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Home My WebLink AboutMiscellaneous - 261 BRIDGES LANE 4/30/2018 (2)I co 00 0 C) CO M cn z m July 25, 2015 THEMGR1F0LK(g5�01E0HAiWGR0UP@ FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1598095 Insured: MATTHEW WOELFEL VARESCHI, COURTNEY Address: 261 BRIDGES LANE, NORTH ANDOVER, MA Policy No.: D0677670 Loss Date: 07/24/2015 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Marie J. Landers Property Claim Examiner 1-800-688-1825 x1 136 NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street, P.O. Box 9109, Dedham, MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone: (800) 688-1825 FITCHBURG MUTUAL INSURANCE CO. Fax: (781) 329-1818 Location No. Z-0 5�- L7 Date 6119 1� -7 TOWN OF NORTH ANDOVEP* Certificate of Occupancy $ l�-� �i Buildina/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee i Sewer Connection Fee Water Connection Fee TOTAL 10 "Ar 9 IL —OBuilding —Inspector 1 0/ Div. Public Works Location b;jc, ?-4 A No. Date �j TOWN OF NORTH ANDOVEJ Certificate of Occupancy $ -7 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee ;f� -Z 1 -(Z7 $ TOTAL $ ___,uild*ng In ct "a "9 9229 Div-04ric works Location No. Date (10 1/'A9 ,40RTsj "'a. 1, + TOWN OF NORTH ANDOVER 0 0 Certificate of Occupancy $ 9 Building/Frame Permit Fee $ P4 3 CHUS Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ cc TOTAL $ G� Y Building Inspector 10878 Div. Public Works PERXITT No._"s APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. MAP q-49. A) LOT NO. !2 / ZONE SUB DIV. LOT NO. LOCATION '? OWNER'S NAME &Z4 OWNER'S ADDRESS zls� ARCHITECT'S NAME BUILDER'S NAME DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET 2 RECORD OF OJW-NERSHIp .111/ PAGE I IDATE BOOK ;PAGE PURPOSE OF BUILDING NO. 0 * STORIES 2- SIZE �5—z- (z -ROD) BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST �2y/6 2ND 3RD SPAN /1/141 �X) (D DIMENSIONS OF SILLS ' POSTS DISTANCE FROM LOT LINES - SIDES L bre'JOREAR GIRDERS ?- AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW y SIZE OF FOOTING x IS BUILDING ADDITION MATER:AL OF CHIMNEY - C IS BUILDING ALTERATION Is BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE VA"4. IS BUILDING CONNE�CTrn T TOWN WATER e' ,7-- - BOARD OF APPEALS ACTION. IF ANY liowe IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS INSTRUCTIONS 3 PROPERTYINFO k�TION SEE BOTH SIDES L -AND COST EST. BLDG. COST -3 EST. BLDG. COST PER SQ. FT. Z PAGE I FILL OUT SECTIONS I PAGV 2 FILL OUT SECTION S 1- 12 EST. BLDG. COST PER ROOM cq ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED i OF OWNER OR AUTHORIZED AGENT F E E PERMIT 'GRANTED F.E-E 19 1 LESS FDk -DUE- FRNE PERMIT $ BE PER T No. A PRO :D BY OWNERTEL# CONTR.TEL# CONTRAIC4 H.I.C. # 114 (U 0 "o "WIN 6 z W W i 0; C Ilk. CD CJ CJ E cr. CD C* 0 C� C/) cm Cm -0 CD E s z cn LA cc m CD 0 0 t; cm ai we" di K.s E 42 0 cm 0 q CN) LNN CL .0 "go (a t 44 F- cm< 0 CD ca cc u CLL� c" cf) cc co c CL 0 CD CMO 0 :5 z CD CD.00 r- P-4 CL C.3 CO) CM3 Z 0 cm 0 CLO M C CD 4� 4D co) *� �H LL. P AA =L u 0.0 CM >q CN3 0 0% CL 0 CD CL 0 u 0 0 i 0; C Ilk. CD CJ CJ E cr. CD C* 0 C� C/) cm Cm -0 CD E s z cn LA cc m CD 0 0 t; cm ai we" di K.s E 42 0 cm 0 q CN) LNN CL .0 "go (a t 44 F- cm< 0 CD ca cc u CLL� c" cf) cc co c CL 0 CD CMO 0 :5 z CD CD.00 r- P-4 CL C.3 CO) CM3 Z 0 cm 0 CLO M C CD 4� 4D co) *� �H LL. P AA =L u 0.0 CM >q CN3 0 0% CL 0 CD CL BUILDING RECORD OCCUPANCY 12 SINGLE FAMILY I �Lo L, Ls MUL71. FAMILY APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 