HomeMy WebLinkAboutMiscellaneous - 22 ANNIS STREET 4/30/2018FOR D A TQ--- T I M E
m
PHONEO
OF- if 'I
P"ONE YOUR CALL
AREA CODE N UJR EXTENSION Zq
PLEASE CALI
M E S 5-A E
SIGNED
SEE YOU
48003
3
ate..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4
This certifies that ....... K. P.!", ..... 0.."'1 ... ... Is ...........................................
.. .... ..... .... .... ... . .
has permission to perform ..........
wiring in the building of ............................................. ............................
at ......... .......................................... . North,�ndover, Mass.
Fee ... 9.P .......... Lic. No. 315,2 5E T-
............. ...................................... . ..... ................
ELECTRICAL INSPECTOR
Check #
41 4.%- 9
,3 --Ot - 0 -'1
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Kt4 r"A " YIJ " S
Thiscertifies that .............................................................................................
has permission to perform ... Rle:vp. r9%.,. i . .......
wiring in the building of ..................
..................... ...........................
at .........
....................... .......................... . North Afndover, Mass.
r 31 S,0zq-v Zj
Fee ..... I.Q .......... Lic. No . ............. ..........
....... ...
ELECTRICAL INSIC�MR
Check #
ccco.��,�n�a�
..[. rlbttrsnt o�}Ira Jarnicad
BOARD OF FIRE PREVENTION REGULATIONS
_ Oficial USC Only
Permit No. J^/
Occupancy and Fee Checked j
ev. 11/991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM- ELECTRICAL WORK
All uvrk to be performncd in acconlanm with the Massachusetts Ghxtrictl Code (MEC), 527 CAIR 12.110
(PL CASE PRINT IN INK OR TYPE :ALL IJYr0 AL•tTION) Date: /Z .
City or Town of- To "
���T c�de� To the Inst ecta of Wires:
By this application the undersigned gives notice of his or her intention o perform the electrical work described below.
Location (Street S Number),�.7i!/�
Owner or Tenant
Owner's Address
Telephone No.
Is this perinit in conjunction with a building permit? Yes ❑ No 1"J (Check Appropriate Box)
Purliose of Building Utility Authorization No.
Date..:./.....r. € :................
This certifies that ......t.l / r <":: . t.. ..'r. t:�... .�...........C...:.a... ....( .........
r
has permission to perform ......... f
wiring in the building of ..
.................. ` 7 .......... ,North Andover, Mass.
Lic. No..... ...%' ` �..
E
EtlEcrwcAL INSPECTOR
`hmdgrd ❑ No. of Meters
)ndgrd ❑ No. of Meters: —
INSURAIN CE CONFERAGE: Unless waived by the owner, no pernnit for the performance of electrical worm-- may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coveragge is in force, and has exhibited proof ofsamue to the permit issuing office
CHECK ONE: INSURANCE ; BOND ❑ OTHER ❑ (Specify:) E � rrf
( Ira( Date)
Estimated Value of Electrical Work:* (When required by municipal policy.)
Work to Start:/ 2 . Inspections to be requested in accordance with -MEC Rule 10, and upon completion.
I certifj, ander tire paids and per allies of p //qty, that lite information on this application is trite and complete.
C IRt�i NAME: C /! fly L LIC. NO.:
Licensee: ,��- Signature LIC. NIO.:
(Ifapplicable llic'ercntpt"inthe licensenumberfrne.) Bus. Tel.i\o.-,/2O_3• /-$7--20/I
Address:tl /�/%lPtriD �".4 or -f�Pr? 0.30 �r
AIL Tel. No.,
OWNER'S INSURANCE NVAIVER.I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am time (check one) ❑ owner ❑ owner's agent.
Owner/ARent PieRilfIT FF_F.:
t.
;'o Fleet
RETURN DEPOSITED ITEM NOTICE
TOWN OF NORTH ANDOVER
DEPOSITORY
PO BOX 124
N ANDOVER MA 01845
PAGE I OF 3
0014102612
NOTICE DATE
OZ -28-2003
1 ENCLOSED ITENS
THE FOLLOWING IS A LIST OF CHECK(S) DEPOSITED BY YOU THAT HAVE BEEN RETURNED UNPAID
TO THIS BANK FOR THE REASON(S) STATED BELOW. THIS LIST ALSO INDICATES THE DISPOSITION
T &T -XT t.."QL"RW"� ARGEQ to 1►otNt acoouNT.
AMOUNT
OF CHECK
RET.
RED.
MAKER
ACCT N0.
RETURN
REASON
ORIGINAL
DEPOSIT
FILM
SEQUENCE
DATE BANK LOCATION
•---
-----
--------------------------
-584012035
_•
DATE
NUMBER
WAS CHARGED ID
45.00
RET
REF CK
02-25 •---
- 200s
-----------•---•-----------•------
IZ02216916
02-28-Z903
1:21&37119&l: 58•4, 40 i 20 31ffl SIP
LESS ITEMS REDEPOSITED
AMOUNT CHARGED TO YOUR ACCOUNT ON 02_28-2005
.00000004500.o
------------
45.80
Id WURT : TT E00Z Z0 'apW VES6 869 8L6 : 'ON XUJ 30Id30 1-103 U3di 8300aNd ON : WObd
List of Professionals
1
Page 1 of 1
Home, I N11ki a j Toolbox I Help .,. , .• � �., �y
i h>asix ffr ra'. iiTI('1 see
Licenses fitting search criteria ,
Profession equals Electrician
Last Name beginning with karantonis
Licensing License License License
Board Type Number Name City/State Status
Electricians Journeyman 31.525 KARANTONIS HAVERHILL, MA Current
Electrician MICHAEL V.
a Anne St
14 t -V � e. R,ky } dA
CLvl a I'
vjly'L
Your search has resulted in 1 licenses
Division of Professional Licensure
239 Causeway Street
Boston, Massachusetts -0211.4
Phone: (617)727-3074 Fax: (617)727-2197
Please send your technical questions or
comments about this web site to
REG.WebMaster@State.ma.us
Disclaimer
Privacy Policy
Enforcement Process Glossary_
C I�'ec'k
\,^J
a-5
jze- Ckf
... /pubLicRange. asp?profes sion=Electrician&1Name=karantonis&fName=&city=&state=&zip=&3/ 10/03
I 401qpqw*
i
r.
