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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
. .. ..............................................................
This certifies that ........ . ...
has permission to perform ..............
wiring in the building of ... ...................................................
..............
77 -) i
at....................................................... ; ........................ I North Andover, Mass.
Fee ....... I ............. Lic. No . ............. .... t .......... .
.................... . . .......................
ELEcrRICAL INSPECMR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Re Commonwealth of Massachusetts
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12:00
Wti�e Use only
Nrrft \o.--- 76-1
Occupancy & Fee Checked -
3/90 Oea�e blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All vmrk to I>e per-krmed In accordance with the Ma"achusetts EJectrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORHATION) Date IIIZ-7160
City or Town of , No Rwpooail To the Inspect vrofTires:
The undersigned applies for a permit to perform the electrical work described below.
Loc-ation (Street & Number) 2-9 9 H
Owner or Tenant Ro&tq ?
Owner's Address
Is this permit in conjunction with a building permit: Yes n No E� (check.Appropriate Box)
60 A t- -7 -1
Purpose of Building 5))V9),E r4" Utility Authorization NO.
Existing Ser -vice 60 Amps Volts Overhead a UndgrdE] No. of Meters
New Serv-ice /00 Amps I ?-9C) olts Overhead 9- Undgrd [] No. of Meters
Number of Feeders and Ampacity AkP5
Location and Nature of Proposed Electrical Work -(�JLOo
21e Ne A. r- Li±J D CA— I CU
t-6 I lcit-4 (I.,
;
No. of Lighting Outlets
f Hot
No. o '4ubs
Total
No. of Tra nsformers KVA
No. of Lighting Fixtures
Above In-
Swimming Pool grnd. Elgrnd . El
—
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Municipal Other
LocalEl connectionD
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
No. f Heat Total Total
0 Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No, of No. of
Signs Ballasts
Low Volt . age
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
U
OTHER: Ir
G, �C"�i2 �%ER 'CC, A,—J 13424 6F -e -
A1 el,5 2.&RF4-
W 7- 14 R. 0snt<Cf) De-VacCe, 1-5;" FL . Z,&F
INSURANCE COVERAGE: Pursuant to the requireiilents of Massachusetts General Laws I
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YESE] NOE] I have submitted valid proof of same to this office. YESE] NO F]
If you have checked YES,,please indicate the type o e by checking the appropriate box.
INSURANCE [i�'BOND [] OTHER E] (Please Specify)- I)t,!& 0!5 )0
(Expiraftion Date)
Estimated Value of Electrical Work S
Work to Start Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAME
Licensee
Address
Signa
B - Tel. )V4.
us.
—Alt. Tel.—No.
VW11Mr1 a 1L1Q)U1VtN%1L WA.Lvr.K: I am aware that the Licensee does not have the insurance coverage or its suD-
stantial equivalent as required by Massachusetts General Laws, a at my signature on this permit
application waives this renuirement Owner A ent (Please ch—k onel 1�ej
10 -
PERMIT FEE S 75 .
LIC. NO. !-Wr-A
LIC. NO. 396k�-A-
Telephone No.
(Signature of Owner or Agent)
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REMARKS BY ELECTRICIAN:
I
Location
�0.
