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HomeMy WebLinkAboutMiscellaneous - 379 BOXFORD STREET 4/30/2018 (2)r O � � W n T O;o v o cn o M C) m-14 ml o - i /� Date............................................ . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that � " Z�- C- has permission to perform ...... . .................... . A ... ............... A .... .... .......... wiring in the building of ...................... - / ............... .............................. Ih Andover, ss. at ...... A.:..................5................. . . .. . ........ ................. ................... .. . .. ........... Fee... ........... Lic.No. aIPv r .. .. ............. ELEOfRICAL INSPECT Check # 12 ", 1 "Q 7-/ Commonwealth of Massachusetts Official Use Only " F[FRRmv,. it No. Z �1 Department of Fire Services OccupancBOARD OF FIRE PREVENTION REGULATIONS 7]yandFee Checked (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC), 527 CMR 12.00 (PLEASE PRINTWINK OR TYPEALL INFORMATION) Date: 0 C1 34 ,.0 t City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of or her intention to perform the electrical work described below. Location (Street & Number) 9 7 `l ,?a X_ r0 S' '1` e e f Owner or Tenant kei-l1 y&L, c ti Telephone No. Owner's Address sifm k Is this permit in conjunction with a building permit? Yes E No ❑ (Check Appropriate Box) Purpose of Building j s 1 dem P Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters No. of Recessed Luminaires �•• .�.� . W cne Ju,tUW1r49 No. of Ceil: Susp. (Paddle) Fans ,auee may oe waivea Dy the inspector of Wires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. of Emergency Lighting rnd. ernd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of Detection and Initiatin Devices No. of Ranges Totallo. No. of Air Cond. Tonsl No. of Alerting Devices rNoof Waste Disposers Heat Pump Number .Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of WaterNo. of No. No. of Devices or E uivalent Heaters' of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total 11P Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of 97res. Estimated Value of Electrical Work: ( When required by municipal policy.) Work to Start: 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: INSURA=NCE ® BOND ❑ OTHER ❑ (Specify:) Icertify, antler thepains andpenalties ofper ury, that the information on th ' lication i true and complete. FIRM NAME:. Cu"r-tv G �+1 ' r e S t— r c LIC. NO.: � 0 9 �D - d Licensee: ts,S /o/" //J 4 . L Signature LIC. NO.: (If applicable, enter "exe pt" in the license nWnber line.) Address: S' K�w our j�e /(/a- l���u�.�r� lvt,p Bus. Tel. No. • 7 V /' W, 790 Alt. /uG % *Per M.G.L c. 147, s. 57- 1, security work requires Department of Public Safety "S" License: Lic. 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 agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ v ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shalt be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the ;. notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Fri Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSP CTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP CTION: Pass [N V Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: 1-2,77—IS- Z— —/.S DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com fi Ui 0 Eli MER i_ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia Compensation Insurance Affidavit- Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTE(OR#Y. Name (Business/Orgau'zation/Individual):. Address: S VAS wao�4 City/State/Zip: Ma - .aW'e'r Mn Are you an employer? Check the appropriate box: 1U �d51r«S Phone #: 78-1- PH -79-0 l.�am a employer withemployees (frill an Part-time)'* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp_ insurance required.] 3.Q I am a homeowner doing all work myself [No workers' comp. insurance required-] t <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. s.