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
A-, I (�
ThiF- Affies that ........... ...........................................................
J, V A C I
has pefTission to perform ........... 17 ....... .... ..................................................
J. *
wiring in the building of ......... 4.-Z..t ........... .....................................................
at ...... IA ... W! j ... U .... f?� 0 a /. North )�d�ov r M s
..................... --4*—******-Iv'--
Fee ... ��2.P .. . .... Lic. No.
............ .......... ............
ELEcrRICAL INSPEC-rOR
Check #
4 4,., 3
_ Otlww use Only
Plrlttiit No.
�a�yand Fee e�ed
L- I U991 Oravehhut)
APPLICATION FOR PERMIT TO PERFORM- ELECTRICAL WORK
All work to be perforrncd in accwdu= with the Massachusetts Electrical Code (M • 1, 52 •CMR 12.00
(PLEASE PRIA TIMIN K OR TYPE i �I77Cl1Yj
City or Town of: t�� / To the l of firm:
By this application the undersigned gives notice of his or her imienyoiu to perforin the elanrmd work described below,
Location (Street & Number)
Owner or Tenant
Telephone No.
Owner's Addrew
Is this permit in conjunction with a building permit? Yes ❑ No (Chert: Appropriate Box)
Purpose of Building Utility Authorization No_
Existing Service Amps / volts Overhead ❑ Undgrd ❑ No. of Meters .
New Service Amps I volts Overhead ❑ Undgrd ❑ No. of 13eters:
Number of Feeders and Ampneity
Ce " P to ftaafdiera ffa N 6 W ad*M rbebederta &MrororV,-"s.
No,. ofRecessed FizGets
iYo. dCea.-Snsp. (Paddle) Fans
NO. ofraw
ML of UgUing Oadcls
HetTaft
Ne. of Fwm,es
ML of Rmplade OuBeb
Pool Above hi-❑
aitAl Burners
_ tmg
ALARMS of zjes
No. of Switeites
o[GasBt�ers _
o' of
NiLofRa�
TOM
e[AaCowIL Toy.
efAktrGt�Deriees
n`0. Of Wasfe D15j/06!!3
Arn H xw
IXW
Q ConaecRoa � othar
N...fnee;�s etr
M0. of nin6uashars
No. erDr _
No. of Water
Heaters ICi1i
o.of
salmi -
nam Witioag:
i ofiees or
NO.
.rte TOW]"
i�Io.efDeeitxsetr
OMEM
,ffa*dW"f.0*8k er.Wb,ALe0J
INSURANCE COVERAGE: Unless waived by the owm. no pant for the perfotmance of dwhical work- may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
mtdersigued cectifit s that suchcovenis iia cad has d proof ofsaure to the ptamh issoiva office.
ccLEcx ONF: DMJRANr.E BOND D OrMX 0 tom) E�rl_� yP r1 _ ..� _
( _ Due)
Estimated value oFEt Wodr. �. fJ� U ( by poky.)
Work- sp Start: Irspeeiioas to be reed in acoonhnee WA lrlEC Ruk 10. and upon completion.
I aertif}; and rhe iu a»d pAes of peurl,at the itufQrmafion on flims apprreatiotr is nave and courp[ete-
FIRi1I NAbI1::_���.ai���911 G!�
Lim_.
(/1 m-mw-inThe /ta e•awberffor,
ONVNSR'S IiNSURANCE W I am acme
required by law By my signature below. I herby arrive this wTfi enmt.
Owner/Agent
C; --- ,......
1rdjV- ,tWM0 W_
I+IC..INO»
LIC_ rio Z=5&S'6
Bus. TeL No.
AIL TeL IGW
not hags the IiAmly misurmcc eo.=age normally
I am the (chert; one) ❑ owner ❑ owners agent.
PnRM-rr FF_F_- S ��, op
r
Q�
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
1 6A (-N V- � C.,/v , 5
Thiscertifies that .............................................................................................
Ty (-&., -, c -e-,
has permission to perform ...............................................................................
wiring in the building of ....... 5.m ... ...............................................
. .. ... .....
at ...... ......... ........... ...... . North Andover. Mas,
Fee .... (9.0 ......... Lic. . . .......
4
ELEcml�;� /IN�
Check #
4 4 kj 4
4DOP
�1 t
Official Use Only
Permit No.
OccuBOARD OF FIRE PREVENTION REGULATIONS
pancy and Fee Checked
ev_ 11/991 (leve blued;)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perromwd in accordance with the Massachusetts Electrical Code (&lEQ. 27 CRIR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORAL-1770N9 Date.-
City
ate:City or Town of: ��i��oyp� To the Insp to of FVt es:
By this application the undersigned gives notice of his or ler intention to perform the electrical work described below.
Location (Street S Number)
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No [3", (Check Appropriate Box)
Purliose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters.
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters:
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
C letiart ojthe fdlou' tablenoy be waived b • the 1 • ' or of limes.
No. of -Recessed Fixtures
roto_ of Cei1-Susp. (Paddle) Fans
110. ot Totat
Transformers RVA
No. of Lighting Outlets
No_-ef Hot Tubs
Generators la A
No. of Lighting Fixtures
Swimming Pool grad• Above ❑ In-
d_ ❑
o, ot J9
Batt Units iAergeIICy ating
-
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
iso_ of Zones
No. of Switches
No. of Gas Burners -
Of Detection and
No. j*WthmDevices
No. of Ranges
Na of Air Cond.. Total Tom
o. of Alerting Devices
No. of tiVaste Disposers
eat �P
TotaLst.
umber Tons 1
o. o outainel
Ve!EF922t,Devices
I I I
No. of Dishu^ashers
Spaceffirea Heating KW
Local ❑ MuWqYA❑ Other
Conneon
No. of Dryers
Heating APp�� K%
unity ystems;
No. of Devices or Equivalent
No. of Watero.
Heaters I�"iVSicas
of 140- of
Batiasts
Data VVirhW.