Date
Building Inspector
126 872311111:13 30-00 PAID Div. Public Works
TOWN OF NORTH ANDOVER
0
4 -
I WA, P,
Certificate of Occupancy
$
4g
Building/Frame Permit Fee
$
0 +
CHU
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
Building Inspector
126 872311111:13 30-00 PAID Div. Public Works
I
Cocation'
�0. Date ]� Ail
. / f F
40RT" TOWN OF NORTH ANDOVER
0�
Certificate of Occupancy $
i� +at Building/Frame Permit Fee $
04
Foundation Permit Fee $
CHU
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
07/13/98 09:203 30.00 wn
Div. Public Works
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No. Date 7
ORTol TOWN OF NORTH ANDOVER
Certificate of Occupancy $
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Water Connection Fee $
TOTAL
Building Inspect
12668 07/02/98 14:30 104.00 Pon
Div. Public Works
Location
No. Date
ORTN
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
3A 14
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
Building Inspector
r. 07/02198 14:30 104.00 PAID
Div. Public Works
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12 6 3 6/11/ge 15-45
Building Inspector
35.00 PAID Div. Public Works
TOWN OF NORTH ANDOVER
41
Certificate of Occupancy
$
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Foundation Permit Fee
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CH
-Gther-Permit Fee
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Sewer Connection Fee
$
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12 6 3 6/11/ge 15-45
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35.00 PAID Div. Public Works
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SWIMMING POOL CENTER, INC.
670 SOUTH UNION STREET - LAWRENCE, MA 01843
PHONE (978) 682-6916
DATE 5J7
water Y N
extras Y N M
NAME— �--VAI A/ I Allk CLI -4)
o IIJ 'ST,
ADDRESS Ll-
CITY/TOWN 0 VE –74e–- STATJVj'6__ZIP_Dj
HOME #J,Ze-�Offj�-7qq�, WORK #
We propose to furnish one (;� / I . EVAS 01V _Above -ground Swimming
Pool for the sum of S 4� S-60 11-9
All above-groundpool packages include: DE Filter, DLX Thru- Wall Skimmer, Ladder(s), Printed Litter
Vacuum Cleaner and Chemical Starter Kit.
Motor: 1/4 IfP -��
Ladder. Tn-76u-t - Deck
OPTIONS
LIGHT
s 7 i0cu`
5% MA SALES TAX
AUTOMAT IC VACUUM $
WINTER PKG
$
DEPOSIT RECV'D
2-0000
SOLAR COVER
$
$
STEP UNIT
$
HEATER
$
F�NCfNG
$
MISC
$
DIRECTIONS:
Filter: Sand � E.
Liner: Solid Blu
0
POOLPKG S
TOTAL EXTRAS $
SUBTOTAL
s 7 i0cu`
5% MA SALES TAX
$ 3 S—
or"
TOTAL PRICE
DEPOSIT RECV'D
2-0000
BALANCE DUE COD
$
DELIVERY: DATE.- TIME:
DATE: TIME:
4ATIE BUYE
§Aff�flfRS R DATE
U
'k
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
************APPLICANT FILLS OUT THIS SECTION*******
10PLICANT i A 4AIC15 L. 9HONE
,,L6CATION: Asseswes Map Number ?.ARCEL
SUBDIVISION ,COT (S)
,/STREET,131 46"T. NUMBER
*************OFFICIAL USE
NDATIONS OF TOWN AGENTS:
CONSORVATION
COMMENTS
I$TRATOR
DATEAPPROVED
DATE, REJECTED
G
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT %
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
0
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4
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No.
Contractor Name 7eggist
ratiom L
.... . . T 0 WN of NORTH AIN D 0 VER
X:"w
AFFIDAVIT
Bmp- -Irhjxmx;q333mt G:x -itra:tjr Law
mw `i:, S rrjAmnt to pennit AmlirnHcn
lazp
. . .
. . . . . . . . . .
C- 142 re#±es ttr b3cajstmztjcn, ;41 rea7vaticn, rkmdr
dmnUda-4, ac camtartim of an riffibra tr) any
3rg 0=tMMrg at leasta-e, bit mt � i - dm fax deLUcg units. - xr to sta=* ar�.,.adjkerttz,
1-8L-� resi� cr b ri Irb be da -p -by tmgis� antmct=s, wiffidcmt3in
ecepEats, alag',-� odler 14,
"Type of'�' �-) CN
W�ork!
Ist-:,
It
ess of, Work
Owfier Na�:. /VIA
'4
'of Peirmit Application:
, c t tat:
tI
Re is tration, is riot tequired-for the following reasori(s):
lwork-4xcluded by law
aMit.
F
Job irride± $1, 000
Date
BulAdaing not own-er-occi-Tpied
pulling own p�it
Other.(specify)
r
�6 t i e:.. i s herebygiven that:
owNm PuLLim mmR c)6 -N PaR�= oR DEALi% wrm,uN=REGiLs= �S-
FOR APPLICABU EDE DTRCVEHM,WM DO NOT HAVE AC= TO THE, ARBMA-�
TION PROGRAM OR GUARAN= FUM UNDER MGL c. 142A. -
-q
A!;
u -d-- paalde!!�bf per��:
9 er- eby iipp y Eor AC.p'ercrd t as the agent of the o,,,me--:
M
No.
Contractor Name 7eggist
ratiom L
� � 7").
'� ,��
A
Date. -. v-. .'5� �7 ....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
C HUS
This certifies that
has permission for gas installation .....................
in the buildings of .... ...........................
at,2 '-1. 7.. /-tz
... .... North Andover, Mass.
Fee.2�,.—. Lic. No. ... .... ......
dtAS INSPECTOR
Check# V
4225
L_11X
MASSACHUSETTS UNIFORM APPLICA 10 FOR PF:PKAIT n nn f%- Oct
(Print or Type)
0�
QOP_T,�l Noobvcz —.Mass. Date NOL) /q,,Z00)_,, Permit -#—
Building Locatio
L--�'Owner's Name R08YU OCKA RO
K)QtTH
Type of Occupancy 9 Q-1 DCk)TI IQ
New Renovation Replacement Plans Submitted: Yes[] No n
Installing Company Name BAY STATE GAS COMPANY'
Addr6ss 55 MARSTON STREET
LAWRENCEr MA 01840
Business Telephone -68.7-�1105
Name of Ucensed Plumber or Gas Fitter Francis X. Corkery
Check one:
X1 Corporation
El Partnership
D Firm/Co.
Certificate #
1862
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No 0
If you have checked Yes, please Indicate the type coverage by checking the appropriate box
.1
A liability Insurance policy 9 Other type of Indemnity D Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does riot 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:
Sign er or Owner's Agent Ownero Agent 0
I hereby certify that all of the details and information I have submitted (or entered).in Plication are true and acculpte to the best of my
plication
0, V ! -
knowledge and that all Plumbing work and Installations performed under the permit I f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gesnse s.
Type of License:
Title umber Signature of Licensed Plumber or Gas
Gasfitter - -145
Master License Number A
City/Town 9" —
APPP0VEffT0TF_1C_ET_SE_0_N_L_YF— Journeyman
NONE
M1191
Eno
0
Now
long ".. M_
3RDFLOOR
ONE
0
ONO
ENO
on
Isgs
MEMO
IMUM.,
0
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0
01
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MEN
Installing Company Name BAY STATE GAS COMPANY'
Addr6ss 55 MARSTON STREET
LAWRENCEr MA 01840
Business Telephone -68.7-�1105
Name of Ucensed Plumber or Gas Fitter Francis X. Corkery
Check one:
X1 Corporation
El Partnership
D Firm/Co.
Certificate #
1862
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes K No 0
If you have checked Yes, please Indicate the type coverage by checking the appropriate box
.1
A liability Insurance policy 9 Other type of Indemnity D Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does riot 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:
Sign er or Owner's Agent Ownero Agent 0
I hereby certify that all of the details and information I have submitted (or entered).in Plication are true and acculpte to the best of my
plication
0, V ! -
knowledge and that all Plumbing work and Installations performed under the permit I f r this application will n mpliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gesnse s.
Type of License:
Title umber Signature of Licensed Plumber or Gas
Gasfitter - -145
Master License Number A
City/Town 9" —
APPP0VEffT0TF_1C_ET_SE_0_N_L_YF— Journeyman
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