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HomeMy WebLinkAboutMiscellaneous - 358 BEAR HILL ROAD 4/30/2018This certifies that TOWN OF, N PERMIT Date ?,APIIA . H ANDOVER PLUMBING ........... has permission to perform ..i/ .LA —t. :-. . 0. F/ , plumbing in the buildings of ./c. ......... ......... at ....... North Andover, Mass. K Nor Fee ....... Lic. No�3 .......... // )-j - ) ) ' PLUMBING INSOECTOR Check # 8 L'. . 0 � it to MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING nL (Print or Type) W Avl,4'17 1,,c- ass. Date �-1 _ Permit # O 1 r Z�Building Location �l'�l/' /4VC,d Owner's Name „ L47— ISO& Type of Occupancy Residential New [-j Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &Plg. Co. Inc. Address 35 Pleasant Street Stoneham, Ma 02180 Check one: Certificate Ut Corporation 714 ❑ Partnership Business Telephone - 781 —43 8-77 76 F1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 91 No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy X 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 ❑ 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 Signat�cen ed MuMb r Title City/Town Type of License: Master Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number 8322 ''/z" Watts 9D bfp on water line to water boiler-- P n U Z Z U) x < O W r- N > Q o Q z a F Z G m u 2 n z Q cc m = ct v� — i LL z a N N x w t- w U w N x rn a — a < z 0 D ¢< w ¢ a w o a rn a a ¢ i w LU r r- r w 3 a 3° N o i >' V e cc r �_ a y o W ❑ r o> Q s a z r- u a a Y w ►` L x N N Ic I- t- o= D yr o z o N Q Q o o B B B�� rl 3 Q Q x - - Q Q Q J J C x 3¢ C Q Y J m 0 01 3= f- w W D a m S ? 3 SUB-BSMT. i BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR t` f Installing Company Name Heritage Htg . &Plg. Co. Inc. Address 35 Pleasant Street Stoneham, Ma 02180 Check one: Certificate Ut Corporation 714 ❑ Partnership Business Telephone - 781 —43 8-77 76 F1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 91 No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy X 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 ❑ 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 Signat�cen ed MuMb r Title City/Town Type of License: Master Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number 8322 ''/z" Watts 9D bfp on water line to water boiler-- P n r J z 0 w N LU U LL LL O ccO 3 0 J W m 0 z O U W a N z W N W cc 0 O cca w W LL N w U r w Y N O Z a J Z m LL 0 w a Y h W Q 2 a w h z Q m H a w IL a 0 h U W CL N z m J a 1) v Location Y; No. Date 40R71y 0*�`•O TOWN OF NORTH ANDOVER '•,�O p x Certificate of Occupancy Building/Frame Permit Fee $ $ yes'^^°'nth sACHU Foundation Permit Fee $ Other Permit Fee $ `.. 0 ,Connection Fee 4tAL $ '��//,/Water on Fee $ -v $ Building Inspector Div. Public Works PERAMOXT N APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. i j/PAGE 1 MAP +40. LOT NO. 2 RECORD OF..OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME ` ✓r NO. OF STORIES SIZE (/ OWNER'S ADDRESS BASEMENT OR SLAB a•./7 % R ARCHITECT'S NAME �w/�N r. l SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME , / ON SPAN - DISTANCE TO NEARE T BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES 1 REAR 'ay S V v " GIRDERS AREA OF LOT `i FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING IS BUILDING ADDITION 7 MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ytos J IS BUILDING CONNECTED TO TOWN WATER Vold - BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 1 2 - SEE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 K ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED At{p AglR D BY BUILDING INSPECTOR `� `'/9Z DATE FILED^ ♦ �i �n f SIGNATURE OF OWNER OR AUTHORIZED FEE PERMIT GRANTED 19 OWNER TEL CONTR. TEL. CONTR. LIC. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST f/ K D OV V ; p EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI, FAMILY_ FFICES OFFICES- APARTMENTS APARTMENT—S _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY VJALL _ UNFIN. 