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Home My WebLink AboutMiscellaneous - 229 GRAY STREET 4/30/2018 (2) 229 GRAY STREET 210/107.D-0113-0000.0 TOWN OF NORTH ANDOVER V° PERMIT FOR PLUMBING p "tcmusE� This certifies that . . . . . . . . . . . . . . . . . . . . . . . %as permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ., �!:�Al. /.,/ . . . . . . . . . . . . . . . . . . . at. . . ,,�.�j . '<� .✓. .C--?'.. . . . . . . . . . . .. North Andover, Mass. Fee.U. . . . .Lic. No..�.?3?. . . . . . . . PLUMBING INSPECTOR Check # 7S 68x.! 6 Date....... ........................ 4, 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING WE" CHUS This certifies that ..... . ....... .. .......................... .. ..... . has permission to perform ....... ................................................................. wiring in the building of....�L22..... ............................ at.... ............,North Andover,Mass. .../ r. Fee.......� ....... Lic.No. ....................................................... ELECTRICAL INSPECTOR Check # /&/, & �Y otfiotd Use On4- I fttiAJR.Wir[�hO SUS[![ u9El�i �/� /� {e1 f111E?�U t0 /]t�� t ..C..�f/Jt�ti fNiNltt Of CIO ulv� BOARD OF FIRE PREVENTION REGULATIONS iRev. 0611 1k-3w htafef APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pnfuiv d in-c-'d=r with the Masssdttnetts Et=tticat Code thtEC) 527 CMR 12 . (pL,EASE PRINT IN INK OR TYPE All INFOI&VATION) Date: 6Q '� -ri City or Town of: F—'b[H A"cam✓2-9, To the Inspec for of Wires By this application the undersigned gives notice of his or her intention to pertatm the electrical work described below Location(Street&Numhe0__Z2-C1 GQ)T ( Ownet of Tenant _ �' �� Telephone No Owner's Address �5�.►�?�-- - �-- Is this permit in conjunction with a building petlniC.' Yes C7 No 61 (Check Appropriate Box) Augxr..te of Building -5'"GL7-- IFA✓h i �` utility Authorization No 1-11)5 23r7 `i Fxistinri Service Amps .l_2C)l�UVotts Overheads Undgrd ❑ No.of.Metets , Zt)O Amps f ZU l Z Volts Overhead l Undgrd❑ No-of Meters Number of Feeders and Atn_pacity �$ Location and Nature of Proposed Etecuical Work: lfllne-�L- S2,RV�Cz_ R PU'aC�L f3Ar-> C-w'�-'T C�zt-iZ t tJyw-'C"Zt"� $ amm Completionof the following table inky be*Wvcd by the Inspector aJ Wires. No.of Recessed 1-uminaite5 lNo of Ceil-Susp (Paddle)Fans ° of Total No.ol-Luminaire Otu.letc INo of Hot 1 ubs �Generutars KVA Al ve Ia- r No.of Emergency 1.t ting No oI Luminaires � Swimming pool � ❑ �� ttery Units No of Receptacle Outlets No.of Oil Btnners FIRE ALARMS iNo o;Zones INo.of Switches No of Gas Burrtets No of ection an t _ Inti -n Devices tNo-of Ranges No.of Air Coad No of Alerting Devices Ions __. No of Waste Disposets Heatptunpirii�ernj.s---—&W.. o.of Self-Contained a Tots Is;:I _1 1 -ting M No of Dishwashers Space/Area Heating KW Local ❑ Municip l ❑ Qther gijW& on steni No.of Dryers Heating Appliance, KW Securrty S � 'aEquivy No.of Water : o of No.of Data Wirer i�' ; -S B acts o t No Hydromassage Bathtubs No of Motors 'total HI' Tetecummttnicatron3 rung: It OTHER: - Atuuh adkUdi rat dr-tail ifdesired oras required by the Inspector of Winet t'g3 Estimated Value of Electrical Work: -- (When required by municipal policy) Work to Start: inspections to be requested iv accordance with AVEC Rule 10,and upon completion LNSURANCE COVERAGE: Unls; s waived by the owner,no permit for the perfotmanec of elec local work may issue unless the 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 promt of same to the permit issuing office CHECK ONE: INSURANCE ® BOND ❑ 07 HER ❑ (Specify:) 1 certify,ander ihr pains and penalties of perjury,that Me infor wdon circ this applicauvn is rare and complere FULMNA.ME: it -21-2-C— iQ ituC LIC No.: 1b339A Licensee: R =i„�N -,TP- Signature LIC NO: QJ applicable.rater 'exempt"m the licenic numhpr lace) Bus Tel No--?h\-`33-QS r) Address: Q k u S� SPkJ2, f> Y ZA QStCO( Alt lel No.:761-S ri-3�3`i `Per M..G L.c 147,s 47-61,security work tequires Dgmtmem