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Miscellaneous - 33 RIDGE WAY 4/30/2018
i Location 3i O G�uJA�" No. `.� "�} 8 Date M TOWN OF NORTH ANDOVER SP 3°6�,�.o ,��ti°° ° � p Certificate of Occupancy $' * Building/Frame Permit Fee $ ,SSA�MUst� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ IZ'gC1 Building Inspector 7774 Div. Public Works Location No. L`) Date l�1 N°"r)jTOWN OF NORTH ANDOVER p Certificate of Occupancy $ °s Building/Frame Permit Fee $ Foundation Permit Fee $ QQ ��cHus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Sb Building Inspector �,� Div. Public Works Location No. 1 Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ — Building/Frame Permit Fee $ 'Ss�cMusts Foundation Permit Fee $ j Other Permit Fee $ --, i� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Buildiq�ln Div. 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No. 34482 O FOUNDATION AS -BUILT == AT I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED LOT /7 ON THE LOT AS SHOWN ON THIS PLAN AND THE NORTH ANDOVER HEIGHTS LOCATION DOES CONFORM WITH THE FRONT, SIDE, NORTH ANDOVER, )LA AND REAR SETBACK REQUIREMENTS SET FORTH IN rwan Alk THE TOWN'S ZONING BYLAWS AT THE 11ME OF TOLL BROTHERS, INC. CONSTRUCTION. I FURTHER CERTIFY THAT THE 1800 ASST PARK DRIVE STRUCTURE IS NOT LOCATED IN THE SPECIAL WOMR0. HA 01581 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT AND P PLANNING LANDXNGnnaP TO BE USED FOR THE ESTABLISHMENT OF PROPERTY � strxvs�r LINES, ERECTION OF FENCES, OR CONSTRUCTION OF ADDITIONAL STRUCTURES ON THE LOT. W7 R&VMO Aor+vIL UUMEAK w 0M9 (WO) gee -+10 FAZ (00) see -6064 MAP NO.000cDc COM N0.250096 DATE: 6 -2-93 IZ-Zl _ r " - 4o cr ON P i Cd w O a -mooco w U)' ��-, cn cz o O z G w° E U x W O �-'+ a°' w a a u V "a ono a°' cn ii a O U w a°' i% z � w A W W ° z cn Q U) 31� z , W Ili m CD v3 W: CD LZ C � �a.. •e 0 -c �m �a cc NCO WC7 LAJ OC c o a N VE= CD CD a CM me M a. E a c y N O' c O Co� .v m 1zz o cm aCa S C13 O V N O O c cc -D2 '02 CDd x m V��-4�} m_... p N ~ y m +p.. H O . V2 ev = m LU M:s . h CL= c Z oc �E C3 .0 � N o LU CD COD C' m� O� = W ` y•�" O F- = w CL m :IN `O 4 443 0 ON CD O E CD L O CDo Z a O y G C ICD Ccm ca C y O �O 'E m m CD ow CD a O i CD O G O 00. y C .0 O C R v J .O ca C Z co V y C ca C CD 0 J z LL F� 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 landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: kws; h4+ua I n—caS kl.,A&/6 'b4 QPhone LOCATION: Assessor's Map Number Parcel Subdivision NbrL*l 6lIJ:Q 1J �Z ALZG t S Lot (s) Street St. Number ************************Official Use Only************************ RECOMMENDATI NS OF TOWN A4-ENTS: Z&n&Z� '�C� Conservation Administrator Comments Date Approved /1 2 - Date Rejected 0 V, P _ Date Approved Vx \ (I Town Planner Date Rejected Comments Food Inspector -Health `,moo � Septic Inspector -Health Date Approved Date Rejected Date Approved lam„ Date Rejected Comments nr-� To 10 , ---S e(") C, r Public Works - sewer/water connections W tZ - I" 014 - driveway permit 7--l-(.t) L -Z- I -- Fire Department .4tj U kt-&'�r:Tb1^f Itr�ile�Tac�l /y/�c� o44,,w cz,d/T,-j 64/140 /, (1rl� Received by Building Inspector Date e 6 , , r of WORX LIA✓if w/ Hq yeHct': Aa t��\ Pic �N Sk \� a elm • 'I ` � �� � god �` _-. `r` �� ov • � � \ -. ""��\ � a mom` � ir LOT /8 1� 34b \ \ TID 0. llub `M Of �r�9E�K '� ' . �\ \kms \ \ � LO T air HLLic <; pvx i0R /I-/- Ai �t'I. c�,p• ` NOTE: ALL UTILITY LOCATIONS ARE TO 8E FIELD VERIFIED EY THE GRADING / SrM PUN SITE CONTRACTOR. LoCAM a LO / 7 EA rD�� Ft oER� G NORTH ANDOVER Wftl" H rS. NORTH ANDOVER, ALA ndru® >plt LAND PLANNING TOLL BROTHERS, INC. ENGINEERING do SURVEY 1400 WEST PARC DRIVE ---' WMTHORO, KA 01581. le 7 hkl .: i :•'.i 1� i : i, $E" �`� .`;/.:; ILA OZ^314 (508) 486-4130 FAX (506) 488-505. i2 - / —91 / ¢v' ivA H-��(s�r� INI 0- i W W cd � oa v , x z �� : A ,� \ a. CAO aG c i a 'o eA M � Cq 'D � � � . P h a w cn 3. ° ° �. cY�w' Wo °' w nEn j uml 7 Oam z W m 0Cr Ci' o Z el �• ac �m `mc�� 0 CF y� w� • �a �W w y 'CWL O mcm e coCL.. N 1 CD 0 cc** H Cc m J % 1 m = c �l N A W: • = h a� �0o C Ca dCt 0 60, y O � �2 O O ..