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HomeMy WebLinkAboutMiscellaneous - 37 ROCK ROAD 4/30/2018w 9625 V Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................................................. has permission to perform .. ) �Y 4€5....... /S< ................. wiring in the building of ..........ff...\... � ....�.1.. '✓f ..................................... at ... .. .... . / C. CCJG ..... .. .............................. . North Andover, Mass. d y�R�IC��A�LiNsgcrOR. Fee .S.'..... Lic. No �l ..... 9��......... r ........... E Check # Z u a.wnmwrwcan.0 v1- . Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: O� •— z -- 1, 0 City or Town of: NORTH ANDOVER 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) -.31- pDc,�_ n3 Owner or Tenant V Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 5 r nod . PfAm � Oyi e. I l ti^ill a 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: 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 ❑In- El rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ran Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ����� .................................................. 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 Sectio. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 5Q0 . (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. -^— CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penaltieso per ury, that the information on this application is true and complete. FIRM NAME: M al1k CVC 7 LIC. NO.: '2LICIPI Licensee: 15gM a Signatur LIC. NO.: (If applicable, e r "exenspt" in the dense umb r line.) Bus. Tel. NO.:�?J 05�2� Address: °v Alt. Tel. No.: *Per M.G.L c!1-47, s. -6-1; security work requires D partment of Public Safety S" Lic n e: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's ______Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 V s• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2 I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip:_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thgpains andperlalties ofpeJury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone This certifies that Date. 7 .. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission,to perform �c k u (-1,4 t(C-'.' .. �....... . r plumbing in the buildings of .. A( �/�.?:... ..................... at ...3. 7 .. P .Q c .r ..%. 2 .� ............... North Andover, Mass. Fee. ..Y) ... Lic. ....... PLUMBING INSPECTOR Check # �p G 8385 -A. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS -{ � Date Building Location Q' 4tl, Owners Name Permit # 7 T ^ ^ K2 Amount !&j New 0 Renovation M Replacement 0 Plans Submitted Yes ❑ No 0 FIXTURES (Print or type) � ��'k Checkone:Certificate Installing Company Name �� �Q�\ \ �ll� o �1R k 6 Corp. .�.�� Address Name of Licensed Plumber: J. " Partner. 11 Firm/Co. Insurance Coverage: Indicate the pe of insurance coverage by ctkcking the appropriate box: Liability insurance policy rq Other type of indemnity❑ BondLMJ 0 Insurance Waive: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent 0 I hereby certify that all of the details and information I have submitted (or entered) inW lication are true and accurate to the best of my knowledge and that all plumbing work and installations performed unde ed for this application will be in compliance with all pertinent provisions of the Massac g o a 142 of the General Laws. By:Signature or Licensea Tide Type of Plumbing License City/Town � I ug�"""� Master � Journeyman PROVED (OFFICE USE ONLY G N° 2639 -P- O Date.. �.�'..� ��......e '00 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................................................ C Iq L 64 CD ............................................. has permission to perform ? ............................................................................... wiring in the building of 3 �'�—�c�i9 (� ...........7............. .............................. .. ................... at........ ....., r �4 �... C .f - ............................ . North Andover, Mass. AA -....... 4)44)4.>G .............. Lic. No.ra„_,..S 1l!t............................................................... ELECTRICAL INSPECTOR Check # 3 WRITE: Applicant CANARY: Building Dept. PINK: Treasurer 77� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No.(03QJ Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Is 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 / --/ -CS✓ O d To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. :3Location (Street & Number /er/�2 o Cl Owner or Owner's Is this permit in conjunction with a building permit / > � 1.0% / _A — Purpose of rJ Yes Existing Service Amps Voits New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Li No ❑ (Check Appropriate Box) Overhead ❑ Overhead ❑ Authorization Undgrnd ❑ Undgrnd ❑ No. of Meters No. of Meters No. of Lighting Outlets No. of Hot fuse Total No. of Transformers (VA No. of Lighting Fixtures Swimming Pool Above ❑ In ❑ grnd ❑ grnd ❑ Generators KVA No. of Receptacles Outlets No. of Oil Burners y Lightin No. of EmergencgBatte Units No- of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Sounding Devices No./ of Self Contained Detection/Sounding Devices ❑ Municipal ❑ Other Local Connection No. of Ranges Total No of Air Cond Tons No. of Di osal Heat Total Total No. Pumps .-Tons KW No. of Dishwashers Space/Area HeatingKW No. of Dryers Heating Devices KW No. of Water Heaters KW No. of Signs No. of Bailases Low Voltage Wiring No. Hydro Massage Tuds No. of Motors Total HP uvourvAN ,t uvvLKAt.t. vursuam to the requ5p, en6ts of Massachusetts General Laws thave a current Liability Insurance Policy inclucV69 o feted Operations. Coverage or its substantial equival have submitted valid proof of same to the Offi ES O = If you have checked YES please indicate the 1 PSURANCE = BOND = OTHER = (Please Specify) NO = rage by checking the appropriate box. (Expiration Date)( Estimated Value of Electrical Work$ WorkStart �� "/ —(J(y Inspection Date Resq ested —Rough Final Signedd under It altie e ' ry: ��I ; FIRM NAME C e' GC /� ,y .,[ LIC. NO. Lkense �4 (^ /// --- Signatur ^LIC. NO.�_ / 9 Ae �/ us. Tel No. f ,O- Address /t/ Alt Tel. No. OWNER'S INSURANCE WAIVER: I aware that the Licenses 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. PERMITTEE (Signature of Owner or Agent) Location 3 ' k No. 4/(5Date 9r"169'G 0 �oRTN , TOWN OF NORTH ANDOVER 41 ' Certificate Occupancy $ • i ; i of ITS '��N�SE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14 11 7 4 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT EKLAI& RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING , ) MOWH 11", BUILDING PERMIT NUMBER: /(50 DATE ISSUED: SIGNATURE: r Building Commissioner/In for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: PD 1.2 Assessors Map and Parcel Number: ^� y Map Number Parcel Number 1.3 Zoning Information: S' % rl IAL / f=,y1 % = ttG ZoningDistrict Proposed Use 1.4 Property Dimensions: c a Lot Areas Frontage (ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided L Ok^ 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public '' Private 0 Zone Outside Flood Zone O/ $ 1.8 Sewerage Disposal System: Municipal 4— On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2..1yrOwner of Record l Vo Name ( nnt) 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: q� CIO � �� .'"t /J. k 0C Licensed Construction Supervisor: '�(r^> G ll 1 10 Address Signatur Telephone �i -�, G 3 q9 L Not Applicable ❑ Q License Numbe Expiration ate 3.2 RigisteredAc6fe Improvernertf Contractor / D� ` 1i / L 4 A c Not Applicable ❑ l / L{ Company Name 1?,F y� ne d / 7 ] PT / �C �/ I Re istration Number Address [191iA<,o4 © d ^ Expiration Date gr�-a-ter Tele hone y 0 O z M O r rM 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: P D - _/ 2( 6QJ _ v iwlf? G a22?I 7`'D /'1 14- PL r ,L ,DAFT%/ �4f ✓L 0 •q D '4 i ' ?L z1f. , - d �i -, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beFFICIAIr Completed by Ennit a licant lG USE QNLY 1. Building d ej e Q (a) Building Permit Fee 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 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB R> Rn /avy S /0,4 L /Z SIZE OF FLOOR TIIVIBERS Is[ �+� 2 ND 3 FLU SPAN DIMENSIONS OF SILLS , DIMENSIONS OF POSTS E. - DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION '/ THICKNESS p SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND / Zj IS BUILDING CONNECTED TO NATURAL GAS LINE It 10 �EC-V y►..5"-,� FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT S1-9 �L PHONE 1� g P tC� ASSESSORS MAP NUMBER V LOT NUMBER ' C� SUBDIVISION NUMBER STREET @ C K T STREET NUMBER 1-3 OFFICIAL USE ONLY ........................................................................... RECOMMENDATIONS OF TOWN AGENTS �lf....... .■ 0000-00 ............................... ■...........■ DATEAPPROVED CO SERVATION ADMINISTRATOR DATE REJECTED DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED SEPTIC INSPECTOR - HEALTH COMMENTS PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERMPr FIRE DEPARTMENT DATE APPROVED DATE REJECTED DATE APPROVED DATE -REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 9 .�/e {rJ`'it��z�na�zu�ea�l� a�:��raacrrr�raaa.Cta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 009708 Birthdate: 07/0511940 Expires: 07/0512001 Tr. no: 11169 Restricted To: 00 PHILIP LACROIX JR 62 BUTLER ST SALEM, NH 03079 Administrator I �� if r �E cs tl t :1! , .,. :,..,..r.: n)l ,. >..., w.t i.... w. t.....'.. f..'. ... ..!.? .4 ;...y,.'t l s :. ..i::.. S.t PRODugItN O$REY INBCrRAN E AGENCY INC. 20 HIRC:H ST " s s s a x 1 \ �; r ss z� ObIFE IAMrQQ,^fY! ,. ......... !. t.... ,a s.x t•.,? <s. .. �... 9 01 00 THIS CERTINOATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CIERTIIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES UELOW. compANiEs E4FFORDIND COVERAGE � DERRY NH 03038- _._._...___ COMPANY (6D3) 432-3883 �._,�,.,. L - A ZURIaH INSURANCE ff=Mm j COMPANY PML LACROIX & SONS , INC . I CXJMPANY 1 C 151 SHORE ROAD SALEM, N.H. 03079 OOMPANY THIS 18 TO CEFITIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE4d ISSUED TO THE INSURED NAMED ABOVE FOR THE PtaLiCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUAEMENT, TERM OR CONDITION OF ANY cONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE Y THE POLICiES DESCRIBED HEREIN IS SUBJECT TO ALL T:4E TERMS , ANDCONDITIONS NS OF SUCH POLICIES. I. LIS SHOWN_ _..., MAY HAVE BEEN REDUCED BY PA CLAIMS. ...... ....... ....Nfi to 1DCGLUSI vw o►POLICY NUMBERCY LTR ,..... __,_....._...._.._ .._....._.__ uralTs......._................ .......... ........... vnL6 FFECTME � POUCY SXPIBATION i j DATE (NIM )OrM I DATE tINM/DDkYYk ., A L—FRAL UAsL! X OCOMMERCIAL OENEFIAL LIABILITY SCP 35395343 CLAIMS MADE FT', OI:CAIR ""r"'$P A $ C ndTRAyTOR 6 PRO7 %X,PRODS/COPS INCI i GENERAL AQOiEC3ATE 100_0 000 09/15/99, o g/ .l ci f l i r�PRODUCT'S-.COMPIOP AOG 181 , _0 0 0, 0 0 0 ., 1 i : EACy br ^lJ�if NCE j F 0 0 , 0 0 0 �F'iRE 7AMAQE (Any 6n®rosy sSD t?