of Public Safety"S"L icerse: Lic No OWNER'S INSURANCE WAIVER:I am aware that the L icensee dor,nor have the liability insurance coverage normally required by lays By my sigrtattim below,I hereby waive this requitement i am the(cheek one) ❑owner ❑owner's agent. Owmer/Agenr Signature _ - feleohone No._ . . PERA01 FEE to" 19,11 _/GG 1 s� � 5 r The Commonwealth of Massachusetts Department of Industrial Accidents Wke of Investigations 600 Washington Street ° 1iI / Boston,MA 02111 www nw gov/dia Workers' Compensation Insurance Affidavit=Builders/Contractors/Electricians/Plumbers ADDlitcant Information Please Print Legibly Name(Business/organizationMdividual): `� J /. 't \�c �1 `t1e-C:�k-`t C Address: 17 I � 1>L City/State/Zip:, -" v +J�- 0 19 0 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.911 am a employer with 7 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 7 ❑Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub-contractors have 8. ❑Demolition workers'comp.insurance. 9. Buildin addition working for me in any capacity. ❑ g [No workers'comp. insurance 5• ❑ We are a corporation and its 10.Vl Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Aapplicant that checks box#1 mast also all out the section below showing their workers'oompensation policy information ny t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractm must submit a new affidavit indicating such. %Conuactors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. or am Below is the and site I inn an er that lj4 rovidiiig workers comlpe�Fom i�rrwrce.f nej'employ PST �' � IPI%' P inforn adorn } Insurance Company Name: G-M, n, lt� Policy#or Self-ins.Lic.#: H 3i 1213 Expiration Date: ��' Q Job Site Address:�7Z"I 'rRA-� k RZX.T City/State/Zip: [\3;A NOen-v :Lr dhl'l. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cot&ander the pains and penaMes of pedsrry Mal the information provided above is tune and correct Si �--� I Date: -- Phone# 7f I -ass- 1 L 7 1 Oficial use only. Do not write in this area,to be completed by chy or town official. 1 City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ;.__ K ' e �� MApehwulrmass. tvtH55ACH,USETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING Dated 20V& Q ___r_ Permit # Building Logation Owner' me Ale Type of Occupancy ` x., New 0 Renovation ❑ Replacements �nsb t 1_Oy5Fan Submitted: Yes❑ No 0 i FIXTURES �� B.P. # SEWER # SEPTIC # . to Z z .7 Ln Z LO ¢ w } VO ~ Z O toLU Lj w N w to r�i 2 U tQ z Z U w p m w ¢ Z a C7 a LU f ¢ .., a w = I-- ' p D to. � 1 Z a •z O Ci 0 _CL z ¢ ¢ > O to v) H z z Z u_ 4 w O u� m c=n _ ¢ tJn O C¢7 m O SUB-BSMT BASEMENT 1ST.FLOOR 2ND FLOOR r 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOO .stalling Company Name Check one:' Certificate idress ❑ Corporation a 07 isiness Telephone O Partnership -------------- Ime of Licensed Plumber or Gas Fitter1 4 1 'fT Firm/Co. NSURANCE COVERAGE: have a current II bllity insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142. Yes No , 0 f you have checked Yes, plea/se Indicate the type of coverage by checking the appropriate box. liability Insurance policy•ff Other type of Indemnity ❑ Bond O iWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass.General Laws, and that my signature on this permit application waives this requirement. ignature of Owner or Owner's Agent Check one: Owner 0 Agent 0 reby certify that all of the details and informatlon I have submitted (or entered)In above applicatlon are true and accurate to the best of cnowledge and that all plumbing work and Installations performed u r the permit Issued for thi a lication will be In compliance with ertinant provisions of the Massachusetts State Plumbing Code and h to 42 of e G eraI Law , By , Title Signa re of Licensed Plum or eA 0120 r nwn DD lrrn inn..........•�___.__ - Tvna ` iELOW 4OII OFFICE USE ONLY FINAL INSPECTIOI/S BlctTemas PROONESS INSPECTIONS FE>: • N0. APPLICATION FOR PERMIT TO 00 PLUMBING NATE A TYPE OP"Ki"NO LOCATION OF/ UNRO PtrwE11 FWRwT GRANTED DATE -19 ..._�, PLUMBING INSPECTOR � Location ,;? 