� CdO FR m M m C a m ('/4� m z 3 r N O r0+ Lu y CL �-off 1 = coo ` y'_ z So.4m 0 v N S� orG m 61 .� C t, z�s O co N ~ LU co 0 Q c � _ z I CD CM LU CO) Q Q ai .= w y O O 'E m m z > CCO CD L) o CL CD O � CL-) CD Q 0 O d CL ca �Q Ccc Q A2 .Q O J CO3 Z CD z CL V y c LU ccf--' _ Q CD COD z_ Q z � LU 15 a_ CU/) i' (M Z a CL L C. O� o a w D O LL. Z o y - w0 a� 00 [z H w C.) z v' w O U 4A_ � z A m Oop,� F F � W H � O W a 0406, 00 E" CAI w 0 wZ H d- q � 0 0 6. CD H �F Z� U E q �� Z a a Oda C�o � xx 75 im k Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..................... has permission to perform ........................................ plumbing in the buildings of ............................... . at ........ ............... ........ North Andover, Mass. Fee.......... Lic. No ........... ...... ........... PLUMBING INSPECTOR Check # FIXTURES UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING tMASSACHUSETTS City/Town: Y&4y� MA. Date: a Permit# �� 7 Building Location: %3 Aiac.0 L/44 Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: d Plans Submitted: Yes ❑ No 5]11' FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes eNo ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A 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 , Siqnature of Owner or Owner's Aoent Owner ❑ _ Agent [:1 I hereby certify that all of the details and information I have submitted (or entered) regarding this n aretrue and accurate to the best of my Knowledge and that all plumbing work and installations performed under the ermit Issued fo is a�,I�catl ion will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapteyl4ft of the Gen I Laws. By Type of License: Title ❑ Plumber =umbv of Li n aPPluumber Cityrrown ElMaster APPRnvr-n lnFCICC I ICC ANI of ❑Journeyman z z rn Y y >- J 0 V x ly— W V) z� a z z_ la- o� rn a a N 0 W z_ _ N x O m N z Q a a W F- N I- �- w N Y rn N (7 0 a X a Q � Q Y= w 0 p I- z x z O z N w N z U LL 19 o: W z y y° 0 a LL 3 Ox a Y a= R a w w a a ammooLL�xYSgWU)U) a a a 0~ 00 ° Q 5 X 0 SUB BSMT. BASEMENT -i 'FLOOR 2 FLOOR -S 'FLOOR 4 FLOOR _5 'FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: grin � So1'✓1rPS Address: 01 &VZSy Sf- City/Town: S`W`w:A 1orporation ❑ Partnership Business Tel: 6 r6bq- —Fax: ❑ Finn/Company Name of Licensed Plumber:, -t f nh INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes eNo ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A 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 , Siqnature of Owner or Owner's Aoent Owner ❑ _ Agent [:1 I hereby certify that all of the details and information I have submitted (or entered) regarding this n aretrue and accurate to the best of my Knowledge and that all plumbing work and installations performed under the ermit Issued fo is a�,I�catl ion will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapteyl4ft of the Gen I Laws. By Type of License: Title ❑ Plumber =umbv of Li n aPPluumber Cityrrown ElMaster APPRnvr-n lnFCICC I ICC ANI of ❑Journeyman .4 '* cn Z Qr CTS 00 N coo N H ti %T 00O g� o �r 'w U U CQ S J Q W : 0� U) to L ~ Q (9 Z a\z_ N l` E O_ Ln N v U UQ 7 M 0Ln o J U L4 Q Z (' ✓y 17 LL O Z < O iii LU ' .•r���xiii:g v o U o F- W Q) O i"a z 0' (D O N f Q VK W O ml s oj,l Ov r a <:^k_: "•1 S 3 Q W ;s a) W a a` CD \7 00 _ CD OZ Cf) Co < 'O �. O ;�! .. �� S (D a0 N W d _rrv Q. o z Q O) \ � _ W 2 X C7 z m W N LL j<'nw y _" 0 N U J m ,• ..r. mQ ;t V� V Q ¢ 00 CD r..p �, 13 ZQ `` Y Q c Dw 4 4 Din z oc: IM I aZ z U Ln L�IV�"/l ZW q��� ,-;.v Q CL O o ;..) —U WQ J �o ND _ (LWa ;a -- V x LD Z H a cn Z Qr CTS 00 N coo N H ti %T 00O g� o �r 'w U U CQ S J Q W : 0� U) to L ~ Q (9 Z a\z_ N l` E O_ Ln N v U ~�I— M 0Ln o J U L4 Q Z (' Q Q_ 17 LL O Z < O iii v o U o F- W Q) O G� z 0' (D O N f Q N N W O p s oj,l a s z a a` CD H _ CD W U1 < 'O uro .. 1.Z5 �;Uj CL QO CTS 0 N H ti %T �, •if r Z o �t 0 U U CQ S J Q r i.i.rt to a - o x U >- CO F cv ~ o E 7- 7- z ac L4 Q Z (' Q Q_ O 00 < O iii v o U o F- W Q) O G� z 0' (D O N f Q N N W O p s oj,l a s z a a` W a H ri �n ri W U1 a= 'O a yu C\, a `m T S S (D W d _rrv Q. o z Q O) \ � _ W 2 X C7 z m uro .. 