3 BASEMENT ., AREA FULL IN B'M"T' AREA '/ 1/7 '/, FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I g FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES B 1 2 3 �_ _ _ CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARDW'D COMMCN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME, _ BRICK ON MASONRY. _ BRICK ON FRAME ATTIC STIRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I --i POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) TOILET RM. 12 FIX.) _ GAMBREL MANSARD FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFINGMODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 1st 3rd ELECTRIC NONO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT,AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT,PLAN. 4 1J FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone ./I F0 F LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) c Street St. Number O ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: �Date Approved Conservation Administrator Date Rejected Comments z 5 Date Approved Town Planner Date Rejected Comments Health Agent Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Received by Building Inspector Date z O OR I z r m (J7 M41--1 co rm m A) m s m v POO O c pc c T v � ce O O MEMS A O C T 7 A CD O O o p c n n C ev Q m O � A A O a a ti) Ma 3 ma H '7 � t fl. c OR I z r m (J7 M41--1 co m m -n cn m m 2! 0 m pc c T y c w? c m ? S T 7 r CD W o n n C C Q m a M zz c o m m z Z z M M T m n r- 4 v z O CIO 9 Z z 0 c 0 m m z r 0 t7 D Location t No. = ' ' Date V/, 7 N°RTp TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ sAC gE Other Permit Fee $ / C O, C [ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector / 1 7 ,% Div. Public Works r EdRltIT NTO. I3 6 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 m I M cf' �i30. /CANE -&CATION;55R LOT NO. I 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE SUB DIV. LOT NO. I EAS. t�l �l<i.. � PURPOSE O �W \ MM I Iu G POC)�- (JAA NEWS NAME 1� ^>'E k-�C, �f" C F- Gl��J r 1 r NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB A HITECT'S NAME r V r SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 1_ SPAN DISTANCE TO NEAREST BUILDING 2p� G• DIMENSIONS OF SILLS PAS TANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR "� t�� (•_L'J -•+✓ GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING �...� X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS UILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ►V® ► WIiL BUILDING CONFORM TO REQUIREMENTS OF CODE `�� IS BUILDING CONNECTED TO TOWN WATER TOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING !Tr ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ` P,LAN �MIUST BE FILED AND APPROVED BY BUILDING INSPECTOR v DE FILED � 1 1 t� * l/// O' SI UR OF OWNER OR AUTHORIZED AGENT FE i©0i 00 PERMIT G NTED Cl ft► M22I8R id CONTR. TEL. CONTR. LIC. r W• 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EBT. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN XI -7 BUILDING RECORD 1 OCCUPANCY 12 s SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 13 CONCRETE CONCRETE BL'K.PINE BRICK OR STONE HARDW D PIERS TASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 '/2 �/� FIN. ATTIC AREA NO BMT FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 _ _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARMU'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR IJ POOR ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE GAMBREL HIP MANSARD BATH (3 FIX.) TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd _ I.r 3rd NONO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. io- a �\ $ 7 2 _ - co \® m 9 4a9 $ | $ a o ' k o- J 30 2` | e r � z $ a 0 >§ Z. F ■ G c :e `■ s,,, o o I -n., r nj 2 @ § m -!■, � .. o m 2 i ®;R § -A }_� ■ . »77� &, o )�.c i )). ,§ 000 9 §2m 980 mm� � � \q a �o� 2 q 2o . . axe k x ■�M »z �. 'Mock -4'402 z� u�o m cAn o$9 } | -V& cm N3 2CA CR o r 4c%2 m -J 0 2 � e 2 ( m � -A � FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************�*'*Applicant fills out th'i/s, section***************** APPLICANT: LOCATION: Assessor's Map Number Parcel Subdivision t7Vi2 4lfLL Lot(s) Street -J (3 ewlz, /u ( / St. Number C, LC�N ��7Z: �'r�-rt Lc:�'�9,CF2c�' 17t1G✓zo u�j S�Ji�N� i�/G � Use Only************************ XRECOMMENDATIONS OF fTOWN AGENTS: Date Approved / Conservati n Administrator Date Rejected Town Planner Comments Health Agent Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out th�i/s, section***************** APPLICANT: LOCATION: Assessor's Map Number Parcel Subdivision —i3t7x lki. Lot(s) Street 3 (2�cnz St. Number 6) ItA) L --7Z- t-rL Lc N,4F - zh/G✓Zo u,(-4-) SiOry M IV6 L ************************Official Use Only************************ XRECOMMENDATIONS OF OWN AGENTS: `7%Date Approved Conservati n Administrator Date Rejected Town Planner Comments Health Agent Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date Z O i z m (J7 C Z ,.. 0 CD w m A) T fA : ?1 M v_ m 7 y C rt O C(D � �• C ? O j v � O R1 O �Avy N 'C —• O aq• 3 O � c � A A O 3 a In � � 3 H �7 O vii > z A v Z i z m (J7 C Z ,.. 0 CD w m T fA : ?1 M ?1 0 m C S. C(D C ? O j < to R1 N N c In � T > z v Z v M zz T T C T n �o e) .