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Home My WebLink AboutMiscellaneous - 274 MIDDLESEX STREET 4/30/2018 (3)N O � Q v b v r m m x o m 1 o m `- - .\ /� 8 Date ...... /.. 0-.. FA ............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies ........ has permission for gas installation in the buildings of.. . C, 6 C ............... .......................................................... ........................ North Andover, Mass. Fee -.-A)-.& ...... Lic. No. . ...... t/ -Ko- �— *'*'**"*******"* GASINSPECTOR Check #66ysl 9611 UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK FTMASSACHUSETTS CITY A P E R M I T # /�J. Avrmw MA DATE qlv --- - JOBSITE ADDRESS01 1-71tl 5;1- 0 W N E R'S N A M E �?eelwxje G OWNER ADDRESS TEL�26149,0-&60 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAg CLEARLY I NEW: RENOVATION: REPLACEMENTY PLANS SUBMITTED: YES NO,�/ APPLIANCES I FLOORS— BSM —1 4 5 6 9 10 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTI-Iff- INSURANCE COVERAGE I have a current liability -insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES P�NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY )� OTHER TYPE INDEMNITY : BONDI OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Cha pter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 complian h Pertinent all ovisjg"f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME.� Peter G. Viens LICENSE # 12116 SIG MPA� MGF JP JGF LPGI, CORPORATIONX# 3631 C PARTNERSHIP #, LLC COMPANY NAME: Merrimack Valley Corporation ADDRESS 15 Aegean Drive, Unit #3 CITY Methuen STATE MA ZIP 01844 TEL 978-689-0224 FAX 978-689-2206 CELL 978-807-2819 EMAIL pviens@mvalleycorp.com The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street ........... Boston, M4 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plumb ers Applicant Information Please Print LegLbly Name (Business/Organization/Individual): Address: '6V x?W eMY111' Phone #: Are you an employer? Check the appropriate box: 521 I am a employer with &V -Z' 4. [] I am a general contractor and I P _mployees (ftill and/or part-time).* have hired the sub- contractors 2.E1 I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have workin- for mein an' tl y capacity. employees and have workers' [No workers' comp. insurance comp. insurance.! required.] 5. Fj We are a corporation and its 3. 0 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. F� New construction 7. El Remodeling 8. R Demolition 9. F-1 Building addition b 10. F-1 Electrical repairs or additions 11. E] Plumbing repairs or additions 12.R Roof �1)60ther:&� *Any applicant that checks box #1 must also fill Out the section below showing their workers' compensation policy information. I I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the narne of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees. Below isthepolicyandiob site information. Insurance Company Name: I<- - Policy # or Self -ins. Lie. Expiration Date: Job Site Address:d2V A o,45;�,, e 5 -/ 2, Citv/State/Zip: /t4 &V _PV 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 tip 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 tip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eert un er thepai d 4n It' s ofpeij�U!l -s r, an7 y that the infVrmation provided above Zisie and correct. aimanature: fiw;oe�� Date: /0 Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I 950 -AR -d ig a 1-6-9 BAG= kr=--) 13GARD,00 '' * i BOAREIV,F PLUMBER$: �A-Ntl, d,`A-SF4T-T.E`RS PLUKBE.'�$"l-AN,' 9ASFITTER-5 ISSUES THE FOLLOWTUG L I C E N E : CE* N ISSUES THE FOLLOWI'--'N.G L S v L I QEN-S..E-'0:: A -'-S A JOURRTYMAN PLUMBIA-�$" 1 El L 'S" tt AS A MASTER PLUM I PETEIR G VIENS A Z 9 BLUE84-RD L AN E Itu PETE. G VIENS Ltj 9 BLUE81:11D LANE -2362 -ON ATR I N90N 0381l i.'. " .- , . 1V ATKINS 4- 03811-2362 05/0 1.1 - 1?585 216,.3.5--::: 0 5*/Q illk 2 1 L586 12 11-6 1. J-6 2 CarnimmmIlh of Mass=htneft Daparb"nt of pubfic Safety of mass=hUmas Hoisting Engineer drqw& Dqwrhnmt of Pubft Safety License: HE -1 10323 Pipefitter Journeyman License. PJ -028388 PETER G VIENSZ� 9BLUEBMILi PETER G VIENS ATKINSON N1F 03il 1 9BLUEBIRDLN-L VI NH-' 8' ATKINSON 03 1 % A Expiration. 'Pt cor"Issioner 11/13/2015 -.4"r-44- oll Expiratiow cor"issioner 11/13/2015 State of New Hampshire STATE OF NEW HAMPSHIRE GAS FITTERt&Jd'N6-1E BUREAU OF BUILDING SAFETY & CONSTRUCTION NAME: PETER VIENS PLUMBING SAFETY SECTION V A ENDORSEMIENT� ' P 1A ! NAME: PETER G VIENS DATE ISSUED: 10/15/2013 LIC #: 3249 M DATE EXPIRES: 11/30/2015 EXPIRES. 11/30/2014 LICENSE #:GFE07 0 87 I certify that I have examined in accordance with the Federal701ofor Carrier Safety PKulations (49 CF -1017391.41-391.49) and with knowledge of the driving duiies, I find this person is qualified; and, H applicable, only when: El wearing corrective lenses C1 driving within an exempt intracity zone (49 CFR 391.62, 0 wearing hearing aid D accompanied by a Skill Performance Evaluation Certificate (SPE) C1 accompanied by a 0 qualified by operation of 49 CFR 391.64 waiver/exemption The information I hayP provi-ded regarding this phy5icaJ examination is Irt)e and complete. A complete examination form with any attachment embodies my findings completely and correctly. and is on file in my office. SIGNATURE OF MEDICAL EXAMINER E 11T "Irlov-11 MEFAL EXAMINER's NAME (PRINT) JODO OMD 0 Chiropractor )eAdvanced Practice Nurse MEDICAL EXAMINER'S LICENSE OR CERTIFICATE NO. ISSUING STATE 0 Phy ician 0 Other Assistant Practitioner NATIONAL REGISTRY NO. �)I'tv- OF IVER INTRASTATE - CDL �SIG�NATUR ONLY 0 YES 0 0 YES $�N�O DRIVER'S LICENSE NO, STATE / / V -S /0 f - /V /7/ ADDRESS OF DRIVER MEDICAL CERTIFICATION EXPIRATION DATE PLY 1 DRIVER PLY 2 MOT& CARRIER 26520 (5/13) Peter Viens Cert # 1023121001-12 Expires: 10/23/2015 Certification N. F. P.A. 99-2012 ed. ASSE 6010 Installer & ASME IX Brazer 600316337 keter-Vieias 16 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Yo. This certifies that / ......... (I ..... 4. let, ... A ....................................... ..... ........ has permission to perform .......................... ................................... '01 wiring in the building of ., 2 . ............ ...................... 4 North Andover, Mass. at ......... IAM&4 ... .... ........... .. aFee ... 70 ........... Lic. No.( .. K.#5 ............. ELEcrRICAL INSP R Check # 7193 Date 4!:;� ZeA TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... M ... ... has permission to perform .............. ..... ................ plumbing in the buildipgs,40f . .......... at .......... North Ando :3? zg—ss- Fee.4-4-J .... Lic. No..,20. .. *** ... * ........ PLUMBING INSPECTOR Check # ut N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT#— OWNE JOBSITE ADDRESS 4 R'S NAME P OWNER ADDRESS TEL[ZtLg FAX[ TYPE OR OCCUPANCY TYPE COMMERCIAL Ei EDUCATIONALE] RESIDENTIA PRINT CLEARLY NEW: El RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ['I NO[] FIXTURES I FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM J— DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER 7—F FLOOR AREA DRAIN t INTERCEPTOR (INTERIOR) IF KITCHEN SINK LAVATORY =-7 ROOF DRAIN F -- L—j .......... SHOWER STALL t SERVICE MOP SINK F— TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES LL WATER PIPING F - OTHER I L IF F INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES E] NO E] IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E] AGENTE] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knov,4edge and that all plumbing work and installations performed under the permit issued for this application will be in pompliance with all Partihoint provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. [-� 1, 1'( v PLUMBER'S NAME I MICHAEL HOUSE LICENSE # 7173 SIGNATURE MP [-, I JP0 CORPORATION 17 #F3 -37-7—c---]: PARTNERSHI P [:1 # [�= LLC COMPANY NAME [ MERRIMACK VALLEY CORPORATION JADDRESS 15 AEGEAN DRIVE, UNIT #3 CITY METHUEN STATE =MA ZIP 101844 TEL 1978-689-0224 FAX L978-6 -2206 CELL 978-815-4523 1=-@MVALLEYCORP.COM I I EMAIL ELITTL V—, Eo 0 z El ui IL U LLI LU CO) CL w > cr LU co z 0 IL IL vj Lii w LL V—, Eo Date ... 4 �0. -. . 4 �.F - . . /0-1 --- TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that., ......... .... has permission for gas installation P-4 -:/-L A- 4OV4 in the buildings of j��A-e . .............. at ....... North Andover, Mass. Fee.30�7.. Lic. No. 3 . ................. GAS INSPECTOR Check# V—Z) G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,-PERMIT# CITY MA DATE JOBSITE ADDRESS OWNER'S NAME OWNERADDRESS FAXJ_ OCCUPANCYTYPE COMMERCIAL F-1 EDUCATIONAL RESIDENTIAL N E W: RENOVATION:, REPLACEMENT PLANS SUBMITTED: YES NOK APPLIANCES -1 FLOORS - BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER ROOFTOP UNIT BSM 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [ NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 comp4,jance with all Pertinr0provision ofthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ��te, Y, (ffi-1U-2X- LICENSE #"-7173 i 8iGNATORE PLUMBER-GASFITTER NAME MICHAEL H HOUSE 3377 C MP I MGF1 JPI,' JGF LPGI CORPORATION I' PARTNERSHIP [,.':#I. COMPANY NAMEI MERRIMACK VALLEY CORPORATION—, ADDRESS 15 AEGEAN DRIVE, UNIT #3 CITY IMETHUE N STATE' 'MA IZIP[61' L8�1, JTELI 978-689-0224 FAX 978-689-2206 CELC 978-884-3427 ]EMAIL Ili mvalleycorR.�om 9�_jrt�fttykr�valleycorp.com Z- Aeew ez/ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 U. www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Information Name Add City/State/Zip: 99 6� Phone#: u a Are 0 n employer? Check t ropriate box: ,.;VI4 am an employer wi 4. I'l I am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. : required] 5.11 We are a corporation and its 3. 11 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] Please Print Type of project (required): 6. 0 New construction 7. 0 Remodeling 8. 0 Demolition 9. U Building addition 10. 0 Electrical repairs or additions 11. El Plumbing repairs or additions 12. 0 Roof repa* ,gs A 13. 00ther 19451�2 49j/V–'4 *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the su b -contractors have employees, they must provide their workers' comp. policy number. I am an enWloyer that is providing workers'compensadon insurancefqr my employees. Below is thepolicy andjob site information. Insurance Company Name: ,0�� - V - AM6 1, 1 Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address:a?2Ve� &/,d� eg-- City/State/Zip: /AL/ /Z,45M 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for covera2e -verification. I d0herby-76 an t ;, pain ndp, ofperjury that the infor7h*T provided above is true and correct. Si,anature: Date: Pr,int Name.- /4-1 14n�f- Phone #: Official use only Do not write in this area to be completed by city or town official City or Town: Permittlicense Issuing Authority (circle one): I.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone#: f;�� 1� ,4 Commonwealth of Massachusetts Official Use Only Permit No. 21 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS . [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR IF.00 (PLEASE PRINT IN INK OR TYPE ALL INFORAIA TION) Date: ) / — e X City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or intention to perforrn the electrical work described below. — � /. A J% - / Pei Location (Street & Number) Owner or Tenant 11) f - Owner's Address Is this permit in conjunction. with a bui g permit? Yes LL - Purpose of Building �ti I ne Telephone No. No 1-1 (Check Appropriate Box) Utility Authorization No. -- I Existing Service Amp s Volts Overhead Undgrd No. of Meters New Service Amps Volts Overhead UndgrdE] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followinz table mav be waived bv the Insvector ol'Wires. No. of Recessed Luminaires & No. of Ceill.