HomeMy WebLinkAboutMiscellaneous - 275 HAY MEADOW ROAD 4/30/201860
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Date...
............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
.................................... ........
has permission to perform....--,d-e-'-41-21--�
...........................................................
wiring in the building of
........... ...........................................
at .. -, -�' 1,, -1
2 41-- "/' , North Andover, Mass.
......................
Fee.48-
................... Lic. No��,q .......... PiLi�r CAL I'NSP�E�
Check # C�'5
8277
%4
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
[Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfornied in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -7/371/01-
City or'Town of: NORTH ANDOVER — To the InspeWor Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit? Yes
Purpose of Building =Z2,WZgE
Telephone No.,_f bY 94Y (f)3'JS-
No (Check Appropriate, Box)
Utility Authorization No.
r
Existing Service 272 Amps /J6o 2&.Volts OverheadE]
New Service Amps Volts Overhead 1:1
Number of Feeders and Ampacity
Undgrdz�_ No. of Meters
Undgrd F-1 No. of Meters
Location and Nature of Proposed Electrical Work: IP t _-
if 0
T.'6 ja)f�')o 19A.'.6 'dlAlw jf�(fzea 7S
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above Ei In- El
grnd. 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. of Detection and
Initiating Devices
No. of Ranges
No. of . Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
J.Njpp!?!�K]
ro-n—s.1
.......................
KW
......................
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
LocalEl Connection [I Other
No. of Dryers
Heating Appliances KW
Security Systems`
No. of Devices or Equivalent
No. of Water KW
Heaters
N o No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: &�-, dj) (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 operatiori" coverage or its substantial equivalent. The
undersigned certifies that such coverag�e�n force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OTHER F] (Specify:)
I certi ins
,fy,underthepa' andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: Ra (e -K Signature LIC. NO.:
(If applicable, ehter "exempt " in the license number line) Bus. Tel. No. -_2!7.P
Address: CC-) _SC1YCi_e,4 &6ZA�&A Mlf, ol 006,C5 Alt. Tel. No.:
*Per M.G.f c. 147, s. 57-61, security work requires Deparfinent of Public Safety "S" License: Lic. No.
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)E] owner E] owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ 46-
The Commonwealth ofMassach
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le2ibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: aeW1z-1m4C Ag 01A.'O Phone#: FA—_ 5�?3 45-77
Are you an employer? Check the appropriate box:
LEI I am a employer with
4. El I am a general contractor and I
eTplayees (full and/or part-time).*
have hired the sub -contractors
_
2. LY-1—arn 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.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. 1 am a homeowner doing all work
E]
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. New construction
7. Remodeling
8. E] Demolition
9. E] Building addition
I O.El Electrical repairs or additions
I I. E] Plumbing repairs or additions
12.E] Roof repairs
13.El OtherJet;71-C_ )-RUolO
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing 0 work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Job Site
Expiration Date:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify uy�dqr th e pains and penalties of perjury th at the -information provided above is true and correct.
?I
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 #:
4
MORTGAGE PLOT PLAN
EK SURVEY
17 ROYAL STREET, LAWRENCE, MA. 01841 Tel. 508-975-1413
MORTGAGOR -DEED REF. �3 /5- P G.
ADDRESS OF PRINCIPLE BUILDING PLAN REF.
2 Z_'T_ q,4 YA1eA.Qek,) RP
M A DATE OF INspEcTION 7UL- Y -5-,
6eAj,E, qo,
Zo67.00 3( o. q 7'
.4
33 AKFA M'r7v
Wrm
ve
LO*r iOA
z 24
N 301
plez,535
MAY 3 0 19,96
'KOPP
0
Location 0"
No. Date &1 -
TOWN OF NORTH ANDOVER
0
V.
