ode dCCAJAN* 195 WB 0.51 (Mat�is�} - Hara(TL} lot 1.0 LL 0.13 10 ia Min I/date - 2ao I Waiaht: 113 Ib I LUMBER BRACING— MP CHORD 2 X 4 PF 165OF 1.6E TOP CHORD "athed ar 2-11.8 oc purlins, 1110T CHORD 2 X 4 PF 2100F 1.9E BOT CHORD Rigid seil;nq diractly applied or 10-0-0 oc bracing. WEBS 2 X 4 5P FS stud `Except - WS 2 4 4 SPF /e50F 1.51 W4 2 { 4 BPF 1650E 1.SE REACTIONS (Ibisizi i 2=2099/0-3-8, 10=2096103-8 May H rx 2=-13(load Casa 2) Max U dift2=-le%load case 4), 10=-166(ioad caw 4) FORCES (ib) - Flrk .old Case Only TOS:' CHORD 1.24 1, 2-3=-4264, 3_t=3eai,, 4-5m-347,54-3592, - 6-7x4592, U-3497,11-0=- 604, 9-10=-42264, 10-11_36 BOTCHORD 2-14= 3821,14-15_-2407, 13-16-2407, 13-16=2407, 12-1d=2447, 10.12=3821 WEBS 8-14:505,742=405, 3-14-049, 6-14x1355, 6-12=1355, 6-12--e49 N0TES 1) This truss has bei n thicked for uhbalanced loading conditions. 2) This truss has bel n. designed forth* wind leads generated by 80 mph winds at 25 ft above ground level, ueir f'S.0 psftop chord dead load and'5.0 pal bottom chord dead I. -ad, 5 mi from iihurricane oceanll in, on an occupancy oatsgg0001V 1, condlor t enclosed building, 01 dimansiors 45 ft by 24 ft with ell oeure 19 ASCS 7.93 per 150CAiANS196 If and vertloa!e exist, they art nct exposed to wind. if cantilevers exist, th®y art axposeo to wired. if pomnat exist, they are not expoad to wind, The ,umber DOL increase Is 1.39, and the plate gOp increase is 1.23 3) Ali plates are Mil, 0 plates unless ethernAss indicated. 4} This trust has b on designed for a live lord of 20.0paf on the bottom chord in all arras with a j clearance greets, than 3-e O between the bottom chord and any other Members Continued on pRoe ; Www 45 Location No. 9 I � Date / -,//, "p"'" TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ '� s'„• NUBuilding/Frame Permit Fee $ �CS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ZI7—/&-- 16'11 0 Building Inspeci%r /b -t3 -oz ® `+:4.;- �o -✓4 =oL g.Q.e ,, !"/24/4"i rsh, 00 M Z O v rn O Z M go O mn ic r v M r r Z P1 TOWN OF NORTH ANDOVER ' BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Tl15O[ IGiAi,SIr BUILDING PERMIT NUMBER: /2 DATE ISSUED: _3 _ Q L/3 .2 /0 C SIGNATURE: Building Commissioner/In for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: L2 Assessors Map and Parcel Number: 21 Silsbee Road 20 64 North Andover Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Q&s 6�U U0 Zoning District Pr osed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provid4 Re red Provided 1.7 Water S Iy M.GL.C.40. 54) 1.5. Flood Zone Information: 8 Sewerage Disposal S tem: Public Private 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Arthurauk Nam P 'n Address for Service Signa re Telephone 2.2 Owner of Record: Name Print V Address for Service: Signature Telephone STICTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ / Ijrlv� 14 co kc c CS UI q Licensed Construction Supervisor: (� P/1/L License Number Add e sPA V ,,, I1 p (a ? �� ��J lX� 4 `� Expiration Date Sign tur Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M Z O v rn O Z M go O mn ic r v M r r Z P1 P59 SECTION 4 - WORKERS COMPENSATION (XG.