3 PINE :ONCRETE :ONCRETE BL'K. 3RICK OR STONE -i�ARDW D PIERS PLASTER DRY WALL UNFIN 3 BASEMENT AREA FULL FIN. M'T' AREA 1/1 % 3/4 FIN. ATTIC AREA NO 8 M*T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOOR$ CLAPBOARDS B 1 2 3 DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING CONEPETE EARTH HARD%V'D COMIACN ASPH iitli STUCCO ON MASO�RY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR CONC. OR CINDER ELK. STONE ON MASONRY 71 WIRING STONE ON FRAME SUPERIOR [Ain POOR E ADEQUATE r —1 -�Cl"N 5 ROOF 10 PLUMBING GABLE BATH (3 FIX.) GAMBREL -t—lp MANSARD 701LET RM. (2 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN. FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST Zoo PIPELESS FURNACE r4,' FORCED HOT AIR FURN. TIMBER EMS. & COLS. STEAM STEEL EMS. & COLS. HOT W T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H*T'G UNIT HEATERS GAS 7 NO. OF looms OIL B -M -T 2� 1.1 il I 3rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 11 FORM U - VERIFICATIOR 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 local or state law,, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: V09961Z 6 Phone LOCATION: Assessor's map Number 1,0-,11b Parcel Subdivis i o n Z -CL .1 z1,4W_P__ Lot(s) Street Gri&e__5 St. Number Z(�> ( /*6,fficial Use only************************ OF,/TQWN/AGENTS: Conservation Administrator M\bn Comments vy tow,n Planner Comments Food Inspector -Health Septi8 Inspector -Health Comments Date Approved �12 07 Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections (-� 7 - driveway permit F ire Department "Rovpej klVO' 3/7X7 Rdc'eived by Building Inspe2cr Date 6 11000 F- CL u -1- 0 Qw z < rn 00 Jz - i Was z 0 z 0 Q-, 0 F- CL u -1- 0 Qw z < rn 00 Jz - H ru LO < cl� LLJ 0 < �— < < U Of 0 0 -i LL U') LL >0 Lij C4 n < F- rn 0 -71 ry o . I LL C) P� 0) co < Cff m r -n L i ::D 0 < �- < u) < u cll-�. 0 0 0 u P --m . < cif rlr r > 0 LLJ (-)C'4 < < u D 00. n -)_j z ry (D CL u H M < Q. -I, ry) rn < 0 C),-- < u C) r) � Lo Crl cr) :j rd W ry F- < ry-) 0 -1< �lu 1) 60 ------------ z 0 Lli -i LLJ LLJ 0� Lij �LLj 0 U< 00 U-) - iz c) rL . H Of rn cD m ::D < Q._- < C) I lw I Li (n LL LLJ -i m -INK CD ,t 00 I lw I Li (n LL LLJ -i CD ,t 00 NZ moo _iz. CL u LL m 1-1 ru r'n m U LU -J I. 0 < F-- < (f) Q:� < C) 0 C) U) I dt W 'o o r) n- < CO 0� LLJ o 0 Z rn 00 CL 0 u H LC) < cf:� rn rn z LL, :D 0 < < (f) ct� 1� < U C) C-) (f 4 4 . . — 9 . #r LO F- F - r < u z .ww 0 > (D In 0 M F- ILI w 0 F- W < — F- — LL Z a in 0 CO z —1 F- 0 z U cn LL 0 x zo w 0 u Z P 0 w -i W X -1 0 b o z U - LL M W a: 0 LL Li - 0 0 0 w LLJ cn cn u co x co w to < z 0 0 F- < co w x 0 N w m m F- < U- w In _j D 0 0 F- a_ F F- (n -i 0 z x < co FD ED ID < ir a P < N X 2 9 . #r LO k .... ............. OCCOPP, n -ANE Of 13SE 8h'lndovet ot Sor-Itil /) H Y osteals----�� J?efff�lt %umb9t st�lldlnlg Ifils IOCXIV ON OCCOIEID A'S X Ns oys'O ,,Vto�vslq Zrf�ONS Ass . -111,,vin rfo cv ,VrviylcAIL q ) Ar�� c k OCE CO')V' XND 0 0 ui CL CO CO w P-4 -zl 1W CCO C2 cr. z C* CD V) Cc 0 U b;l Ca. Cc CL 0 CD CD CD CL cm< Ca CD 'COL ca C* 03 Z ts CD CD C.) E E m C2 CD 4-3 CO) C.) 0 CO t C" CD m CP) S ca .0 Cc U ca E CD 0 co ca. CD CC :S .00 cm CM"S q OCL cc ZIP 0 CL cm S 0 ID Is CC C, CL— Ce CO2 go CL= C2 cc LU E ..S 5= ;; , ow ca z CD C.3 Q .00 Ed cm C C COD Cm. 2 -5; 0;5 F= .0 a MOJ :w -L C2 C -S C=o 5 CO CO w P-4 -zl 1W cr. z C* b;l ca co CL 0 CD CL cm< Ca Cc ca C* 03 Z ts CD CD C.) ca m 4-3 CO) CO -zl 1W cr. z C* ca co CL 0 CD CL cm< Ca Cc ca C* 03 Z ts CD CD C.) ca m CO) R= 20.00' L:=31.42' CHRISTiAN S 870,1735" E 48.00' 17.28' 30,721 I 0.8ox W� ") , I , , m CN I 00 ri / fl� / / t TANK Q (50'WID. WAY r- �10 ,D 6,N Nr, k;-- X 4'1 'I 5.OU W, 9 OLT fe . 10,k�ov loo, f Toln exjstj�nv wetlands ly 3 ......................... .................. ................................... . .......... 7,71, 28' F-, coo m 'n .0 v N iK �34 .12 14' 32' SUIT t k)siufl c WWI) 41A WET :�?O, 0 �Ifvlz 0 00 7 F, R FENCE It A /P,66� D VVE' VA BE FILLF, 300 S -F/ .17 �\I A UZ "1 4,1 Vs - XO - X I W 28' 10, 0.8ox W� ") , I , , m CN I 00 ri / fl� / / t TANK Q (50'WID. WAY r- �10 ,D 6,N Nr, k;-- X 4'1 'I 5.OU W, 9 OLT fe . 10,k�ov loo, f Toln exjstj�nv wetlands ly 3 ......................... .................. ................................... . .......... 7,71, 28' F-, coo m 'n .0 v N iK �34 .12 14' 32' SUIT t k)siufl c WWI) 41A WET :�?O, 0 �Ifvlz 0 00 7 F, R FENCE It A /P,66� D VVE' VA BE FILLF, 300 S -F/ .17 �\I A UZ "1 4,1 Vs - XO - X 2(N. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Datel 6 Permit # 19 -3) Building Location LO -4 oil Owner's Name Ak Type of Occupancy SINGLE FAMILY PNevvLorl"" Renovation 0 Replacement 0 Plans Submitted: Yes 0 No 0 FIXTURES Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P.O.BOX 1701 HAVERHILL, MA 01831 Business Telephone 508-374-1743. Name of Licensed Plumber —STEPHEN C. GALINSKY Check one: Certificate 13 Corporation 1906 El Partnership E) INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. yellp No El If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy)"? Other type of indemnity El Bond El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the General Laws, and that my signature on this permit application waives this requirement. �igrtalure ot Owner or Owner's Agent Check one: Owner 0 Agent FJ I he,eby ce,tifv that all nf the details and information I have submitted (or entered) in the above application are tr d accurate to the best of my Itnowledge and that all plumbing v,ofl, and i-tallation, twrfo—ed under the permit issued for this application will be ue a" G"n-'11 Laws in comph, ith al rtinent provir f h h Sla lumbing Code and Chapter 14 2 of the lv� " n . . . .. ...... Signature of License Plu Title Type of License: Master journeyman 13 (-itv/7()wn License Number AWROWE) f0fircr 17q ONJ�J— BASEMENT i. 2nd FLOOR 3rd rLOOR mom Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P.O.BOX 1701 HAVERHILL, MA 01831 Business Telephone 508-374-1743. Name of Licensed Plumber —STEPHEN C. GALINSKY Check one: Certificate 13 Corporation 1906 El Partnership E) INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. yellp No El If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy)"? Other type of indemnity El Bond El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the General Laws, and that my signature on this permit application waives this requirement. �igrtalure ot Owner or Owner's Agent Check one: Owner 0 Agent FJ I he,eby ce,tifv that all nf the details and information I have submitted (or entered) in the above application are tr d accurate to the best of my Itnowledge and that all plumbing v,ofl, and i-tallation, twrfo—ed under the permit issued for this application will be ue a" G"n-'11 Laws in comph, ith al rtinent provir f h h Sla lumbing Code and Chapter 14 2 of the lv� " n . . . .. ...... Signature of License Plu Title Type of License: Master journeyman 13 (-itv/7()wn License Number AWROWE) f0fircr 17q ONJ�J— Date. 3335 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ................... has permission to perform e ................. plumbing in the buildings of ... F! .......... at. ... VR . 