1.Z5 �;Uj CL QO CTS Jul 05 06 08:18a N H ti %T �, •if r Z o S W U U CQ S J Q r i.i.rt to a - o x U >- CO F cv ~ o E 7- 7- z ac L4 Q Z (' Q Q_ O uro .. 1.Z5 �;Uj CL QO CL Jul 05 06 08:18a N H ti %T J 3 WHW N Q ce J S W U U CQ S H Ort Q r i.i.rt to o Jul 05 06 08:18a 00 W C Q O U O { U C O CO F cv ~ Z E �Z) Z r,- ° U. O c') Q Q_ on \J U 1 LL CD 0 o 0 rLn v o U o F- W Q) O G� O N N N W O s w C, N. a s z a a` W a ?,d co O O a= O C C d a yu C\, a `m T S a IL .i r W d _rrv Q. o z Q O) \ � _ W 2 X C7 z m W N O y _" 0 N U J m a Q O < O O Y c IM I 2 U L�IV�"/l { AGORA. CERTIFICATE OF LIABILITY INSURANCE DATE 07/06/200711339 PRODUCER (800) 225-1865 , Fred C. Church StreetHOLDER. 41 WellmanALTER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THIS CERTIFICATE DOES NOT AMEND, EXTEND OR THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lowell, 01851 POLICY EFFECTIVE ' 800-225-1865 INSURERS AFFORDING COVERAGE NAIC # INSURED Pann Home Services Corporation 207 Prospect Street INSURER A: Hartford Fire Insurance Company 19682 INSURER B: Lexington insurance Company 6763067 Cambridge, MA 02139 INSURERC: EACH OCCURRENCE $1,000,000 PREMISES JEaoccurenoe $ 50,000 INSURER D: INSURER E: GENERAL AGGREGATE $ 2,000,000 COVERAULb THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRDO' - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRATION DATE LIMITS LT B IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR 6763067 3/17/2007 3/17/2008 EACH OCCURRENCE $1,000,000 PREMISES JEaoccurenoe $ 50,000 MED EXP (Anyone person) $ PERSONAL BADV INJURY $ 1,0001000' GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/op AGG $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER, POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,000 (Ea accident) ANY AUTO A X X X ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON -OWNED AUTOS 08MCPUF8021 7/1/2007 7/1!2008 BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTYDAMAGE $ (Per accident) . GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY OCCUR FICLAIMS MADE 6760898 3/17/2007 3/17/2008 EACH OCCURRENCE $ 2,000,00U AGGREGATE $ 2,000,000 $ $ DEDUCTIBLE $ X BY WC STA SUS OTH- A X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? NO 1I yes, describe under SPECIAL PROVISIONS below 08WENL8443 7/1/2007 7/1/2(lOR E.L. EACH ACCIDENT $ 500,000 E.L. 0 ISEASE.EAEMPLOYEd $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER CERTIFICATE HOLUETt^••���•^• �^ - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE.:" anon rnPvnRATIf% 19RH ACORD 25 (2001/08) Client # 3042 Mst # U / WC Auto GL Umn Cert 4 certificate "' THE ROBERT L. PANN COMPANY . i Air Conditioning Carpentry Duct Cleaning Electrical Heating Home Automation Plumbing Remodeling Telecommunications Water Filtration Lic. 8626 Const. CS032952 Elect. Al 6799 OF see lip III Il Ike Verlill Yellow Pill: www,robertlpannxc m The Robert L. Pann Company, Inc. Corporate Offices 207 Prospect St. Cambridge, MA 02139 FAX: 617-8684339 PHONE: 617-864-2625 EMAIL: info@robertlpann.com www.robertlpann.com i jo= We don't just tall: about service. We guarantee it. As seen on TV and beard on tie radio Ills", -13 T9 1�,� ", — M Date .. . ,"........ `..... . pi ,.to ,s a pL TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ............................................... has permission for gas installation ........................... . in the buildings of ...... ....................................... at ................... .............. , North Andover, Mass. Fee...::.... Lic. NO......:.... GAS INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �'�{y- N AnAy •r ,Mass. Date q116 200 Permit # Q 9 Building Location -93 ; J4p bfAv Owner's Name -S�jh Owner Tel# Type of Occupancy Resid-colC New ❑ Renovation ❑ Replacement V Plan Submitted: Yes ❑ No I FIXTURES Installing Company Name RM Check one: Certificate Address 907 Nped- S*-• dCorporation 9W (S,Ae. J ,e All CM35 ❑ Partnership Business Telephone # ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Z, r1 