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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
1�B �e.v So �.� I-eC
Thiscertifies that . .... R.....................�..............' ........ N.................
has permission to perform cv / v ti P� �. U
....................................//.........................................
wiring in the building fof . ((set -t�.... u-� ,� 1w .......................................
nn11 �o to ttit W� ........ , North Andover, Mass.
Fee..... ... Lic.No.��`%a ! lv co -- k.`P.................................
ELECTRICA INSPECTOR
Check # °� S
(f1 nLrwnwaa&
1JaPaflntanl o�}ira �arvica�
BOARD OF FIRE PREVENTION REGULATIONS
For Office Use Onl
(Rev. 11199)
Permit Number:
Occupancy & Fee
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
(ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00)
PLEASE PRINT IN INK OR TYPE ALL INFORMATION OSS 0 6 o
Date: 0 o c2 0 e 0C-�;,L
City or Town of: & ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the.el.ec rical work descr'bed below.
Location: (Street & Numbe' .Q
Owner or Tenant:
Owner's Address
Is this permit in conjunction with a Building Permit? Yes le..' No ❑ (Check Appropriate Box)
Purpose of Building: O tom° L 1 N Utility Authorization #:
Existing Service: Amps / Volts Overhead O Underground.❑ of Meters
New Service: Amps / Volts Overhead O Underground.[) # of Meters:
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical Work: ICP Wil 10) N 3 YZA rho K,
No. of Recessed Fixtures. /
No. of Cell.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool: Above ground ❑ in Ground ❑
# of Emergency Lighting Battery Units
No. of Receptacle Outlets y�
�v
No. of Oil Burners
Fire Alarms # of Zones
# of Detection & Initiating Devices
No. of Switches
No. of Gas Burners
# of Sounding Devices:
# of Self Contained
Detection/Sounding Devices
No. of Ranges A
g
No. of Air Conditioners TOTAL TONS:
Local ❑ Municipal Connection ❑ Other o
No. of Waste Disposals
Heat Pump Totals:
Security Systems:
Number: TONS: KW:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: KW
Data Wiring, No. of Devices or Equivalent:
No. of Dryers ......
Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent:
No. of Water Heaters KW
No. of Signs: # of Ballasts:
OTHER; Lc fW� RAI
# of J Massage Tubs
�—
No. of Motors Total HP
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 t,-' BOND o OTHER ❑ Please specify:
Estimated Value of Electrical Work
(When required by municipal policy)
Ca
Work to Start:_ r f g — O Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the Information on this application is true and complete.
Firm Name:? - tni �� p LIC. #
Licensee: %+ /Y Signature: C? LIC.
(If applicable, enter "exempt" in the license number li e) y a
A/
Address: Bus. Teder!/� l.# &IS,/ M. Tel. #
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I herebyi
waive this requirement. I am the (check one) Owner ❑ OR Agent o /
Signature of Owner/Agent: Telephone #
PERMIT FEE: S
Location �3� CO LIA �3 1
No. bq9 Date 6 S 0
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
a
sACNUS9
<� Buildin /Frame Permit Fee $ 3
E
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 3Q
Check # 3
Y' 'a (t"--
om
15662 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
-" i; -x°. �} �`�,�zd,�c g'7'� � "1 _ ;�#�' �,�'�'k � � '•°'t, `°�� ms`s ,.. � 5 4' .,xt
BUILDING PERMIT NUMBER: /- /� DATE ISSUED: ` 0-z 'g- —
SIGNATURE:
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
35 CAI ,uoLcc, Qc,,�
1.2 Assessors Map and Parcel Number:
Coo
Map Number Parcel Number
IVUr A A48eu-e 2
1.3 Zoning Information:
R , q_N f
Zoning District Proposed Use
1.4 Property Dimensions: -
75-0(3 -75
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
,�)o N � �)�,L V 37 (SO(( ,� -L to .
Name (Print II��� %, .Address for Service:
979', G22-S�&;L-7
SignatWe Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Constpction Supervisor:
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506)
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
/Descriiprtion of Proposed Work: ` <
fL c �( -2n1 ( ""J (.i s 1%!t'i , j�.2� �t`�.U� `— S�Y 1 (� VJCA,�I 2�
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SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
:!` OFFICIAL USE ONLY
1. Building G
0 Q
(a) Building Permit Fee
Multi Tier
2 Electrical
3O
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (e) X (b)
f
4 Mechanical (HVAC)a
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, k-1 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.
S ignature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I,'/ Q (' t`� w� �`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
Ly� L w G -:SIL.
Print Name y
Si ature of Owner/A ent Date
MIN NEW
NO. OF STORIES' SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I s 2 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS 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
17-
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
(Location of Facility)
Signat of Permit Applicant
C< �,(<02.
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
.:(978) 688-9542 Fax
Please print'
DATE (` 2 i ° 0 2
JOB LOCATION
Number
"HOMEOWNER b
HOMEOWNER LICENSE EXEMPTION
T L WL
Name
PRESENT MAILING ADDRESS
City Town
Street Address
Phone
�- P, D C,c
State
Map / lot
Work Phone
1�
Zrp Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of two units or less and to allow such homeowners to engage an individualfior hire who does.
not possess a license, provided that the owner acts as supervisor. (State Budding Code Section 108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which
there is, or is irrtended to be, a one or two family dwelling, attached or detached structures ac-
cessory to such use and/or faun structures. A person who constntcts more than one home in a
two-year period shall not be considered a homeowner
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that helshe understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that helshe will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFIC
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform . 5---_2
.1 .................
plumbing in the buildings of ...............
at ► .......... , North Andover, Mass.
Feed,?1..... Lic. No... I.�/ �?�,.�.... v......
%PLUMBING I PEC R
Check #
5331
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
�-\ (Print or Type)
19
VD - /406`o U f -l' , Mass. Date 06"^ 20) G oZ Permit #
Building Location_ / C.O-s,•L,f,�` r Owner
New ElRenovation Replaceme
B . P . # SEWER# FIXTURES
s
Name 5
Occupancy c--�(c
Plans Submitted: Yes ❑ No ❑
FPTTr4
Installing Company Name O1.,, ,���A-) l��,s, ,`i✓�
Check one: Certificate #
Address ❑ Corporation
❑ Partnership
Business Telephone?�'� �/ ��� B Firm/Co.
Name of Licensed Plumber
`INSURANCE COVERAGE:
iI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes D - No ElIf you have checked yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy l�� 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:
Signature of Owner or Owner's Aaent Owner ❑ Agent ❑
=���Y Lxl lily mat an or 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 installa/reoet
under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plud Chapter 142 of th�G�
BY—
Title Snsed Plumber
City/Town/Type of License: Master R ,. E]Journeyman
l
APPROVED OFFICE USE ONLY) License Number 92 6�
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BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name O1.,, ,���A-) l��,s, ,`i✓�
Check one: Certificate #
Address ❑ Corporation
❑ Partnership
Business Telephone?�'� �/ ��� B Firm/Co.
Name of Licensed Plumber
`INSURANCE COVERAGE:
iI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes D - No ElIf you have checked yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy l�� 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:
Signature of Owner or Owner's Aaent Owner ❑ Agent ❑
=���Y Lxl lily mat an or 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 installa/reoet
under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plud Chapter 142 of th�G�
BY—
Title Snsed Plumber
City/Town/Type of License: Master R ,. E]Journeyman
l
APPROVED OFFICE USE ONLY) License Number 92 6