1. .............. I North Andover, Mass. Feer'9 Lic. No.. . ........ PLUM-BI-N�G T 06/26/97 11:57 M- 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 2h 5 9 3 '7- /� - �7 Date ............. 7 .... tORTm .1 TOWN OF NORTH ANDOVER 6 PERMIT FOR GAS INSTALLATION This certifies that .............. ................ . ..... has permission for gas installation ..... . ....... C" in the buildings of ..... at jr North Andover, *SS. Feeil� . 5'. . Lic. No.. .. ............ ............. GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer e I MASSACHUS ET -TS UNIFO R&I APPLICATION FOR PERMIT TO 00 GAS FITTING (Print or Type) M. ff. An d� ver Mass. Date 19 9 Permit y C�m Building Loc;itiono-(� &z� in --Owner's Name (di &rr4f Map:_ Lot: Zone:_ Type of 0=u;4nc Ne Renov;ilon :3 Replacement C3 Plans Subm itted: Yes D Installing r---In;2ny Na: -.,e' EASTERN PROPANE GAS 1NC Address 131 WATER STREET DANVERS MA 01923 Esl�rza!e Value of work: Business Telephone (508) 774-1930 Narne of Licensed Plumber or Gas Fi:,er alleck one: CeniNcal.e f Ccrperation Finm / Co. INSURANCE COVERAGS: I have a flabil;*.y jrs�;ra.-,Ce PCI. -Cy Cr i"s suts,2r,"al which r,-,ez:s ',`8 reqUirer-Unts of MC -L Ch.*1 Ye 1)0: No :3 9 you have cahecked!�es, please jr.d;ca:e ,�e type ccve.- �-e by c ecking the pprz-prf a- h a a*,e bcx. A liability insurance policy 'I 0-.1her type of indernni-If Bond -0 OWNER'S INSURANCE WAIVER: I an.1 2wae 1,.2t t�;e ji:ce.-.see dce$ r.01 �,a V,3*, -,t.8 required Chapter 1�2 of the Mass. General Laws. and lhai'm-y S' nature on parnut ` i�al� i - ' ' application iv s this require rrieent Check one: owner 0 Agent 3 Stgn'turs Of Ownst at Ownoes At; ant I hereby rmr0y that all of Lhe deta3is Lnd inforra6on I have submIred for eri:eredd) in above 2, rtca:ion are rue wid accuralm to ne bes: my kn4wledge and ftt all plumbing veork wid instafalons performed under:he ;>errut issued for Ns appricalon will be in c*mpllar=,v� 23 perInent provisSons of ne Vassachusens Stae Gas Code and Chap:er 142 of re e Laws ype cl L�ceras-e. rXA 6 Ov� Title Plumber Sj;na!L-:e of E;—cWn—sed Plumber or C4ks Ficer Gzsfiner N�7 Cily / Town License Nurnber 14PPACVED (OFFICE USE ONLY) RI E '72S Date—'. . ............. This certifies that ...... has permission for gas installation .............. .............. buildings of ... ) ....................................... ............................. North Andover, Mass. Lic. No ........... ............... ......... ,GAS INSPECTOR ,1ITE: Applicant CANARY: Building Dept. PINK: Treasurer TOWN OF NORTH ANDOVER 0 M PERMIT FOR GAS INSTALLATIO SSA ljslt� ............. This certifies that ...... has permission for gas installation .............. .............. buildings of ... ) ....................................... ............................. North Andover, Mass. Lic. No ........... ............... ......... ,GAS INSPECTOR ,1ITE: Applicant CANARY: Building Dept. PINK: Treasurer 7! 