HomeMy WebLinkAboutMiscellaneous - 25 SURREY DRIVE 4/30/2018N
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�—\ O:iicc Use Only
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"�' P2 writ �o: [ �✓ r��
Department of Public Safety
_ Occupancy S Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank)
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 J / `.J;Cj "Gl
City or Town of Na, / t)&) E/c f' To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
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Location (Street & IiRber)
Owner or -Se mt
Owner's Address (9 S opty OD /) ::
Is this permit in conjunction with a building permit: Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building s " ` ' �e " ` !jWd 'fin e, Utility Authorization NO. % G � l 74 0 _
Existing Service % do ps �J J J 3� Volts Overhead Q Undgrd ❑ No. of Meters %
New Service J O O Amps J/5- /03 0 Volts Overhead M Undgrd ❑ No. of Meters /
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical WoJjrk)) -,G Jig
i9i'f _f 1?,en _ r/r.7:n� rJ /i' -,j--i 4 `ms's � L -
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
of Lighting Fixtures
Above ❑ In -No.
Swimming Pool grnd. ❑
grnd.
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
Batter Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
g
No. of Self Contained
Detection/Sounding Devices
Local ❑ Municipal[]
Other
Connection
No, of Ranges
No. of Air Cond.Total
� tons
No. of Disposals 44 -No.
of pumps Total Total
Tons KW
No. of Dishwashers d-
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters 6t
Signs Ballasts
Voltage
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
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 p NO W I have submitted valid proof of same to this office. YES ❑ NO 14
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND ❑ OTHER J (Please Specify)
Expiration Date
Estimated Value of Electrical Work $ / 0 (1
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM PlXlE
Licensee�7-Ao s5
Address %.,/
sta it eggiva
a ication/wai
Signature /
LIC. NO.
LIC. NO. /92-' ) L%
fJ & 'Bus. Tel. No.
Alt. Tel. No.
.,t r •a . _ /a
R: I am aware that the Licensee does not have the insurance coverage or its sub-
requi ed by Maetts General Laws, and that my signature on this perm
req 'irement. Own Agent (Please check one)
F Telephone No r i z � S6y PERMIT FEE S
ier or Agent
REMARKS BY ELECTRICIAN:
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REMARKS BY ELECTRICIAN:
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Datel.--....'.?*1�........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....................................................
has permission to perform ...1 iL W r -L C & .� �..._ a ✓ f'""
.................. .....................
wiring in the building of2'. '. ......(T .......r....................................................
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at ..... ..........:::�r.,..`.`..`1........................................... , North Andover, Mass.
Fee ,�? ..`'�
ELECTRICAL INSPECMR
Check # �0 /
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Lngcation
No. 4� Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
12229124/98 14:01 25.00 PAIR ilding Inspector
My Pnhlir Works
Location `�' o
No. Date
MORTM
TOWN OF NORTH ANDOVER
3�C•i.ae '•��OL
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Certificate of Occupancy $ _
Building/Frame Permit Fee $� '
,SSACNUSEt�
Foundation Permit Fee $
Other Permit Fee $
..
Sewer Connection Fee $
'
Water Connection Fee $
TOTAL" ,
Building Inspector
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from,compliance with any applicable or requirements.
APPLICANT FILLS OUT THIS SECTION r
APPLICAAA&R-11L-I.W IAw11) PHONJs '
LOCATION: Assessors Map Number 0 D
SUBDIVISION
PARCEL
LOT (S)
STREET aS zu gJ UCS `' ST. NUMBER
OFFICIAL USE ONLY
NDATIONS OF TOWN AGENTS:
A IT I
CONSERVATION ADMINISTRATOR
COMMENTS ,/►/�0 �,I } Q
DATE APPROVED
DATE REJECTED,
TOWN PLANNER DATE APPROVED
rJ� DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
1-2 1-
RECEIVED BY BUILDING INSPECTOR DATE
TOWN OF NORTH ANDOVER
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units ... or to
structures which are adjacent to such residence or building" be done by registered contractors,
with certain exception, along with other requirements.
Type of Work: Est. C — _� Est. Cost c�a6-6
Address of Work
Owner Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s): For office Use Only
Work excluded by law
Job under $1,000
Building not owner -occupied
_Owner pulling own permit
Other (specify)
Notice is hereby -given that:
Pemit No.
Date
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FIND UNER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner.
Date
OR:
Notwithstanding the above notice, I he
property. /
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ate
Contractor Name
Registration No.
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