[ -]I am a general contracto : and 1 have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.t 6. Q We are a corporation and its. officers have exercised their right of exemption per MGL c. 152 § 1(4) and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ Nerxi'construction 8. El Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.6Electrical repairs or additions 1Z,Q Pl<iunbing repairs or additions 13•. Roof repairs 14. [] Other *Any applicant that check's t,ox �#1 must also fill out the section below showing their workers' compensation policy information. Homeowners who sul,mit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCoutractors that check this box must attacheed'an additional sheet showing the name of the sub -contractors and state whether or not those; entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company M Policy # or Self -ins. Lic. Expiration Date:. f �City/State/Zip: Job Site Address:. % _91? © X -Tr''' �� /1% Attach a copy of the workers' compensation policy declaration page (showing the policy number and expirration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 enalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a and/or one-year imprisonment, as well as civil p day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DTA. for insurance coverage verification. I do hereby u th al n an a lties of perjury that the information provided above is true and correct. Date: Si atur Phone #: 7 �7 ` 7 g Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 0 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enferprise, and including the legal representatives of a deceased employer, or the receiver'or trusted of an individual, partnership, association or other legal entity, employing employees: • However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment bd deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicarit-who has'not produced acceptable evidence of compliance with the insurance coverage requiired." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if nece§sary, supply sub=contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of .Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatiori policy, please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost Q 175:8.00 m $ - $ 141.10 Plumbing Fee $ 17.64 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 17.64 Total fees collected $ 276.37 379 Boxford Street 373-2016 on 9/22/2015 Remodel powder room Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ . Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -� Check # CD 61e M V ,. % Building Inspector • L 4 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ©� DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1Property Address: - n J/� " 1 -2 m�L�o ACX- 1.2 Assessors Map and Parcel Number: p, / Q6—c J Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Require,d Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 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 ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Recor brl:s�Q�i Njrint) �9 zz�% QAddress for Service: to Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone S TION 3 - CONSTRUCTW SERVICES 3. icensed Cons ct Supe is r: ro i ensed Construction J�St sor: T e Addres Signature o�Val Telephone Not Applicable ❑ CJ 6,5 i License NumberNat ig/ — 6O /�� Expiration Dat� 3.2 Ogistered H Imp veme ntractor Not Applicable ❑ C pan ame C � /�j✓j� {� (J� Registration Number Add ss Expiration Date Si ture Tele hone • L 4 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 an applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify 1 Brief Description of Proposed Work: S �>, hDolt-kyl a1�uo ,I�q SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beOCiAti Completed bypermit applicant USE C?1�TLY`� 1. BuildingX U (a) Building Permit Fee Multi lier 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 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/Aent 99-4940-2-21— NO— NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City wo/ 7 A J11 OQ(le Y Phone "f 69 O D/ 6 aam a homeowner performing all work myself. =I am a sole proprietor and have no one working in any capacity = I am an emplo r providing workers' compensation for my employees working on this job. rmmnanv name: 4t. 6a l t a O� h P L (�d h Address , ).