HomeMy WebLinkAboutMiscellaneous - 24 MARENGO STREET 4/30/2018 (2)Date.
This certifies that ... AO!r T � r !� '.' �? ....... /`.`.
has permission to perform .. .......... wiring in in the building of ..... 4.r .......................
at ......... ........... ,North Andover Mass./
Fee. ).5 Lie. No./) :......% ... ....... .,;Y _ ..
Check #_��_
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�P ECTRICAL INSPECTOR
14
mmonw.eatliz o� 1//a ac�uaeit� Official Use Only
ccam�
Permit No. %%��
2epariined ol3ire Servicaa
9
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BOARD OF FIRE PREVENTION REGULATIONS [Rev. Occupancy and Fee Checked 1/071 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK r
All work to be performed in accordance with the Massachusetts Electrical Code (MW, 527 . 12.00 F
(PLEASE PRINT IN INK OR TYPE ALL )NFO TIqA9 Date: r
City or Town of: Aja ✓` �dwelC To the Insp ator o Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. I
Location (Street & Number) /7 T -
Owner or Tenant G� T— (�' Telephone No.
Owner's Address,
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
Now Service __r.._._. Amps J Volts Overhead Undgrd ® No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical W r
l� CG?� rr o�
rt)mnletinn nflhp fnllnwino tnhie may ho wnivod by the Incnortnr of WirPc
I
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
f o. of Luminaires .
Aboven-
Swimming Pool, rnd. � rnd. �
o. o mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No, of Switches
No. of Gas Burners
o. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pu
Totals:
Number
ons ...........,
o. o f- ontam ed
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 0 Municipal
Connection [I Other
No. of Dryers
Heating Appliances KW
�N of �vices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No, of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring•
No. of Devices or E uivalent
OTHER:
All= auarttanat aeuut r� aestrea, or a$ regWrea Oy We tnspecror OJ wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MLC Rule 10, and upon completion.
INSURANCE)<BOND ❑ oT1-wiz 01 HARTFORD INS. CO.
NORTHERN LIGHTS ELE0TF=1IC,IN(—,_ A-20059
E-51095
50 FISHER . AT EBORO MA 02760 B 5d8) 699-9251
C 508
962-19251
H L S MCC URT Pirxllr FEES 3S
Y- 2/ -/Z`
I
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.t ,i[. 4 :1` 3:. 3. <+. �. .7 `^iire i'v^ .[ T i I'r'i 9.( Vii' .y. t..415 5,M7, Y .t'I'ti. IW:
:Lt •f; -" ,-
?-;- M-?o
Are you= l of project (req*red);
employees (fan =&Orp=t-tme).* bmbired Arte sub +zs ? 132. Q I am a solepsogaiewr orpa um- la'std on ftatia< does x
slip and bane w employ= 7besc mb-contracozs la S. 0 D=oWon
&r= is =Y may: Cry' G4,i 1. w.mawo. .9. i!Daft
[No workers' camp- ice 5. 0 We arc a � and its - mmdsed S& IQ.L0..9 � � or addidm
�,] ods lwe e
3. Q 1 am a bomeawm doing aU woad rigb; ofaeqM-m Pec MGL 11.OPkwbbgrepoftoraddffi=
mywz [No wv&M, Comp. G i52, �1t aatd webav+e axo 12•.o ltoofigxdas
iusrce z+agaacd. 4 o woe=° 13. �Euer
comFmsurdm
*Aaygplie=tWc bD%#1mwtalso0*—im1ca: be--- --gig c r s�s'a o��po Cy t e
t}wstcrs w$o sa�t46,os avii '&eyate aii �tsud� brxc a ss�esubax�it aiocwa� taiu2t,
��ate�ec�C�sb�;�sta3aestttrtffieaameaf'�e -, -- tr�d'daszcwaa�s'eamg.po�►ia,
Ian an =pPWAd ispropfircg work=' compensa6ox bar nce farmy Mpfte�
e
Inf/eiPJna it 9
Ir _ , E A i'[ ! 1^
Poiicy # or Self -b& Lie. TL -411-7
t -1
0
j-
AtlkclA a copy ofthe workers' satxon Vie• dedwatim page (-*owiag0e pormy ®=Mb= - „. �-,�,n-„-- ).