Rnv) INSURANCE COVERAGE: I have a curren lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked y�s, please indicate the type coverage by checking the appropriate box. A liability insurance policy 1, 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agen� Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) knowledge and that all plumbing work and installations performed under the permit pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the/ By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: • -Plumber • -Gas fitter • Waster • -Journeyman trueaccurate to the best of my nyffl be in compliance with all $igmdtue of Licened umber or Gas Fitter License Number (1, /b 1 Date .....- / Q- 4 6 °ft"`° '•1"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that��_ . �= �%d'1��1 �.............................. has permission to perform .......... ..... ......... .................... ... ....... wiring in the building of .......... wl............................................................ ........................ , North Andover, Mass. - dd Fee.... 5.. ` Lic. No.3.©,a 5'.s- ......... . ............................ ..... 7UcniCAL INSPECTORf Check # J ? by 6 7 1 i, N Commonwealth of Massachusetts Oficial Use Only Permit No. (0 � ` OHM 7 �.� 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 12.00 .1 10 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: �ill�dde,L To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3S /e, Owner or Tenant s�, h Telephone No. Owner's Address SI -s -s -t -,c- Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 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: fO LK ✓ C AC, 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 [i In- rnd. rnd. El o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. 3 of Gas Burners No. o 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. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Munic'pal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. 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: `44 v (When required by municipal policy.) Work to Start: '7 /D —0,i1r, 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 X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjury, that the infornJadup on this appli ation is true an complete. FIRM NAME: �✓L- -e�o✓h C. NO.: L�JI o.2 Licensee: o,�,.� !�p/l,• Signatur LIC. NO.: (Ifapplicable, enter "eze pt" in th license u ber ' e.) // 40, us. Tel. No. -43 ZS -45W- 17114 %� O a tel" 43d-7% Alt. Tel. No.to"e T ZEL 16P *Security System Contractor License required i6Kthis work; 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 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSS...., 1st _ 6 _!� This certifies that . 1146t. ,d4�. A. ( Inti!" .:.. • • • • .. . has permission to perform l.t"�Q111tr �• plumbing in the buildings of ..7r1, —• • • • at ..... 0Q... U X577 .�^!.'' ........ , North Andover, Mass. Fee. Lic. No .......... ........................ . PLUMBING INSPECTOR Check -�--'—�- 703 . (Print or type) _ Check one: Certificate Installing Company Name n ' ✓ C_ 0 -corp. Address Partner. r��i C r� % Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicatet hetyVof insurance coverage by checking the appropriate box: Liability insurance policy � �/ Other type of indemnity ElBond El 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 I Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 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 Massachusett , Plum Chante 42 ofthe General Laws. Y: Title City/Town APPROVED (OFFICE USE ONLY "ype of Plumbing License icense iNumDer MasterEr Journeyman N . . MMM M ........... MMM ....=MM -..-■ MMM MM MM MM / / . • ..- ..-.�....-.......--� .. • MMM .M ................-..-■ • ........................-■ • ..........mmm- �-�---� 1 1.• mmmm�.=-�=.. MMM .----.■ - o • .......................--■ • S ....................-.