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HomeMy WebLinkAboutMiscellaneous - 35 WOOD AVENUE 4/30/2018I MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723.3800 Ma Only (800) 392-6108, FAX (800) 851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.313 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: RACHEL AZER AND CHINRDU OGBONNA Property Address: 35 WOOD AVENUE, NORTH ANDOVER, MA 01845 Policy Number: 1132404 Type Loss: Water Damage; All Other Water Damage Date of Loss: 01/13/2014 Claim Number: 320088 Claim has been made involving loss, damage or destruction of the above captioned propert, which may either exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. if any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 1/2412014 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800 Ma Only (800) 392-6108, FAX (800) 851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139, Sec.36 NORTH ANDOVER HEALTH DEPT NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: RACHEL AZER AND CHINRDU OGBONNA Property Address: 35 WOOD AVENUE, NORTH ANDOVER, MA 01845 Policy Number: 1132404 Type Loss: Water Damage: All Other Water Damage Date of Loss: 12/1112013 Claim Number: 318952 CMA00021 1211312013 FI�.E COPY Claim has been made involving loss, damage or destruction of the above captioned propert, which may either exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number, MPIUA Claims Division MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108.1904 (617) 723-3800 Ma Only (800) 392-6108, FAX (800) 851-8424 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.36 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: RACHEL AZER AND CHINRDU OGBONNA Property Address: 35 WOOD AVENUE, NORTH ANDOVER, MA 01845 Policy Number: 1132404 Type Loss: Water Damage: All Other Water Damage Date of Loss: 1211112013 Claim Number: 318952 Claim has been made involving loss, damage or destruction of the above captioned propert, which may either exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. MPIUA Claims Division CMA00021 1211312013 9013 O, ,NORTH AL0 +Zia O 9 �s s ,SS.ICMUSE� Date .6. --?,Y - I i... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .C-.... ' � f .1�G . '- r, 1. �-, has permission to perform plumbing in the buildings of �. fj ... A.z..,e C:.......... . at..5..t'�i0� fv�- �.,, North Andover, ass. Fee—�O �`�.. Lic. No..q.61 .Ks.. ..... /��'�'�. —C—.%L .... . PLUMBING INSPECTOR Check # i 1 r -F PLUNIBPIG: PIPLNG — FIXTURES - FIXED APPLLANCES — APPURTENANCES Z RATER TnTfl INCL IT Cna cars) ccs rr nu a w. rrcn rn mi i --u e ALTF-RNATIVE TECHNOLOGY ,NL-kSSACHL'SETTS CN-IFORM APP.LICATIOiti FOR A PERMIT TO DO PLUMBING j . CIT `ll i OWN: rvaV. APRUCATiON DATE: res..��i_. �.1......._. ............ i DRAIN: AREA I I FLOOR Ll 1 A � JCB ACCFESS::., ..:,._....N..c��a_C........tyq' _..._.... _ ......... P1 MS SUM, i E : YES[] NOE] � SACKNATcR VALW OCCUPANCY TYPE: COMMERCIAL? RES JCr:NTIAL11 1 BAPTISM: FCNT SACRARIUM NEW E] ALTERA i CN® REPLACEMENT Q REMOVAIJUEMI CLITCNF -F PLUNIBPIG: PIPLNG — FIXTURES - FIXED APPLLANCES — APPURTENANCES Z RATER TnTfl INCL IT Cna cars) ccs rr nu a w. rrcn rn mi i --u e ALTF-RNATIVE TECHNOLOGY (�-- OISPOSER ( SINK: MCPU SERIACE -- ASPIRATOR ; DRINKING FOUNTAIN i STERILIZER DRAIN: AREA I I FLOOR Ll EJECTOR 1 1 STORAGE TANK j SACKNATcR VALW EMBALMING AUTOFSY 7 i ---1 URINAL BAPTISM: FCNT SACRARIUM -� FCCO CHEST MISTING SYSTEM '; __ VACUUM DRAINAGE SYSTEM I BAR SINK GLASS WASHER WATER CLOSET - BATHTIJBIL'j WHIRLPOOL :I ICE MAKER WATER HEATER ALL TYPES --- BICET - ___4 INTERCEPTOR ALL INT =RICR 11__ WATER PIPING: - - -- CROSS CONNECTION DEVICE ...i. KITCHEN SINK F OTHER NOT LfS7cs7 7 v--+ DE'W (CA itD: ACID WASTE SYSTEM 1 LAUNCRY CONNECTICN DEDICATED: GASCILrSAND SYSTEM LAVATORY—�— DEDICATED: GREASE SYSTEM - PIPE RELJNING WCRK ONLY DEDICATED: RECLAIMED WA TIER I - _i ROOF DRAIN - DENTAL FIXTURE I EQUIPMENT - � SINK: 1-2-3 BAY PREP. r DISHWASHER __ SINK. CLINIC FLUSH RIBA `r-`_.