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 buil "d I permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Description of Proposed Work (check A anolicable New Construction ❑ I Existing Building ❑ I Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: OL, -46e\' I SECTION 6 - ESTIMATED rnNCTR1TCT1nN CnCTR I Item Estimated Cost (Dollar) to be Completed by permit applicant OFTTCIAL USE ONLY 1. Building Ute" (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing D Building Permit fee tel X (b) 4 Mechanical HVAC 5 Fire Protection i "6b 6 Total (1+2+3+4+5 Check Number ar%,iivi'q is %1VVI' rLAUIilV1(1GA11111V 1V BE l -:VN IFLEIED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l 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/AUUTHORIZED AGENT DECLARATION 1, 1 Y L' ` lg ,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 Nan Si att of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2 v 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CIMvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT Pauk, Arthur PHONE LOCATION: Assessor's Map Number 20 PARCEL SUBDIVISION LOT (S) 64 STREET Silsbee Road ST. NUMBER 21 ************************************OFFICIAL USE ONLY*********************************** RECQFA#ENDATIONS QF TOWN AGENTS: 'ATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS • FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVE AY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm lelolk z TE 0 6 <tr 3 QL- lz-aflrlllv�� WME The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Pauk Location: 21 Silsbee Road City. North Andover MA Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity X—I am an employer providing workers' compensation for my employees working on this job. Company name: Michael A. Collins DBA: Collins Co Address . 429 North Main St. P 0 Box 281 City Salem NH 03079 Phone#: 603 898-6338 Insurance Co. Liberty Mutual Policv # WC7-31 S-227489-021 Company name: Address City_ Phone #: Insurance Co. Poligy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment -as Htell_as_civil,penaltiesin2heiorm d -a STOP WORK_ORDER..and..afine -of _(.$1-0..0.00)-ajday.againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify ujjr the f ,�a ►Aand p7altiA of perjury that the information provided above is true and correct. Print name Michael >K. Collins Phone# 603 898-6338 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept []Check if immediate response is required (] Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 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 a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: � P�x - ��� A� (Locatio of Facility) 0 da, /Signature of Permit Applicant ,/.� —,;7/16 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Max Do" : LL"Lim TL • lltllll 3.6',4250 : No � Composite Adson : No %m v n.rnwG vCwi11 $pDOiitg (1n.) :9.0 Slope : - Ong 3.6'.43 psi iAv* f Wm LkVLJW Lw ie~ wow dommy saw am--" Addmonmwb 36 118% 0 OW 11'e' 29 Cr &a.- ROOF LM -set LOS t1 0 as 0 Oa ii �.,.V *C--SYRAPPMA&WETRM ...�—A.—-.� - �- - - - - - vvvt tun "FA 4006 4016 2310 2010 Im a SSefe e Wo 2ow 700 170 OfiN _ 3222 law lee t1tyM ils% OAS � Q & 4" 31 116% oAo 4016 0 11' e' 31 67lde 100% 0.77 eM N&A sa 014 1 fir 61 am um Woo 31 -M.1.7a11_M" 1 Aim dradbotO oil, byuw [AM ter+ Oran Is*m+t: — Capp. tYd1 1.Oa�udei sou vftm Iwo 11,00 11 fts" Wieft"Um mr fArbOoi c o mewwo w t� O�yu93yerrr�etn�aMtr�bcuraan�rNtawM�dwsn�nba.Caa�ww�a t ftowNr4w�t�gtbjr�r�wrMartiweerter�wTeX�o troAKa rwl,urt wrt+ehn"aroa m t t��+>uNdtbra>7/uM�puy. A TtUO nt�etwtb ewtetaaeNANIft olll a dlsrNsatlieiane tA+tp++oot �oMrsntlY+td�rye�slws tt n�ettoe 7rtrrrMr,R, arjaw I 4"IsquWA w oon iaboL aepomr.r�.ta saSg►o�.�,�, T mar w ►a N "In3�ap►�raerq����, . ��01�'�0�'�+Ys►odrl�n�Mnd�t3rrll�tli�tarrdll�iYaRa�,�idvrhll�►ll�+e�uRl�rawdp+apt�et R Ift�s�*�Ouluatruf07rnrtiid�tttlt�Aeese�ltdkMtl�'���oiA►gttYtbol 'fly. �Nr0A111� �t i1 0� 1jrA OiiN/ lM4w !Z OwoOfn .err rl+wl�aAiarAgptj 01•diN �f r..ollar�s 1bro�t►iofwe OQLA114'wOtIROto+rlt Id fkiftL fs� prodoetar4r�td�n�+raMw�adteirar 6�aM+�dtlr�'�dVwewnl+� taralee 0+te�li60aD+"OK 4000+fUMSOmD+ r + N!=0.10{Mld+►, 60�j1+ *!1'Jlir ,ta0a0+lOdlitlt0lfs'�+T �q01�+1t'aff►�D�li+fop%4Im ,. tam me D �f td !_��tlAiMlY�/t'dl'abpre��s Pyotd'i 09f19/2DO3 11:05 ED3898i676 C'Y'R LUMBER COMPAWd PAGE 01 n O Y i wi CX)\ 1 \..e n O Ill., S4 i Cur k bo c-, r -o (7i OQ k bo c-, (7i k bo fl D (7i V r U) m n o �O -� o z opo n 0 D U) �l r M M �— ... 0 O O V r Tl G Lei CERTIFIED PLOT PLAN N O LSSM ROAD NORTH ANDOVER, MASSACHUSETTS 1208.80 71.00' N 16177'59" W TAX MAP 20 M LOT 64_ 7,086 SF. f w m� I I SETBACK UNE (TYP.) W �. :. w I* N - ) 2 59.05' 1 S 16177'59" E S/LSBEE (4D WIDE) ROAD lo - 30' DA 7E Aine 12, 2002 / HEREBY CER77FY 70 7HE TOWN OF NOR7H ANDOVER, MASSACHUSETTS BUILD/NG DEPAR7MENT THAT IHE FX/S77MG ONELLING /S LOCA7ED AS SHOW91/ ON 7N/S PLAN AND THAT 7HE EYJS77NG DKaUNG AND GARAGE ARE EXEMPT FROM WOLA770N ENFORCEMENT AC77O1V UNDER M.G.L 7771E VII, CHAP7ER 40A, SEC770N 7. UNES 2 7NE REWDENCE 4 DIS7RICT M/NIMUA/ mmom FRGYVT -.3o FF£T SIDE - 15 FEET REAR - 30 FEET MINIA/UM FRaVTA6E 100 FEET MINIMUM AREA: 12,500 SF. Job No: 502010 1 P., O z` ..t o � � Fri D O z :r - P., V I ZI O o � � cl) D z / i ................ o � Cf) 0 z �; 01� I to I 0 i� LU z C � O C om �. C7 O.= :a 't o o a �- _� E O LCD z o o O c S RE E N lC lob. O m �_ CD � e% ,o C/)• N m C=Mm 9 � y m .o c Q c i = w O E m _O . v U 2 J � � 0 cm c m0 av C/) No �' / • .c o � w : o o Q w acz m ca Z O . . CL o c a con o�'C43mc .o 2 m dwL'' p N F- CIO fi=r xO Z W C ' S 'o v.. •N C=L:Z cc =O W .E 0 ,0 v •N CO co Ci O O O .] N d O� O 2 m aoy'm o O f— z L � y co moO a 0 �. CD •� C Q 44 M � V y Q+ O � C O 3 0 Q d �a C r'C•+ C O 10 O Z' V O d y C o a a w a U ►., z w w aCdOr w iu w W 'C°D X, o w c w w v m' o z cn v o cn LU z C � O C om �. C7 O.= :a 't o o a �- _� E O LCD z o o O c S RE E N lC lob. O m �_ CD � e% ,o C/)• N m C=Mm 9 � y m .o c Q c i = w O E m _O . v U 2 J � � 0 cm c m0 av C/) No �' / • .c o � w : o o Q w acz m ca Z O . . CL o c a con o�'C43mc .o 2 m dwL'' p N F- CIO fi=r xO Z W C ' S 'o v.. •N C=L:Z cc =O W .E 0 ,0 v •N CO co Ci O O O .] N d O� O 2 m aoy'm o O f— z L � y co moO a 0 �. CD •� C Q 44 M � V y Q+ O � C O 3 0 Q d �a C r'C•+ C O 10 O Z' V O d y C TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ...........