�}D. MEC EXP 4Aoy an Parson) J$5, COQA AUrOINCdEilll LIAEIurY h"- ANY AUTO SOP 35395343 �j ALL OWWn AUTOS 1 J K SCHEDULED AUTOS i 4RF_0 AUTON 1 NON-OWNED AlJT06 1 �.._—.—._._._....... 11II �09/15/99�109f15f0i j f dMBL�IFC PINOLE LIAR' v 8004. Nj Adf fPar Psrsan) lPeraccldsnt PROPERTY QAMAGE 6 . . 8 F WAAGE LIABILITY ! t._._..? ANY AUTO 1 AuTj ONLY . KA ACCICENT LOTHEq THAN AUT04NLY: S i -- --- ! WH ACCIDENT AGGREGATE =US LMAOILITY � � EACH OCCURRENCE S ' I UMSR'=LLA FORM 01,HER THAN UMBFCEL.A FORM % f ,� J AG{ GREGATE ....._.,,.4... _.. _ �- 6 A WONalRtS 9X*P&MAYION ANDI iTCO 98575525 PARTNEMEXE+^UTROE X I I J OI i � 109/15/99109/15/01rKEACHACCk&nmi510Ci,000 I TORY UMTTC I 10 R _ I BL DI&£At.E - PGLICY LIMIT i.-5 _0 0, 0 0 0. rPL EL DISEASE - EA EMOYEE 1 0 0, 0 0 0. A, aT►seRSLTRETY OIdD PENDIIIG 1 i ' ; � l 12 99 1 1i 12, 01 ; DRAI[�TT,jAYERS SOldD I ti- I i I I I a I DESCRIPTION OF OPERATIONG/LOCATKWAWri1Q{,.E8119?ECtAI ITE1M9 FAX: 890-3998 •� ..1 y 1 4 t '. : x k � a' i s a t � t,.. yet �, a 1 *4R"""'�'�""^"'"'\"" < a BHOULD ANY OF TME ABOK DE30RW-0 POLIOII10 DE CANCELLED ®EFQRE THE EXPIRATION DATE THFREOF, TitiE I34i l*a CAaIPAmy BILL EN®EAYOR Td aMA16 QAYB WRITTEN NOTICE TY➢ TD19 CFcRTTFICATE HOLDER NAMED TO THE LEFT, BUT FAILURR Ta L euCo-s NOTK:E bWALL -PQ06 NO ObLIVIAT1ON OR LLARILITY '.Ott' OF NORTH ANDOVER 9f ANY KIN N THE PANY, ITS AGENTS OR REPRESiNTATIVES. AU Al V... i s \x y` x .i'':sNs � ..:k Vz.,.lil,z .,a k .: L:tl , s, ii, F-:.{{�i.klxf ki3 Ee\1igg baa f I, yyuy, A9�. Wyk cyo q 1 .«. �� ... �,�.ace:rwsum'.rw"W'r.^'��-ur'ti.i..ww�w•i r �y� k i ... i" } V S Ulf r % i Cl) m m C/) Cl) m y .0 CD n Z O O d d �.=. Q =. n� .0 .0 0 o v CD C7 CD :Z O co CD CO) '0 CD O CA d•. O CA '0 C7� C O C CA d CD 0 CD a y* CD CO) O CD O CCD O _ O -• H G Q H a0 a0 CO) :3 co o m o M a o• -n CL .. O O m y O -1 o CO)iCD o n O 7 N m O C� Oto f 1 o 0 c') O y' l . Cc N lu CLto C3 .« jum m N V J =c COL 1 O O ` O7 D1 y H O ?:� C a o, U) a !t! ^ y C ti. ? �' m A H (o "d% C CS ti otom O O z _ V o CO) �0 0 a. 0 m CO) m o CD CL now c o o = ' o � z 0 rn �q cn O ,� cn z ° Co m w 7z o G S m w �p G r. w G m phi n 7d G �- 'r1 G o CTS d y` g d dz 0 W y 0 9 0 c NOY-03-35 TUE 14:52 BAII_LIE.CO. Igr 6e 6.17 944 6112 P.01 MORTOAr = IWcaFr_'-«~1I1 D1 A KI I,orrt-- itaAV THIS PLANS BASED ON A TAPE SURVEY (NOT AN INSTRUMENT SURVEY) AND IS TO BE USED FOR MORTGAGE PURI`05Es ONLY. THEREFORE, THE OFFSETS AS SHOWN SHOULD NOT BE USED TO ESTABLISH PROPERTY LINES. 5sse>4 COUNTY DEED REFERENCE: PLAN REFERENCE: PL NO. -t-178 BK. 3898 PG.IZ4 PL.BK PL. CERT. NO. BK. PG. I hereby certify that the existing structures are located approximately as shown and were not In violation of the zoning by laws at the time of construction, or are exempt from violation enforcement action under, Chapter 40A Section 7 of the Mass. General Laws. The structures are located in Zone_ IS according to ilia following F.E,M.A. map, Note: Zone C represents areas of minimal flooding. FLOOD HAZARD COMMUNITY NO '4521098 BOUNDARY MAP NO—004--' EFFECTIVEL Tumi—U RE ISTEREbL'AND SURVEYOR /!-/-1 EI? DATE THO�raS '± C. IBAILL.IE A t, sac leap 6I1R�11<C� - PLAN OF LAND IN PREPARED FOR: PEOPLE IS M0FTgNor 'eo'e py &M 0r) rOoMAS 6c TANS sE`c.t A SCALE I IN.=30 FEET BAILLIE & COMPANY LAND SURVEYING & RESEARCH 33 HOWARD STREET READING, MA. 01867 PHONE: (781) 944-2767 FAX: (781) 944-6112 2 2 51 Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... -,.4.-..D.T ........ ....... has permission to perform......... .. (.04-4.m .......... wiring in the building of .............. ,.A.