� PLL'NIBLNG L`[STALLER - FIR-M-COMP.k,NY LNF0t2-MATION CFECK ON -Z ONLY +-. NAME: '" � 9,1"A '11% �. �.: (I ©Corporation Business _�' ,_-_: ADGRESS: n•a , CITY: ,�-� Cod 'STATE ZIP ,�� �.r0. Partnership Business F_==._ TEL: '4ot 63�i..`',�1:1: FAX . r_ ... ,..w EMA►L ..r. _ ULLC Businessl`__-_-- s. _ NAME OF LICENSED PLUMBER: �' c �,� Q, r r C (c �i o x � rn OBA LUnincor+vxated I E'iSURXXCE COVERAGE I have a current —liability insurance pclicf or, its substantial equivalent, which meets the requirements of MGL. Ch. 142 YES FX_1 NO 0 N you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy to Other type of indemnity © Bond OW1NEri'S "NSURANCE RAI4EL- I am aware Mrat the I censee does not have the insurance overage required by Chapter 142 of the Vassachusetts General Laws, and that my signature on this permit application waives this requirement. OWNEt� CtiECX ONE ONLY AGENT Signature of Owner or Owner's Agent OWNER'S NAME: TEL:r./..,z.i5.�.:.��...�.�,r_.` I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my knowledge. I certify that all plumbing wort and installations performed under the permit issued, will be in compliance with all per5nent provisions of the Massachuseds Uniform State Plumbing Code, and Chapter 142 of the General Laws. (OFFICE USE ONLY) TYPE OF LICENSE: Parnit # ®Plumber inspec cr I Master ;:ee: ❑ Journeyman ature of Licensed Plumber License?tumheT-, r 7 / i 4 Date.. 6.-oc .Y i1..... . .'.'"o TOWN OF NORTH ANDOVER O L ^o PERMIT FOR GAS INSTALLATION . h �9SSACMUSE'( This certifies that.,. �� . !'��!�` ! �.`� .f� /6 - . has permission for gas installation in the buildings of .. 1 X4.4 �`� .� ... �' Z r' .................. . at .. -`. . ..`.`?-�...A u .......... , North Andover, Mass. Fee 3 Lic. No.. .6 �. �.. C--/ . . GAS INSPECTOR Check # 61 i 77 14 I {{i i KASSACH- SETTS UNIFORM <,PPLICATION FOR A PERNnT TO DO GA,SFITTI G I a C{Tf tTvWN: IU -V -V—NO-h �4 0 V -%V STAT: MA APPLiCA i CCN CAT= : 1t ... f� X6 ADCRESS: �^--_-1� I OCCUPANCY TYPE: COMMERCIAL[] RP M ESIGENTAL � PLANS SUFI T cD: YES 17 NC Z ' I NEN LAL T ER,t, i CCN [] REPLAi EMEN ;g P,EMOVALUEMCLi i iCN NATLR -L & L.IQL-EnED PETROLE-L-M GAS: PTPP G - EQC" NEN I' - APPLIANN CES - S'Y-STENIS Z CLTCD Tn7A! ALMlYT !RD :fru ±c1 Grams n .YrrcT T� m.r .n v..»r...... AIR ROTAMN UNIT FURNACE: ALL TYPES -TEMP HEATING EQUIPMENT -- SCILER. ALL TYPES GAS PIPING 1 THERMAL OXIDIZER --- BCOSTER GENERATOR cSTATCNAtRY ENGIN - -- TURBINE - BRCILER --- ILLUMINATING APPLIANCEUNIT HEATER BURNER ALL TYPES INCNERATCR I -- 'NATER HEATER ALL TYPES � -- 1 CO GENERATiCN UNIT =1 (NGUSTRIAL AR HANCLrR— -- EQUIPMENT OVER 12.5CCMBH -- COFFEE ROASTER INFRAREDHEaTEtZ — rOT'r!ER y0T L COCK APPLIANCE HOUSEHCLD - KILN I GLORY HOLE t CRUCBLE ----'� CCCK APPLIANCE COMMERCIAL - -� LASCRAtTORY CC — ---V-- -----_, I _—._ DECCRA TIVE APPUANCE �— MAKEUP AIR UNIT - -- �— DIRECT VE'47 APPLIANCE I MECHANICAL EXHAUST EQUIPMENT -- CRYER: ALL TYPES i — , OVEN: ALL TYPES - `-- RPEPLACF: VE47ED I MEN -MOD I PIML HEATED — `— -- -`-- FRYOLACTOR RCCF TOP UNIT - FUEL CELL RCICM HEATER-VENTEtDPVzW. ESS -------------- ---. ( __ ?Lb'-NIBLYG / GAS FTTTPfG FIRM WFORNL- MON CHECK ONE ONLY NAME: � r .