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HomeMy WebLinkAboutMiscellaneous - 217 WINTER STREET 4/30/2018j }1 0 1 uno A L CNIC ,SM CLAIMS DEPT. September 09, 2011 Commerce Insurance - The Commerce Insurance CcmpanysM Citation Insurance Company SM Members of The Commerce Group, Inc.s' 11 Gore Road, Webster, Massachusetts 01570 (508) 949-1500 www.Commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL N ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: DAVID L LEIBOWITZ / JODIE S LEIBOWITZ Property Address: 217 WINTER STREET -- Policy#: ZP4607 Date of Loss: 09/08/2011 Filek XTW372-VNRK15 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. LISA BATES -CIC Telephone: (508)949-1500 Ext: 11515 Clm Representative II, Subrogation Toll Free: 1-800-221-1605, Ext: 11515 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. September 09, 2011 CcI1 mCrc CcmPanies .... COME GROW WITIA us CIC 254 (Rev. 4/95) MAIL I64 �iii:e t'se U,ly p- Tiie Commonwealth of Afassachusetts „ Department of Public Safety /�fl Occupancv S Fee Checked BOARD OF FIRE PR00 PREVENTION REGULATIONS 527 Ch1R 12 3/90 eleave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance with the Maraachuselu Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORM&TION) Date 3 — 6 — 97 City or Town of /VoeT// .4.vO0kEEe To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) a/ -7 L!%iNrE.2 T Comer or Tenant A%.4d/D Z--1,60W1r-2_ Owner's Address -5 .4 irs E s% TO J ) 48rr - 75/7,7 Is this permit in conjunction with a building permit: Yes ❑ No X❑ (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service Amps / Volts overhead ❑ M-4 d ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ 110. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation Of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners , Batter Emergency Lighting UniNo. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Soundin Devices g No. of Self Contained Detection/Sounding Devices Local [:]Municipal ❑ Other Connection No. of Ranges g Total No. of Air Cond, tons No. of Disposals No. of Heat s Total Total -PumpTons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters NoNo. of Signsf Ballasts Wirinoltage LA No. Hydro Massage Tubs No. of Motors Total HP OTHER: CII SMoe-E -PETE,-rhe A INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[] NO ❑ 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 ❑ (Please Specify) Estimated Value of Electrical Work S �•��'�D Expiration ate Work to Start 3-10-97 Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY -SYSTEMS NORTHEAST INC. It LIC. NO. 1231C Licensee DONALD A BROOKS Signata NO. 1231C Address 60 William Street, Wellesley, 8 I I 1d's. Tei. No. 413-732-4400 Alt. Tel. No.617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S c-15-00 Signature of Owner or Agent ;s:. �s,-�,:.��...-oc��-w.—�+..ti.- �--, . �:..s..N✓'�''��`�-.MII,.+��s-r-� - -v�.:,ri...,t, � d.+-�r --�-c . g "`�r-, nc. -� y Date.... ....1... 784 HOR7H - °`t` TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHUS� - N s n, . T S Ss�+ This certifies that ........ - .......................... �:............... .... ................ ,.; has permission to perform ...........�r...........4�..�� e.