01 4t LfammumenO of llepart=nt d Publir —AnfitU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use 0 17 Permit No. Occupancy Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM hLtt; IHIUAL WUMM All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM5 12:JO (PLEASE PRINT IN INK 0 R TYPE ALL INFORMATION) Date I / 4 f Q* or Town of NORTH ANnOVER To the Inspecto r of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) e Owner or Tenant Owner's Address - this ermit in coniunction with a building p rmit: Yes No El (Check Appropriate Box) Purpose of Building R-0 S, ( 61P ti *I Utility Authorization No. Existing Service Amps —Volts Overhead Undgrnd New Service Amps ____J_V0lts Overhead Unclgrrid Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _Ae C U V k- IA-,jO' No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs Total No. of Transformers KVA Swimming Pool Above In- No. of Lightir)g Fixtures grnd. 11 grnd. Generators 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 No. of Detection and Initiating Devices No. of Sounding Devices No. of Ranges Total No. of Air Cond. tons No. of Disposals —TNo.of Heat Total Total Pumps Tons KW P, No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Local E] Connection El Other I No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: J;Y fi-1,q INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws E S Z�-<O I have a current Liability Insurance Policy including Comoleted Operations Coverage or its substantial equivalent. Y have submitted valid proof of same to the Office. YES E""'NO Z If you have checked YES, please indicate the type of coverage by checking the appropriate box. * � BONO OTHER (Please Specify) INSURANCE �2 (Expiration Date) Estimated Valij�e 4of lect cai Work S Work to Start Inspection Date Requested: Rough Final P.. Signed under the Pe aties o per r pe I . y - FIRM NAME 25 /,/—LIC. NO. Licensee —Signature -LIC ' N C.2 .2 IV -7 J-9 Bus. Tel. No. ro Y7 Y Address �i,,4 Alt. Tel. No. 0 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does ot have the insurance coverage or its substantial equivalent as re quired 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 (Signature ot Owner or Agent) X-6565 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that zle ........................................................ ...... .. .. has permission to per rm wiring in the building of ........... Z�/S ................................ Z'4 .......... KIMI�:��,'A../.��. , North Andover, Mass. at Fee...... Lic. No . .......... if—:i ............................................................. Check # ELEcTRicAL INSPECrOP. 5 3 6 41 Date ..... 1041 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING IQ This certifies that ........... .......... ... .. ..................... has permission to perform ........ ..... ........ .. ...... . . ....................... wiringin the building of .................. ........... .... . ..................................... at... ZZY ...... ..... ......................... . North Andover, Mass. Fee... Lic. No . ............. ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATI APPLICATION FOR PERMIT TO PE All work to be performed in accordance with e Massach (PLEASE PRINT IN INK OR TYPE ALL INFORMA �4 N) City or Town of. — /vq , q,1-40 V By this application the undersigned gives nodce of hTs-or hir intQhfioi Location (Street & Number) --Ip 6 / Owner or Tenant Owner's Address official Use 0nJy Perm.it No. Occupancy and Fee Checked [Rev. 11/991 (leave blank) ,�FORM ELECTRICAL WORK cas Electrical Code (NEC), 527 CMR 12.00 Date: . I— �?,� —6 1_/ — To the Inspector bf Wires: ' to perform the electrical work described below Is this permit in conjunction with a building permit? Yes 1:1 Telephone (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead [-I Undgrd 0 No. of Meters New Service Amps Yorts OverheadE] Undgrd El No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: :-_3 _36/ Completion of the followinz table inav be waived bv the Insoector of Wires - No. of Recessed Firtures No. of Ccil.