No_ of Devices or Equivident
rtzauag
No. H-, dro a Bathtubs
No. of Motors Total HP
1 elecommumcations ' ring:
No. of Devices or Equivalent
OTHER:
Att
tl&PW deMN Ff d abr4 or at nVtd, d by the Impeaer of tires. ack add
INSURANCE COVERAGE: Unless waived by tie owner, uo permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. 11ie
uAdersigned certifies that such coverraa e is a forge, and has exhibited proof of same to the permit issuing office_
CHECK ONE. INSURANCE 0 BOND ❑ OTHER ❑ (SPecifT.) �%j%C- �yolt/3;. gal
► ( irat' n Date)
Estimated Value of Electrical Wort:: 9D (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify; tinder the pains and pe alliesa!9f ,that tete injormaden on this application is true and complete
-
f,
NAME: ���/a� /l��f ,�,,G _ IJC.NO.:
Licensee: <'.G�14.���L�/`��e�? Signature,;��i�,�� LIC. ii0.:
(Jjapplicable t 'crettrpt" itt the IicenseatanberG►rej A/ .Bus. Tel: No.•,��03•yfAv20/
OWNER'S INSUt2 �:`iCE ♦rA1vE I am aarare that the Lrcetrsee does not have the Itabitily insurrnce coy eraee normally
required by la«% By my signature below, I hereby waive this requiretrerrL I am the (check one) ❑owner ❑ ow'rrcr's advent.
Owner/A�ent
c:......a.,. a 'r'otnsahnnn \*.. Pl: RrIfIT FF_ F_ • S
,0)
.3- Z)�- 03
Date..... . .........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This cAfies that ............
................ JA ................................................
has pern fission to perform .......... R ... VA .........................................................
..... .....
wiring in the building of ..... ...................... ................................................
at ..... .......... ....... North Andover �Mm
..... Lic. No . ............. .... ;� .. .... . . .......
Fee ..... 49.
Check # 0 1 q q ELECMICAL INSPECMR
1 44-5
official use Only
Prrnnit iota
Oa upas ey and Fee Checked
_ 11199] Itcave biaak)
APPLICATION FOR PERMIT TO PERFORM. ELECTRICAL WORK
All work to be perfornicd in accoahuwe with the Massachusctts Elcurical Cotte (MAC). 52 ClllR 12.00
MLFriS,E PRINT WINKZ ZYP fL A INFORAL•iTTONj
City or Town 5i7': To the In peer r of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) � � • �� f (�40��
Owner or Tenant 7,7-/7/7//)0-,'- - - Telephone No.
Owner's Address
Is this pennit in conjunction with a building permit? Yes No d (Cheek Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Antes / Yoits Overhead ❑ Undgrd ❑ No. of Meters.
New Service Amps / volts Overhead ❑ Undgrd ❑ No. of Pyleters.
Number of Feeders and Ampacity
Location and Nature of Proposed Elecirl Work: - 3 C -le, o,,
files ,rdlel
- - c�re�rars�ror����...n,.:e..,�.�.e ►.K.wn...w«w..�..
No. af'Recessed Fixtures
No. of Cal.-Susg. (Paddle) Fans
rmezKVA
No. of Lighting Outlets
Na Ofnot Tubs
ors KNIA
t
Pio. of Lighting Fixtures
wia�ng Pool ❑ ' ❑
Emergency ting
No. of Receptade Ontlets
e. otCOR Burners
ALARM -JWo of Zones
No. of Switches
Na of Gas Burners .
a oDetection
Xnifiafim
No, ofRan ges
Tom
efA!r CouL Total
a ofAkrtingDevices
No. of Waste Disposers
Heat
offi
o. of Self-ContainDevices
No. of Disbuashvs
Pio. of Dryers
Spaciffirea E[ea g KWQ
HeaftAppromms xW
�sptl � no ❑ Other
SecuritySysfDtems. r t
Mo_ of Water
Heaters IAV
a o. _
BallastsNo.
Data
of Devices or Equivalent
Na Iiydroatassage Bathtubs
of blotovs Total ]l1T
74 XL of Devices orIVU-ring:
a valent
OTHER:
dtmeb=bNa ddetrn? gVAs&ed. or asInaired byAL- bsspector of ;*V&
INSURANCE COirwRAGE: Unless waived by the ownq m panat Jac dee paf mmnce of electrical work xray issue unless
the licensee provides proof of habMly nwxa= includift ' bampleted operations coverage or its subst umd equivalent. The
undersigned certifies that such cove:a is ut foil and bas eabihited proof of same to the permit issuing oii'tceCHECK ONE-- WSURANCE norm ❑ O MM ❑ tSpeeifT.j G��!%e . � e/ : 24rafi
Y
a e)
]Estimated Value of Ejectrigal Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion -
J, cerdfr, under ,, p as and pegaftim efperdWY, that dwinformatioa on thin appfimdon is true and complete
FIRi11 NADiE:
Licensee: -1.0/
fff app/irnb/ey� t�•jeiromp"!a the hearse iumberEwj
Address: fl /"!%lPLr/Giar�/PIVA,,
OWNER'S INSURANCEWAIVEW I am aware I
required by law. By my signature below, I hereby wail -'e this requirement.
CJgjej�.rnr/Aaent
w..w
TAPvshnnw N*n
_ LIC -NO.;
LIC. No.:
Bus. TeL 10.,4-
73;r AIL Tel. N041 -AV --ODA
not have the liability insarauce eo%wuge normally
I am the (check one) ❑ owner ❑ ovmces agent.
Pi?RitfIT Fe F, T P, 0E)
Date .... .!. -.. 0..?
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
A.,
Thiscertifies that .............................................................................................
V�k'u JI-er 0 �- J,, A, S - �-
has permission to perform ....... ......................... LC ..............................
wiring in the building of .... .......
at ...... .......................... . North Andover, Mass.
.. .. ...... ........ ... .. ... ...
315'�*-5-c- -�-- —D 41 A
Fee... ........ Lic. No . ............. ...........................................
ELECTMCAL INSPI �R...