�� ....�. �.�}n� t.A� hC ADCRESS: % �1�..R � 4..i-.�1 ��. s t1 7Corperation Business y a', Y:..�.% Y1 c o ! .-........ .1� ; ST ATE. Z'P: ®Partnership Business # —!`I LLC Business TEL: FAX: _._._ _ -__; EMA{L:...... '..................-_._..........-_._......._ ... -- 706A I UnincorporatedNAME OF LICENSED PLUMBER F GAS FITTER: `` F r Q O e.`(' �C k Y t a �q V(SU'RAINCE COVERAGE I have a current liability insurance policy or its substantial equtvaient which meets the requirements of VGL. Ch.142 YES M NO 1 you have checked Y3s, please indicate the type of coverage by checking the appropriate box below. A liabilitj insurance pcticy ® Other type of indemnity a Band CWNER'S INSURANCE NAIVER: I am aware that the !Icensee does not have the insurance coverage required by Ompter 142 of the 1Aassachusetts General Laws, and that my signatureon this permit appitcadon waives this requirement CHECK ONE ONLY AGENT Signature of Owner or Owner's Owner's Agent XX OWNER'S NAME: �,��Q� �'1 2 P..x' TEL:'7..�s,1.,,�.2.�....\6'1.3 .... I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and agate to the best of my :knowledge_ I certify that all plumbing wort and installations performed under the permit issued, will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. (OFFICE USE OtN'LY) � Type of license: l ►� t�errnit # ,®plumber 17Gasfitter Inspectcr { ZMaster ❑ burneyman Sign 're of Licensed Plumber I Gas Fitter Fee: [:]Undiluted LP installer (License Number: Zai 1 ❑ Limited LP Installer D t F t �y Location 000 ) No. =,?G Q Avg Date �'- y bw TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee /pc $ TOTAL Check # L $ %3 i—W(�—'— Building Inspector V TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENO VAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING �r BUILDING PERMIT NUMBER: DATE ISSUED:o �� �C SIGNATURE: Building Commissioner/I for of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: v�- 3 a Map Number Parcel gumber 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area (sf) Frontage, fL 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.GL.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 Public 0 Private ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record / Name (Print) rtr `,e^�1 L (/1�I� 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: Not Applicable ❑ y Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone IN )Z - SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 § 25c(6) Workers Compensation hnsurance affidavit must be completed and submitted with this application. Failure to provide this all in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description. of Proposed Work(check au a licabie New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Demolition ❑ Other 0 Specify Brief Description of Proposed Work: II II�� _ ! /" I n— , i Av -A /NISA I An ^4,-A f A Ln _-,ll n A A J I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I will result Item Estimated Cost (Dollar) to be Completed bypermit applicant (a) Building Permit Fee 1. Building Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) , 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number aEU11UN /e UWNEK AU 1HUKIGAIIULV 1U BE UUMYLEIED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, C s wner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 S Print Name M' Sip -nature of Owner/AQent Date r'uxiV1 - U - LV 1 1c.LLLE AZIE V 1J1KIV1 E B h), r INSTRUCTIONS. This form is used to verify that all -necessary approval /permits from �.3t q _ O l Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements_ I■■.■■■....■■...■r■...■....r.r■.■■.......■■.-■.U■■r.rr..r.................... or APPLICANT lJY -, �'—PHONEeI'� �S J ASSESSORS MAP NUMBER l 3 LOT NUMBER 4 SUBDIVISIONfl LOT NUMBER STREET W©�– STREET NUMBER ......................................... ........................ ■.......■ OFFICIAL USE ONLY I.•COrNIlI�ENDATIONSOFTOWNAGENTS••••••••••••••••••••••••••••••••••• . .........,...............................■.....r.r..r..r...........r...■ DATE APPROVED 1 U CONSERVATIONADMINETRATOR DATE REJECTED CONRyIENTS {�✓ O4� d I G 4f Q DATE APPROVED TOWN PLANNER DATE REJECTED FOOD INSPECTOR -'HEALTH SEPTIC INSPECTOR - HEALTH CO1�RvIENTS PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COIvIIvfENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE R -A ,U� Northpoint Survey Services >BD ratter st'rwet fAaveirhac, zi almo . �9yBJ 87P-0836 Ic o. co' 101 pe -7 L NQ�T�. 3 0 � I � PRAWN FER SITE RA4 OF so s. NSDU iMM UnarrunILIM 1" I AMHE,OT aiReY D6r1YIh1 � �ro os �e D90 MAY 7D,199(a,-0 W n Z UNIT ca>y>aaMlnrui� � I � �ptTB OF MPJ I O GREGORY L w - - 1[a0, oo BOWDEN - � i1348iQ W60D A V� N U E PLEASE CALL 978-372-0835. PRIOR TO USING THIS PLAN FOR ANY OTHER REASONS THAN MORTGAGE PURPOSES THE ABOVE MORTGAGE INSPECTION WAS CLIENT: } &CA- . BORROWER: �/2T /" 1AYD PREPARED FOR AiJbLJ°JT IS MEREDITH MY6 DATE: (fgJ GHkE� MANHATTAN SCALE: I�3DB ADDRESS: 2,r--�NWWD AIENQ AND IS NOT INTENDED OR REPRESENTED TO JOB NO.. Z317 00 N. / tl I I A IVGIL / ,hF . BE A LAND OR PROPERTY LINE SURVEY. NO CORNERS WERE SET. IT CANNOT BE USED TO THE BEST OF MY PROFESSIONAL RECORDED AT REGISTRY OF DEEDS FOR ESTABLISHING FENCE, HEDCE, OR BUU*4G LINES THE LAND SHOWN IS BASED KNOWLEDGE AND -BELIEF THE LOCATION OF THE PRIMARY BOOK: PACE: LC. CERT. ON CLIENT FURNISHED INFORMATION *4-D MAY STRUCTURE SHOWN WAS EITHER IN PLAN REFERENCE. C-EE7 NOTE AWLC BE SUBJECT TO FURTHER OUT -SALES, TAKINGS, EASEMENTS AND RIGHT OF WAYS. COMPLIANCE WITH LOCAL APPLICABLE ZONING BT -LAWS IN EFFECT WHEN DRAWN PER OF ASSESSORS NO RESPONSIBILITY IS EXTENDED TO THE LAND OWNERS OR OCCUPANT. IT IS CONSTRUCTED (MOTH RESPECT TO HORIZONTAL DIMENSIONAL MAP SOCK PARCEL NOT INTENDED FOR THIS DOCUMENT TO BE D. REOUIREMENTS ONLY) OR IS SUBJECT DWELLING LIES IN FLOOD ZONE}( NOT IN EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.GL TITLE VO, AS SHOWN ON NATIONAL FLOOD INSURANCE 47AR ) CHAPTER 40A. SEC. 7. UNLESS OTHERWISE NOTED OR SHOWN., RATE MAP DATED: JUNE 7- 177j AREA COMMUNITY j ' jQj PANEL# OCY Cj - v 0 b 0 F=04 �l �¢ V. a Vi a O c ° W° a�' U w O F a�' w a w w a a�' w F z a W ca o cn ,: cn o :a �= y O C �OILIz = �.: 0 Q a 5, 14: z aSs o • rr E ca N O f--1 lvJ CD m IIF•••------•••���� CD 3 L Co C � � �z �:N17 o W L20- cl- CCM m m • V;N O G. >Z c �o � ♦ 0 =CLO. m` z CD W N•B m m y,n O • = .! f+ coo CL gZf N p N •= Q • a_. f W ca I o Mo d O �E m m co � _ CL }/ Cm 3.0 O OL r O a fl.. CM a C* M O cm V �'p c C Z CD CL V y O C •C C 0. CO2 0 N2 1741 NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING c" This certifies that t ... . . -1i '*"**"*****"*****":i""******., / 11 has permission to perform " . �6 .. . ......... ........ ............................. wiring in the building of . . .... ......................................... at .............. --AT,�. -�Z4 ............ . North * Andover, Mass. Fee.! .o ......... Lic..... ... 7 CkILINSPECTOR .......... ill WHITE: Applicant CANARY: Building Dept. PINK: Treasurer � Q�THO LASS4aMS'M V Once Use oniv MAP % V DEPARTME7VTOFPUBLICSAFL7Y ;nti/ �7 Pet No. OFFiREPREVEN17ONREGUL4770NN527CM 12-00 d !\ PARCEL Occupancy &Fees Checked VI .