`M......................... wiring in the building of ......L C.4..... !?.1.. .Z' ....................................... K r: at .. .l7.... ,�y ............................. .North Andover, Mass. kLic.JP3 h ELECTRI CAL INSPECTOR 03/13/9713:54 3�5. k WHITE: Applicant CANARY: ui ing 80R. PINK: Treasurer Location a ` ! /.t//N7` £ !2 S 7 No. % Date • r i p Q a TOWN OF NORTH ANDOVEF Certificate of Occupancy $ Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ a Sewer Connection Fee $ M Water Connection Fee $--------C� TOTAL $ y '' Building Inspector Div. Public Works is n 1 F z 0 � Z z O d y' 000 m (n W m w G�zl m w o L V v - c � aw er is n 1 o 0 o Z z O F z 0 � Z z O q 000 m (n W m w G�zl m w o L V v - c � aw er W o ca z a Y x O 5 A F F x d A � w w a z � v � z O � � z � U d o a z F Cl) z 9' E z d w w w w O hal U m , � •0. w d 'i z i w r m i a O w O w O, zC7 w O � U n z i z z 0 z �u o ° o � w o w O L o z z F o a o l a a z w w z w C7 w Fw W ri a O O H � U � o z � a -f ✓g Q z _ - ✓J z w z w w a d z z d d ~ z z n z z z r , d z U C Y 1+1 c. N O C d m q q q -tn cn n o 0 o Z z O F z 0 � Z z O q 000 m (n W m w G�zl m w o L V v - c � aw er ca F � w w a z � v � z U d o a z F Cl) z w w m , � •0. w d 'i F wV. zz V O O O r' °: �. 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 SECTIONS ********************** _Q (� r. APPLICANT DAt)t� Lel PHONE LOCATION: Assessor's Map Number PARCEL r SUBDIVISION LOT (S) STREET W I N �`e S� ST. NUMBER a *************************OFFICIAL USE ONLY********************** I A-' �. (� l ..� / �e � [ r 21 J+- l a) l.N RECOMMENDATIONS OF TOWN AGENTS: CONSERVA COMMENTS n6 ADMINISTRATORN DATE APPROVED JFI l " DATE REJECTED TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm PAUL A. HIMMER 10 HAGGETTS POND RD. ANDOVER, MA 01810 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged in home improvement contract- ing, unless specifically exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: ro °e r Registration Number: to Y 44 7 Salesperson's Name: U d)" VA -e r This agreement is made on 7 between %ay / J41 vm rYt le �— NATE) / / (CONTRACTOR) of arC,e � C6 c( e ass 978 qIS- 6910 DRESS) (PHONE NUMBER) hereinafter called "Contractor" and (OWNER) (ADDRESS) (PHONE NUMBER) hereinafter called "Owner". I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED ' Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the rL DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described work consist of the following: II. PRICE G Contractor agrees to do all work described in Section I for the total price of $ ,7��" III. PAYMENT Payment will be made as follows: 3( 3 1/31 % ($ upon signing Contract; _36 %(S 3, Y91 ) upon completion ofd� 0 .36 %(s � ) upon completion of and the remaining % ($ �Q 93 ) upon verification of the work by Owner and Contractor as having been satisfactorily com- pleted, which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day followin the signing of this Agreement, unless specified here in writing. Contractor will begin the work on or about /0 (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by &—. (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in Section III (Payment) above for the reason that he deems himself or the payments to beinsecure. If, however, he deems himself to be insecure, he may require, as aprerequisite to continuing the work described herein, that the balance of the payments under this contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself, his employees or his subcontractors in the performance of, oras a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. VIII. CONSTRUCTION -RELATED PERMITS The following construction -related rmits will be necessary in order to complete the scope of work included in this Agreement: The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the homeowner obtains his own construction -related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. IX. MODIFICATION This Agreement, including the provisions relating to price (Section II) and payment schedule (Section III) cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed). X. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of i following completion and shall comply with the requirements of this Agreement. In the event any defect in 4rkrnanship or materials, or damage caused by the Contractor,. his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner maybe required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the owner specific legal rights, and owner may also have other rights which vary from state to state. Under Massachusetts law, sales of goods carry an implied warranty of merchantability and fitness for a particular purpose. XI. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until al l blank scctions have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the owner of a. copy thereof. 1%1V il1J 1V l.H1r l.GL The owner may cancel this agreement if it has been signed by the owner at a place other than an address of the contractor which may be his main office or branch thereof, provided that the owner notifies the contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. </ 114 Owner's Signature Date Signed Contractor's Signature J Date Signed H - GG 25M 6/92 Y SALESMAN �vt L_ /4&// F.O.B. — ('ESTIMATED DELIVE From receipt of order TERMS SHIP VIA FOLLOW UP DATE �77F &y� ���� - ABOVE PRICES GOOD FOR DAYS. PLEASE REFER TO THE ABOVE QUOTATION NUMBER WHEN PLACING YOUR ORDER. SIGNATURE _ CC Adam 3813s Quotation/Proposal .........................::::...:::...::.....:.. PRODUCER SAM EL INSURANCE AGENCY INC. 15 CENTRAL ST. ANDOVER MA 01810 INSURED PAUL A HIMMER 10 HAGGETTS POND RD ANDOVER MA 01810 DATE IM/DD/YY).i' 'NbU Am !L2.9_1 .. .....:.::<:::::.: THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A CONSTRUCTION INS COMPANY B LEGION INS COMPANY C COMPANY D THIS IS 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMfT3 IDESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS GENERAL CONTRACTOR RESIDENTIAL $1,000,000 $1,000,000 $ 500,000 $11000,00 $ $ 10.000 S e 100,000 500,000 100.000 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CFP 1%% 4 3 5 3 6 11/09/97- 11/09/98 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG CLAIMS MADE a OCCUR OWNER'S & CONTRACTOR'S PROT PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one Tire) MED EXP (Any one person) AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) _ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Par accident) PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT ; AGGREGATE I EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE — AGGREGATE g OTHER THAN UMBRELLA FORM H — WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC2 012 2 019 6/06/98 6/06/99 g X ORY LIMITS ER EL EACH ACCIDENT g THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: FIEXCL OTHER EL DISEASE -POLICY LIMIT g EL DISEASE -EA EMPLOYEE $ IDESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS GENERAL CONTRACTOR RESIDENTIAL $1,000,000 $1,000,000 $ 500,000 $11000,00 $ $ 10.000 S e 100,000 500,000 100.000 l i� ._„+, M,'� ✓126 l/O�/)7/J72p'/?fUC2lCftOI ,l'7,(!'JilCdCfi./IJI'�ll 1 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number r� Expires: eirtlldate: ` CS. 0214,43., 05128J200e 05,128/19K Restrtcted`Tu, 0q fPAUL A� HIMMER 10 HAGGETTS POND RD ANDOVER, MA 01810 �71te HOME IMPROVEMENT CONTRACTOR Registration 104419 a Type - INDIVIDUAL Expiration 01/14/00 PAUL A. HIMMER GENERAL CONTRA _ Paul A. Himmer &7s*-`Haggetts Pond Road ADMINISTRATOR Andover MA 01810 I North Andover Building Department Tel: 978-688-9545 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: -�I--�s WgSJe wend �� (Location of Facility) Signature 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 4 � w Q x o� u o w° . u a CG o w a4 z z Q o "a w° x °�° P4 G U '� w a � w a z a �. °7° w d u a �, W °�D g2 w � w x o H w w L 0L w z Z z w' o cin v E E N L_ N O CO) C 0 A cm m cm v m L O cm C •C O N m O Z O v O zip f^ O O E CD O Z y O y O .