--■ (Print or type) _ Check one: Certificate Installing Company Name n ' ✓ C_ 0 -corp. Address Partner. r��i C r� % Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicatet hetyVof insurance coverage by checking the appropriate box: Liability insurance policy � �/ Other type of indemnity ElBond El 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 I Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 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 Massachusett , Plum Chante 42 ofthe General Laws. Y: Title City/Town APPROVED (OFFICE USE ONLY "ype of Plumbing License icense iNumDer MasterEr Journeyman Date.:.. y` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation .�''� ...!�-f%�........... . in the buildings of ...•. ........`!............... . at ....... �.. , North Andover, Mass. Fee&li ..... Lic. No. U GAS INS�e'�T,OR Check # t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Pri r Ty e -Ma) // ss. Date � AOb Permit # Building Location k.4Owner's Name . `c � - Type of Occupancy New ;4 Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES Check one: C�e�rtlfl-7ca�t'e Installing Company Name �✓ fTor�G taw c� S �i Corporation' c.� Address U v ❑ Partnership ti *Qa 13 ❑ FimUCo. Business elephone l`1'"(O� o�bd�5 Namn of 1 irpmPti Ptnmhar INSURANCE COVERAGE: I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesV No ❑ If you have hecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 ' ' sued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing de and Chapt r 142 of the General Laws. By Type of License: Title 110Plumber ❑ Gasfitter City/Town WMaster Zignai4 of Licensed ?974 APPROVED (OFFICE USE ONLY) ❑ Journeyman License Number ■ ■ i ■ _ i ■ - ■ ' ■ i ■ � !f - ■ - ■ - ■ - !! i i ' i ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ • ••-iii■■■■■■■■■■■■■■■■■■■■■�■ ••-■■■■iii■■i■i■■■ii■■■■■■■■■ Check one: C�e�rtlfl-7ca�t'e Installing Company Name �✓ fTor�G taw c� S �i Corporation' c.� Address U v ❑ Partnership ti *Qa 13 ❑ FimUCo. Business elephone l`1'"(O� o�bd�5 Namn of 1 irpmPti Ptnmhar INSURANCE COVERAGE: I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YesV No ❑ If you have hecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 ' ' sued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing de and Chapt r 142 of the General Laws. By Type of License: Title 110Plumber ❑ Gasfitter City/Town WMaster Zignai4 of Licensed ?974 APPROVED (OFFICE USE ONLY) ❑ Journeyman License Number W z O w U D U u., Lr O w O U- 0 J m co Z O U w z_ to U w O w a w w L_ U) w U F - w Y U U z O H U w (L z_ J Q z LL O z U) O Q O F- F- W a w O L_ z O F- U J a CL Q } 0 z_ m LL O w IL F- w R w w r - U. Cl) C7 O w w m a n a w F - z L7 F- w IL rn w Q Q w 0 w a U) z co 6 m k sl .1 numuen UHI,.•Y,;CHfJ' L••I'. 01840385.0 DATE OF BIRTH ' CLASS REST `HEIGHT 'SFX ! 07-22-1850 0 .9"1b ; M EXPIRES 07-22-2008 i PAIN ' MICHAEL S 411 L•EWIS.O GRAY OR SAUGUS;MA 01906-4410 i pp • A ij ✓ite TOomannoozeaea o��/retuGe%C6 1 Board of Building Regulations and Standdrds c HOME IMPROVEMENT CONTRACTOR RegistK tion; 101001 i • ^.. Ezpi,r•atori;_;_B/24/2006 ! 'e==F[ivate Corporation PANN CONTRACTINGF3 Michael Pann 207 Prospect Street;, ^„ Cambridge, MA 02139 `} -'�✓ � Administrator t • i'; ' "ii ✓iie '[O ,Aommr�unea� ........i1... u� • %3 .1 � . 1I o�./�aa6aci ee OE BL�`IoIFfGr t2lJA1'1ON$ I:Iceri e: C�iVST�CIICTfCI�[SUPEkVI$bR Numbeff?S 032952 Biot : es _ 950 I ' 'v p[_ces J27 .07 Tr. no 8823.0 I! IVi;ICH AEL 8 k 411 •LE"--•Wf'S O'G`�KA�;:�,,`Ft- w=- i SAU6-l1S&;''MA 0190 ' Cammisslorter MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t (Print or Type) NORTH ANDOVER Mass. Date Lj _ building Location Permit # _ Owners Name T1/ .00,�G 2� New Re ovation D Replacement �] Plans Submitted =] y FIXTUR':IS (Print or Type) Check one: Certificate Installing Company Name /�/' E/Partner. Corp. Address Firm/Co. Business Telephone: -C/C/&_ Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Edother type of indemnity Q Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 0 Agent 0 1 hereby certify ttut all of the details and information L have submitted (or entered) in above application are true and accurate to the best of my knowledge and tleat all plumbing work and installations petfomted under Permit