M
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check# C-IPA9-777
18320
/7�Uilding Inspec(or
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION To COjqSrRUCr W,�M RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
r0, - � I . . . ; , , 4 , � w
BUELDING PERMIT NUMBEIL DATE ISSUED:
SIGN
Building Commissioner/I r of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Ad& ss*. 1
1.2 Assessm Map and Parcel Number:.
jeD
-
/� V 1/3 1� �
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District 0;�—W�Uw
LA Am (d) Frontage (fL)
1.6 BURDING SETBACKS (11)
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply NLGI.C.40. § 54) 1.5. Flwd Zone Infommaim 1.1 SewaW Dkposd SyBtem
zow Oubide FloW ZOW 0 M-i-ip-1 0 OnSiteDispmal System 0
Public 0 PrivaW a
SECTION 2 - pRopERTY OWNERSIBIWAUTHORUXI) AGENT 1C; L)iStr!(,-t: \,/,?S —No
2.1 Ownerof Record
Address for Service/
Signature Telephone
2.2 Owner bf Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
c 5
Licensed Construction Supervisor:
License Number
3
Address
97?-
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
. 'Fohaftv . -rf
Ile
Company Name
2-
Registration Number
2'e'l zoo&
Addrels
4 "-
ExpimtA Date
j,
Signature_ Telephone
4
SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Description Proposed Work (check noWilcable I
New Constnxtion 0 Existing Building 0 Repair(s) 0 Alterations(s)- 0 Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 specify
Brief Description of Proposed Work:
IF
12- �A71roe*lr6 &'"C'
10
J 19 A eA121 Ak�r_ <7.7-eorzti
QVrTION A - V.QTtMAT19n VnNVTD17f-r1nTa f%eir.
Y
item Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICL4L USE ONLY
I . Building ev
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Phunbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5) la, CV
V'V'r"rT^W n- r%'&WrffWT2
Check Number
Junim" VVr=J'J
OWNERS AGENT OR CONTRACTOR APPLIES FOR BU]IDING PERAUT
r as Owner/Authorized Agent of subject property
Hereby authorize e Ll 4T -
16�
A—r- klpv 5 to act on
My beh�qt, in all matters relative to wo-rk authorized by this building permit application
2zi�
Signature ot'Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, 'Z�� /Z 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
nk
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS Or --
2NU 3 RD
SPAN --------------
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHI?v!lNEY
IS BUILDING ON SOLID OR FELLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LTNF.
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North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
The debris will be disposed of in:
�IwD 12,-Poct�;,51
- 5 �el. (Vo W, / V -
ocatio of Facility)
Sig�ndlture of Permit Applicant
1.7—
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
A
I
1he Commonwealth ofMassachuselts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Busiiiess/Orgariizatiowlndividual): xllfreje /�, , &a,0�41sf
Address: I i � r // b,, IkI, 7, / A /, / -,:-7
City/State/Zip:. 04/10 1-1 0/ zj��I�, Phone #: !77_4�F c?13— Q7�'_77
Are you an employer? Check the appropriate box:
1. U�ram a employer with
4. El I am a general contractor and I
employees (full and/oR�.
have hired the sub -contractors
2 1 am a sole proprietor or partner-
listed on the attached sheet t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. 0 We are a corporation and its
required.]
officers have exercised their
3. M I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1 (4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. El New construction
7. E] Remodeling
8. M Demolition
9. El Building addition
10. El Electrical repairs or additions
I 1 -0 Plumbing repairs or additions
12 -El Roof repairs
13.[:] Other
,—,)' 'FF----- I—' UUA tt I Mum ZUNQ iiii oui ine section below showing their workers' compensation Policy information:
t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractm that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers'compensation insurancefor my eMP10yees. Below is the polky andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address:__.27,37_hkv,&��z ,�I) City/State/Zip:
and expiratioll, date).
Attach a copy of the workers' compensation policy declaration page (showing the policy number
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500-00 and/or one-year m1pnsonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certift nderthep
!plins7d enalties OfPerju'Y that 'he information provided above is true and correct
6 -0a
QVIcial use only. Do not write in this area, to be completed by city or town o0ciai
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
S
Contact Person: Phone #:
i[nformation and Instrue ions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their en'Ployees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral Or written."
An I employer is defined as "an individual, partnership, association, corporation 6T other legal entity, or any two Or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of au individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an en'Ployer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
. renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
MGL chapter 152, §25C(7) states "Neither the connnonwealth nor any of its political subdivisions shall
Additionally, n, with th insur n
enter into any contract for the performance of public work until acceptable evidence of complia ce e a ce
requirements of this chapter have been presented to the contracting authority."
Applicants sation affidavit completely, by checking the boxes that apply to your situation and, if
Please fill out the workers' compen
-contractor(s) naine(s), address(es) and phone number(s) along with their certificate(s) of
necessary, supply sub joy so er e
insurance. Limited Liability Companies (LLQ or United Liability Partnerships (LLP) with no emp ee th than th
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be subinitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
industrial Accidents. Should you have any questions regarding. the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-inswed companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in ____L_(city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or pen I nit to burn leaves etc.) said person is NOT required to complete this affidavit
The office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents.