P to seaac coverage as rcr Sccoa 25A of MGL 152 r iead to afc�irtat per ca�Fa
fens up t6 S1,500.00 =&or orae-ymimpair as well as civil pies &The Of SMP WC OMER gad. a fixof up to $250.00 a ray agayimt die vioL�a: Be advises€ first a cWy offt ====ybe f w=W to &e 4fets of
i"vesta� of !&e DtAi.—xc covaoge ved&zdm
rdo it a ►cmv�,
Pmafifiwafdw.&eWOrm9giOn Pn wi&dismw=d wrrect.
C' by or Town: Peuzr C.€ce s: #
L%*g AuharW &&do om):
1. Sward of Re*h 7. Bvaftg Departmmt 3. city/'ovm Cjag a. EkCwC2d TAqnCWr 5. Pius mor
C. Omer
�s
toDepw*wxf lif IndUSbfd Addde? S
Offl4ce Of J'nVeWg4d0 IS
600 VY' SireW
Briton, X4 02111
wry nu gov/iliac,
Workers' Cojupertfoo zmwt ce .c c4►Wf: B ders/ContractolVElt idaus/]Mumbers
.1// � :+I }�fi4.`V � �I, tl �;1M f 1 ! t 111✓.
Address:
city/StawzP:
c
Phone:
Are you an employer? Ch the"appropride �
1. W I = a emp with (a 4. Q 1 am a gencW connac�r and k
eZZ,
as and/or part tim). * havc hied te sub-miu d ors
2. [.� pmprietff or pafter listed on the attached sheet =
ship have no =Vloyces These sHbWUtracoors have
G
fir= ha any c4za*: oar.. =Sumo.
[N war7tars' comp. cx 5. 0 We ac a coiporadion and its
offi=s have erex" m d their
3.[] 1 a howammer doing all work right ofexemption per MGL
workers' comp. c. 15% X1(4), and we have no
iasmra icx employees. [lila wofi=1
'Any appliamt ibatd=bbox#17 Malabo 59 oaffbe Zlx*w * Mak murba' eo
7 bIomrawraxs wha wbn fiis affdwA =Scmg fbny arc do g un wmk ad tbca bite
$Ccututm fbdctw*fbisbox =w atm as adft=d *wtsbowin t&e ((arae off6e ab•c
TYPe Of Project (required):
. u Now coffin
7. B Reawdeft
S. 0 Demolition
9. 0 Wig;; dm
10.1Z Electrical repairs or additions
11.0 Pkmtigg repairs or additim
12.0 Roofrepaus
13.[] Oilier
aneav�g such,
X am an mw oye 4w is previding workers' con:pensation insuranceforMY mPloYem Bdow
Infer lam
bsmamce Company
9
Pdlicy # or Self-fw- Lia #: d &" S164
Job Site
Misch a copy Of the workers' eompeusation policy dedWratfou
Pa&= to secure eovemv as zegmkcd wader Secdon 25A o
fine upto $1,5oo oo and/or owe -year imprisO MU% as well
of up to $250.00 a day agah= the violabar, Be advzsod ffial
bv+esri z -s Of to DIA fir a ge
X do hereby cerafy wzffer tlupitins,aad
;oolicg.audpQb ,fie
the + peg nu=NM saw date).
vtci 152 can lead m theme OfajWjUg ofa
il PeoWdes in the form of a STOP WORK ORDER and a fine
COPY of this statement may be foxwardcd to the Office; of , '
that'OW in. farmatiQn provided abM is true dnd conte
by ctty,ortown
My or 'own: P� #
bsuiug Authority {circle one):
L Board of $eaith ZY BaUding D Vartazent 3- Cfty/Pown Clerk. 4. kcal fox S. MwiUag Impec for
Other
Coubwa Person:
Pie #:
•
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 396-1112812005L Date: Jily 2S. 2006
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 4- nizo St ,(53 Wa ly 9
MAY BE OCCUPIED AS One U of .ate? hm&. IN ACCORDANCE
WrM THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY ABLY.
Certificate Issued to: Highview LLC
46 Forest St
Haverhill Ma 01930
—iwdligbnpww
oMoo, ,4
'" � .. _,...'. •, Qct
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER '
66 r
Building Permit Number �FDate: ��P%1.
THIS CERTIFIES THAT
THE BUILDING LOCATED ON IM 14*0
939 Wq,er �
MAY BE OCCUPIED AS * tN ACCORDANCE WITH
THE PROVISIONS OF THE MASSACHUSETTJSTAA BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
Certificate Issued