iuued fo: this application will be in compliance with all perUneni provisions of lho Massachusetts State Cas Code and Qupter 142 of the General LAWS. TYPE LICENSE: By Plumber Title Gasfitter Signature of Li e n s e d .aster Plumberor Gasfitter City/Town: Journeyman APPROVED (OFFiC[ USE ONLY) Ll ens Num er to � W N CC �` N cc N CC 0 N = k- P aW ch O aW_ wO M W z U "' zmZ F- 4a: N ry G `Sct w at W ww F- V c� a tz lW yl", to O Oy z O ~ Z W O N W z Q d ,u W y w 4 G d t7 a o o W `� o W r F - o z o O w n .a o a a SUR—BS'MT, t BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TR FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8THFLOOR (Print or Type) Check one: Certificate Installing Company Name /�/' E/Partner. Corp. Address Firm/Co. Business Telephone: -C/C/&_ Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Edother type of indemnity Q Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 0 Agent 0 1 hereby certify ttut all of the details and information L have submitted (or entered) in above application are true and accurate to the best of my knowledge and tleat all plumbing work and installations petfomted under Permit iuued fo: this application will be in compliance with all perUneni provisions of lho Massachusetts State Cas Code and Qupter 142 of the General LAWS. TYPE LICENSE: By Plumber Title Gasfitter Signature of Li e n s e d .aster Plumberor Gasfitter City/Town: Journeyman APPROVED (OFFiC[ USE ONLY) Ll ens Num er Office Use Only of 4C LAriirim"ImIalt4 of ifinsaoustft5 Permit No. lievartmt21t of Pubik —Anf ttl Occupancy & Fee Checked � � ( BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (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- 12 - 9 (XK or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below.. 3 I.lJ� Location (Street & Number) I W Owner or Tenant —1^Z' i I 8'P Owner's Address 1g08 Weafc Q-4 1A e_I—(;AID Is this permit in conjunction with a building permit: Yes No C (Check Appro ri Puroose of Buiidina% Utility Authorization o. r- Existing Service Amps —J Volts Overhead `! Undgrnd ! No. of Meters ,n,, r- �- New Service '70A Amps l� bvolts Overhead '� Undgrnd L5,-- No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Eiectricai Work -5"^'{' I No. cf Lchang Cutlets ( No. of Lighting Fixtures o of Recectacie Cutlets l No. of Swttcn Outlets tilt � � No. of Rances No. of Discosais No. of Hot '.:bs Above— In - Swimming Pcci grr.a. — grna. ' No. of Oil Burners No. of Gas Burners Total No. of Transformers KVA i Generators KVA No. of Emergency Lighting Battery Units FIRE .ALARMS No. of Zones No. of Air Conc. Totai No. of Detection and tons Initiating Devices No. Heat /} ,Drat Total Pumps ` Tons v K� No. of Disnwasners I ScacerArea Heatina KW No. of Dryers t, 1 Heating Devices KW i No. of No. of No. of Water Heaters KW I Signs Batlasis No. Hvcro Massace Tubs j No. of Motors Total HP OTHER: No. of Sounding Devices No. of Self Contained Detect.on/Sounding Devices Local — Municipal 7—i Other Connection Low Voitace Winna INSURANCE COVERAGE: Pursuant to the recutremer.ts of Massacnusetts general Laws t I have a current Liabdity Insurance Policy inc!uetng Ccm c Operations Coverage or its surstantial ecuivaient. YES NC7 = I have suomtttea valid oroof of same to the Office. YES - If you have checked YES. please indicate the type of coverage by CheCKing the aper mate box. INSURANCE e 0ND — OTHER = (Please Spec:fyt 2D ,� �Q (Expiration Duel Estimated Value of E'. ctncal Work S �J ItV v� Worx to Start 3 _ 9.< InsceZion Date Recuestec: Roush wC Final Signea unser the Plttes of perjury: FIRM NAME / e LIC. NO. k?=:l 3 Licensee a✓ Signature LIC. NO. 6 ZL 0 2 Ti Bus. Tel. No.