� L ,T O Q� CD cc y O_ v O cc cc ®. co is H coco_ o O O L ® 0 cm J '® O co co W LU 0 cn CCw w w co c� CD kc� s •�'oo O N C 0 V •dam CL C m N s C = O w W O N w v m C=D C. +' N Ec ® L o m •cam o 0 ®. C I N CC ®� L O N �:�3 N C O 'd C cm N W E 291 mo ♦:ave N s .a�oc G C L O C O ..� r: `C O. CD Q O m � �• Q, O Lu •O. N m O s 'o C y 6L mr.+ C �. C! C CD N .O LU V 0 p O cm C V� O O CLca •O = l0 L H a m E N L_ N O CO) C 0 A cm m cm v m L O cm C •C O N m O Z O v O zip f^ O O E CD O Z y O y O .� L ,T O Q� CD cc y O_ v O cc cc ®. co is H coco_ o O O L ® 0 cm J '® O co co W LU 0 cn CCw w w co N° 2945 Date .... ..1. l .� NORTH 3a Oet���•�-+°''s+O0 TOWN OF NORTH ANDOVER ~ ,' PERMIT FOR WIRING This certifies that ...... `- -.....� ���' G� ........................................../............................. has permission to perform . ........C^.!'�..� .` wiring in the building of Lf % �� '� S , North Andover, Mass ..... ..... j q �._ Fee.....) U:. �... Lic. No�/.. �% � .......................... ?, !1+....1�!...��..:. ll//`ELECTRicAL MpECTOR Check 11 � WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4 ti O??ue 4ae 0161 T'ne Commonwealth of Massachusetts Dcparrr,lcnt of Public Safety • •�''t+. r.,c�ranc�'S Fee QbeeleA_— �; BOARD OF FIRE PREVENTION REGULATIONS .S27 CMR 12-0 3/90 •heave blank) APPLICATION FOR PERMIT TO PERFORM ELEGTRICAL WORK All work to be performed In accordance with the Mawchuscru Eltctrieal Code. S27 CPR 12:00 (PLEASE PRINT IN INK OR TYPE ALL ItiFOFMATION) Date L1 ,n t City 0 To of -nTo the•_In:peccor of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Scree Owner or Tenant O.ner's Address Is chis permit in conjunction with a building permit: Yes ❑ No © ' (Check Appropriate Box) Purpose of.Building Utility Authorization 110. Existing Service / Amps leu / 2J% ® _Volts Overhead 0 Undgrd•❑ No. of Meters_ flew Service 2 -00 -Amps f2z> / Z q d Volts Overhead 0—Undgrd ❑ No. of Meters / Number of-Fceder.s..and Ampacicy Location and Nature of Proposed Electrical Work 7;�- x(7/4 A- n 0 n A 4) 1-- OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massacfiusetcs General Lags I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES Vj- NO 0 I have submitted valid proof of same ro this office. YES gL NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE CR BOND [] OTHER ❑ (Please Specify) Expiration Gate) Estimated Value of Electrical Work S Work to Scare 1r+--rV\ Inspection Dace Requested: Rough Final Signed under the penalties of perjury: FIkM NAME F.T.F. -TRIIirMAN, TNG' LIC. No.A16199 Licensee Peter Manzelli II Signature -An LIC. NO. —--------- _.. -- - - --------�5 tts«-.'� i �K,�7 T6n � rR-n� — "rr�r-h Ad d rC S r -- - - 99 Main Stra.af NPstforri, MA 03R - Alt. Tel. NO. OWNER'S INSUP uNCE WAIVER:, I an aware that Che Licensee does not have the insurance coverage or its sub- 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. PMMIT FEE -S SQ1 !DO r x.,.� e No. of Lighting Outlets g g No. of Hot Tubs No. of Transformers Total i.'VA No. of Lighting Fixtures Swimoin Pool Above g grnd. In- ❑ grnd. ❑ kGeneracors KVA No. of Receptacle Outlecs No. of Oil Burners INo. of Emergency Lighting Barcery );nits No. of Switch Outlets No. of Gas Burners FIRE ALULMS No. of Zorts No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices llunici?al Local ❑ Connection❑ Other No. o` Ranges K Tocal No. of Air Cond. cons No. of Disposals No. of Heat Total Total i.1: Pumas Tont No. of Dishwashers S ace/A-ea Heating KW P g No. of Dryers Healing Devices KW No. of Wacer Heaters 11'W No, of No. of