-Susp. (Paddle) Fans No. of Total Transformers KV A No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Xbove Ej � In- grnd. grnd. No or Emergency Lighting Baitery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners N_o_.o_FD_ctection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I ��q in be..r] Tons I KW ...................... No. of Self -Contained Totals: I I------] Detect ion/Alerting Devices No. of Dishwashers Space/Area Heating KW LocalEl Mun'CO' El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. or— Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total FEP I Telecommunications Wiring: No. of Devices or Equivalent OTHER:. . 1_6 / la-, A, Z) /,, ) II A rtach additional detail i(desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides pro -of of liability insurance including "completed operaftn" coverage or its substantial equivalent. The undersigned certifies that such cover e is in force, and has exWbited prc.:)f ok� same to the permit issuing office. 7-9, CHECK ONE:- INSURANCE [2 BOND OTHER n (Specify:) (Expiration Date) Estimated Value of Electrical Work: --!--(When required by municipal policy.) Work to, Start:' Inspections to be requested in accordance with NEC Rule 10, and upon completion. I cert�&, under th . e pain! andpenalfies ofperJury, that the information on this application is true and complete. FfltM NAME:_,L(J;M 1,12 irlp 6 ye LIC. NO.: Licensee: Signature L I C. N 0 ; _A//,,�? (7fapplicable ;te6 "exentpi .. i . n the li��ense number line.) Bus. Tel. No. 61 �3 - 0 Address: W"h)'AX4 AM_�rh& Au"C-h4w 41q 6kk- Alt. Tel. No.:Zk-o"97 ow S SS RANCEWAIVEft: I am aware that die Licensee does not h1ave1flic It insurance cov�magelnormally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [I owner E] owner's agent. Owner/Agent Signature Telephone No. ff RMIT F EE: S MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASRTTING (Print of Type) Permit # 0 Mass. Date- ,2, -3 _2J Owner's Name M V Building Location Telephone. Type of Occupancy—gadLeCL-e-1. New. Renovation [I Replacement 0 Plans Submitted: Yeso No* (3 CC t- X 0 0 0 = I- 1_� W 0 1 - Ir 0. 0 Ci < C = 0 0 W 0 Z I- .;; r- > -K z 0 U11 W o K cc W 7 .j - a W 0 > U. i- lu ui W 2 t. 0 0 z 0 z ul 0 , , ; 4 -K < 0 0 Ui a: Ui W = — 0 0 0 U. SUB-BSMT. Nj \ BASEMENT I ST FLOOR 2ND FLOOR 1 0 .10 VA I 3RD*FLOOR �1,t I I G IN* 4TH FLOOR STH FLOOR 6TRFLOOR 7TH FLOOR OTH FLOOR Installing Company Name EnergyUSA, Inc. Check one: Certificate Address 2000 West Park . Drive, Suite 300 9 Corporation .1 15C Westborough, MA 01581 0 Partnership Business Telephone ext. 8051 0 Firm/Co. Name of Licensed Plumber or Gas Fftter —William. Kent Corson INSURANCE COVEPAr--E: EnergyUSA has )jXM0 a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V No 0 If you havfi checked yes. please Indicate the type coverage by checking the appropriate box, I A liablW insurance policy E;r Other type of indemnity 0 Bond El OWNI�R'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: OwnerE-) Agent E] Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and.that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General La ws. IBY Tr�e of Ljcense� Plumbef S4gnature ol Licensed Plumber or G�—sFittef *G Title N aslitter SZmaster ticense Number 3707 City/Town LJ Journeyman AP��(�OFFICE USE ONLY)