�� Address U Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware th t the Licensee Ices net have the insurance coverage or its substantial eautvalent as re- quired by Massachusetts General Laws. and that my signature on tats permit application waives this requirement. Owner Agent (Please check onef Teieonone No. PERMIT FEE S (Signature of Owner or Agent) x-5565 M NORTH QE �.ao ,e �tiO O A 9 +�t4TfD �fi"1' ,SSACHuSE� Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that............................................................................................. has permission to perform............................................................................... wiring in the building of................................................................................... at............................................................................... . North Andover, Mass. Fee..................... Lic. No............................................................................. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File w TI? Date. J o l-/.,`.? ... . 1769 NpRT'+ 6..4' TOWN OF NORTH ANDOVER 1O �?PERMIT FOR GAS INSTALLATION 41 P y s si -a This certifies that . PA. df .. P.�c........... .......... has permission for gas stallation ..... ��! - ... in the buildings o 4194�An*d at.� pover, Mass. Fee ..CCI ,�.-- �- . ..................... . �4& C Qi) �j$ INSPECTOR � WHITE: ApplicalSt CA ing Dept. PINK: Treasurer GOLD: File Location --7--, ? 4 ST IC cIU A y No. 3 (0 C-14' Date Nom,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / 0 y Check # D-3 16121 //�/fl ( 62,_ Building Inspector • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 3 DATE ISSUED - (a Z, I . I SIGNATURE: /44 C U"O%mw Building Commissioner/Ifor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning DistrictPrProposed Use 1.4 Property Dimensions: Lot Areas Frontage (tl) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.CAWO. 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPER T*X%IjSH (AUTHORIZED AGENT 2.1 Owner of Record .-n FA-rp-t(K S, Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: FO (p r S A- LLicense Address Signature T15j,rsd 70 Not Applicable 0 z - Number (D Expiration Date 3.2 Registered Home Improvement Contractor Z— � &/ 0 x,-- k r Not Applicable 0 Company Name Address t le 0 -3 -T- ¢ Registration Number () Expiration Date Signature Telephone T M X z 0 rn SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) 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 .......❑ No ....... 0 SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Buildmi ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ !r Pet i-0 C --a t Accessory Bldg. ❑ _ molition ❑ 1 Other ,, ❑_ Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item �r O 00 i Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) ! D 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 U -t . Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ✓� �ii�/ (�(QGf7 Z a 41em. , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; in all matters relative work authorized by this building permit application. ZZ 3 Signature of Owner LZDate SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION (w, Zsz R ave i 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 � � I • �-�,� 2R�✓r✓�7Z✓l Pri t Name Sip -nature of Owner/Anent. Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2 ND3 SPAN DIN ENSIONS OF SILLS DINIENSIONS OF POSTS DINENSIONS OF GIRDERS —HE IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE oz O r Z irr �- � n � r- ..�..... /firs}A^ k oz O r Z irr �- � n � r- ..�..... /firs}A^ ,� J/�e �8AG73tOnl�JG(XCflt O�c/`I'jlAd(af�,ILJC(�. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 050281 Birthdate -'10/i5/1959 Expires: 10/15/2004 Tr. no: 4488 Restriete_ d: ' 00 WILLIAM J ZANNONI $06 SALEM RD DRACUT, MA 01826 Administrator The Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity ©am an employer providing workers' compensation for my employees working on this job. Company name: �� 1:77r Z-47vo✓o -1 -W-1-)C . Address S-0 City j2k�ii ; M A-- Phone #: Q 7X &1-3 44� l 5 iAr Poficy# 4.3 Company name: Address City Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as well_as_cMI.penaltiesin-lheinrmd-a_STOP WORK_ORDER.and..a line_of_(.$1t10.OD)_ariayigainst.mee I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 1 - ZZ— Print name W i ('i"( " v Z& N N O N( P_hone.