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05 www.mass.gov/dia
'r1ea5p, (ttwvt
Mark A. Jenkins
3S Clinton Avenue
Chelmsford, MAO 1824
Builder General Contractor
Roofing Specialist
Free Estimates
25 Years Experience
PROPOSAL
Customer Name: Mark and Terry Venator
275 Haymeadow Road
No. Andover, MA 01845
Job Location: Same
Proposal: Front Entrance Remodel
Job Cost: $12,600.00
Downpayment: $1,600.00 Commencement of work: $5,500.00
Completion: $5,500.00
Start Date: June 2005
Completion Date: 1-2 weeks
This proposal is validfor a Period of 60 days.
Workmansh* guaranteedfor a period of 5 years.
Ip
T4haYou,
Mja
a r kA. e 4nn s
Customer Acceptance: Date:— a�'
Irlease, rlttur vl�
SPECIFICATIONS
Builder to procure all necessary plans and permits
Demolition to include removal of upper and lower railing system
* Removal of existing roof decking and rafter system
* Removal of existing French door
* Framing to include all labor and material necessary to rebuild
roof structure
* Roofing to be fully adhered John Mansville rubber roofing
Roof deck to be Weather Best maintenance -free decking
Roof railing system to be Weather Best vinyl rails
Lower railing system to be fir colonial rails and ballisters
Trim to include pre -primed pine, crown molding and dental
blocking
• Wood gutters to be 4 1/299 fir
• French door to be replaced with 5'0"x 6'6" atrium door
• Cedar siding to be replaced as necessary
• Contractor responsible for removal of all debris
AG Location &n2z
No. 42 z Date /I
I 40RTH A
TOWN OF NORTH ANDOVER
0.
Certificate of Occupancy
$
_5"/7ev o
Building/Frame Permit Fee
$
0
"...-..Foundation Permit Fee
$
er Permit Fee
$
Sewer Connection Fee
$
-Water Connection Fee
$
JUN 7 -
1�ffAL
$
_TC
't- 6140
Buildind inspector
Div. Public Works
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Property Maintenande Services
General Construction
PROPOSAL: Sweeton residence,
275 Haymeadow
North Andover,MA
To include; Construct approx.301lx681'shower stall
to replace existing stall.
Install ceramic tile to inside of
shower and floor of shower room.
Install shower door approx. 30"wide.
Move shower faucet to new location.
Existing drain locati-on to remain.
Install new six panel pine door in
existing archway location,l/h swing.
Construct linen closet in location to
be determined,with louver,,'1-1/V1thick
bifold door,with casing to match
existing style in thraqghout house.
Steve Jesus
Install ceramic tile to surround area
of raised bath in bathrocm,replacing
sheetrock damaged by removal of existing
tile with MR(moisture resistant)sheetrock.
Durock type cement board to be installed
in wet area of.new shower stall,with
:MR board in dry areas of room.
Paint/stain new doors and walls as needed.
Seal all new ceramic tile with silicone
sealer.
New shower pan to be constructed of copper.
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Location
9 4
No. Date
V40P TOWN OF NORTH ANDOVElf
Certificate of Occupancy $
Building/Frame Permit Fee $
V10
,CHU Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building inspector
9817 Div. Public Works
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FORM U - VERIFICATION 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: Phone
LOCATION: Assessor's Map Number Parcel Oc) Ll -
Subdivision Lot (s)
Street C� St. Numl�er
************************Official Use Only************************
REC ONS F WN AGENTS:
_�/T.111
7 1
777 Date
Conservation Administrator Date
Comments wlhw ,A W * �4 �M4
Town Planner
Comments
Food Inspector -Health
4M&JA___)
Sep'E-1(5-in-spector-Health
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
f7' �e.ceived by Building Inspector
MAY 3 0
C�zh/
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date
I-,- - -- , -- , - - . ,
Date
NO 3849
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
--A cmus
This certifies that .....................
has permission to perform ... V .............................
plumbing in the buildings of ...................
at �'- ? )-. - WA4 ty. ,q �,- L . ............. North Andover, Mass.
Fee Lic. No.. 5-3.3. > . ............. ................