Si ns Ballasts Low Voltage Wirine _ No. Hydro "Lssage Tubs No. of hocors Total HP I OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massacfiusetcs General Lags I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES Vj- NO 0 I have submitted valid proof of same ro this office. YES gL NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE CR BOND [] OTHER ❑ (Please Specify) Expiration Gate) Estimated Value of Electrical Work S Work to Scare 1r+--rV\ Inspection Dace Requested: Rough Final Signed under the penalties of perjury: FIkM NAME F.T.F. -TRIIirMAN, TNG' LIC. No.A16199 Licensee Peter Manzelli II Signature -An LIC. NO. —--------- _.. -- - - --------�5 tts«-.'� i �K,�7 T6n � rR-n� — "rr�r-h Ad d rC S r -- - - 99 Main Stra.af NPstforri, MA 03R - Alt. Tel. NO. OWNER'S INSUP uNCE WAIVER:, I an aware that Che Licensee does not have the insurance coverage or its sub- 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. PMMIT FEE -S SQ1 !DO Location i--�% % � No.I /7Z Date ; jORT" TOWN OF NORTH ANDOVER f � O. Certificate of Occupancy $ cMus `� Building/Frame Permit Fee $ 1 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #ice ,f ✓f f i 4 7 8 1�'`" Building Inspector d: BUILDING PERMIT NUMBER: / j I UNIb 16buhl): -1-1-6,16, '_C-5� oo / SIGNATURE: Building Commissioner/I for of Buildings Date rt�rrynAT t_ CiTTi 1r1"n1QMAT1rnN rr v 1.1 Property Address: / �j / Gtlf/V��R s� 1.2 Assessors Map and Parcel j0 Map Number Number: ` 17 Parcel Number 2.2 Owner of Record: Name Print Address for Service: 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Not Applicable ❑ Front Yard Side Yard 3.2 Registered Home Improvement Contractor Rear Yard Required Provide Required Provided Rec ed Provided 1 Expiration Date Signature Telephone 1.7 Water Supply M.G 1-C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTROKIM13 AU EN r 2.1 Owner of Record 1 �cl u t Name (Print) Address for �Service: Signa a Te ephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: CP /i1 ie apUVA-9 -9/Z Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (AML. C 152 § 25c(6) - 4w 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 .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Demolition ❑ Other 0 Specify Brief Description of Proposed Work: � 4 9d SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be -' Completed by permit applicant 1. Building(a) Building Permit Fee C3 00"1- i O, Multiplier 2 Electrical (b) Estimated Total Cost of Construction ©� 3 Plumbing Building Permit fee (a) x @1 4 Mechanical AC _ o2 c5 1 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 1, As Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge ' and belief Print Name Signature of Owner/Aigent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 13 . 2 ND 3 ko SPAN DUVMNSIONS OF SILLS M ENSIONS OF POSTS DRV ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM inxa� Sh�� INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from Boards .and Departments. having jurisdiction have been obtained. This does not relieve the Du -k- a lass applicant and or landowner from compliance with any applicable requirements. )>4 P A r -LA, c) BE wrong ■ NONE ■s■s00memomma0■■■■■ MEN a. gone N■ mass amass upon summon= woman now .ssa as i�1/jQC� Q APPLICANT i>A u id-+ -'oji e �-Q tib o ccs ii' z- PHONE � ` 8 8 4S 39 ASSESSORS MAP NUMBER I O C LOT NUMBER SUBDIVISION LOT NUMBER STREET W t N +U l- STREET NUMBER R) rl .............................................O.r.......r......n..r...s...wa■ OFFICIAL USE ONLY ........................r................. Oman ...................noun noun ■. RECOA4N ENDATIONS OF TOWN AGENTS ..................................