# 1( 7 8 _( 01 - '' 4� Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required E] Licensing Board Contact E] Selectman's Office E] Health Department 0 Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL 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 c11,S150A.. The debris will be disposed of in: (Location of Facility) L� Sign ure 9f Permit Applicant I � ZZ -a3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector 0 z ui c o m c O ots CH O C CO.3 C-3 •dam CL C O O Sri3 m� Eao CL N C O O c IMP ma a� m a s t H CD m H co H O O E `" m a� �co N m ; ga m mom co cI IZ O ccolo H � Q m :cmc .o = m :m.o N F" o vs o o f- m w o .m :5'm LL... c m 'a,c m c Z oc E 1 ti o LU C.3 4DomE CL g N m� Oc � = A v N �� CD►- ; z s o.w m z 0 w w y y E m O v �.7 CIO 0 .CL CO) O V s. C cc (A uj 0 U) U) W ccW crW uj U) O w Cf) 8 cn O � •� O w '� O w C U C w O U w R+ � p aG C w O w a w 'Coo O w U Ch w' p H cc "Cao 0 oG w w W a ao Z � 11. U) L O cn ui c o m c O ots CH O C CO.3 C-3 •dam CL C O O Sri3 m� Eao CL N C O O c IMP ma a� m a s t H CD m H co H O O E `" m a� �co N m ; ga m mom co cI IZ O ccolo H � Q m :cmc .o = m :m.o N F" o vs o o f- m w o .m :5'm LL... c m 'a,c m c Z oc E 1 ti o LU C.3 4DomE CL g N m� Oc � = A v N �� CD►- ; z s o.w m z 0 w w y y E m O v �.7 CIO 0 .CL CO) O V s. C cc (A uj 0 U) U) W ccW crW uj U) 14 Date.........! ; .1.. .... ................ + TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ................. t .. .................................... i� g - has permission to perform ... --Z. .......1 ..... wiring in the building of ...... :v7r.-d jin� .................................................... at ... .......... ,North Andover, Mass. ....................... .................... Fee.�' N oO. .......... ..... ................. . ............... Lic. INSPECTOR Check # `r _ Commonwealth of Massachusetts Official Use Only L13 /,S ` Department of Fire Services Permit No. c V. Occupancy and Fee Checked10 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: z -d Lia City or Town of: } At) 0y, e J< i� To the Inspector of Wires: By this application the undersigned gives notic of his or her intention to perform the electrical work described below. Location (Street & Number)III (�/Q�@ Owner or Tenant V I M Telephone No. Owner's Address S &it-! Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building ;PCEI J--� X X;/t Utility Authorization No. Existing Service Amps lok / .,ZYUVolts 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:���lS� Completion of the. following table may be waived by the Inspector of Wires. No. of Recessed FixturesNo. of Ceil: Susp. (Paddle) Fans No. of Tetal Transformers KVA " No. of Lighting Outlets No. of Hot Tubs Generators No. of Lighting Fixtures J Swimming Pool Above ❑ In- E]rnd. rnd. BatteryUnits o. o Units cy Lighting No. of Receptacle Outlets ` No. of Oil Burners FIRE LARMS I No. of Zones No. of Switches No. of Gas Burners No. o ection and Initiate Devices No. of Ranges a^ Total No. of Air Cond.Tons No. of Alerting s ev' No. of Waste Disposers p Heat Pump Totals: Number Tons KW I No. of Self -C a ed Detection/ rtin evices I I No. of Dishwashers "—'"' S ace/Area Heating KW p g Loc Municipa Other Connection No. of Dryers `__., Heating Appliances 1; pp`� ecurity Systems: No. of Devices or Equivajent No. of Water K W Heaters —�– No. of --NZ-d— Signs Ballasts Data Wi No. of Devic or ivalent No. Hydromassage Bathtubs .---- No. of Motors T . uy Telecommunicati icing: No. of Devi es or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 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 X BOND ❑ OTHER ❑ (Specify:) 0-b(Expiration Date) Estimated Value of Electrical Work: 3150 (When required by municipal policy.) Work to Start: (f–aq-0.3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:ii 101 f4 ��pp �A /SOrXS' CG tC LIC. NO.: /%7 Yo Myl� V Licensee: R. ,,41A J(7, Signature LIC. NO.: E3 yy 73 (If applicable, enter "exempt" in the license numbe line.) Bus. Tel. No.' � 7J -613 Address: Alt. Tel. 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 a ent. Owner/Agent PERMIT FEE. $ 0v Signature Telephone No.