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets f No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above Ei In grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches No. of Gas Burners No. oT—Detecti( nd Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat ump Number]Tons J..KW .... ...... No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E] Municipal 0 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 HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: I Attach additional detail if desired, or as required by the Inspector of 14"ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, 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 covera e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA- ;%BOND El OTHER n (Specify:) I certify, underthepains andpenafties o�fperj' yjlkaulieinform tion on this application is true and complete. FIRM NAM�E LIC. NO.: iE Licensee: 01ric-1 6J0";,?ztV Signature ylAe-� LIC.NO.: (1fapplicable enter -exen t "in the llq�nse ill, III umbeh4r7e) "us. Tel. No.:- eVR* 4/A'J Address: 12 12 1? 46'— 14,r6 Alt. Tel. No.: -- *Security System Contractor License required for this w6rk; i�applicable, enter the license number here: OWNER'S INSURANCE WAIVER: 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 the (check one) 0 owner F1 owner's agent. Owner/Agent Signature Telephone No. FERMIT FEE. $ LocationjV/ No. 1461 Date TOWN OF NORTH ANDOVER M Certificate of Occupancy $ hs —4Z Building/Frame Permit Fee $ Ar. S Foundation Permit Fee $ Other Permit Fee $ TOTAL s /0 Check# -� 70 14 6 0 building InOector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIPL RENOVA AONEORTWO BUELDING PEPMT NUNMER: DATE ISSUED: SIGN ATURE: Building CommissiondrMpsMtor of Buildings Date SECTION 1- SITE INFORMATION 1. 1 Property Addres 1.2 Assessors Map and Parcel Number: s' Aw 9 6o Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Z Zoning District Prop6ied Use Lot Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required I Provide Required I Provided R�*red Provided 2.2 Owner Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Lic nsed Construction Supervisor: Z,/ '605 z .1 Licensed Construction Su sor: 4 A.. � 77 1 1-1 1 Address S ignature /f Telephone 3.2 Registered Home Improvement Contractor Company Name Address Not Applicable 0 License Number Expiration Date Not Applicable 0 RegistrAion Number I.. - . 6 1 -a -IF _6 Expiration Date I.Mater M.G.I-C.404 54) 1.5. Flood Zone Infotmation: 1.8 Sewerage Disposal System: Public Poprivate 0 Zone Outside Flood Zone (I-- municipal 12— On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT 2.1 Owner oVfecord 11jugir (qws 3") Name (Print) Address for Service: i`9 6L2-,, Signature Telephone 2.2 Owner Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Lic nsed Construction Supervisor: Z,/ '605 z .1 Licensed Construction Su sor: 4 A.. � 77 1 1-1 1 Address S ignature /f Telephone 3.2 Registered Home Improvement Contractor Company Name Address Not Applicable 0 License Number Expiration Date Not Applicable 0 RegistrAion Number I.. - . 6 1 -a -IF _6 Expiration Date SECTION 4 - WORKERS COMPENSATION (AG.L C 152 § 25c(6) I Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... 0 No ....... 0 SECTION 5 Description o Proposed Work (check applicable) New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) .0 Addition Accessory Bldg. 0 Demolition 0 Other 0 S�epify Brief Description of Proposed Work: go rr'X I viv.—m-trux UCPYIL4Arv"nrn]%TQTIDTTrTTnNrne.T.4Q I Item Estimated Cost (Dollar) to e E 'A Completed by permit applicalnit I- W--4 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection — 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHOR1ZED AGENT DECL4,RATION 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 Nani Signature of dger/Agefifit Date NO. OF STOET!!�� SIZE BASEMENT OR kAB-) SIZE OF FLOOR TI?v1BERS /C? IST 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GrRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING w X X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A10 FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the - applicant and'or landowner from compliance with any applicable requirements. Immommmummum mmm.mmm No now own Manua mommems mommum.mm an on m memo namenommosem on 0 0 was an APPLICANT VJAJ PHONE - 9-77- 6 8Q- 2PA� ASSESSORS MAP NUMBER LOTNUMBER.— 60 SUBDIVISION LOTNUMBER, STREET STREET NUMBER c;27 . . . . . . . . . . . . . . . OFFICLAL USE ONLY a a We a a a a a 8 0 0 a a a 0 0 0 a a 0 0 a 0 a a 0 a 0 a x 0 a a ........ RECOMNIENDATIONS OF TOWN AGENTS DATE APPROVED miim- mw a CO)fthRVATIONADMINISTRATOR -417 . . DATE REJECTED DATE APPROVED TOWNPLANNER. DATE REJECTED CON54ENJS DATE APPROVED FOOD INSPECTOR -'BEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - BEALTH DATE REJECTED CONBENTS PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTN4ENT DATE REJECTED CONOJENTS RECEIVED BY BUILDING INSPECTOR. Office of the Building Department 0 RECE!Qgmmunity Development and Services Divisioll JOYCE BRADSHAW William J. Scott, Division Director TOWN CLERK ZT1. 11* 27 Charles Street ACHU NORTH ANDOVER North Andover, Massachusetts 01845 'y """ D.0 Telepho�tie (978) 688-9515 ,MNicetta - Bi o4iPoPor 3 b Fax (978) 688-9542 Any appeal shall be Fj . led Notice of Decision This is to certify that twenty (20) days within (20)Aayj after the Year2001 have elapsed from date of decision, filed date of filing of this notice iiihout filing of an apoeal. Date—ap P, I in the offl e of the Town Clark. Property at: 274 Middlesex Street Joyce A. Bradahaus Town Clerk NAME: Vincent Grasso DATE: January 10, 2001 ADDRESS: 274 Middlesex Street I PETITION: 038-2000 North Andover, MA 01,845 HEARING: 1/9/2001 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, January 9, 2001 at 7:30 P.M upon the application of Vincent Grasso, 274 Middlesex Street,. North Andover, MA for a Variance from Section 7, Paragraph 7.1, 7.2, 7.3 for relief of lot area, street frontage, front, side & rear setback in order to erect a two-stall,.single story detached garage. Petitioner is requesting a Special Permit from Section 9, Paragraph 9.2 in order to construct a garage on a pre-existing, non -conforming lot within the R-4 Zoning District. The following members were present Walter F. Soule, Raymond Vivenzio, Robert Ford, John Pallone & Ellen McIntyre. Upon a motion made by John Pallone and 2 nd by Walter F. Soule, the Board voted to GRANT a dimensional Variance for relief of a front setback of 14%. relief of a side setback of 9', relief of a . rear setback of V in order to erect a two -stall single story detached garage, on the condition that the addition is Iei�;7than 25% of the existing structure as required per the bylaw, and to GRANT a Special Permit from Section 9, Paragraph 9.2 in order to all ' ow for the construction of a garage on a pre-existing, non conforming lot in accordance with the Plan of Land by: Scott L. Giles, PLS, #13972, 50 Deer Meadow Rd., North Andover, MA 01845, dated: 1/9/2001. Voting in favor. WFS/RV/RF/JP/EM. The Board finds that the petitioner has satisfied the provisions of Section 10, paragraph 10.4 of the Zoning . Bylaw and that the granting of this . variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. The Board finds that the applicant has satisfied the provision of Section 9, Paragraph 9.2 of the zoning bylaw and that such change, extension or alteration shall not be substantially more detrimental than the existing non -conforming structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised* within one (1) ye ar of the date of the grant, they' shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, they shall lapse and may be re- established only after nobce, and a new hearing, Town of North Andover Board of.Appeals, MI/Decision's 2001/5 Raymond Vivenzio, acting Chairman BOARD OF APPEALS 688-9-54.1 BUILDING688-9-545 CONISERVATIONM88-9530 HEAUT-1698-9540 PLAXINMNG688-9535 XrTEST: A True -COPY ply, 0. A44444., Town Clerk Registry of Deeds Northern District of.Essex County Lawrence, MA 01840 04/03/01 VINCENT GRASSO GA # 51 Rec- Type NOTC Inst ?689 # 52 Rec: Type 'PLAN inst 969rd- Copies Total # 53 Payment Cash # 54 Chanoe THANK YOU! Thomas J. Btirke Register of Deeds 30.00 36.00 3.00 69.00 80. 00 1. 00 k A DEPARTMENT Of PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuiber: Birthdate: Expires: -03/26/2001 03/26 CS :0695 -OS... /1973 gestr' d To.:' 00 ViNctNIT'i -GRASSO 104 CASKEHERE PL N ANDOVER, NA 01845 HONE IMPROVEMENT CONTRACTOR Registration: 129041 - Expiration: 6/28/01 Type: Private-Corporatio - Coutructio DevelopleRt Grasso 104 Castleaere Place —EtAincent DMINISTRATOR N Andover 04 018LS The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: 777 F-1 I am a hom66wner performing all work . myself. F-1 I am a sole proprietor and have no one working in any capacity M EO'_�l am an employer providing workers! compensation for my employees working on this job. Company name: Coz _ L&4�, '-s- &12(&Z� If Address City: Phone#: Company,name: Address Ci!y: Phone #: Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties ofa fine up to $1,6M and/or one years' imprisonment -as -wefl-as -civil.penalUes in -the -form -of A-STOP.-WORKORIDERand-afine _of.J.$1.00..00)-_aAay against -me. I understand that a copy of this statement may be forwarded to the Ciffice of Investigations of the DIA for coverage verification. I do hereby- pain ndpena s of pedury that the information provided above is true and correct. ,,3,a Itie Print Official use only do not write in this area to be completed by city or town official' � 2-6 -0/ # 2LZ-6_�V-05�6 City or Town Permitil-icensing Building Dept []Check if immediate response is required _E3 Licensing Board E] Selectman's Office Contact person: Phone A- E] Health Department o Other 17L�,Ir 'IF T R F, Enr 1_11-11 JjJJQ�jjj _1JJi j,: jj),Tj -.H.. oDj, r _i ._.._ ..... ..... < LLJ N LU LU - x CN ui (D < Ir- < CN x CN - - - - - - - - - - - - - - - - C/) m m m m m m Cf) m cn 0 m M CA CD a z CO2 CD T2. CL C7 CL CA CD CDQ CL cr CD Er CD 0 CD ca E3. CD CL C2 CO) to CD a- a CO) 0 10 co z CD CD 0 r) Q E; *AIM =r D) dwmb a co ccr COD SO `0 CA 0 % = CD C-) MCD 0 0 CL CC,' m 'z !. 0 5 'r- 0 0= RiF 5 0. �* 0. 0 M cl) =r w m =r .* CD ol CA a -40 -0: 0 414, 4 64 0 0.0 to �c z:5- C2 CO2 : CL;0 C/) a cn CD 0 CD 0, n o0 Z C/) INC 0. C.. cc, C,* CAQ: M C'4 CA Wr : C'J: Er �ML:: CD 0: NAt C/) cl) "Mo: C/) : 1 A CD C/) C/) C, CD -d CLR: C-) C3 omi go I la N �� Nt*,; * I tii CL M 0 rn aa 0 401� CD 0 PIZ- n A z fD C) z 0 :3 C) COD e)* U) CL M 0 rn aa 0 401� CD N2 4 5 1C.' 1 0 J Date. 7 — ��. -. % �� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ............ has permission to perform P-(�: IYA, �-./ * , ' -( * , ' , --***-*- plumbing in the buildings of ... e—. j- f .'� ....................... at. . -�'l e.r. ......... North Andover, Mass. Fee. :'0 Lic. No..��. . ........ ...... PLUMBING INSPE�kTOR Check # ) q WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date -7,117160 Building Location j� Lt M[OcAX S�- --Ow_ners Name Q-SSO Permit Amount Type of Occupancy New Renovation Replacement PlansSubmitted Yes No (Print or type) Check one: Installing Company Name (&aerso--� CQ Corp. Business Telephone M1-2-70-14aos" ED Firm/Co. Name ofLicensed Plumber.- Pc\,A&L� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity 11 Bond Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Ir Zez;�� -- — By: =ignarure ol 17censea riumSer Type of Plumbing License Title 911 City/Town License lNumDer Master r I-- Journeyman APPROVED (OFFICE USE ONLY L- MAN (Print or type) Check one: Installing Company Name (&aerso--� CQ Corp. Business Telephone M1-2-70-14aos" ED Firm/Co. Name ofLicensed Plumber.- Pc\,A&L� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity 11 Bond Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Ir Zez;�� -- — By: =ignarure ol 17censea riumSer Type of Plumbing License Title 911 City/Town License lNumDer Master r I-- Journeyman APPROVED (OFFICE USE ONLY L- 3503 Date.27z�-!� . ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . /I. ez—'. 5. 14 has permission for gas installation in the buildings of I j� ............................ at /I A L,� r. -r ;-� ...... North Andover, Mass. Fee. A�U Lic. No.. �.. . . . A , C! - ..e-. ......... j/GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4ASSACHUSETrS UNEFORM APPUC�T ON FO, TO DO GAS F=G or print) Datp _ ?117 --19 I-4VK 111 AVU4V V ILK, 1VKA33A4-r1 UOL I 13 Building Locations �Z7Y pi,4die5ey- _,;j- Permit 9 3j-0.3 Amount S Owner's Name New 9- Renovadon F1 Replacement F .