Check # 0 11 q.-
44,6
" Otulicm Use Only
Permit Na
Oveupamy and Fee Checked
kl�_ 11199] (leave bb*)
APPLICATION FOR PERMIT TO PERFORM. ELECTRICAL WORK
All work to be perromnd in accomfoncc with the Massachusetts Elwrical Code (MEC), 27 CR I? 00
(PLEASE PRINTININKOR 7TPE , FOR3L�tT1011� Uat�
City or Town of: �� r� ver", To the Inspectr- Of Wires:
By this application the undersigned gives notice of his or her inJteatiog to perform the electrical work described below.
Location (Street 8: Number)
Owner or Tenant ,UUP/ Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No [9-- (Check Appropriate Box)
Purliose of Building Utility Authorization No.
Existing Service Amps / Volts ' Overhead ❑ Undgrd ❑
New Sez-vice Amps 1 Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
No. of Aleters .
No. of ivleters:
Location and Nature of Proposed Electrical Work:
COL111r99011 nfdW fillamao F.W. r r_.-_
No. ofRecessed F=tuves
Na ofCea1-Sasp. (Paddle) Fans
- ...-
NO. o otal
Transformers KVA
Na of Lighting Outlets
Na of Hot Tubs
Generators I,'VA
Na of Lighting Fixtures
min ting pool loo ❑ 1n- -
anuL
C°
Na of Receptacle Outlets
No. of QE Burners
ALARMS
info. of Zones
Na of switches
a QrGas Butrners -
°- - and
Ini ' Devises '
No. of Ranges
No ofAir-ComL. Tons
a of Alerting Devices
Na of Waste Disposes
?aTOM
� o»
Area H KW
AppWnees-XAV
o. o rained
echos( Devices
aYa of Distaisashers
No. of Dryers
❑ Cottaion ❑ Other
a o Devices or est
o. of water
t3eaters K
e. a
Batlasts -o,�
5 -aty-
ur ent
Na litiedroam>�age Bathtubs
o. ofb1otors TotalHP
of Devices orkatlo=* wi cleat
OTSBR:
dfmmndffmaeoidets fde*edcrassagu ,0abyAe1nspectorvfWvMvM&
WSURANCE COirTRA.GE: Unless waived by the owner no pcm* for the performance of electrical work may issue unless
the licensee provides proof of liability inwcan - -cO mpleted operation" oo =Z -e or its subsMnfid equivalent. The
undersigned its that suchis in Qmm and has exhibited pwofofsamt: to the permit issuing office.
CHECK ONE: WSURANCE 7oNn 0 07EM O (SIectf►:�
Estimated Value of EI Work:
4:Q2 : z� U (When mq*cd by anmieiltal policy.)
Work to Start: 1,ZZ11,Inapt clivus to be tiequested in accordance with MEC Rule I0, and neon completion.
I certify, ander the p_ _ s and peyaltnrs ofp5j'urp, that the information on this apprwation is true and complete.
FIRilI N AIME:
Licensee:eziAel-A,
(japptrcwbte,�ntey� er�7rrpt »
OWNER'S INSURANs CE AVAIVEM 1 am aware mat tate Lnoetesee does
required by law. By my signature below. I hereby =!Ve this requirement.
Owner/Agent
_ ILJC. NO.:
ucti0 :
Bus. TeL
not have the liability immra= co%vmge normally
I am die (check one) ❑ owner ❑ ou-per's ageut.
PJSRitfIT FF- F: y, Q -00
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
C) U
fhiscertifies that ....... . ..............................................................................
4
has permission to perform .......... p., K ...........................................................
I -r
wiring in the building of ...... ? C-Jz .........................................................
........ ....
at ... �L North Andover, Mass.
Fee.... q.Q .......... Lic. No . ............. .......................................... .......
ELECTRICAL INSPECTOR
Check # 621 41 � _
F Official Use only
Pbatit No.
Occupancy and Fee Cid
11/99] ---]
Ome blnki
APPLICATION FOR PERMIT TO PERFORM- ELECTRICAL WORK
All work to be perfornacd in accvnhuacc with the Massachusetts L-ic"n ylne�W
(PLEASE PRINTININK OR TYPE.iLLINF W�-1TION) Zte:City or Town of:rjo✓� TathofreS:
By this application the undersigned gives notice of his or her intention to Rcrflon.a the electrical work described below.
Location (Street S plumber)/' - J/� %d✓
Owner or Tenant
Owner's Address
Telephone No.
Is this peanut in con junctioai with u building permit? Yes ❑ No ll!! (Check Appropriate Box)
I'uriiose of Building Utility Authorization No.
Existing Senice Amps / Potts Overhead ❑ Undgrd ❑ No. of Meters.
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of itileters:
Number of Feeders and Ampacity
Locution and Nature of Proposed Electrical Work:
t'aauplet6ort e%�etarWe�aavbr aais�rd br d% Ineanrro,-ortPu�e
No. ofRecessed Fixtures
No-eiC L—Susp_(Paddle)Fans
o. of Total
raunsforene:s TO
KYA
No. of lAghtsng Outlets
w of Hot Tubs
Ceaerators KVA
Pio. of Li bftg Fai ftwes
p� Above ❑ 1n- ❑
o. o Emergency ting
Uidb
No. of Receptacle Outlets
o of Oil Burners
ALARM
o_ of Zones
No. of switches
o. of Gays Burners .
o. o tecues and
Detioes :
iYa of Ranges
TOW
Na: of Air Coad.. Tons
o. nkrtittaDkvices
of Waste Disposers
offi
HmtFuiNo.
SpacdAnm Heating XW
o. o
Devices
Local ❑ ❑ Other
Connection
No. of Dishirashers
No of Dryers
Healing A MV
secSysurity
pa ericis air t
No- of Yater
Heaters i�iVSkm
a o.
