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HomeMy WebLinkAboutMiscellaneous - 32 PALOMINO DRIVE 4/30/2018 f i -°o 901 ddr� THENORFOLX DEDHAMGROUPo August 12, 2014 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 313 Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1478312 Insured: MOHAMAD YAMIN MARYAM SALEHI-ALA YAMIN Address: 32 PALOMINO DR, NORTH ANDOVER, MA Policy No.: D0465547 Loss Date: 08/08/2014 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, William Lamb Claims - Property manager 1-800-688-1825 x1137 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. p Fax:(781)329-1818 95`i3 Date.................................. Ot �aORT►�1ti TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHUS� This certifies that .... ... ..k1 .C11......../.4.Cl Aon Y .............................. has permission to perform 1/...�� .r.k'xt -...... ............................... wiring in the building of...C.!;..�. ,�!i�!!t.��..6k .....` �? .(.!�'`................ '. L! J. ' North Andover,Mass. Fee.....� ....... Lic.No. ././.�./. 1.....'..S..... ........ ELECTRICAL INSPECT Check # I Ll 3 2-- , a Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( C),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /Q /o City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice his or her intention to perform the electrical work described below. Location Street&Number Z f t41A04 wo (7 Owner or Tenant (O Yf)WIA) Telephone No. Owner's Address Is this permit in conjunction with building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building tc - Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: , to RecrSs,y/ L, k ce=z �,A OKrs�aE GFS o.J N€w pore�f Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus addle Fans No.of Total p ) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batte Units No.of Receptacle Outlets 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 No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: I I............ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Dr Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of Devices Equivalent or E valent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Pectrical Work: (When required by municipal policy.) Work to Start: 6/10J/6 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: eic4 eo Signature LIC.NO.: //6/-7 —t3 (If applicable, enter "e empt"in the license number line.) Bus.Tel.No.:A91••ZS"S"2x3-3 Address: f-7 1urigit A/E , (tiAd riga) W-4 deem Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security kork requires Department 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)❑ owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE. $ t� moa y K The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): C qA,2,0 Address: 7 �u'TG-E� Aa City/State/Zip: &U 019VI) Phone #: 7d I -75o1- Z55 3 Are you an employer?Check the appropriate box: Type of project(required): 1.21�,am a employer with4. F1I am a general contractor and I 6. ❑New construction —�* have hired the sub-contractors employees(full and/or pact-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition } working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its j required.] officers have exercised their l0lectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 111-1 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 insurance for my employees. Below is the policy and job site information. Insurance Company Name: 145SOGtfI-i 60AuStn(E S OF moi} Policy#or Self-ins.Lic.