4 r7 &S- No. l Date 81 NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ / y �.�Ss••° E��' Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ --- -o �L Check # C;2 a 000 18491 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING fbr 7- BUILDING PERMIT NUMBER. ly DATE ISSUED: &V/ Arn AW ic SIGNATURE: -'I Building Commissioner/In for of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 113 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard -Reqfired Provide Required Provided Required Provided 1.7 Water SupplyM.G.L.d.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 10 i Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ' �' ' `'+i 2.1 Owner of Record Name(Print) Address for.Service: fes/ p Si nature Telephone g 2.2 Owner of Record: A Na Print Address for Service: z ax Y M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number ✓17 �(•c� 12 Gr/ AddreC . C _ � 6 "7Z 5 Expiration Date C re Telephone 3.2 rgistered Home Improvement Contractor Not Applicable ❑ Co pang Name l M Registration Number r Address L 55- z Expiration Date re Tele hone t � SECTION 4-WORKERS COMPENSATION(M.G.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 building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Desch tion of Proposed Work check all a Hcable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ .a t , > Accessory Bldg. ] Demolition 0 Other k0 Specify Brief Description of Proposed Work: l SECTION 6-ESTIMATED CONSTRUCTION COSTS `g, Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 2v 5 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x tb> O '� 4 Mechanical(HVAC) 7 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN 14 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize_ to act on r My behalf,in all matters relative to work authorized by this building permit application. ' Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ~ 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 ue er/Agent Date NO. OF STORIES SIZE BASEMENT OR SLATS SIZE OF FLOOR TEIABERS 1' 2' 3 SPAN �# DIMENSIONS OF SILLS DIMENSIONS OF POSTS Iwo DIMENSIONS OF GHtDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUII.DTNG CONNECTED TO NATURAL GAS LINE � -7 HIC Registration#129774 Federal ID#04-3277886 Pella Windows & Doc Pella Windows & Doors of Boston 45 Fondi Road "Viewed to be the Best" Haverhill, 866-9886' 6 - 8 ' � PH: (800) 866 998866 Service: Ext. 124 Fax: (978) 556-0394 (� ENTRY SYSTEM CONTRACT Sales: (866) Pella06 Sold To: Ay + VERP�i.l71NE t'`y2 u Date: � 1 o� P 1i1 Address: 1Z.CA 0,zb 1 �"�'' . Phone (Home) 77- City: ZelCity: y�0qz,:_N,\A State: .,& Zip: 0IMS5 Phone (Work) ) Job site Address (If different): Phone (Cell) ) E-mail: 10. 121 ❑ All workman's compensation and liability insurance maintained 11 H ❑ Warranty mailed to customer upon completion when full payment is received. 12. .0 ❑ Total Project Amount$ 7'L0 13. )a 13 Financed If Yes:Amount Financed$ �ZO (Reference# ) 14. ❑ 0 Deposit Received$_ 15. 0 ❑ Balance on Substantial Completion$ (Payment is payable to installer at completion of job) 16. ❑ J" Additional Comments: �o�'�i tac.rc F ti:.�.uG4�Cl• C��A�c N PELLA IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE PLEASE REMOVE ALL SHADES,VERTICALS,BLINDS,CURTAINS,DRAPES ANY REPRESENTATIONS OTHER THAN CONTAINED INTHIS AGREEMENT ORWINDOW MOUNTED AIR CONDITIONERS,PRIORTOTHE INSTALLATION AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OR OF YOUR NEW ENTRY SYSTEM. INSTALLERS ARE NOT RESPONSIBLE RELIED UPON BY "OWNER".YOU ARE ENTITLED TO A COMPLETELY FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. FILLED IN DUPLICATE OFTHIS AGREEMENT. CONDENSATION INSIDETHE HOUSE DOES NOT INDICATE A WARRANTY DCONTRACT EPARTMENT.BJECTTO FINAL INSPECTION BY PELLA CONSTRUCTION PROBLEM. This contract Is a legal document.Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OF D H TH D INE DAY AFTER HECONTRACT B I T P B I GNI BELOW.YOU A L T T EAB V S E IF1C TI S FOR THE PELLA PRODUCTS YOU ARE ORDERING ARE ORRECT. Date: Pella Rep.Signature: -7— Custom7 .7 er Signature: Date: s White-Original Yellow-Customer Pink-Store 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: -5 t (20 . Cly-'�,'�� , 1/ tX� (Location of Facility) (---'-'----!fig-nature 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 I i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 ',M �•�� www massgov/dia Workers' Compensation Insurance Affidavit: Bul'lders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organizatiowlndividuai): pe lk W J VJ�S AA61 Address: City/State/Zip: /74av& 2 Phone#: 74?-726S-72 SS Are you an employer? Check the appropriate box: Type of project(required): I.X I am a employer with 4. ❑ I am a general contractor and I 6. El New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or,additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other i comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their wogs'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. --11 ��-A Insurance Company Name: ffetr4 Afro �►1S urgrlCe �vrlQCgr►� Policy#or Self-ins. Lic. #: OR SAIL.5 7g I 44Expiration Date: -7/01/o Job Site Address: Z t'� �/� City/State/Zip � . Attach a copy of the workers' compen ation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under pabys and penalties of perjury that the information provided above is rue and correct Signature: Date: Phone#:- 9 '- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ' NORTH Town of Andover T No. �a = x _ C% dover, Mass., Lf 0 C CHICHEWICK A'rE D P' CO BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 4 # BUILDING INSPECTOR ...........A0 THIS CERTIFIES THAT..... . ....f........................................................................ .... Foundation Ghas permission to erect..... buildings on ..... zo..T.. Y.........�..#................ Rough V-4-0�4- boo R Chimney tobe occupied as............... .. . ... ......*.................. .................................................................................. provided t 1 accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to Pe Inspection, Alteration and Construction of Buildings in the Town of North Andover. /07V/1/3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST-RUCTION ST TS Rough ............................................ Service 00" BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous "Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SlDt_j Smoke Det. .. .......___------ Office Use Only r Permit No. 04e �III11riT nW&dt4 III ,. .5*1Wttts Occupancy s Fee Checked Srtmr-rit of ubliC 3190 (leave blank) l �rlr � �afctg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12.00 Ward Area 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 9l/''l9. City or Town of ,/1&a72V 4AIDn0,5�2 To the inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) .2 2 q G.eA y .S'�i2EE T Owner or Tenant DAVID T. GEtZALDI NE MU2214Y Owners Address __ S A N%E SOF ) 9 7,S- 721-j is this permit in conjunction vvlth a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps—J Volts Overhead ❑ Undgmd ❑ No. of Meters e Am —J Volts Overhead IJUndgmd ❑ No. of Meters New service s P Number of Feeders and Ampaciry Location and Nature of Proposed Electrical Work Installation o f alarm system No.of Transformers Total No.of Ughdng Outlets No.of Hot Tubs KVA No.of lightln9 Fixtures Swimtrtirug Pool Abog �o tg,.L ❑ Ger+er-ators KVA No.of Emergency Lighting No_of Receptacle Outlets No_of Oil Burners Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones Total No.of Detection and No. of Ranges No.of Air Gond' tons Initiating Devices 1 Heat Total Total No.of Disposals No. ofpumps Tons KW No.of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW DeteaiocdSounding Devices Municipal No_ of Dryers Heating Devices KW Local ❑ Connection ❑Other No. of No. of Low Voltage No.of Water Heaters KW Signs Ballasts Wumg t) ALAEM No. Hydro Massage Tubs No.of Motors