BaIIasts
pal 4yt-n-n
Na of Devices or E niva[ent
Na iiedBathtubs
a efltlotors 7'109 HP
Ate. of Devices or, ui�valest
OTHER:
A60* 4aftio it ddm7 JrAe*ed arasiequirby&C nspemw of Wire
I MMYRANCE COVERAGE: Unless waived byte owns, no pcn* for Sue perfonnutce of electrical work may issue unless
the licensee provides proof of liability insurance ibclading "bompieted operation" coverage or its substantial equivalent. The
undersigned certifies that such'�le in fewer and has c&aAwd proof ofsam� to tic permit issuing owxr-
' CHECK ONE- IN%URANCE 93 BOND ❑ OrhiF.R ❑ g Y.:_...
( iraC n Date)
Estimated Value of ElFchicill W orL-: ZaWdd (fin required by municipal policy.)
r Work to Start. � 2jr-2_ Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify; under re pa ` and pepaities of pejsrf. t jai dw hifomradea on dais opph`cat7ion is tme andmmplde-
FIRAI NAME:
Licensee_
(lf applicable,g�►t.
Address: X
OWNER'S IXV!
required by law.
Owner/A gent
Cin....,�.rn
ercnrpl
URA*NCE NVAIVEM 1 am aware tsar the s tc 5ce dots
By my signature below. I hereby waive this requirement.
'rntnnhnnn W-
_ LIC. NO.:
LIC ivoz
Bus. Tel: No. Zi6V
1137AlL Tel. itis "A7-irADla�
not have the liability io5 I - I Co.. eragc normally
I ata the (check one) ❑ owner ❑ owner's agent.
P%Jir3fIT FET S -1/19
Date .... 3 ..... �R-! ..... Y -3 -
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... N\.�.Kn .......... N f, A 0 k, I �
.....................................................
has pcqnission to perform ......... P.,e .. RA ..................................................
.... .. ... ..
wiring in the building of .. e. �A. �:!f� � ... I ............................................
at .... )R� ....... t/h..kk/- k " 9 q
JJ ......................... : ................ . North Andov r, Mass.
Fee .. . ... Lic. No.4.3.5d5�-
................
ELEc"rRICAL INSP
Check # Ct
44 � 0
' a Official Usc Only
pamit Na
O«apancyand Fee Checked
lk�i I M (leare bbnk)
APPLICATION FOR PERMIT TO PERFORM- ELECTRICAL WORK
All work to be perfonved in aiconimcc with the Massachusetts Clcctrical Code (ME ). 527 NIR 12.00
(PLEASE PRINT W INK OR TYPE ALL INPORAL4 01V Dote:_ f
City or Town of: ����� �✓� P,-, To the Ins ector of Ores:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) IPb Alrl LtIld x2ZILC
Owner or Tenant o �� f'iTelephone No.
Owner's Address
Is this permit in conjunction Suitl% a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Yolts Overhead ❑ Undgrd ❑ No. ofr/leters .
New Service Amps / Volts Otierhead ❑ Undgrd ❑ No. ofiYieters:
Number of Feeders and Atnpacity
Location and Nature of Proposed Electrical Work: i?r A
V Caw oldero 1mbk -- be mdvrd by Ar Inch war or-1rum
Me. of'Recessed Endures
No. ofGa1-5mp(Paddl4 Fans
o' o Total
KVA
No. of Lighting Outlets
Na -of 1Hot Tabs
C�eaantors 1'VA
No. of Lighting Fhitures
winmang Pool W ❑ ❑
° ml °w
it
IsummeNo.
of Receptade Outlets
a afOB Dunmrs
ALARM
o_ of Zones
No. of Switches
�6atsBar _
°' of t
Na. of Raftes
Ne. `o. of Waste Disposers
NO. of" Cosec.- Tom
T � i offi
a of Alerting lkviees
o. a
No. of Dishi= ers
Spacf&= Hm ft KW
❑ Mpg Coaus ttion ❑ Other
No. of Dryers
KW
Neb oTDesitxs ttr lent
No. of Watera
Heaters ICiYSim
of a _
Bats
Tfirkm
Dater ofrites or
No. 13_vdromassage: Bathtubs
1 a aihtlotars Tota' BP
No o Desices or uivalent
01�iEIL-
AMK6 A0W 1(dW&e t orarsJ8Pt&nd bltlreInVecWroJ rrrrec
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provuies proof of rmbMW inanance inchuft wcuniplMd opaafiod" coverage or us subsmnfi l equivalent. The
undersigned certif'its that such cenrua is m regm, and has ed Oiitcd proofofzmac to the permit issuing of icc.
CHECK ONE-- INSURANCE Ls�f isONiD ❑ oTiIFR ❑ (SPecefY oil�hllatc)
(
Est4n ated Value of Electri Work:* . a v (When required by municipal policy.)
Work to Start:
I ce dfj, under e p a6ins and Zan
t<IRRI NAM: �C���,i
Licensee: ,fV/Lfit�/l/.
tlw?ptrca6te,�,t ;cz� e
Addis-. f� //1P�•✓D -
OVI ER'S INSURANCE
Inspectimhs to be mquesled in aeowdance with MEC Rule 10, and upon completion-
rLies of pj5 ft7, that the iaformatdon on this applieadon is tree and complete -
am amrc
required by law. By my signature below, I hereby naive this requi rem
Owner/Agent Te.lnsst+nnn i�.+
IJC. NOa
�� Art. Tei. h'ie f6D.3-�-s'8 ?alar
not have the liability irusttaace coverage normally
I am the (creek one) ❑ owner ❑ ouver's agent.
Fi:Ri1fIT FFF_- 9 yd. DD
APp�}'CA
DECtSt®t4 CUE - '
MADE IN U.S.A.
0
N0. 752 1/3
e o
Legal Notice
TO W
NORTH ANDOVER
BOARD OF APPEAU%
NdTICE
i
April 23, 1985
Notice is hereby given that the
Board of Appeals will give a
hearing at the Town Building,
North Andover, on Monday
evening, the, 13th day of May
1985, at 7:30 o'clock, to all par-
ties interested in the appeal of
JAMES AND KAREN HETHER-
INGTON requesting a variation of
Sec. 7, Par. 7.3 & , Table 2 of the
Zoning By Law so as to permit
relief from the side and rear set-,
back requirements to allow the ',IZ*,
construction of an addition on
the premises, located at 22 An-.
nis Street.
By Order of the Board of Ap-
peals.