`J D( /V CW '-h J U City�7ZQt�� /�p0/)U'ry Phone#: � G Address //b 0 UC /7 City 2'to ��1/ f! e "6S S Phone #: Insurance Co. Policy # 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 civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do he Sign Print //63 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION ✓ize %�'orrvno�.uuea�/ o� ,%�aaacu./uaea4 BOARD OF BUILDING REGULATIONS _icense: CONSTRUCTION SUPERVISOR Number: CS 059233 I Birthdate: 12/08/1961 Expires: 12/08/2001 Tr. no: 12249 To: 00 JAMES A GALLAGHER 352 HOWE ST METHUEN, MA 01844 C.i.«..i —i 4� Administrator f t ^^ O = A� p Q3 m CO ° ° - CO CoM r*(nC0 ° :T ~ � Q �rm Z (!1 0 (Q --q CO n 0 F- (0 Z o (n 0 Al D I"n rt I r1 -i + 0 O �a O O 0 U1 N N N 0 lv ZJ O O,�aO p ()I o D [ i D I � I I � I �.I K :23; I Z M M.a r t 3 mca a N = m o r M00 ►� a r 1— � •C m I 4+ xZ S 'N -t con r of o tea Z n � � a i O � I z o I A `C O O (D I- m co 3 W U (.4 m'LTID» 4 rt H j3 N m 3 x z rpt' Z U C=(n0 M 0 D 01-0 H 0 C zr- Dr- Cpm m r H 3 c z (A O 0 -i D rX CD r 0�1� OD D W O m Z X n fi O f t ^^ O = A� p Q3 m CO ° ° - CO CoM r*(nC0 ° :T ~ � Q �rm Z (!1 0 (Q --q CO n 0 F- (0 Z o (n 0 Al D I"n rt I r1 -i + 0 O �a O O 0 U1 N N N 0 lv ZJ O O,�aO p ()I o D [ i D I � I I � I �.I K :23; I Z M M.a r t 3 mca a N = m o r M00 ►� a r 1— � •C m I 4+ xZ S 'N -t con r of o tea Z n � � a i O � I z o I Cf) m Cl) Cl) m v .p CD C � d y � Cl) Z y CD O 'C CL r �� c � � c CZ CO) C CD CD O Cr d CD Er Dow B. c O co) v. v yCD 0 b' FA 0 C c E� o m 2 C �• CAo Q N .�� G O CL SO m -O Cl) m m y n d !7 Z =r= H — CDC M =r O aim o ti p o i am O = O O O CA O •p O cli O o H•Cot t9 W 3 o O :Omb c• �yCL� n =co 0 o,m� CCD CD c a O CO) C C y d Q _• aCL CLCA _;� C CA y CO) _ H O CD d HclCDrN Fu' 3 O Q CDoi z CA � CD CP) cm '1CDCD o m o CA CD m m 1 �C 0 rD 0 d C rz n — aGc r w- � ao 0 r z C Q. n H w o I 1 O C y 0 9 0 c Location v Q-3` No.` Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ � - s Building/Frame Permit Fee $ SAC MUSE Foundation Permit Fee $ Other Permit Fee,, $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector J L 08/04/99 11:58 60.00 PAID Div. Public Works C U z z N lb M. /. Z 70 '� Z' •T: cz F — � - = -1—Z. C4- Lh- < z 44 - CA zz W ^ z z z i2 r inic ., > R • G w r s44 _j ' c F Z G � �U_ U .0 n y :U CA t Z Z ..' -ZZ- - �b - C 1. ^ ^ CO L tm C4 i F O O w C O U •U Ur �U. ..i' w W W cn F Z ^ C C p p U. Z z we z_ G C z z Z C ^ W Z' N G 0o C� ..m -- - _T C U z z N lb Z 70 '� Z' •T: cz F — � - = -1—Z. C4- Lh- < z - CA zz W ^ z z z i2 r inic HOMEJMPROVEMEN T -CONTRACTORS-REGISTRATION , Reu'lat ions and Standards �j oard.,of, Building ,,,One; Ash b urtn Place - Room 1301 Bo:st'o n mass'achus�etts 02108 H6,- -'t PROVE11E'4i.60NTRACTOR ME� Regi �,t 'a t 166 10 07. 1 Expir'ation 06/23/00 ,r.1'0 (L Typ.e,DBA' . . lq HOK E IMPROVEMENT CONTRACTOR ReqiWati6ri 100712, CHARLESI ROOFING', . WbOS,TE.R:.',j TYP: 6 - DBA �Iharl.es`m'Uboste- 1 ation 06/23/00 Expir W 0 Q U R N ST, - ,i,5,25;' it,, JEWKSE36ky.,'HA' 611876' . . . CHA RLES 1. WOOSTER ROOFING,' Charles J. Wooster ST ADMINiADMINISTRATOR.01876 TEWKSBURY MA CONSTRUCTION SUPEfRVrSU 1JU-N1'. Nimber: E XPJ reg;: Bixthd6ite: CS 054268 05/11 /?000 y5/.11./1961 Restricted To: 00 It CjjAR1J':"' J WOO �Jf* R . ..... 1 ' I 7i , �!132 17'C0:,1v11 PO BOX 805L LOWS L L MA 0185:3 Kt els 1:01 for receipt and change r - -PROPOSAL 'RE ALWAYS ON TOP" • :L TYPES OF ROOFS Proposal No. CHARLES WOOSTER date 7/9/99 FFICE (978) 251-7181 FAX (978) ,251-0159 REASONABLE ILOVE R FS@ wi.cgm DEPENDABLE Work To Be Performed At ,,Street City State Zip Code 5L 15 Fax Number �� Telephone Number �e We here pro t furnish the materials and perform the labor necessary for the completion of the- following job. ou -p the entire roof down to tfie roof deck excluding the rear addition. 1. Replace an rotted roof decking at $3.00 per foot. Install 8" aluminum dri ed e. . liatall 6` of ice and water barrier on all eaves. 4. Paper remainder of roof with #15 roofing f 5. .ristall bird Seal King 25 year s in les 6. k'�3ash solar system to roof. 7, ln.stall rubber roof on rear low pitchd S. install continious ridge vent. •'' f,a, ; 9. Clean and dispose of all debris. f Workmanship guaranteed for 10 years. We are fully insured th workers' compensation as Well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifica- tions submitted for above work and completed in a substantial workmanlik a sum of Dollars 5,650.UQ �� ($ ),with payments to be made as follows: Job paid upon b leti /���Q Respectfully submitte ap�ll ur Referenceso be withdrawn by Fully Insured — us if not accepted wl I _ s ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby acce . ou are authorized to do the work as speciered--Pajrment will be made as outlined above. Date Signature m m m m 0 m y C � CO) CD n Z y CD O M CL r n� JW C3 =• y n� z, c v CD CDCL O � aC=D CD O CD W c CD v). CD d O CO) CD CD I VJ 2 0 O �• N C CS CDN »c m O NCn D oZ Stam vNi =r CL ® =• d O CO) o ='m m O O O N m C CD O C) C9 �. O .+ O z CO) O N C'7 C � � I n N CO . CD CD N ' tOo CD C a 1 QN M N N a Chi Cr C c• O CA CD O CD CD v' N "3 CD CD CD CD CA O m O O O Ca CAo: CD .m. CD a3: N CD -, O to o =r: Ca m m C•) C� CD C c O C -- 0O2 C7 m m CO2 2 a4• b B D o rn N • � . oGq CA 7C PTJ s A Date./ ...................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ...... 4�� . ..................................... has permission to perform ........1.: ................ wiring in the building of .... ...................................................... at 7..... 7.9 ...... ............... . North dover, Mass. . . 01-41 — 21 ...... , ... Fee --29 .... . ....... Lic. No�&7y ........... se Check 5467 THE COMMONWEALTH OFAMjSS4CHUSE77S Office only DEPARIAIENI OFPIIBII S9FEIY Permit No. e`7�G % BOARDOFFIREPREVF. MON ONSR7(M]2:t'JI� Occupancy & Fees Checked APPLICATION FOR PERMIT T / PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH TIE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIbN) / Date I%11Qc 12 200 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ,'� 7q RA %ec 0" ,0 / cz, n n r,v Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes a No (Check Appropriate Box)` Purpose of Building Owe-ti,1-4 - Utility Authorization No. Existing Service Amps �Volts Overhead a Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1a)aSF Ile -L �co��ecoHcw-a4, No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round 1:1round No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners 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 Municipal r ---J Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• kUUIXeCC)Mnge. Ptust=lDdlete4MMICrAs tsetlsCOUWLaws IaamentLiabilityhnurRtoePblicyinchrfalgCorr#eto Covaageoritstialegtuvala�t YES' NO IbaNeahniiedvandptoofofsametotheOliim YES ffyouhaNedrekedYES, pleaseindcalethetypeofocvaageby Lhedongdr ' box INSURANCE BOND GII ER (Please Spec y) EViationDale Estir WdVahXdE1wmcalWolk $ FIRMNAME t c c 2c iiar>seNo. Cs. 0211? 7 Li0e me L64-LL� i C( 'E"2 Signa w ,Ml, 11-2a2? (( !! '' tt BusSffmTel.No. _ q7.0 3? 28) (Yi a, t4y C a L1J SZ4 l �rt� e e! k4 4 � kk U lA, AkTUNo. ` ` OWMR'SINSURANTCE ANER;IamawatetudrLioalsedoesnothavetheinsttranceODWMgeoritssubg�egtrivalentasWmedbyNimadx>xseusC',malLaws and dratmysigniueonthispeanitapplicationwaivesthis n gtmenalt. (Please check one) Owner 1:3 Agent Signature ot Uwner or Agent Telephone No. PERMIT FEE $ O ' %