- PERAIRTTOPERFORM EL£CTRICU WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town ofNorh Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in coniunc ion with a building permit: Yes = No � (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service dU Amos , Volts OverheadL-Undereround No. of Meters New Service ,Amps / Volts Overhead = Underground � No. of Meters Number of Feeders and Ampaciry Location and Nature of Proposed Electrical Work i:/;V No. of Lighting Outlets No. of Hot Tubs No. of Transformers Tout KVA "No. of Lighung Fixtt:res Svnmming Pool AboveBelow Generators KVA and around 71 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 Ranges No. of Air Cond. Totai Tons No. of Detection and No. of Disposals No.'61' Heat Total Total Pumos Tons KW in tiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers 10 7Connections Nesting Devices KW No. of Water Heaters KW No. of No. of I Sivns Bailasis Nry Hydro Massage Tubs No. of Motors Total HP OTHER . •'1 i .:• • 1 J .` •' ••1 I rl •Ii • • :•`:!-.N,•1• • ♦ : ..� • I\ � ..�Yk :VJI .•: 1 . � � - s • • .• m:♦ . 1• • •r r � - • 1 -.ilr ��1 � � • -.:.:. '.r. • xr• � a•a- 1 •• r .• : - • • a o .• I �J •II :':. 1 ' r �.N •. r i Lica�see Qa,-"a 1, rJr sure L=IeNa h/ AITe-No. �s�6 T OWI�Z'S Itv�1RA1`KL WAIVE2; I amawmett� �La�et� not ht�•e the a>rara>�ta-asst3�r�;a! o�iva��as r�t.�ty �s C�1 Lam and �-Satrrn�tsemth�rz�r�.�nc'aztvr�.es this re�r�� (Please check one) Owner Agent Telephone No. PERPAIT FEE S N2 3, 78 Date...........f/. / TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ J� q y ..................... ............................. has permission to perform <........................................................... wiring in the building of ..... .......................................................... .............. .. . , North Andover, Mas Lic. No./ -77_3M1/ ....... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �-� THE C0W0NWE4LTH0FMAMCHUSE77N Office Use only DEPARTMMEVTOFPUBLICSAFETY Permit No. BOARD 0FFIREPREVElVI70NRWUTATI0N.S5270R 12DO VA Occupancy &Fees Checked PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street b Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Purpose of Building Yes M No M (Check Appropriate Box) Utility Authorization No. Existing Service ,moi Amps c) U/ W Volts Overhead 13 Underground No. of Meters New Service Amps / Volts Overhead M Underground No. of Meters ----+----moi_-- Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work T71177 4�r=lko LAUM 67 No. of Lighting Outlets No. of Hot Tubs No. or fransformers Total KVA No. of Lighting Fixtures Swimming Pool Above rM Below Generators KVA ground 1,4U ground j 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 Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local r7-1 Municipal Other No. of Dryers Heating Devices KW Connections r7 No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER lastaa=Co Pxs=ttDthete pana>$dMassactasMGenaWLam l..�J lha%eamnal inbkyhtstratcePoi yndtxtagCc�rtito Com2Wcritsaisuni oWiv*nt YES NO Iha-,ees bnacdvalidpoofofs=tDtheOfm YESlfjcuhawdWgdYES,pl minds&thetrypecfcm byd=kitgthe wpWi*INSURANCE [2"BOND 0 MIERR p ftm)/Oa EViratim D& U� ,.-- EsiQrt>�edVatuecfP7ectliralWaic$ y�. Wotktos4R htspadmD*Regitsd Rt4I FM Sigt0dtslda�iePtrtalt Z FIRMNAME _ Liar�seNa _„ LitxnseNo r< E aMES54 N AILTdNa OWNER'S2g9JRANCEWAIVER; lam awateth1lteLit= Laws andiatmysgttattsaatilis pent$applirationruaivesthslecpl¢aretrt (Please check one) Owner Agent Telephone No. PERMIT FEE v s (17- (rc11� ► �� vt,,�l7 -f Ca L k il