Frank Serio, Jr.
Chairman
Publish N.A. Citizen: April'25,
May 2_1985 jil
y, 1
A' � A►IIIL?TV ib
;i:• tsss ; �,
TOWN OF NORTH ANDOVER
MASSACHUSETTS
BOARD OF APPEALS
NOTICE
April. 2= ...19.. $5
Notice is hereby given that the Board of Apr als vill give a
hearing at the Town Building, North Andover, on ... N. )nday
evening....... the 13•th day of ...... May........... .
19.8 5 , at. 7 : (Mock, to all parties interested in the appeal of
.......... JAMES. AND, .KAREN. .HETHERINGTON
requesting a variation of Sec.. �. P... ..& Table 2
.... of the Zoning
By Law so as to permit...reiie f from the side and
...................
rear setba.ck..reg.uir.ements..to..al.lQw..the...
cons. tructi.gn..Qf..an.addition
............................
......................................................
......................................................
on the premises, located at....22..An n i s S t re e
............................................. .......
By Order of the Board of Appeals
By: Frank Serio, Jr., Chairman
Publish: Citizen: April 25 and N -ay 2 1985
Send bill to: James Hetherington
22 Annis St. °
No. Andover, MA
o
MORT"
RE ..twlar:r, 3:; n . . o�
•
NOR7„IJI (j[p7 •
,SUN IZ ,+ 12 Atf X85 'SSAcmUS�`
TOWN OF NORTH ANDOVER
MASSACHUSETTS
BOARD OF APPEALS
P9r.. Daniel Long, Town Clerk
Town office Building
north Andover, MA 0.1845
Dear Mr. Long:
Any appeal shall be filed
within (20) days after the
date of filing of this Notice
in the Office of, the Town
Clerk.
Jur � 1_2, 1.985
Heti ,rington, James
22 Annis Street
Pet:. tion No. 31-'85
At a regular meeting held on Monday, June 10, 1985, the Board of
Appeals voted unanimously, with Members Frank Serio, Jr., Alfred
F. Frizelle, Augustine V1. Nickerson, WiLI_iam J. Sullivan, and
laal.ter F. Soule present and voting, to amend the decision of the
above captioned petition which was filed in your office on May 23,
1985.
Specifically, the Board voted to delete the following condition:
1.
"That the existing garage be razed prior tc the issuance
of a building permit"
and replace it with the following:
"That the existing garage be razed thirty (10) days after
the proposed addition is closed in"
Please attach this amendment to the original ..cc. sion.
3w
cc Applicant
Parties in Interest
Building Inspector
Assessor_
File
Sincerely,
BOARD OF APPEALS
Frank Serio, Jr.,
Chairman
s
yi►►a
►�%A RTfj
kt
RECEIVED
q
DANIEL S�:
ONG
APII�L,�� i';'
;.
'
TOWN C1.:RX
A 1855 ; q•
:�9•• �� •
NORT1'1 Atg0OVER
►rSgCHUS�'�',
MAY 23 1155 AN 185TOWN
OF NORTH ANDOVEF
MASSACHUSETTS
BOARD OF APPEALS
NOTICE OF DECISION
Any appeal shall be filed
within (20) days -after the
date of filing of this Notice
in the Office of the Town
r:lerk.
Date ...... MAY. .19E 5 ......
Petition No.... 31-.: '. 8.5 ...........
Date of Hearing .. May. .13.,.. 19.8 5.
Petition of ......... JAMES. AND..KAREN. HETHERINGTON .............................. .
Premises affected ... 2. 2, Annis. Street ........ ............... .........................
Referring to the above petition for a variation from the requiremep cs of the .. Z on i ng . Py.. Law
..... Se.cti.on..7, . Par.agr.aph..7. 3 . and. Tab.le..2 ......... .
relief
so as to permit ..f rom . the. rear. and.. side. setb.ack..ruqui..-ements.. to. allow ...
.... .the. con s.tru.ction.of. an. addition .......................................... .
After a public hearing given on the above date, the Board of Appeals voted to ... g z an t... the
.....rear. setback .variance .... and hereby authorize the Building Inspector to issue a
and deny the side setback variance'
permit to . cons.truct the addition. -within . the . rear. • setback. -only . . . . . . . . •
for the construction of the above work, based upon the following conditions:
1. That the existing garage be razed prior to the issuance of a
building permit.
Signed
,Frank..Serio.,... r. ,..Chairman. .. . .
Alfred E. Fri, elle, . Esq.. , . Vice .Chairman
A, u,gustine .'...I i,ckerson,. ,Cle.rk. .
William. J.. S.ull- van ..............
Walter. F.... Soul.e .................. .
Board of Appeals
rD1
D�Hir"_L 14-1
.o�G f NOR7M
NUM! 1400VLtR 014
p
MAY 23 1155 AM 185 -1. ;
sAcNus��
TOWN OF NORTH ANDOVER
MASSACHUSETTS
BOARD OF APPEALS
Mr. Daniel Long, Town Clerk
Town office Building
North Andover, MA 01845
Dear Mr. Long:
Any appeal shall be filed
within (20) days after the
date of filing of this Notice
In the Office of the Town
Clerk.
May 23, 1985
Ji.mes Hetherington
2' Annis Street
Petition No. 31-'85
The Board of Appeals held a public hearing .i:•:)nday evening, May
13, 1985 upon the application of James and Ka�.r:n Hetherington.
The hearing was advertised in the North Andover Citizen on April
25 and May 2, 1985 and all abutters'were notified by regular mail.
The following members were present and voting: Frank Serio, Jr.,
Chairman; Alfred E. Frizelle, Esq., Vice Chairman; Augustine W.
Nickerson, Clerk; William J. Sullivan; and Walter F. Soule.
The petitioners seek a variance from the provisions of Section 7,
Paragraph 7.3 and Table 2 of the Zoning By Law so as to permit
relief from the rear and side setback requirements to allow the
construction of an addition on premises located at 22 Annis
Street.