■r.....N..........r...ENa■ sa■ ..P.amasses l rpt DATE APPROVED CMiSERVAMNAWMMTOR DATE REJECTED COQ FOOD INSPECTOR - HEALTH DATE REJECTED te W --e . Gam-- DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE rA W xow A a2 5 0 t A or. G 92 v U co w" a o w c ii. x 0 P -4z W o w u w x o u: c w w A w W z cn ° cn -.-9 CO 0 CO CDo C. O y G c 0 cm co� o o_ y co •E m m 0 ow c co co O _O 00. CL C Q y c c ev V CD C CD V y � C CL_ CO) is -., 0 U) U) CC W w uj 5 0 0 z -.-9 CO 0 CO CDo C. O y G c 0 cm co� o o_ y co •E m m 0 ow c co co O _O 00. CL C Q y c c ev V CD C CD V y � C CL_ CO) is -., 0 U) U) CC W w 5 0 `1 V a o, c c� 4D N � • �. oCD �. CD C_C' AE c� ; c m m bb O N H O y m� Of J c� a N�C y C O ; E y m OV CD o acs y m m • x � O C O: dCt 0:NOo V y O m I..�: C� •— Z �: O co. p C dC CD Z Q m y m�p3 CDN _c C cat W o . o "gt .y c ++ cc .`m ata- 0=' m •y 0 Z O LLJ v CM V� a m� = A .0 (A O .0 -.-9 CO 0 CO CDo C. O y G c 0 cm co� o o_ y co •E m m 0 ow c co co O _O 00. CL C Q y c c ev V CD C CD V y � C CL_ CO) is -., 0 U) U) CC W w I - " - � , I -- F". iM ll� 70 'Amll -W�7 - --,g -i"Wkj, V77, TO X V X get 7-o r. VII -tT- 1, V., gf,740i� jK,6 I 1 1.1 �2f, 7.A� ARN jto;,J,i� gzpq- .3-2 -5-- t .>3?.WIT 4k, ���� I- Ag, ac.,!. m 311�� '0 7z, 1 W, Ox i au 4 Z;km 4 " C la 'IkAl 'AM %Now4mi /,,,4.1 L1 t7 ry T ara5s f ° .ea tv I C�1► 4-1 09 0 I I• n Location C,?//) No. "IS -957 Date �0z) TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3oZ, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3Q, 6-0 Check # l 5539 Building Inspector APPLICATION TO CONSTRUCT RE] BUILDING PERMIT NUMBER: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT IR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING " �a DATE ISSUED: SIGNATURE: C Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION LI Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone 1.3 Zoning Information: Zoning District Proposed Use .,SECTION 3 - CONSTRUCTION SERVICES 1.4 Property Dimensions: Lot Areas Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided R aired Provided Company Name _+ Registration Number 1.7 Water Supply M.G.L.C.40. 54) Public 0 Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner of Record Z/7 Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone .,SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: AIC Licensed Construction Supervisor: G�/�/ Address -7 Signature Telephone OXY 1100 Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Tele hone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 .4 2506) 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 Proposed Work checkall applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL ''USE r ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 TSU Check Number SECTION 7a OWNER AUTHOIIIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUII.DING PERMIT I, it //�;✓l� !_��6��% as Ov<mer/Authorized Agent of subject property Hereby authorize to act on My behalf, in all ve to work authorized by this building permit application. iQnature o wn Dat SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 attrre of Owner/A ent Date 7 NO. OF STORIES SIZE ` BASEMENT OR SLAB SIZE OF FLOOR TIMBERS is 2 3PZ SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HE, OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U. LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/pernjits fro Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with 'any applicable or requirements. 'HrrLIL;ANT FILLS OUT THIS APPLICANT LOCATION: Assessor's Map Number o—`/ PHONE T PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONLY** *: RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION AD TOWN PLANNER FOOD l� tSTRATOR SEPTIC INSPECTTR—HF-ALTH COMMENTS y !00 :D 0 DATE APPROVED DATE REJECTS' D DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 0 u �b A2 * lV $4 U) h 0+ 0 z 0 u �b A2 * u U LD TO 3EET A STATE'. E PHO M=EZ0. PfNESS PHONE NO.q'l*g ZIP W. EDPs DF MODEL #/DESCRIPTION -67218 � 7 J 9 4 !­ v loci, Y P P 4 x 2 L V �..4 0 il 6 7 4 DLY h2n�,Rff 'Jff 17- TO UT4 R W f Jr. A -67218 J 9 4 !­ v loci, Y P P 4 x 2 L V �..4 0 il 6 7 4 DLY h2n�,Rff 'Jff TO UT4 R W f Jr. 4 U 0 ! -7 111": IN2, _5_51,LC" Sub Total, 1 '39/0 - Tax I - 00 0 Total Less Deposit I - Balance Due YERS SIGNATURE: X I HAVE READ AND UNDERSTOODLALL .P&ICIES AND CONDITIONS ON REVERSE SIDE..: CUSTOMER COPY PLEASE READ STORE POLICIES AND INSTALLATION SUGGESTIONS ON' REVERSE PLEASE READ LIMITATIONS AND EXCLUSIONS. -OF WARRANTIES ON REVERSE THIS ORDFR TC C0TSMNrMWT ONJ APPPnVAT ()P rnPlDfAlo A-qrrz rwrYfIrD -67218 J 9 4 !­ v loci, P P 4 x 2 L �..4 0 il 6 7 4 DLY h2n�,Rff 'Jff TO UT4 4 U 0 ! -7 111": IN2, _5_51,LC" Sub Total, 1 '39/0 - Tax I - 00 0 Total Less Deposit I - Balance Due YERS SIGNATURE: X I HAVE READ AND UNDERSTOODLALL .P&ICIES AND CONDITIONS ON REVERSE SIDE..: CUSTOMER COPY PLEASE READ STORE POLICIES AND INSTALLATION SUGGESTIONS ON' REVERSE PLEASE READ LIMITATIONS AND EXCLUSIONS. -OF WARRANTIES ON REVERSE THIS ORDFR TC C0TSMNrMWT ONJ APPPnVAT ()P rnPlDfAlo A-qrrz rwrYfIrD CA W t. 00 o w cncz C/) O w g2 a U x O H U a: is. a O W W a: U) co 5 u. O U a o a c ii. W w c4 z cn cn 0O z z 0 w a 091.1 Nl01 mm O co O Z y y .9 . ct m O CIO O y C O A C m y 0 C QM D � On m CD Eft O E3 o O C" CK cma cc O O Z m C. COD C. 0 U) ccW W crw U) : c c 4: :�m c = c o = C:l V V CL A A w O c � �Q ' m c z 3 -cap H Is wIs a�E m CD ca •• cm cm •Cc -p N O N c O H " RIBcmRIB S.: CD y m m 0 cm c N Q mom � o �Z O. C F- •O = m :moo N La CD .y MD O Z L3 4D CD FE CL COO = A 0 CD JM 0 N �O C 4 -a4 -m> z 0 w a 091.1 Nl01 mm O co O Z y y .9 . ct m O CIO O y C O A C m y 0 C QM D � On m CD Eft O E3 o O C" CK cma cc O O Z m C. COD C. 0 U) ccW W crw U) 3 7 G 8 Date.. S 2-- ...... . . . .... .. ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...................... ................. L-1 . . ................................ has permission to perform .... j ....... ................................................ wiring in the building of ........ ....................... ........................................... .... . ............................................. at ....... 1.7 .... NoA,2Mover, Mass. Fee.� ..... S ............ Lic. NoeZ,!�7,-� ............. ELECTRICAL Check # Official Use Only Permit No. ..__..�Y_.._. _. aeJg%o"-a 4;PSammy Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 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 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the �electrical work described below. Location (Street & Number 2/ % �o /Y i 7Z - Owner or Tenant z�k / Owner's Address Is this permit in conjunction with a building permit Yes I< No ❑ (Check Appropriate Box) Purpose of Building ��Y � � 4qk Utility Authorization Existing Service�y Amps Voits New Service Amps Voits Overhead Overhead ❑ Undgmd ❑ Undgmd ❑ Number of Feeders and Ampacity 1" -V Location and Nature of Proposed Electrical Work No. of Meters / No. of Meters INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ 1 -?2-6, Do Work to Start Inspection Date Resquested Rough Final r--� Signed under the Penalties of p ��z 1 J r` FIRM NAME (�'MS eya,6r LIC. NO ' C- �/ A Lkensee Signature" f LIC. NO. - �U Bus. Tel No. 7 k ✓ - /�' �� Address ��� .� % i 7 AltTet. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that myrsignat re on this pe ' a ication waives this requirement. Owner hAgent�(CPlleeaas-e Check one) Telephone No.! ,�� o 7Y77 PERMITfEE $ (Signature of ner Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA No. of Lighting Fixtures Above Swimming Pool grnd J�1 1n ❑ ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hvdro Massage Tuds No. of Motors Total HP ? � INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ 1 -?2-6, Do Work to Start Inspection Date Resquested Rough Final r--� Signed under the Penalties of p ��z 1 J r` FIRM NAME (�'MS eya,6r LIC. NO ' C- �/ A Lkensee Signature" f LIC. NO. - �U Bus. Tel No. 7 k ✓ - /�' �� Address ��� .� % i 7 AltTet. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that myrsignat re on this pe ' a ication waives this requirement. Owner hAgent�(CPlleeaas-e Check one) Telephone No.! ,�� o 7Y77 PERMITfEE $ (Signature of ner Agent) Z Date.. ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................... has permission to perform ...... ...... wiring in the building of ..........4 /,;; ....................................... at ........ ... 1.2 ... ..... ..................... `North Andover, Fee Lic. Nq/�/JV ......... ..... . .................... ELECTRICAL INSPECTOR Check heck # r r' h Commonvrealth of Massachusetts Official use On] E= Departfhent of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank �a PLICATION 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: , t9 2 % i/ J,?,(/{j,?!/L To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. t er. (Street & Number) 1)7 TEA ti.vner or Tenant' 26 U 1'D LL /d3,9W /'T2 Telephone No. 92j�'_�j-,�127 Owner's Address S4 IY2 .his 6 r ❑/ No P1 (Check Appropriate Box) xs permit in conjunction with a building permit. Yes of Building �L= 9Z'/9,(/% -1: Utility Authorization No. :,isting 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: (,V l•j� ,`/J G 130()Z7- Lp. P,0©L, ;1-15,F191 Completion of the.following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of ,-`- Total Transformers KVA 's o. of Lighting Outlets No. of Hot Tubs Generators KVA D` !-,ghti� Fixtures g Swimming Pool Above In- ❑ g gr d. rnd. o. o Emergency Lighting Battery 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 '' 'o. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices Heat Pum KW No. of Self -Contained �."Waste Disposers o p Totals I.Number I.Tons Detection/Alerting Devices iN"o. of Dishwashers Space/Area Heating KW _ Municipal Local ❑ ❑ Other Connection _ _ No. of Dryers Heating Appliances KW _ Security Systems: Y No. of Devices or Equivalent `�. of Water Kms, No. o No. of Data Wiring: '-t eaters Si ns Ballasts No. of Devices or Equivalent ,'-o. Hydromassage Bathtubs No. of Motors Total HP Teleca:nmunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. !NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless 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. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Start: �[ tti o2 Inspections to be requested in accordance with MEC Rule 10, and upon completion. -,N JU, under thA pai s and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Express Electric Unlimited LIC. NO.: A 12757 Licensee: Yan Kener SignatureLIC. NO.: (I) applicable, enter "exempt" in the license number line.) us. Tel. No.: -.77763_254(L— . ,\,'dress: PO Box 1 169 Everett, MA 02149-1169 Alt. Tel. No.: .`•'77F'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally e luired 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: $ 05/20/2002 08:27 9786928658 4 14 N cq J W N 00 P MANZI -i runt rn � a i _LLI PAGE 01 NLn n o D m O .' m x n 2 ti m . z < mim m m c g c3rmD ; � w cnAr �M-4.. b I — m= m �. <n M-4 r > ro c ry m m ic D W mC7t7 a. N ►. r r -r m Tn �(� n' O��D N oa Do I _ N � �� co o p �� to Signet We i _LLI PAGE 01 r v,i