//. V .... ('.:. .................. has permission to perform .... ... ... wiring in the building of .... / ... .. ......... .... C.?.. /( ......................... at .... 09., ...... S�.As .. Lte ....... ................. North Andover,pes Fee.�.f • •Y�,..W Lic. No. "" ...... ...... ELECTRICAL IN ECMR zM Check # 4316 TBE COAMONWEALMOFAIAS94CBUSE77S Office only DEPARTAftM0FPUXJCS4FE7Y Permit No. BOARD OFFIREPREVEMONREGMHONS527GM12W Occupancy & Fees Checked APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 V (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. r Location (Street & Number) Owner or Tenant -Y _ _ AQ D A ii Owner's Address Is this permit in conjunction with a building permit: Yes ro No (Check Appropriate Box) . Purpose of Building W 15 L L A/ C_ Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground 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 No. of Lighting Fixtures Swimming Pool Above Below Generators ground 1:1round No. of;teceptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS 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 LocalMunicipal —of Connections No. ter Heaters KW No. of No. of Signs Bailasis No. Hy 4 . assage Tubs No. of Motors Total HP • Total KVA KVA No. of Zones I --------- Other Ir�uarloeCovfrage, Ri�eltiatl]el0cpvta]na]tsofM�adl>seltsC3a]e�'illavVs M IbaNeaomaiLiabhtykw==PblicyimhxfmgCo CovmaWnntst>Mal sequivalerlt YES NO t Ihavest>Z maAvandpmdc sametDdrOffce YESj ffy�ha�d�acWlY ,plmmdc& hetypeofcovaageby d�ed*the box 151 Lit INSURANCE BLIND lcli R jj F4ira6mDPk per, EfrtatedVah�eof)~ xhJca1Wolk $ Rough FVA t✓ - Y • • / I I 4r�Clrxc At Tel No. :)WNF1Z'SINSURANCEWAPdE,Iamawarethad&Licer>sedoesnothavetheirtstrmmoovaageoritsatsmtialegnvalutasregtmedbyN %adximCoralLaws M thatmysigt)Aue on thispemtapplicahon waives thismqu'aerrrnt Please check one) Owner O Agent F-1 ,) Telephone No. PERMIT FEE (T d (/ Igna ure o caner or gen Date..:.. .`. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. . f ....fir ' r..l.................... has permission to perform .... 1r? e -c ........... plumbing in the buildings of ... Z. ................... at. ................ . North Andover, Mass. Fee...'.. Lie. No..?....' ::. .......... c.�. PLUMBING INSPECTOR Check # �� S 5547 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) { NORTH ANDOVER MASSACHUSETTS _ r/3 ANDOVER, Date Building Location �7l ,� e Owners Name + %` Permit # n e � Amount Type of Occupancy �{ New Mx" Renovation ❑ Replacement ❑ Plans Submitted Yes [:] No (Print'or type)�� Check one: Certificate Installing Company Name j6, e G �'+ O' ol S . n Corp. 11 Partner. . Firm/Co. Name of Licensed Plumber: AiG{1A J (,,J M G Insurance Coverage: Indicate thea of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond a 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 Signature Owner ❑ Agent F1 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 installatiopaperformed. under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusS 2,ut, ge and Chapter 42 of the General Laws. By: Igna a kensum er Type of Plumbing License Title City/Towni nNumberse- Master � Journeyman � jj/ APPROVED (OFFICE USE ONLY 6,s4