Mr. and Mrs. Hetherington, testifying on their own behalf,
presented a plan showing the proposed addition They stated that
it will consist of a two -stall garage, a bathr-om, a laundry area,
and a breezeway. It is needed for a growing f. mily. T -ie existing
garage and entrance on the opposite side of the dwelling will be
removed. The existing dwelling and garage are crowded on one side
of the lot and the petitioners feel that the aclition will be more
aesthetically pleasing..
The abutter on the side of the proposed idition spoke in
opposition. Mrs. Sylvia Little requested -nat the required 12
foot side setback be maintained to avoid overcroL-dinq on her side
of the lot.
Upon a motion made by Mr. Soule and seconded by Mr. Nickerson, the
Board voted unanimously to grant the variance for the rear setback
and deny the variance for the side setback, with the condition
_ that the existing garage be razed prior to the issuance of a
building permit.
James and Karen Hetherington
22 Annis Street
Petition No. 31-'85
May 23, 1985
Page 2
In granting the variance from the rear set.b-ck requirement, the
Board finds that desirable relief may be gr attz.1 without creating
a detriment to the area and that a- hardship woL,i.d be suffered by
'the petitioners if this variance were denied by the Board.
In denying the variance from the side setback requirement, the
Board finds that there is ample land on the side of tha dwelling
so that the addition may be constructed without the encroachment
to the neighbor; and, therefore, Section 10.4 of the Zoning By Law
has not been satisfied with regard to this request.
- _..._ j w
(plan to follow)
Sincerely,
BOARD OF APPEALS
F: ank Serio, Jr.,
C} airman
,r
Is
R
Mk.7
r
13
is
• iY
r
w
0
r
h3vo.
10
s
0
V
•
Fl
Y2
N
s
f
h3�o
Received by Town Clerk:
REUMO
DANCE. LONG
NOR H A Do VER
TOWN OF NORTH ANDONW11MA � �CPub
'TS
BOARD OF pAI�i��
APPLICATION FOR RELIEF FROM THE REQUIREMENTS OF T149. ZONING ORDINANCE
Applicant James + Karen Hetherington Address 22 Annis St. N. Andover
1. Application is hereby made:
a) For a variance from the requirements of Section 7 Paragraph 7.3
and Table 2 of the Zoning By Laws.
b4 For a Special Permit under Section Paragraph of the .Zoning
By Laws.
0 As a Party Aggrieved, for review of a decision made by the
Building Inspector or other authority.
2. a) Premises affected are land and building(s) numbered
22 Annis St. Street.
b) Premises affected are property with frontage on the North ( )
South ( ) East ( A West ( ) side of Annis
Street, and known as No. 22 Annis Street.
c) Premises affected are in Zoning District R4 , and the premises
of f ected have an area of 7700 square feet and frontage of
90.2 feet.
3. Ownership
a) Name and address of owner (if Joint ownership, give all names):
James + Karen Hetherington ___
Date of Purchase October 1,_19 4 _Previous Owner Thnmac LMcNu1 t�/
b) If applicant is not owner, check his/her interest in the premises:
Prospective Purchaser
Lesee Othel -(explain)
4. Size of proposed building: 57' front; 32' -f eet deep;
Height 1 stories; _ 9 _feet.to eaves 20' to peak .
a) Approximate date of erection: October 185
b) Occupancy or use of each floor: Residential
c) Type of construction: wood
5. Size of existing building: 25.6 feet front; 36,6 feet deep;
Height 12 _stories; 2? feet.approx. to eaves -34 ft. to peak
a) Approximate date of erection: 1898
b) Occupancy or use of each floor: living space Residential
c) Type of construction: wood_
6. Has there been a previous appeal, under zoning, on these premises?
�A_ If so, when?__
4
7. Description of relief sought on this petition -Reduction of
sides and rear aptb�'from 12' to 6'+- and from 20' to 7' +-
8. Deed recorded in the Registry of Deeds in Book 1249 Pgge 666
Land Court Certificate -No." Book Page
The principal points upon which I base my application are as follows:
(must be stated in detail)
We desire mnrP garage and living space fnr our grnuing_ f amilt'
needs.We would like a first floor bath and laundry area as well
as a familvro_gm..,_We would like the convenience of entering a
�_aara_ge without going out of doors.0ur present--g-arag_e is. far too small..
I agree to pay the filing fee, advertising in newspaper, and incidental
expenses*
Sign/ture of P,etitkioner(s
Every appjication for"action by the Board shall oe i, -Ade on a form approved
by the Board. These forms shall be furnished by the Clerk upon request.
Any communication purporting to be an application sYall be,tr.eated as mere
notice of intention to seek relief until such time as it is made on the
-- - official application form. All information called for by the form shall
be furnished by the applicant in the manner therein Lbescribed.
Every application shall be submitted with a list of "Parties.In Interest"
which list shall include the petitioner, abutters, owners of land directly
opposite on any public or private street or way, and abutters to the
abutters within three hundred feet (300') of the property line of the
petitioner as they appear on the most recent applicable tax list,
notwithstanding that the land of any such owner is located in another city
or town, the Planning Board of the city or town, and the Planning Board of
every abutting city or town.
*Every application shall be submitted with an appi?cation charge cost in
the amount of $25.00. In addition, the petitioner shall be responsible
for any and all costs involved in bringing the peti-.ion before the Board.
.Such costs shall include mailing and publication, b*.t are not necessarily
limited to these.
Every application shall be submitted with a plan of land approved by the
Board. No petition will be brought before the P,ar- unless said plan has
been submitted. Copies of the Board's requirements regarding plans are
attached hereto or are available from the Board of Appeals upon request.
LIST OF PARTIES IN INTEREST
Name
Address
d__ James + Karen Hetherington...............22 Annis St. North Andover
f,- Michael + Cynth>ia Caffrey.................30 Annis St. "
Sylvia Little .............................14 Annis St. "
V Stephen + Thelma Lovejoy..................10 Annis St. "
r/ Paul, Jeanne + Joseph Gallagher ........... 26 Annis St.