� .......... cl.t .. (,Z -A: .............................. ,-At ........ ...7....., ........ 1�d .......................... . North Andover, Mass. -;> ' d') Fee.......... ;� .......... Lic. No. .1111.X ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. 3CWK: TpMrer 02/16/99 12:09 Ulllc© U50 vniy Ile &MM0uwealt4 of malij�oclluoetto Permit No. O Nepartinent of Public bufctV occupancy ,& Fee Checked 3190 peeve blank) BOARD OF FiRE PREVENTION REGULATIONS 521 CMR 1c.00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1 :00 (PLEASE PRINT IN INK OR ;TYPE,14LL INFORMATION) Date City or Town of OY[aTo the Inspector of Wires: The udersigned aooiies for a permit to perform the electrical work described below. Location (Street E Owner or Tenant Owner's Address Is this permit in conjunction with at building permit: Yes ❑ No IN (Check Appropriate Box) Purpose of Building Utifity Authorization No. Existing Service Amps _! Volts Overhead ❑ * Undgmd ❑ No. of Meters New Service Amps _I Volts Overhead ❑ Undgmd C1. No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general LawsI I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES G NO O nava submitted valid proof of same to the Office. YES O NO O it you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCE C BOND. G OTHER ❑ (Please Specify) (Exp atlon Oate) Estimated Value of@ctr cj1,AJdrk S Final Work to Start 1.�.__ Inspection Date Requested: Rough Signed undor tho Penaltles of perjury: UC. NO. _1Z31C-- FIRM NAME LIC, NO.. ;?311 Llcensen ilnnal ci,A $ranks _Signature Bul(413) 737-4400 s. Te. No. Address 111 Morse Street. Norwood. MA Au. Tol. No. 1131— not have the Insurance coverage or Its substantial equivalent as re - OWNER'S INSURANCE WAIVER: 1 e aware that the Licensee does qutred by Massachusotis Gonoral Laws, and that my signature on this pormit application waives this requirement. Owner Agent r /) (Please chock ono) ,. Telephone No. _ ...__.-- PERMIT FEE $ ._------- — (Signature of Ownor or Agont) x•0545 Total No. of Hot Tubs No. of ltansforrners KVA No. of Lighting Outlets No. of Lighting Fixtures Above In' Swimming Pool grad. ❑ gmd• ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units FIRE ALARMS No. of Zones No. of Switch Outlets No. of Gas Burners No. of Detection and No. of Ranges Total No. of Air Cond. tons Initiating Devices No. of Disposals No.of Host Total 'total Pumps Tons KW No. of Sounding Devices No. of Self Contained Space/Area Heating KW* DeteclionlSounding DOVICea ' No. of Dishwashers • Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Volta Wiring Zo No. of Water Heaters KW Signa Ballasts ' No. Hydro Massage Tuba No. of Motors 7otai HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general LawsI I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES G NO O nava submitted valid proof of same to the Office. YES O NO O it you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCE C BOND. G OTHER ❑ (Please Specify) (Exp atlon Oate) Estimated Value of@ctr cj1,AJdrk S Final Work to Start 1.�.__ Inspection Date Requested: Rough Signed undor tho Penaltles of perjury: UC. NO. _1Z31C-- FIRM NAME LIC, NO.. ;?311 Llcensen ilnnal ci,A $ranks _Signature Bul(413) 737-4400 s. Te. No. Address 111 Morse Street. Norwood. MA Au. Tol. No. 1131— not have the Insurance coverage or Its substantial equivalent as re - OWNER'S INSURANCE WAIVER: 1 e aware that the Licensee does qutred by Massachusotis Gonoral Laws, and that my signature on this pormit application waives this requirement. Owner Agent r /) (Please chock ono) ,. Telephone No. _ ...__.-- PERMIT FEE $ ._------- — (Signature of Ownor or Agont) x•0545