Total HP x ^ OTHER: kiy 4s n INSURANCE COVERAGe Pumtsam to tf+e requkernents of Massachusetts General Laws 1 have a axrent Liability Insurance Policy incSud- ing Completed Operadons Coverage or Its substantial equivakmL YES O NO O 1 have submitted valid proof of same to rhe Office_ YES ❑ NO O M you have checked YES.please indicate the type of coverage try checking the appropriate box. INSURANCE XJX BOND O OTHER O (Please Specity) A4 aG (Expiration Date) Estimated Value of Electrical Work S (OO 4 Work to Start 9/.20196 Inspection Date Requested: Rough Final Signed under the Penalties of Perjury: FIRM NAME ADT Sec:11 r1 h Syst-Pmg Toc, �1 /� LIC. NO. 12 Licensee Signature SIL/.��/�7/ 7Y1.�� UC. NO. Bus Tel-No.617-431-5800 Address 60 William $f; /Wel ieG1 ey. MA 021 R1 Aft.Tel.NO. L OwNews f11mRAmm vAuvot!atn-woo that the uosnsee does not have fIM kmwwwe oavaage or its substa"equivalent as fr a by Me"adweeM Gen@ d Sawa.and that ny si9rllaaws oto this Pte! aPf ;wanes aria arquinri+eet..Owner...;y.: AQUA, =, f r��chectcone)-•`-t...T,�:%' --t:._ aG ��tf!J, i��YMX'a�� *+�.X'1�irl`T.VIJW. hYtlsi!a. i011f►He. .4 24a rC ,Ti �, ;.� Date.....71. 2..,112� T.3 463 Ot NO°TM TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACNUS� This certifies that , Q. �. S.Q.c.K�2�..�. S.�! f('C!�has permission to perform .... .��{./.1. Y1........... y. ./�P!�i.................. wiring in the building of......1!Y1. ................................................. at...... ..fig...... .f ��.?4. .. ..1:..........................North Andover,Mass. Fee a..J....C1 t).. Lic.No...... 3.. ELECTRICAL INSPECTOR 09/25/96 16:19 ` PAI WHITE:Applicant CANARY:Building Dept. PINK:Treasurer �. _ .Y-a---�- -,. r . ,. k/1-1N°- Date..... ..... ....... . ........... ti �aORTM TOWN OF NORTH ANDOVER 04.k >0 PERMIT FOR WIRING s i • SAC US ..... This certifies that .... .... ....r DAT.......��°°..�?.r c...........�.Mzes e C `� has permission to perform .: F �f wiring in the building of.....,, ..)�� ..... ` �l.S . v.......................... / /'`� ..... ,North Andover;eMass:- Fee� C..r. J Lic.No. . � � :.r........1. ELECTRICAL INSPECTOR Check # ?� - WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Otlicial Use Only Department of Fire Services Pen-nit No. 7 r BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �� :7 4J City or Town of: M d - Y\(ULVe11 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street umber) '"t- owner or Tenan r Telephone NoIt . _ Owner's Address Q Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose 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 1 Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Inspector of Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Bove o❑ In- . o Emergency Lighting rnd. rnd. ❑ 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 [t Initiating Devices No. of Ranges No.of Air Cond. Total No. of Alerting Devices Tons g � Heat Pump Number Tons KW No. of Self-Contained No.of Waste Disposers ............................................................ Totals: ��'� Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW ecuritySystems: No.of Devices or Equivalent No.o Water o.o o. of—Data Wiring: KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Ifires. INSURANCE COVERAGE: Unless waived by the owner, no pen-nit 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: 46 (Expiration Date) (When required by municipal policy.) Work to Start: — Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify, under the pains and penalties of perjury,that the information on this application is true and completes FIRM NAME: ADT Security Senices 111 Morse Street,No voo ,MA 02062 LIC. NO.: 1533C Licensee: John S.Bassett Signature LIC. NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus. Tel. No.: 781-278-1169 Address: Alt. Tel. No.: _781-278-1131 OWNER'S INSURANCE WAIVER: I am aware that the Li nsee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent FPERMIT FEE. $35• Signature Telephone No. oll