✓ Antonette Finocahigro .....................17 Annis St. "
Ruth Frederickson..........................21 Annis St,. "
,i Martha McDowell ............................25 Annis St. "
fi Marilyn Torosian .........................77 Ford St. Methuen
&-- Richard + Roberta Smart..................233 Middlesex St. N. And.
r/ Jetwood Buil-ders .........................231 Middlesex St. it
L, -Phillip + JoAnne Cahill...............20 Morningside Lane "
(use additional sheets if necessary)
Joseph Call-ahan........................... 30�Union St. N. And.
NORTH ANDOVER BUILDING DEPARTME:.'T
120 MAIN STREET
NORTH ANDOVER, MA 01845
INSPECTOR OF BUILDINGS
ELECTRICAL INSPECTOR
GAS INSPECTOR
Board of Appeals
Petition ##25 = Christopher Adams:
May 13, 1985
Mr. Adams was refused permission to operate,a retail bakery
at 1591 Osgood Street. Such use, however, is allowed by a special
permit issued by your Board.
Petition ##27 = Douglas R. Moulton:
Mr. Moulton was referred to your Board for V a necessary
special permit to allow a family suite on his property located at
864. Winter Street.
Petition #28 = Joseph Giacalone:
Mr. Giacalone was referred to your Board for +he necessary
special permit to allow a family suite on his property located at
125 Sullivan Street.
Petition ##29 = James Fitzgerald:
It was discovered that the dwelling located at 4.4 Sylvan
Terrace was too close to the sideline and Mr. Fitzgerald is applying
to your Board for relief.
Petition ##30 = Jefferson Office Park:
Jefferson Office Park was refused a building permit because
the barn that they plan to convert to business use did no£„meet the
required setbacks for an industrial zone.
Petition #31 = James Hetherington:
Mr. Hetherington was refused a building permit because his
proposed addition did not meet the required setback .
Petition #32 = Andrew Varrichione:
Mr. Varrichione was refused a building permit because his
proposed addition did not meet the required setbacks.
TEL. 888-8102
131 /N�6-
od-le ��.3
MAY 13s 1985
RE: 22 ANNIS STREET
NORTH ANDOVER$ MASS.
WE, PAUL J. GALLAGHER & JEANNE M. GALLAGHER, BEING THE OWNERS OF THE
RESIDENCE OF 26 ANNIS STREET HAVE STUDIED THE PROPOSED PLANS FOR THE
CHANGE OF 22 APHIS STREET AND HAVE NO OBJECTIONS. WE ;ALSO FEEL THAT
THE ADDITION WiLENHANCE THE NEIGHBORHOOD
SINCERELY,
P UL J. G AGHER
ANNE M. GALLAGHER ,�
Date..:�? .... ? ............... I ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... ........... z ... ........... / ..... / ........... / ......... C ..........
I
has permission to perform ..........
..........................................................
wiring in the building of ...................................................................................
at .............. ....... ...... I ........... L-/ . .......... . North Andover, Mass.
Fee..�Z..? ............ Lic. No. JZ.2 ...
................................................................
E�EcTRIC�L INSPECTOR
Check # t' /
4 3 5 1
..Uspar�unE a�_fire ,,.3sroicxJ
BOARD OF FIRE PREVENTION REGULATIONS
OtTicial Use Only
Perntit i`to.
Occupancy and Fee Checked j
Rev. 111991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM. ELECTRICAL WORK
All work to be perfomied in accordance with the Massachusetts Electrical Code (MEC. 527 CMR 1200
(PL CAW PRINT LV INK ORTYPE- :I1LL/IWOI�VL•lTION)
City or Town of: iTy /T�c%/er To the lns ectoiof Wires:
By this application the undersigned gives notice of his or her intention o perform the electrical work described below.
Location (Street S Number)O�
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit?
Purliose of Building
Existing Service Amps / Potts
Neiv Service Amps / Volts
Number of Feeders and Ampacitv
Location and Nature of Proposed Electrical Work: ,
Telephone No.
Yes ❑ No a (Check Appropriate Bos)
Utility Authorisation No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters:
Camaletian o>•dM fintb►nino mitt........ L .....;.. i L -..e- _i'nr__-__
No. of 'Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
NO. Of Tota
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
gti�ti�wg pool Above ❑ In- ❑
d. end.
o. o mergence tg ting
Batt , Units
No. of Receptacle Outlets
No. of 01 Burnes
FIRE ALARMS
ho. of Zones
No. of Switches
No. of Gas Burners .
`lo. of Detection and z.
Initiating Devices
No. of Ranges
No. of Air Coud. Tunas
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totais:
I ► umber Tons I\
No. of ontatned
tection/61e Devices
I
No. of Dishwashers
Space/Area Heating KW
Local ❑ uuctpal El Other
Connection
No. of Dryers
Heating Appliances K%V
See ir No�oi stent s or Equivalent
No. of Waterh�1V
Heaters
t o. o t o. of _
512,11S Ballasts
Data Wiring:
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Tobi HP
Telecommumtcations ' (ring:
No. of Devices or E uivalent
OTHER:
Asad( additional derail if desired, or as repared byrhe Inspector of 1Yires
INSURANCE COVERAGE; Unless waived by the on mer, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such c;�70NDEI
a is in force, and has exhibited proof ofsame to the permit issuing office.
CHECK ONE: INSURANCE OTHER ❑ (Specify:)
(Eafirafi& Date)
Estimated Value of Electrical Work.* �D� 00_ (When required by municipal policy.)
Work to Start: / 2 . Inspections to be requested in accordance with.MEC Rule 10, and upon completion.
I certify, under t11'e paik and pet allies of p err, that lite information on this application is true and complete
1:I UNI NAME:
Licensee: �C11s s i v.���'Add' _ Signature.
(/f applicable�jnte 'e rempt ` in the license number fine.) Af
Address- tl /`��/!P�/Dvd �D.ir off _ ,�*� /v A/
OWNER'S INSURANCE WAIVER. I am aware that the Licensee does
required by law. By my signature below, I hereby waive this requirement.
Owner/Agent
LTC. NO.:
LIC. NO.:�07.�
�9 Bus. Tel: Co. -Z",,"
Alt. Tel. No.;ZX&7-y-48 -7D/fit
not have the liability insurance coverage normally
I am the (check one) ❑ owner ❑ owner's agent.
Pi:RilfIT FT_F.:.S