HomeMy WebLinkAboutMiscellaneous - 36 MILLPOND 4/30/2018i
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Town of North Andover
D.B.A. — Zoning Compliance Form
978-688-9545
This form must be reviewed with the Inspector of Buildings.
Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday.
Applicant Name• -VA1 �- V 1 NXCS Name of Business SIWVOf— V i' -�
Address of Business• 36 MUAMD P - VH1-Zoning Distri
_ r11�-aCB�i�
Map � � _ Lot
Phone: 0J- — 03 09I Email 5e,1Viidoir.VI0ct� f-2y't li,I - wwq
Nature of Business: 11'b (A — ebHvu"'f-e. 1VPAd- IV -10Y6.
Do you own this property? Yes ✓ No
If no, written permission is required from your landlord.
Will you have clients coming to this property? Yes No
Will you have any employees? Yes No V-1
Will you have any major deliveries? Yes No 'I/
Description of Business Activity (Must be Completed)
Signature of Applicant
For Signage Refer to North Andover Zoning Bylaw Section 6
The proposed use is an allow d use ' this zoning district.
Issued y to 0 �E d/ Z'�
a
C114P (ffomI1l1QnwtsU4 of Massachusetts Office Use Only
Department of Public Safety
_ Permit No.
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 �.
Occupancy & Fee Checked b
3/90 (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
/t
City or Town of ( / t gr �t •r% t �` —+ To the Inspector of Wires>
The undersigned, applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
t
Owner's Address C36
FEB 8 P9
Is this permit in conjunction with a building permit: Yes No' (Check Appropriate Box) t.
Purpose of Building ��� /CJ—►)'O?eUtility Authorization No. r r .-�:
Existing Service iSLti� Amps 112) 0 4/aolts Overhead PUndgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity �}/�j�
Location and Nature of Proposed Electrical Work _�ii.�/�'� eo / ae
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO O ! have submitted valid proof
of same to this office. YES ❑ NO LJ
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE t_J BOND ❑ OTHER❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start Inspection. Date':.Requested:- - Rough Final
Signed under the penalties of perjury:
FIRM NA LIC. NO.
Licensee ignature LIC. NO.
Address s j Bus. Tel. Nc�
�3�V / Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement, Owner Agent (Please check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
TOTAL
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
AboveIn-
❑ ❑
No. of Lighting Fixtures
SwimmingPool rnd. rnd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No..of. Oil. Burners
Battery Units
j
No. of Switch Outlets
No. of Gas Burners /
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Conditioners Tons
Initiating Devices
of Sounding Devices.
Heat Total TotalNo.
No. of Disposals
No. of Pumps Tons KW
No. of Self Contained
Detection/Sounding Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local❑ Connection ❑Other
No. of Dryers
Heating Devices KW
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO O ! have submitted valid proof
of same to this office. YES ❑ NO LJ
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE t_J BOND ❑ OTHER❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start Inspection. Date':.Requested:- - Rough Final
Signed under the penalties of perjury:
FIRM NA LIC. NO.
Licensee ignature LIC. NO.
Address s j Bus. Tel. Nc�
�3�V / Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement, Owner Agent (Please check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
1018`891
TO
2859
SA
Date ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... J7
............
..........................
has permission to perform ....... I -I. -t.. -IJ ......... ...........................
wiring in the building of ....... & ...................................................
at ........... ...... P..C.k ..... . .......... North Andover, Mass.
Fee... .... Lic. No. ...............................................................
ELECTRICAL INSPECTOR
C �z 4 h24412:41
WHITE: Applicant CANARY: Buildin62;SPt. PAID Treasurer GOLD: File