�Jlijaekj� &aA�Z-66 Plans Submitted M (Print or 0 Address Business Te Niame of Licensed Plumber or Gas Fitter F—tc1tLzJ- <' -�'ggegygo^-) Check one: Certificate Installing Company 11 Corp. F-1 Partner. El Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes EZ1, NO If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— Other type of indemnity M Bond Owner�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. Signature of Owner or Owner's Agent Check one: Owner A2ent 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 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 Laws. A - - � ";p - 67 - By: Title Ciry/Town APPROVED (OFFICE USE UNLY) Signature of Licensed Plumber Or Gas Fitter Plumber /w, 9 a 4 ;L Gas Fitter Lict-nse Numoer r7 Joumeyman 6 T 1i F L 0 0 R (Print or 0 Address Business Te Niame of Licensed Plumber or Gas Fitter F—tc1tLzJ- <' -�'ggegygo^-) Check one: Certificate Installing Company 11 Corp. F-1 Partner. El Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes EZ1, NO If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— Other type of indemnity M Bond Owner�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. Signature of Owner or Owner's Agent Check one: Owner A2ent 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 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 Laws. A - - � ";p - 67 - By: Title Ciry/Town APPROVED (OFFICE USE UNLY) Signature of Licensed Plumber Or Gas Fitter Plumber /w, 9 a 4 ;L Gas Fitter Lict-nse Numoer r7 Joumeyman RT 0 Zoning Bylaw Review Form 4� Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Al - Phone 978-688-9545 Fax 978-688-9642 Street: Map/Lot: C/ — Applicant: Request: Date: 0 Lo Please be advised1hatafter review of YoUrAppri'dation afid'Plafis y bur Apoli6ation is APPROVED / DENIED for the following Zoning Bylaw reasons: Zoning Item Notes Item A Lot Area Notes F Frontage I Lot area Insufficient ._'i_7r_ontage InsuYi�cient_ 2 1 Lot Area Preexisting 2 1 Frontage Complies Lot Area Complies 3 Preexisting frontnrip 4 Insuffic ' ient Information Insufficient Information B Use 5 No access over Frontage I Allowed 4 G Contiguous uilding Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 C . omplies 4 Special Permit Required 3 Preexisting CBA 5 Insufficient Information Insufficient Information C Setback H Building Height I All setbacks comply I Height Exceeds Maximum 2 Front Insufficient _5 J_ —Complies 3 Left Side Insufficient *'5 3 Preexisting Height Ll e-5 4 Right Side Insufficient 5 Rear Insufficient 4 Insufficient Information 6 Preexisting setback(s) I Building Coverage I Coverage exceeds maxim um 7 Insufficient Information 2 Coverage Com lies D I Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Inform—ation 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E storic District -Farking I In District review requiribd 1 More Parking Re juired 2 Not in district -j e 5 Parking Complies 3 1 Insufficient Information 9ceme Y for the above is checked below. Item #. Special Permits Planning Board Item # Variance SFte Plan Review Special Permit Setback V Access other than Frontage Special Permit Parkinn V - Frontage Exception. Lot Special Permit Lot Area Variance Common Drivewav Special Permit Hei ht Variance Congregate Housing Special Permit Variance for Continuing Care Retirement Special Permit Independent Elderly Housin S ecial Permit *ecial Pen iiiZ—oning Mits Zoning Board 7 m f pecialPermitNon-Conformin ';-- I Large Estate Condo S ecial Permit S =L rr Us_eZBA --- I S= --9— rth R mo I De 'I Pr., Earl emWaLl S ecial Permit ZBA Planned Development Distdct S ecial Permit e m t s� Hct ial P Special Permit Use not Listed but Similar Planned Residential Special Permit 'i I P t ecial Permitfo r Si R-6 Density SDeCi2i Permit Watershed SDecial Permit I n Other j, F_—j The above review and attached explanation of such is based on the Plans, request for or Information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for this action. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrativer shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. A9 _1a — Z9 0 Aileing D�epartm�ent 0 Wplic—A -2d TPplication Denied atio Rec Denial Sent: If Fax I ed Phone Number/Date: Plan Review Narrative I The following narrative is provided to further explain the reasons for the action on the property indicated on the reverse side: Referred To: F 7ire— Ith Police I'- Zoning Board Conservation Department of Public Works Planning Historical Commission f I BUILDING DEPT A" VV J-�V,1LL=4VVV TOWN OF NORTH ANDOVER I BUIEDING DEPARTMENT I APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY BUILDING PERM[IT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/lETector of Buildings Date SECTION I- SITE INFORMATION I 1.1 Property Address: r�17y A 1.2 Assessors Map and Parcel Number: 01 b3 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required I Provided Required Provided 1 3,0 1.7 Wate—, S;pply M.G.L.C.40. 54) Public a--' Private 0 1.5. Flmdzoae_ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal 7,-- On Site Disposal System 0 SECTIOIN 2 - FKUPERTY OWNEKSHW/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service: Telephone 2.2 Owner of Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: & &,�Wa Licensed Construction Supervisor: 3.2 Registered Home Improvement Contractor U Company Name Address for Service: Not Applicable 0 06,9505 - License Number am/ Expiration Date Not Applicable D 1,,IP*,J ?-7 Registration Number Address r I w ?-z'? 2 -�W Expiration Date L70 0 z M 0 M r� r 2 G) I SECTION 4 - WORKERS COMPENSATION (MLG.L C 152 § 25c(6) 1, 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 ....... Roo' No ....... 