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
n��
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
ass. Dat a
Aw�wal 19 '72 Permit #_5
Building Location 5�6wner's Namw�k -7,e-
A2/hkn�4 Type of Occupancy, 2��)
19
New 0 Renovation El Replacement 2"" Plans Submitted: Yes 13 No C3
FIXTURES
Installing Company Name '�ktlEe,-r _14 (r M A T A e 10 Check one: Certificate
Address I
co�q(Hmt4k) pi 0 Corporation
/r E Tw o L:=7A) Al f4l IT VL/ C] Partnership
Business Telephone (1,41 z 7 — 9-A�/C'0.
Name of Licensed Plumber '2Le-3FP_r 4.
INSURANCE COVERAGE:
I have a curre ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No M .1
If you have checked ves, please indicate the type coverage by checking the appropriate box
A liability Insurance policy Other type of Indemnity 0 Bond 11
I
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.
Check one:
Owner 0 Agent 0
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
knowiedge and that all plumbing work and installations; miformed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State PlumWjg jtode and C�apte of the eral Laws.
�
By.
Title Vlaflre of Ucei
City/Town Type of Ucense: Master Journeymah 0 e
Ucense Number 133
a
40
v
m
30
z
I
V
I
F
01 4c Totnmonwralt4 of filass*uortts Office Use Only
Department of Public Saj�ty Permit No.
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Occupancy & Fee Checked
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 3-18-97
City or 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) 275 Hay Meadow Road
Owner-'QPMAI: Marc and Terri Venator
Owner's Address
Is this permit in conjunction with a building permit: Yes ID No (Check Appropriate Box)
Purpose of Building
Existing Service
New Service
Amps Volts
---Amps Volts
Aility Authorization No.
Overhead 1:1 Undgrd
Overhead 1:1 Undgrd
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Wiring for 50Amp 220V spa unit to be located on outside deck
Location and Nature of Proposed Electrical Work
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES M NO 0 ! have submitted valid proof
of same to this office. YESM NO 0
if you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE 21 BOND 0 OTHERD (Please Specify) National Grange Mutual 3-11-98
Foy Ins. Group, Salem, N.H. (Expiration Date)
Estimated Value of Electrical Work $
Work to Start
Signed under the penalties of perjury:
FIRM NAME
Inspection Date Requested: Rough
Laroche Electrical, Inc.
Final
LIC. NO.
.Licensee Arthur W- Laroche, Jr. Signature &42 -f 7 ZL±W4 LIC. NO. -
Address 16 Wiley Hill Road, Londonderry, N.H. 03053 Bus. Tel. No.(603) 437-8352
Alt. Tel. No.
.OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
.General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE $ 15.00
(Signature of Owner or Agent)
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
A�o—ve In-
F�
No. of Lighting Fixtures
Swimming Pool rnd. 0 grnd.
Generators KVA
N-o-.—oT—Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
nits
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Tota I
No. of Ranges
No. of Air Conditioners Tons
. Initiating Devices
No. of Sounding Devices.
Heat I otal Total
No. of Disposals
No. of Pumps Tons KW
No. of Self Contained
Detection/Sounding Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local[:]* Connection DOther
No. of Dryers
Vlin, Devices KW
No. t No. ot
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES M NO 0 ! have submitted valid proof
of same to this office. YESM NO 0
if you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE 21 BOND 0 OTHERD (Please Specify) National Grange Mutual 3-11-98
Foy Ins. Group, Salem, N.H. (Expiration Date)
Estimated Value of Electrical Work $
Work to Start
Signed under the penalties of perjury:
FIRM NAME
Inspection Date Requested: Rough
Laroche Electrical, Inc.
Final
LIC. NO.
.Licensee Arthur W- Laroche, Jr. Signature &42 -f 7 ZL±W4 LIC. NO. -
Address 16 Wiley Hill Road, Londonderry, N.H. 03053 Bus. Tel. No.(603) 437-8352
Alt. Tel. No.
.OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
.General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE $ 15.00
(Signature of Owner or Agent)
IZM97T a Date .........
Oil
TOWN OF NORTH ANDOVER
0
0
PERMIT FOR WIRING
CHU
8
This certifies that ..... ......... ..................... Ui
has permission to perform ...... ...... ....... ..............
wiring in the building of ...... .................................................
cc
at ... ;L?.5 . ...... .............. . North 4,ndover, Mass. -W
Fee ... .... Lic. NoMq'� ... 7,) .................................... ....
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer