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2012 Massachusetts Electrical Code Amendments 527 CMR 12-00 § Rule 8: in accordance -with the provisions of M.G.L. c. 143, 3L, the
CS11-, pern-iit application form to provide notice of installation of wiring sh . all be uniform throughout the Commonwealth, and applications shall be filed'
on the prescribed form. After a permit application has been accepted by an Inspector of Wires apbointed pursuant to M. 01 c. 166, § 32, aa
electrical permit shall be issued to the person, firm Or corporation stated on the permit application. Such entity shall be responsible for the
notification. of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of ongoing construction activity, and maybedeemed-by-theJnspector-of-W-ires abandoned-aadduxalid.Mc—
or she, has determined tli�t the authorized worl� has not commenced or has not progressed during the preceding 12 -month period. Uponwritten
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the. permit application.
Th e Permit Extension Act was created by Section 173 of Ch a VLer 240 of the Acts of 2010 and extended by S c4ons.74 and 75 of Chapter 23 8 of
the Acts of 2012. The purpose. of this act is to promote-j&growth and long-term economic recovery and the Permit Extension Act finthers this
purpose by establishing an automatic four-year extension to certain -permits wd licenses concerning the.use, or development ofreal property. With
limited exceptions, the Act automatically extends, for four years beyond its other'Wise applicable expiration date, any permit or approval that was
"in effect or existence' during the qu'alif3dng period beginning on August 15,2608
-and extendingthrough August 15, 2012.
9,R,ule 8 — PermittRate Closed: No - Reapply for new perdlyig,
�1�ermit Extension Act — PermitfDate Closed—�5----"—��'—"/"'
d
Date ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........
.............................................
has permission to perform ......... &�� ..........................................
wiring in the building of ....... Aa !� 0 .................................................
at ........ & jq LV.//Z*/`; X .... & ................ . North Andover, Mass.
Fee.�� .... Lic. No.42 .4 ...... //
k�,N P
)Check 4
85 1 2
A
-C-\ Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. 02 / 2 -
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICALWORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 52tCMk 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMA TIOA9 Date:
CityorTownof. n6f'J�\ fW\00Ve-R- Tothe
By this application the undersigned gives notice of his or her intention to perform
Location (Street& Number)
J i
Owner or Tenant �-� \ �-R C
Owner's Address
of Wires:
work described below.
Telephone No.
Is this permit in conjunction with a building permit? Yes No [:] (Check Appropriate Box)
Purpose of Building C,.� i r, kl,\,- C) wen Utility Authorization No.
Existing Service Amps Volts OverheadE] Undgrd 0 No. of Meters
New Service Amps Volts Overhead [:] Undgrd [:] No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion ofthefollowing table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
H
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers K -VA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above Ei In-
Swimming Pool grnd. grnd. E]
No. of Emergency Lighting
Ba-fteEy Units
No. of Receptacle Outlets Z
No. of Oil Burners
FIRE ALARMS
I No. 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:
Nu-mber
...................... .
I Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal -
Local [:1 Connection 0 Other
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of 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 i(desired, or as required by the Inspector of Wires.
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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE t!!� BOND El OTHERE] (Specify:)
IcerWfy, underthepains andpenalfies ofperjury, that the informadon on this applicadon is true andcomplete.
FIRMNAME: LIC. NOA 3,OS-&-p
Licensee: Signature LIC. NO.:E-39 O'��
(If applicable, enter "exempt" in the license number line. Bus. Tel. No.:-n2l.a3.4 - f -:57'7
ILI_ Grel EA.0,
t f7k
Address: Z 0\90co Aft. Tel. No.: PD/ LH 01
*Security System Contractor License required for this woirk; if 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 ft6reby waive this requirement. I am the (check one)EJ owner F1 owner's t
Owner/Agent
Signature Telephone No._ PERMIT FEE: $
--69-el A--(-
w
'No
Date
+0 TOWN OF NORTH ANDOVER
oz -
0 0
% PERMIT FOjF(PLUMBING.
CHUS
This certifies that ....................
has permission to perform .... 7k�C A,.v -� /,,,bc. % ..................
plumbing in the buildings of ... 1-7cpAt�a .� fe .................
at. . 3 �-?. 13 i� �' i�, A, . /—.� ....... I ........ North Andover, Mass.
Fee.'�.? — Lie. No. . ....
..........
PLUM13ING CSPECTOR
Check # � 1-1 ? 1)
7928
-1�4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
I Date 1C)
Building Location P7114"kl n, Narrieie�'Ku 10 Permit LT
Type of Occupancy Amount
New Renovation Replacrment' El Plans Submitted Yes No
0
FDff UPEs
3 �16
all
I so,
so,
al.
so,
L-WALF-91 A
(Print or type)
Installing, Company Name
&eeAl
4,� /I
Check one: Certificate
Address 0 A/-)
Corp.
Partner.
Business'l elephone
0—Firm/Co.
Name of Licensed Plumber:
.L' "C' A'4
Insurance CoveragE. Indicate the type of insurinc
Lability insurance policy M---�':
werage b y ';"ec=g the appropriate box:
Other type of indeniTlity
ri
Bond ri
Insurance Waiver.. I, the undersigned, have been made aware that the licensee of this application
three insurance does not have any one of the, above
Signature owner
Ih El Agent F1
ereby certify that all of the details and information I have submitted
best of my knowledge and that all plumbing work (or entered) in above application are true and accurate to the
and insta).,Ula', Pe P 't Issued for this application Will be in
R r�
tts on n u V� Ch te 142 of the General Laws.
compliance with all pertinent provisions of the Mass s6t ita�5 Ibi der
rBy:
71-g-n4afttlre 01 I-Tftns um Er
Title T �Plurnbi!712 License
City/Town Z/
APPROVED (omcE usF ONLY 1-1cense Numue—r Master Journeyman
�Location 212
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 2
Foundation Permit Fee $
. Other Permit Fee
Sewer Connection Fee
Water Connection Fee $ -------
TOTAI $
Building Inspector(
VA
6254 Div. Public Works
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I FORM U - IA)T 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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
L,-IPPLICANT: x�! PhoneU T7 -:)R 3 _37
Map Number"'
tl��ATION: Assessor's \ Parcel
Subdivision Lot (s)
Street St. Number
************************official Use only************************
RECO14MENDATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
Fo d Inspe6tor-Health
Septic Inspector -Health
Comments
.Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
JUL - T
E r, 1 -DING DEPVT
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William F. Weld
Governor
Daniel S. Greenbaum
Commissioner
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
P.irtment of
Environmental Protection
Metro Boston/Northeast Regional Off ice
North Andover Board of Health
120 Main Street
North Andover, MA 01845
and
Dean Koulouris
I
I U, *1 -1 'D 14
April 21, 1993
RE: NORTH ANDOVER - BRP WP02
Variance Request -
310 CMR 15.03:(7)
Repair of Subsurface System
30 Bruin Hill Road
North Andover, MA 01845 DEP Transmittal #64 -7-0.
Dear Board of Health and Applic ant:
The Metropolitan Boston/ Northeast Regional Off ice, of the
Department of Environmental Protection, Division of Water Pollution
Control, has received and reviewed your application for approval of
a sanitary sewage variance pursuant to 310 CMR 15.20 with the above
transmittal number.
The application contained a written notification dated March
9, 1993, stating that the North Andover Board of Health granted
variances to the provisions of: 310 CMR 15.03(7): (Distance to a
Leach Area from Slab Foundation) of Title 5 of the State
Environmental Code. Accompanying the application was a plan
consisting of two sheet(s), titled as follows:
Title: Proposed Subsurface Sewage Disposal System
Location: 30 Bruin Hill Road
Municipality: North Andover, MA 01845
Applicant: Dean Koulouris
P.E. or R.S.: Steven Eriksen R.S. #886
Date (Revisions): December 28, 1992
10 Commerce Way Woburn, Massachusetts 01801 * FAX (617) 935-6393 * Telephone (617) 935-2160
North Andover Board of Health
Page -2-
An engineer of the Department has reviewed the plans and the
accompanying data, and it is the opinion of the Department that the
plans are in compliance except for the following provisions of
Title 5: 310 CMR 15.03(7): Distance to a leach area from a slab
foundation. 10 feet required 5 feet allowed, due to the
construction of a garage.
It is the opinion of the Department that the requirements for
the granting of a variance(s) as specified at 310 CMR 15.20 have
been satisfied. The enforcement of the provision of the Code from
which a variance is being sought would do manifest injustice and
that the applicant has proved to the Department's satisfaction
that the same degree of environmental protection required under
Title 5 can be achieved without strict application of the subject
provision. The Department hereby approves the variances as granted
by the Board of Health.
It is your responsibility to assure that the approved plan is
available at the site during construction.
If additional informati
(617) 935-2160. 1
Ei
is required, contact Bob Ross at
uly our
Ve3zy tr z: s,
ZSabin M. Lord, Jr.
Regional Engineer for
Resource Protection
SML/BR/bc
cc:- DEP/DWPC, 1 Winter St., Boston, MA
- Kevin Mahoney, Programmer, NERO
- Steven Eriksen, 3 Pondview Place,
Attn: Steven Eriksen
02108 - Attn: Bryant Firmin
Tyngsboro, MA 01879
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CERTIFICATE OF USE & OCCUPANCY
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Building Permit Number 70/92
0
Date August 10, 1992
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 30 Bruin Hill Road
MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
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CERTIFICATE ISSUED TO
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