0 SECTION 5 Description o Proposed Work (check applicable) New Constiuction 0 Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. Demolition 0 Other 0 Specify Brief Description of Proposed Work: C SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ix 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction Plurnbing Building Permit fee (a) x (b) -3 Mechanical (HVAC) -4 5 Fire Protection Total (1+2+3+4+5) Check Number -6 SECTION 7a OWNER AUTHORIZAf16N TO BE COMPLETED W11EN OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERNUT as Owner/Authorized Agent of subject property Hereby authorize to act on 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 Signature of O;vnerlX�qdt Date NO. OF STORIE�� SIZE ax 7'd BASEMENT OL&� 44 SIZE OF FLOOR TIMBERS 2 ND 3 RD SPAN 20 r DE�ENSIONS OF SILLS Z -)C -b DIMENSIONS OF POSTS DRAENSIONS OF GIRDERS 4,61A HEIGHT OF FOUNDATION & f, THICKNESS SIZE OF FOOTING eel X MATERLA-L OF CINANEY IS BUILDING ONQOLID_bR FULED LAND IS BUILDING C01,VITCTED TO NATURAL GAS LINE 4110 -687-Cll 413 -11TEP 10'� 05/2000 0q: 11 978 It .NET INSUPANCE PAGE 01 D CERTIFICATE OF LIABILITY INSURANCE A MfDm F;MUGER 10105/2000 INSURANCE A=NCl, INC 522 CHICIMRING THIS PmmT)FICA'- - — --1 — 10 100VED A3 A MATTER 0E--1NF0ft-WT-10W— ONLY AND CONFErRS No RIGHTS UPON THE CERTIPICATE ROAD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED 13Y THE ELOW. POLICIES B NORTH ANDOVER, MA 01645 �00/01/2000 [INSU—RIb— INSURERS AFFORDING COVERAGE CONSTRUCTION 4; DmvxLQpmmT Inc �INZRERA- )d�BZLLA PROTZCTZ&i� 733 TMNPXIM ST11118T, #223 !INSURER 5: AJMLLA PROTECT 7—' LINSUREIRC, LIBZRTr HMMAL NORTH ANDOnit MA 01945- INS6AEn 0 ------ INSURER El THE POLICIES OF INSURANCE LISTED BCLOw HAVE BEEN ISSUED TO THE INSURED NAMED AE30VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAY BE ISSUIED OR MAY PERTAIN, THE INSURANCE AFFORDED By THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REIDUGED BY PAII) CLAIMS, -JR TYPE OF INSURANCE T Pw —;11—i POLPCYNUU09R POLICYWIFECTI 9 po 0ENEPALLIASILITY UMITS EACH —000U;--- REKE I Doc A COMMERCIAL GENERAL LIAIIII-rry 3600013541 07/01/2000 07/01/2001 FIRE DAMAW An one fir6 S CLAIMS mAaE OCCUR 50,00 MED CxP ( uns mn) 5 000 PERBONAL&ADvlwj _._ 1, loco, GENEM-AGGREGATE it I e L —AG(;A.ECATE I ITAPPUESPER' 0- PRODU 1,000,000 POLICY nil CT ILOC DEDUCTIULE 2,000,00 WORKERS COMPENSATION AND - EMPLOYERS'UJIMILITY Eli 1-318-312772-039 20/20/1-999 10/20/2000 E.L. EACH ACCIDENT 100 000 _jjL DISEASE - EA EMPLOYEE I lop'000 E.L. DISEASE - POLIty LIMIT 3 500,000 D25CRIMON OP Orr:KkTiONStLOCA'nOW3NE"ICLESMWLLtSiOriS Aj;ufp oy ENDOMEMENTISPICtAL PROVISIONj WOFMRS C00 POLICY WILT, BE REMNING 10/20YOO TO 10/20/2001 CERTIFICATE HOLDER I �_] I ADIXTION AL. INSURED: IN3URgR LETTIElt CANCELLATION TOVM Or NORTH ANDOVER, M SHOULD ANY OF THE AWYE D990ftISED POLICIES GE CANCELLED BEFORE THE EXPIRATION BUILDINO INSPECTOR DATE THEREOF, THE ISSUINO INSURER WILL ENDEAVOR TO MAOL nAVBVdIUr%W 120 MkIN STREET NOTICE TO Nr OWNICATF HOLDER NAMED TO THE LEFT. BUT FA)LURE TO DO 90 SMALL I IMPOSE NO OSUOA'hON OR LULGIL]ITY OF ANY KIND UPON TWF INSURER. ITS AGENTS OP. WORT" ^MOVER VIA 01945- AVT"QMFD RLI�'VRM AWERK isaa L±IJTOMOBILIE LIABlUty i ANY AUYO ALL OWNtD AUTO$ 144501400001 3CHEDL)LEDAUTOO I �00/01/2000 00/03./2001 DSINaLE (Eskafodont) iLODILY INJ HIRED ALrro$ 7—' 8OOiLY INJURY (Per steld") NON -OWNED AUTQ6 I PROPERTY DAMA03E 8 1 CL4RAQF LIABILITY — Y AUTO AUTO ONI.Y - EA ACCI DENT Is OTHERTHAN EA ACC $ AUTO ONLY., AQG 19 EACH OCCIjRRENCE $ A?MRFrATF FXCESSILIABILITY DCCVR MLAWMADE DEDUCTIULE 2,000,00 WORKERS COMPENSATION AND - EMPLOYERS'UJIMILITY Eli 1-318-312772-039 20/20/1-999 10/20/2000 E.L. EACH ACCIDENT 100 000 _jjL DISEASE - EA EMPLOYEE I lop'000 E.L. DISEASE - POLIty LIMIT 3 500,000 D25CRIMON OP Orr:KkTiONStLOCA'nOW3NE"ICLESMWLLtSiOriS Aj;ufp oy ENDOMEMENTISPICtAL PROVISIONj WOFMRS C00 POLICY WILT, BE REMNING 10/20YOO TO 10/20/2001 CERTIFICATE HOLDER I �_] I ADIXTION AL. INSURED: IN3URgR LETTIElt CANCELLATION TOVM Or NORTH ANDOVER, M SHOULD ANY OF THE AWYE D990ftISED POLICIES GE CANCELLED BEFORE THE EXPIRATION BUILDINO INSPECTOR DATE THEREOF, THE ISSUINO INSURER WILL ENDEAVOR TO MAOL nAVBVdIUr%W 120 MkIN STREET NOTICE TO Nr OWNICATF HOLDER NAMED TO THE LEFT. BUT FA)LURE TO DO 90 SMALL I IMPOSE NO OSUOA'hON OR LULGIL]ITY OF ANY KIND UPON TWF INSURER. ITS AGENTS OP. WORT" ^MOVER VIA 01945- AVT"QMFD RLI�'VRM AWERK isaa MORTGAGE- INSPECrION PLAN Ar 274 MIDDLESEX SrREET NORrH ANDOVER, MA. NO. ESSEX REGISTRY OF DEEDS.' 8K. 875 I/ PL AN NO, CERT(FIED 710.' NUMAX MORTGAGE CORPORAWh S cl,"A L E. * I "s i o' DA 7E.* FEBRUARY //I tfxzo MIDDL ESEX S rREE;r k X NO rEs.* 0 rHIS IS NO r A PROPER T Y SUR VE Y, DO NO T USE THIS PL A N 7-0 ESMBLISH PROPERTY LINES OR. -M ' ERECT ANY STRUCTURE �)PROPERTY LINES ARE DErERMINED FROM COMPILED INFORMA rION rO BE USED FOR MOR rGAGE PURPOSES ONLY PG. 148 0247 2000 CERMICAMNS.* BASED ON My KNOWLEDGE, INFORMArION AND BELIEF, HEREB Y CERTIFY rHA r THE PERMANENT SrRUC TURES INDICA rED ARE LOCATED ON THE GRCUND APPROXIMArELY AS SHOWN AND ARE CONFORMINO W rHE ZONING SETBACK REOUIREMENTS OF THE APPLICABLE mumapAury WHEN coNsmucrib OR mAy BE ExEmpr PER mAssAcHusErrs GENERAL LAW CHAPTER 40A, sEcTIoN 7, AND rHAT 7 -HE srRucTuRE sHowN L$ Nor LOCA rED IN A FL OOD HAZARD ZONE PER FEDERAL EAERCENCYAj4NAGEAeWA6rACym4p* commuNlry No. 25oo98 EFFEC r/ VE DA TE. * 06- 02- 93 ZONE' x JOHN ABAGIS 8 ASSOCIAMS, PROFESSIONAL LAND SURVEYORS 137 CHANDLER .. ROAD, A ND 0 VER, MA. t978) 688-4899. APPbVANr.'GRASSO NO. 4270 DEPARTNINT Of PUBLIC $AfETY CONSTRUCTION SUPERVISOR LICENSE 49505 03/26/2001 03/24/1173 CS 00 VINCENT J� GqfSSO 104 CASILHIRE PL All u x MAP 9 PARCEL 57 266 MIDDLESEX ST SHEIPERS MAP 9 PARCEL 16 265 MIDDLESEX ST. GOLDSTEIN R.T. MAP 9 PARCEL 63 53 HAROLD ST LONG MAP 9 PARCEL 62 47 HAROLD ST GUILMET G Y P, '. vlt 50.13 NOTES 495 4 iss. ( '10 1 4.0 MAP 9 PARCEL 60 274 MIDDLESEX ST WHITEFIELD D.H. S.I�. IND. 50 THIS STRUCT, IS NOT IN FLOOD ZONE COMM. NO. 250098 6-2-93 ZONE X Rj Oval 49 15—.,- 1.1, -V Ar 50 *NO MONUMENTATION SET *TIUS PLAN IS TO PROCURE A ZONING VARLkNCE 6 PLAN OF LAND � LOCATION NORTH ANDOVER., MA DRAWN FOR DONALD A. & DOROTHY A. WHITEFIELD SCALE: I"= 20' DATE: SEPT. 5,2000 ol 20' 40' 60' PROPOSED GARAGE PROFILE VIEW MAP 9 PARCEL 61 280 MIDDLESEX ST CAPOBIANCO '� O'� P3- 3S4.4W MAP 9 PARCEL 46 127 MARBLEHEAD ST HOLMES NORTH ANDOVER BOARD OF APPEALS DATE OF FILING: DATE OF HEARING: SCOTT L. GILES, P.L.S. FRANK S. GILES NORTH ANDOVER,, MA (978) 683-2645 REFERENCES PLAN #0247 DEED BOOK 875 PAGt 148 ZONING DSTRICT R4 lot LEAD PLUG S.B. FND. 1 0 -k THE PROPERTY LINES SHOWN ARE THE LINES DIVIDING EXISTING OWNERSHIPS, AND THE LINES OF STREETS AND WAYS SHbWN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED, AND NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP OR NEW WAYS ARE SHOWN. THIS IS TO CERTIFY THAT I HAVE CONFORMED WITH THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS)N PREPARING THIS PLAN 6ATE SCOTT L. GILES, P.L.S. REGISTRY OF DEEDS USE ONLY Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ..... r/f (; � ................ has permission to perform .......... ................ wiring in the building of ...... C, .? Y. ............................................... 'no e Nim ........ .... .......... North Ando Mas Fee�.( ........ Lic. No. ...... .... .............. .......... ... .... .. L RIC I ECrOR Check # Official Use Only Permit No. 3,? vomo-a Po. 5,4d# occupancy & Fee Checked— BOARD OF FIRE PREVENTION REGOLATIONS.527-CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AjI work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date_C,-- 3 o - (-) '-L— To the Inspector of Wires: Townof North And The undersigned applies for a permit to perform the electrical work described below. Location (Street & Numberj '19 M,d A Lf owner or Tenant ywe-e-inr- Owner's Add Is this permit in conjunction with a building permit Yes 111,1" No 0 (Check Appropriate Box) Purpose of Buildin Ublity Authorization No. Existing SeMce_____------A[nPs-----------YOits Overhead 0 Undgmd 0 No. of Meters New Sg2&e Amps_--_---YOits Overhead 0 Undgmd 0 No. of Meters Number YFeeders and Ampacity Location and Nature of Proposed Electrical W OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed OperationsPoVerage or its substantial equivalent YES = NO _baye-j*bwAtakalid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE.��- BOND = OTHER = .(Please Specify) (Expiration Date) Estimated Value of Electrical Wo Work to Start Inspection Date Resqpested- Signed under tWenalties of J FIRM NAME =0 / C' V 144MVZ .0z LIC. NO. LIC.NO.'/::: 0'307 s Te IV - 270 - 39a 9 . I NO. ("03 PQ 4 P Address lo P�oawoc>d 'Alt Tel. No OWNER'S INSURANCE WAIVF- ,JR: I am aware that the Licenses does not have the insurance coverage or Its substantial equivalent as required by Massachusetts General Laws. And that my,�Jgnature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No PERMIT --FEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA 'No. of Emergency Lighting No. of Receptacles Outlets 44 No. of Oil Burners — Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Inifiating Devices No. of Sounding Devices No./ of Self Contained Detection/Sounding Devices 0 Municipal 0 Other Local Connection J No. of Diposal Heat Total Total No. Pumps Tons KW No. of . Dishwashers SpacelArea Heating KW No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hvdro Massage Tuds Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed OperationsPoVerage or its substantial equivalent YES = NO _baye-j*bwAtakalid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE.��- BOND = OTHER = .(Please Specify) (Expiration Date) Estimated Value of Electrical Wo Work to Start Inspection Date Resqpested- Signed under tWenalties of J FIRM NAME =0 / C' V 144MVZ .0z LIC. NO. LIC.NO.'/::: 0'307 s Te IV - 270 - 39a 9 . I NO. ("03 PQ 4 P Address lo P�oawoc>d 'Alt Tel. No OWNER'S INSURANCE WAIVF- ,JR: I am aware that the Licenses does not have the insurance coverage or Its substantial equivalent as required by Massachusetts General Laws. And that my,�Jgnature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No PERMIT --FEE $ (Signature of Owner or Agent) Date. ............. . ... . .. .... TOWN OF NORTH ANDOVER Mona PERMIT FOR WIRING W�4 This certifies that ........... ... j .. ... ..... ..... ............ ................................ has permission to perform ..... 7�r -- — - --- — --------- wiring in the building of ....................... ....... ..................................................... /-at ............. . North Andover, Mass. Fee ........... Lic. NA.1442 ..... ....... .. ;7.� ........................ LE ICAL INSPECTOR Check # —2A�3—d- 5272 I (flmnwnweaR v/ VaJJaclu�oeltdl official Use Only ", use 0 "c� Permit No, 2eparlmeni! ol3ire Service -i F Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PFRFORM ELECTRICAL WORK All work to bc perl-ormc�l in Qccordmicc wl(h tlic Mjss�ichusells Elccirical Co.& (,mL--), 527,-N!R 12,t9t) (PLEASE PRINT IN INK OR TYPEALL INFORAL 171 City orl'own of: '�i . - aj,.CA By this application the undersigned gives notice of his or h� Location (Street & Number) Owner or Tenant V-�'�t Owner's Address Z -7 Y �7";,41kdoV IV) Date: (o - '7 o To- the Inspector of J-Vires.- ii(ention to perform the eicctrical work described below. Telephone No.__.? 7k So 7- 7.6'o 6 Is this permit in conjunction . with a building permit" Yes El N 0 (Check Appropriate Box) Purpose of Buildiiig Utility Authorization No. Existing Service /00 ' Amps t`?` 'Z-10 Volts Overhead UftdgrdE] No. of Nleters New Servic e - Z.00 Anips /ZO / -Z1e Volts Overhead V Und-rdE1 No. of Meters —/ Number of Feeders and Anipacitv 3— Z40 0 Location and Nature of Proposed Electrical Work: a-.v%� Coiiipletioiioftliefolluiviiigtribleiiia be)�-aivccibvfhcIiisbccioi-ofillil-cs. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Falls. No. of Total Transformers KVA No. of Lightin g Outlets No. of Hot Tubs Generators K. NIA -No. No. of Lighting Fixtures Above Ill- Swimming Pool , El 0 ,rnd. grrid. ol Emergency Lighting Battep, Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS lNo. of Zones No. of Switclies No. of Cas Burners No. of Detection -2nd Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number ITons IKW No. of Self -Contained No. of Waste Disposers � I Toti &j ))et�!ctidii/Alertitid'l)evices No. of Disliwasliers Space/Area Heating.K'W` �Local F-1 MI'lliciP21 El Other L -j Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent INo. of Water KW No. of No. of Daia Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No—Hydromassage Batlitubs No. of Motors Total HP Telecommunications Wiring: b No. of Devices or Equivalent OTHER: '-Ntacli addiliotiol detail i,(4esircd_f?r as /-C(711'/6�1 OOVO I N S U R,0 C E C 0 IT R -A U n I css x-,, ived bi 1hf1-- o,,l il e r, no permi t for I he perfomnan c t, o e c a 1 work n izi y ss � i e. u !i S tile licensec provides proof of liability Insurance Hicluding "completed operation" coverz.,oc or itS subs tanlial equivalent. Ilie LIFICIUSigned certifies that stich cove/ge is in force, and has, exhibited proof of same to the permit issuln'v office .5 /Z' CHECK ONE: INSURj\NCE BOND 05 (Expiration Date) Estimated Va I ILIC' 0;f'MCc tr - ica I �Nfbfk:' 1306? (N lArequired by municipal policy.) work to. Start: G- 0 111spcctions to be requested in accordance with MEC Rule 10, and upon completion. I eet-10" Ill . ider the paiiis andpenalties qfpejjitry, fhat the information oil this application is true and complete. F1101 NAME: ONViNNER'S INSURANCE WAIVER: I am awarc mat ine I-Icense� tioc, rcquiredl b,,, lav, 01� lier"A4,01it I !3,,. mv slunatme below, 1 heicinywiw, c this requircniciit I'Clcphonc N.V LIC. NO.: Ll C. NO.: J7 1913 11. V L Tel. N 0, - 77 9' '0? 42� 9 2 iot iravc mc iiaDmty it is Lira rice covei 30—C F1 or M a I i�� am tile ('11C) [a 01-k lic! o' "'. I ic I S .1 t, '2.,., 3 PLEASE FILL OUT BACK SIDE tri I'd t -I tri �d H n N2 2468 qwr -w4r Date ..... ��zf� .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that6; .............................................................................. haspermission to perform-"---'� .. ..... ..... ......................................... wiring in the building of ................................................. . ..... :-� ........ ................... . North Andover, Mass. . ...... .. ... Za ............... Lic. No ...... .. ..... ..... ....... ,�-.62:::=ELEC rR [CAL INSP ECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer =CO"IOAff FALTHOFAAMMUS= DEPARTM17NTOFPUBIJCS4FM BOARD OFFYEPREVEMONREGULMOAS52701R 12.-00 Office Use only Permit No. Occupancy & Fees Checked APPUCATION FOR PERW TO PERFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS al)CMCAL CODE, 527 cmR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) a :ILI Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes -q' No (Check Appropriate Box) Purpose of BuildingQamry4t Yo Utility Authorization No. Existing Service AmpsZ202C[ Volts Overhead 0"Underground No. of Meters 1:3 New Service Amps Volts Overhead [:3 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 71-77047 4JZ. �4 (s)PT-LL, No. ofLighting Outlets No. ofHot Tubs No. ofTransformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El ground No. of Receptacle Outlets No. ofOil Burners No. of Emergency Lighting Battery Units No. ofSwitch Outlets No. ofGas Burners FIRE ALARMS No. ofZones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. ofDisposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. ofSelfContained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW M Connections El o. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER IrarwxCa4rar- I ha-veaamertLi"tyh&r&=POILyffdj&ECmVI&Opaafi'�FsCovwdWcrismbstitiaI eWi�*nt 1. NO Ihmsthmitledvalid. ID*cOTu-- YES NO I 1f)w hawdu:ked YES, PLM FdCE*-AX�W0fWArdWbyd=king tic � "I We I .. . , � M�E7= j . 10 1 � .. - 1. 1 1 W01k ID SW _J�— S�wd urxkr-'fi F;.RM NAME ExpffMmDale EMmEkdVA&dDe&aWoik InspactimDaleReVewd Rough ZOE., 6 — Final j2!:�4 J AigY9S L-�g Signare Li==NTQ awessTdNo,/�n2 —r QW -7 2 AILTeLN4 OWNER'S MRANCEWAIVER, I 3mM=dAfC1i=wdam not tcima=wvwraisabskxMcqivakttasm#edbyNbmh&%CcmaiLa"ps (Please check one) Owner ED Agent I elephone.No. PERMIT FEE This certifies that ........ Date..�/ .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING has permission to peifor-fiiZ.j, wiring in the building 0 at(. . ..... . .. ��Ild F e e. ........ Lic. No./ 7 Check # .,5313 ......... .... .......................... ...... . North Andover, Mass. .......................................................... ELECTRICAL INSPECTOR I Commonwealth of Massachusetts Official Use On> t Department of Fire Services Permit No. Occupancy and Fee Checked [[Rev. 11/991 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT T All work to be performed in accordance with thi (PLEASE PPJNT 17V 17VK Q��E City or Town of- J J , By this application the und r ign6d g'lv( Location (Street & N4m 01 r ,be P17 OwnerorTenant \, Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps Volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: FORM ELECTRICAL WORK setts Electrical Code (MEC), 537 Cr�R 12.09 Date: To the Inspector`6f WiVes: to perfortl the electrical work described below. Telephone N Yes, El . No 2" (Check Appropriate Box) Utility Authorization No. OverheadF] Undgrd No. of Meters Overhead [:1 Undgrd No. of Meters — I V A - \ Installation of Security syste56&4_Tff_C(41) I,- Cn-nlotin� �fth, MAI. — A. -;--4 1- L- T_--__ -,rw.*--- 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 tl Swimming Pool Above [D In- grnd. grnd. EJ - of Emergency Lighting BNattery Units - No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners NT-7—Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals:, Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E] MunicipM El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs — No. of Motors Total HP TFIecommunications Wiring: No. of Devices or Equivalent OTHER. Attach additional detail if desired, or as required by the Inspector oJ Wires. INSURANCE COVERAGE: Unless waived by the owner, 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [I BOND [_1 OTHER F1 (Specify:) Estimated Value f ica Work: b6ff I— (Expiration Date) pf Ejectr (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certij�, under th�pains landpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: ADT Security Ser�.�ices 12 rliA+An Mr, wnilic mw LIC.NO.: 15,1_Jr Licensee: John''S. 6etssett Signature ----43949 LIC.NO.: 1533C (If applicable, enter "exempt "in the license number line) Bus.Tel.No.; 603 594 S928 Address: I/ - Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid9hsee 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) El owner El owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. I — I