#: wCC 6_00t�� &� /0/ Z001 Expiration Date: /0 Job Site Address: 3z PAZ,"two rr/�. City/State/Zip: ',,� t¢n�0o✓ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). i 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. Ido hereby certify ur the pains a penalties ofperjury that the information provided above is true and correct. Si nature: Date: Phone#: S,;T 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#: ,.oa. Town of NORTH ANDOVER O BUILDING PERMIT INSPECTION REPORT t'b6L>S_ PERMIT NO.: � PROJECT: Sla UIC V 0 DATE: 3 ®Z) UNIT NO.: FLOOR: aZ�� WING: BUILDING NO.: 3Z;k kz)f11A- P4- I�u414,o DiZ REMARKS: Excavation-depth and soil conditions Framing- Other: Date: /-`%- ' Date: �`� ' Date: C �/ Inspector /LI� �i�-�--- Inspector ,�1� 6""'- Inspector Footings and foundations and drains- Insulation- Other: Date: /— / - / Date: '3`1 Date: Inspector z4/jA 12— Inspector /�✓� � '- Inspector Electrical-roug! -� - Plumbing and/or gas-rough- Other: ' Z- Z 4>Date: Date: � - Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: y_ 8` Date: ` 7-0/ Date: Inspector tf Inspector Inspector ire Dept- 1il burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: `/- /z- -d/ Date: Inspector /u( Inspector Inspector Form#995 Action Press,685-7000 Date. i` ",0 RT:�� TOWN OF NOR*H-ANDOVER PERMIT FOR PLUMBING • � a .L ,SSACMUSE� This certifies that . . . . :�: has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . '.Az . . . . . . . . . . . . . . . . . . . . at . . . .o .� . . . . . .. North Andover, Mass. Fee. ?. `. . . .Lic. No..`.. . . . . . . . . . . . . ���.. f . . . . . . . . . . . . . PLUMBING INSPECTOR Check'# MASSACHUSETTS UNIFORM APPLICATION FOR-PERMIT TO DO PLUMBING (Print or Typ i . Ma Oat 2 r it # Building Locatio Owner's am 1/4 YYY666 Type of OccupancyOA I-V New❑ Renovation❑ Replacements Plans Submitted: Yes 0 No❑ FIXTURES B.P•4 'SEWER# SEPTIC #' z z Ile to Y �� O ¢z > w Z ¢ Qf U ~ z O z to W O w vz = N v w U- z Z rl � � NYS 0 � � f U zOf ¢ W Q �LLJfZ-. SLL Y W Q Z u_ U = !Z H ] O n Z O Z Z ¢ U 0 W ¢ ¢ O Q O O Q W ¢ O U W 2 M to _ to LL O D Q m 0 O SUB-BSMT BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR nstalling Company Name Check ong: Certificate 4ddress 0 Corporation ❑ Partnership 3usiness Telephone_ � SCJ 1°/=— alw-.r��s���rmlCa. dame of Licensed Plumber or Gas Fitter_ u� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGI-Ch. 142. Yes No . 0 If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity 0 Bond ❑ OWNER'S INSURNACE 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 permlt application waives this requirement. Signature of Owner or Owner's Agent Checkone: 0 Agent 0 hereby certify that all of the details and-information I have submitted entered)in above'appiication are true and accurate to the best of y knowledge and that all plumbing work and installations performe nd r the permit iss for this application will be in compliance with .1 pertinent provisions of the Massachusetts State Plumbing Code4Sina W-i the eraILaws. ByTitle ed l�um��ber APPROVED Type of License: tH aster APPROVED(OFFICE USE ONLY) - OJourneyman License Number i CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number �� Date 'y`a G _'a off/ THIS CERTIFIES THAT THE BUILDING LOCATED ON 1d Z/)0/##-cya Ad 10 407 d D Rl u � MAY BE OCCUPIED AS 5/'n ZA mi k/ !Juice l/l,y (r IN ACCORDANCE IliWITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ly MORTM /"e �!�'I� Ck CERTIFICATE ISSUED TO �U�7- ADDRESS c;25/ 1L,2VAi St, &c--A k,,oL y`j MA ;9�sACHU Building Inspector � NORTIy Town of And o 1 y�•4�•• �r, •tn, moo l0-�L ` 00 A E dover, Mass., ` 0p 2COCKICHEWICK V ORATED S BOARD OF HEALTH PERMIT D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT V... .v I� A ................ ................. ............ ........................................................... Foundation has permission to erect..................../................ build'ngs on +4. ...?4.10. M No.. � Rough to be occupied as-.9.r....0 . a�� ..8 ..... �... .. ��... ..... ,.... ....... �jt Chimney Ch' provided that the person acceptin� this permit shall in every respect conform to the terms of the apple ation on file in Final 7 D this office, and to the provisions of the Codes and By relating to the Inspection, Alteration and Construction of � � Buildings in the Town of North Andover. m ' O t C p 'd a 4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. o� z— _ �� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N S Rough ........... . ........ ... ........... ...................................................... Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fin No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 9, Street No. CO`l SEE REVERSE SIDE Smoke Det. 0- a Town of North Andover & tAORTH q O 1t�eo ,6 �• Building Department �,? h� ^•.'6 °o 27 Charles Street 0 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 � po coc.ncwiw¢. 1• �s,�s`SgCa1i!`����h III APPLICATION FOR CERTIFICATE OF OCCUPANCY/ INSPECTION ADDRESS 32- PA-10k4 7'/x/0 LOT NUMBER. / SUBDIVISION ���b'� �-��✓ DATE REQUEST FILED 7 DATE READY FOR INSPECTION ��- FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION DATE ( b � PLANNING DATE q�2 ,316 D.P.W. —WATER TER S b 4 o D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. 0� KA1.1, SIGNATURE/ W THORIZATION Date.... N 0 '-"q f NORTH'1 (- TOWN OF NORTH ANDOVER PERMIT FOR WIRING o -T.o Ac u This certifies that ........ ...... has permission to perform .... .......... wiring in the building of........6�.z/ ...... ............................ 1 9 ... .. At -.7.....� ......el.L./..9.(A. .......J/? North Andover, a s 4 Fee:WA--./ Lic.No.Z.6-"N%;z�, ... ...... ... Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts ,_/!� r.rmn No. �" ! Department of Public Safety °ccu"ftcy & t.. ch-'CLO.t 3/90 (ie.vr et.n4► BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W All work to be performed In accordance with the Matcachusetts Electrical Code, 527 CMR 12:00 WORK (PLEASE.PRINT IN INK ORPE IIfFORRATION) Date City or Toon of 640(1� To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number)--le Z QA 1 `d /A Q11 S ,e I T / Owner or Tenant, /L� / �, •C� 61lia Z_ Owner's Address 2 Is thispermit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. /Q Q 0,/ Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service <�_Amps_/Z-� / eC� Volts Overhead ❑ Undgrd No. of Metes Number of Feeders and Ampacity �? A110 E� r Location and Nature of Proposed Electrical Work No. of Lighting Outlets z` No. of Hot Iubs No. of Transformers Total No. of Lighting Fixtures Above ❑ In- KVA = Swimming Pool � grnd. grnd, ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting 3 No. of Switch Outlets BatteryUnits a No. of Gas Burners FIRE ALARMS No, of Zones o No. of Ranges No. of Air Cond, Total No, of Detection and I tons Initiating Devices m No. of Disposals Neat Total Total _JTons KW W No. of p� s No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KWLocal❑ Municipal c Co ❑Other 4LL No. of Water Heaters KW No of Low Voltage nnection Sims Ballasts Wiring O No. Hydro Massage Iubs No. of Motors Total HP OIHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy includingCompleted equivalent. YES NO I p ted Operations Coverage or ® ❑ have submitted valid proof of same to this office. BYES®itssubstantialIf you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S z"-'QC)o ®-- Expiration ate workto Start WILL CALL Inspection Date Requested: Rough g Final Signed under the penalties of perjury: FIRM NAME__JAMES E. BUCHANAN ELECTRIC INC. Licensee JAMES E. BUCHANAN knthe LIC, No.A15616 SignatureLIC. NO. E32062 Address P.O. BOR 544 SUTTON MA 01590us. Tel. No. 5U8-865-3335OWNER'S INSURANCE WAIVER: I am aware that the Licenseinsurance coverage or its sub- stantial equivalent as required by Massachusetts Generr my si n application waives this requirement. Y atu t. 8 re on q Owner A this permit Agent (Please check one) P it Signature Ot Owneror Agent Telephone No. PERMIT FEE S��� JAN-0�-2081 02:09 PM HARCHIONDA&ASSOCIATES 781 438 9634 P•02 —I_nANSvllAN+oGQ I— 1 iaoersrSYE W. 3'' NOt3'27'S3`[ 7/.lb' o� d� 5S.g' Na 69.T W LOT 4A t imS B.F. 0.21 Ac. LOT 3A 11410 S.P. N 0.27 As. -' ao 00A I A t �- r TOP El-EVAO P!0 32 ,� �P �? a 18.2' 270' 31.2' `i+pg8,��sga LaiQ$,33' Itr375.0� 4 s18�3•pg 8.375.W P RLQt�1 t N 0 . D R I B/F- c MMAHEAI M. No. -o P WE HEREBY CERTIFY THAT WE HAVE EXAMINED THIS PLAN IS INTENDED FOR ZONING THE LD E PREMISES AND THAT THE BUILDING 15 LOCATED AS SHOWN. THE STRUCTURE SHOtNN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U_D. FI-000 INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY, THIS PLAN COMMUNITY PANEL NO. 250098 0018 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/1993 , THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED FOUNDATION PLAN LOT 3A FOREST VIEW ESTATES MARCHIONDA & ASSOC. ,L.P. NORTH ANDOVER, MA ENGINEERINO AND PLANNING CONSULTANTS PREPARED FOR :. PULTE HOME CORP. OF NEW ENGLAND 82 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 257 TURNPIKE ROAD SUITE 200 (781) 438-6121 SOUTHBOROUGH, MASSACHUSETTS 01721 SCALE:1"=30' DATE: 1/05/01 MAR-14-2001 04 : 14 PM MARCHIONDA&ASSOCIATES 781 438 9654 P. 03 Marchionda & Assoclates, LP. Engineering and Planning Coneultents March 14,2001 O Ms. Heidi Griffin North Andover Planning Board 27 Charles Street North Andover,MA �Lot orest View Estates ! Dear Heidi: i The grading and landscaping for the above referenced lot has been completed and is in confi)rmance with the intent of the Definitive Plan Approval and subsequent ! Modification to the Definitive Plan Approval dated 1/31/00. I Should you require additional information, please do not hesitate to call. Very Truly Yours MARCHIONDA &ASSOCTATES,L.P. r Michael J. Rosati Project Manager I 62 Montvale Avenue Tel: (781)438-8111 Suite I Fax: (761)436-9854 website:http://www.marGhionda.com Stoneham,MA 02180 Email:mall@marchlohde.com Date. t" "°RTti, TOWN OF NORTH ANDOVER ,► PERMIT FOR PLUMBING SSACMUSE� This certifies that . . . 2 �-- has permission to perform . . . . . r (, . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .Y P.'�? '. .`. . . . . . . . . . . . . . . . . . . . at . . . �. H. . .`.. ` . . . . . . . . . . . . . . North Andover, Mass. Fee. . . . . .Lic. No.�?G.`! U!. . . . P UMBING INSPECTOR Check # t C 649 MASSACHUSETTS UNIFOR /API ATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOV MASSACHUSETTS Date L Building Location 04ers NaAI N Permit UY g Amount Type of ccu•anc New ® Renovation Replacemej F1 Plans Submitted Yes No FIXTURES E-H CIO CC cc 06 Cn 7-54 W W O w a �RSMC RASEMRI r s M FLOOR 2M FLOOR 3M FLOCR 4IH FLOQ2 SIH It" 6M FLOOR 7M ROOK SIH FLOOR (Print or type) / Check one: Certificate Installing Co anY Corp..e AdAr' 1 1.4El Partner. Busi T p one L Firm/Co. Name of Licensed Plumber: atop, r U Insurance Coverage: Indicate dik,4ype of surance coverage by checking the appropriate box: Liability insurance policyOther type of indemnity El Bond ❑ 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 El 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 wo4a 'nst ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the s State umbing Code and Chapter 142 of the General Laws. By: e o icensea FlumDer Type of Plumbing License Title C City/Town License 114UMDer Master Journeyman ❑ APPROVED(OFFICE USE ONLY. 7 I / Date...../../.. .. 5 ... �. "a0 TOWN OF NORTH ANDOVER AL p PERMIT FOR WIRING ��sS�cNUSE� ..Q Q ... kG This certifies that ..... A !........bu. .� . ..V1 ..................................... has permission to perform ....... s ew*v ,r " wiring in the building of..... ..................... .. ............................................. t at - P0.l t1✓' t5,. � _ .....:................................... ..... . ....�T............. , � rth Andover,Mass. Fee...��. .:d�... Lic.No..//...��rOf.................... �-�. .....�0............ EL RICAL INSPECTOR Check # _ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer .� The C01711110»wealth o A10.3saciltusetts r...,tr N. Ucportment of Public Safety ckr"na n 3/90 ..r Sri 80ARD OF Fill'! PREVENTION REGULATIONS 527 CMR 12-00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed In Accord.,,,, with the Maecachucetrs Electrical Code. 527 CMR 12:00 All (PLEASE PRlirr 111 INK OR TYPE ALL Ii1FORIIA"171011) City or Toon of `d Date The undersigned applies N A oV CZ _ To the Inspector of Wires. for a permit torrfo F rn the electrical work described below. Lo ca [ion (Street S Number) O-ner or Tenant Overt er's Address ---------- Is this per-mit in conjunctiowith a bu lding permit: (� Ycs 11 Ho L_� (Check Appropriate Box) Purpose of Building- :T"- 3 uildin � g -----__ Utility Authorization No. pGg _ 13Z Existing Service -- Volts Overhead ❑ en ServiAmps ce Undgrd lilJ ilo. of Ate 2 a L J tees --- _Volts / ---- Overhead ❑ Undo RL- Number Nn. of tsete-s. / <, of Feeders and Ampacl.ty � ----/ i�catf.on and filature of Proposed Electrical work No, of Lighting Outlets �_ 110, of Hot Iubs No, of Lighting Fixtures No. of Transformers Total i Swimming pool Above In_ KvA ` No. of Receptacle Outlets $end. ❑ grnd. ❑ Generators ` KVA iio, of Oil Burners No. of Emcrger-'ry-1.iF-hting 3 No. of Switch Outlets Battery Units No. of Gas Burners A FIRE AIM11S 170• of Tones o No. of Ranges Total z No. of Air Cond. No. of Detection and 110. of Disposals Heat Total tons OTota1 Initiating Devices w 110. o f pumps --- - -- D Tons KW t1o. of Sounding Devices No, of Dishwashers / tt Space/Area 1leating No, of Self Contained �- "�* - No. of Dryers Detection/Sounding Devices Heating D7;m; KW Local ❑ ihtnicipal a No, of Connection❑Other n No. of Water Heaters KW � o Si nssts Low Voltage o No. Hydro Massage Tubs WtrinR No. of Rotors Total IIP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of itassachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES® NO[J I have submitted valid proof of same to this office. YES LA No you have checked YtS, please indicate the type of coverage by checking the a `1717 p INSURANCE 91 BOND ElOIHER appropriate box. ❑ (Please Specify) Estimated Value of Electrical Work S -,5dC> —(Expiration ate Work to Start ( 1 W1.1.1. (;/ALL �� Inspection Date Requested: Rough Signed under the penalties of perjury: Final FIRM NAME--JAMES E. BUCHANAN ELECTRIC INC. Licensee JAMES E. BUC[IANAN LIC. HO.A15616 Address P.O. BOX 544 Signature SUTTON MA 01590 Bus. Tel. N0 _LIC. NO._E32062 OWNER'S INSURANCE WAIVER: X08-865-3335 I am aware that the Licensee doe of have Alit. Tel. No. contra e stantia2 equivalent as required by Hassachuse[ts General s, and that m Signature Application naives this requirement. Owner Agent g- or its sub( ease check one) g on this permit Signature of Owner or Agents Te.le1'hone N0, No i TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACHUS� This certifies that . . ./1 -7 . '. .': ... • t. • ::•��•� • • • • • . • . . • . h,-s permission to perform . . . .i� (Y . . . . . . . . . . . . . . plumbing in the buildings of . . ./.�.4 . . ! . � . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . ... .. North Andover, Mass. Fee. ?. Lic. No.. . . . . . . . . . . . . . . . .'> . L._. . . . . -. . . . . . . ,PLUMBING INSPECTOR i Check # WHITE: Applicant CANARY: Building Dept_ PINK: Treasurer 3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO.DO PLUMBING (Print or Type) - /.71 Mass. Date Permit# / L��. � �—- 2 rgGt3N(�n10 R. 1) Building Location-3 (1.0?4.4 l Owner's Name I6F.CJT7q Type of Occupancy New Renovation ❑ Replacer,ent Plans Submitted Yes X1 No ❑ FEATURES z ? v> cn to z zw w Z to = < z 0 z z z 4 OJ N w Co _ M w Y cC a Cry a cC O U E Co = rn w } �" cn z o cn z 0 w = O 2 0 z = 3 Y a� O ~ z z to�i w o U i c > Q v=i o a 0 z O Ow a cc cc a Q O c Y m cn o o _ ►- cn w 0 o ¢ 3 Cr m O SUB-BSMT. BASEMENT J IST FLOOR �. r 2ND FLOOR 2, JAI I ZI I 3RD FLOOR 4TH FLOOR Y 5TH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR r Installing Company Name F9A2169 f' &JE4[.5 NCoifi _)1e.4 Check one: Certificate Address P U 160 X sg Ge"Corporation 2 19 Cj C /q'-17)o_-'o � �l£3`l� ❑ Partnership Business Telephone 978' 89-7 /7-/ ❑ Firm/Co. Name of Licensed Plumber ( HA1 £S /'OA10S INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes ❑ No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNERS 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 ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) In above.application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature or LIcenseo Plumber Title Type of License: Master Journeyman ❑ CityrTown License Number APPROVED OFFICE USE ONLY)