� O _ �o m m z ni mi z w O 'u a as•�,y 2Z 0 2CAL, �Yr-el Location S �� 6 No. , Date TOWN OF NORTH ANDOVER "o Certificate of Occupancy $ s Building/Frame Permit Fee $ ,SSACHUSEt Foundation Permit Fee Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ r ��^ $ c TOTAL Y/ Z<-5::� s Building Inspector iu7n /05/97 08:52 130.00 PAID 0 Div. Public Works PERJIIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. V/ PAGE I MAP K40. y�{I ZONE O LOT NO. O SUB DIV. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE — j. I LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES L SIZE OWNER'S ADDRESS x BASEMENT OR SLAB ARCHITECT'S NAME -- SIZE OF FLOOR TI ERS IST 2ND 3RD BUILDER'S NAME N, 1 « SPAN DISTANCE TO NEAREST BUILDING DIMENSIC04S OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR •' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ol ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANF,�MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 3✓'�� ^ A 4� SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED — 71!4�, � 19 3 PROPERTY INFORMATION LAND COST �l EST. BLDG. COST �ai DOCS EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY iUILDING INSPECTOR OWNER TEL. # CONTR. TEL. N CONTR. LIC. # H.I.C.# /15�3!5�j BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 13 PINE CONCRETE CONCRETE Bl. K. BRICK OR STONE HARDW D PIERS PIASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/4 1/1 1/4 FIN. ATTIC AREA N_O B M'T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 �_ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING CONCRETE EARTH HARD1rJ'D COMAACN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD A TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 10 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. fI v. y C � CA C7 St CD CLO �• r c CC O. CO) a� v 0 0 CD CD O Q CD CD 0 CD c CD U; C. 0 y -• O �C I C2 CO)10 O CD Z CD O o \Y/C/�� i5 W ?uO 1 Cl m O — �NOQ y d O 4c VD M. O o Cl) y C7 a n m Z =rlm N 0=. -* o T =rm �0 O y O -40 m y O O 7 o y cc -Co. O O Z N n O .m C =='o a sm CL ,w U2 o s M: dc O O O CO) C C CD c CL CO .�-►� y H C d Q CL CA O ^fi C y �f =r :E m �, y CO) O O m � : O � y 'O m2 �co0 DD: say CO) o m =► C?: CD CD CD �} CD y 11 \(V�V OCD d � ;1 a'o CA 1 � Cp Cn o C� R �, b7 ^f w 77 G a O ^r1 w Cn R. "z c ] "r! w °c S b r "�x7 w (� ` "JC1 G �' s7 G CL ° i� Cn b � C� y Z7 C °�' x �' o� O M41, z d '!i'X+. r ... z - 0=3 0 0 c Date..... &...................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .......� .... �.............................................................................. has permission to perform wiring in the building of .... L ..... n.:. r at .....: ..:'... �1: �/.................../::??�_... North Andover, Mass. Fee.4.`......... Lic.No. �?.:�-'...- ....................... V-�............. ELECTRICALI pECTOR Check # n r, 7 r U3 . Commonwealth of Massachusetts Official Use Only TPJ Department of Fire Services Permit No. - 00 Occupancy and Fee Checked 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 C R 1;.00 (PLEASE PRINT IN INK O Y E AI INF RMATION) Date: City or Town of: 111 (�To the Inspector 6fWires: By this application the undersigned gives no,46 of his or int n ion t pe form the electrical work described below. Location (Street & Nu er) Owner or Tenant J I4 Telephone No. Owner's Address 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 ❑ Und rd g [:1 No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity , Location and Nature of Proposed Electrical Work: Installation of Security system Cmmnletinn nfthe fnllnwina tnhlo m n ha,univarl h,, �t t .. rur, No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- E] rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle OutletsNo. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. ot Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number I I Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or E uivalent No. of Water Heaters KW No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of iv'iotors Total HP Telecommunications Wiring: No. of Devices 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 ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: Work to Start: Inspections to be req I certify, under the ains Andpenalties of perjury, that FIRM NAME: (When required by municipal policy.) (Expiration Date) uested in accordance with MEC Rule 10, and upon completion. the information on this application is true and complete. 1P 1 i LIC. NO.: 1 r, �r Licensee: John S. Bassett Signature LIC. NO.: 1533C (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594$ Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic, see 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 EI owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ,