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Date...
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TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
/— &-- 6)'�v 0
This certifies that ........................................... ft -j ........................................
has permission to perform .......... 41t
....................................................................
wiring in the building of ............... ....................................................
at ...... ........... ,North Andover, Mass.
Fee ....... c2:��c. No.... -MIV�74 ................ . ................
CAL
Check 'I
e�ia11t1J`N/I!f/u tf ✓ trC �.lrsr�ww
BOARD OF FIRE PREVENTION REGULATIONS
Occupancy and Fee Checked
[Rev. 1/071 eave blank
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:
City or Town of: & rr(4h Qh dwZj 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) J c' p of it ��� .9=0 -raw
Owner or Tenant _ f/Qr�a 1 _ Telephone No. G
Owner's Address W -e—
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building p ) J e P, C 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
No. of Recessed Luminaires
No. of Ceil.-Sus addle Fan
P �)
TransTotal
Trsformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA —
No. of Luminaires
SwimmingPool Above El'n-
d. rnd. ❑
o. o Emergency Lighting
Batte Units
No. of Receptacle Outlets
o. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Detection and
No. of Switches
o. of Gas Burners
Initiating Devices
No. of Ranges
No. of Air Cond. Tonsl
No. of Alerting Devices
Heat Pum
Number
Tons
KW
No. of Self -Contained
No, of Waste Disposers.
P
Totals
` -- -
.---...... • -
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Mc F1 Other
Local ❑ Counn
No. of Dryers
ry
Heating Appliances �t
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications inng
No. of Devices or Equivalent
OTHER:
Attach additional detail tj destred, or as required by the inspector qt rr ares.
Estimated Value of ElectriWWrk: ISO �% (When required by municipal policy.)
Work to Start:C-6 Mspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVE GE: Unless waived by the owner, ho 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 cove a is in force, and has exhibited proof YVIIIC14
ame to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) � 15 Gi � � C C-
I certify, under thepa, en of perjury, that the information on th' plication is ue and complete. l
FIRM NAME: DL1 O/f% LIC. NO.: r / 7
(Ifapplicable, enter: `texempt" in the license number line) Signature t- L I us. Tel N o z ' �rS 7
Address: " Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, 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 a ant.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
Location 9v2
No. Date f — 1.2
T
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
14" 41111'rPuNw- - ,
Building/Frame Permit Fee $ --------
'Qf0ondation Permit Fee
tiE�,wpprmit �Fee $
Se4unection Fee $
-7
.%\,,g Water Connection Fee
ig,
TOTAL
Buildind- Inspector
hro 352 Div. Public Works
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE S__ —/ "PL—
JOB LOCATION 3 �?� 1NA16�-RL� i
Number Street Address
"HOMEOWNER" /~'
Name Home Phone
PRESENT MAILING ADDRESS
City/Town
State
lection of town
6k3-s-��
Bork Phone
Zip code
The current exemption for "homeowners" was extended to include owner
-occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided
that'the owner acts as supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory to such use acid/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding Official,
that he/she shall be responsible for all such work -performed under the
building permit. (Section 109.1.1)
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 he/she understands the Town of
North Andover Building Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
KAREN H.P. NELSON, DIRECTOR
117
In accordance with the provisions 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 c 111, S
150A.
The debris will be disposed of in:
(Location of .Facility)
.',
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Signature of Permit ,,l,
OP- - XP - 11�3
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
?P
<
Town -Of
120 Main Street
OFFICES OF:
APPEALS
:i:
_ ,.
NORTH ANDOVERt
North
BUILDING
N
'"
DIVISION OF'
chose tis O1845
Massachusetts
(617) 685.4775
CONSERVATION
HEALTH
PLANNING & COMMUNITY DEVELOPMENT
PL.-iNNING
KAREN H.P. NELSON, DIRECTOR
117
In accordance with the provisions 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 c 111, S
150A.
The debris will be disposed of in:
(Location of .Facility)
.',
o� _i
Signature of Permit ,,l,
OP- - XP - 11�3
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
34
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V,OR'rN
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Date . .........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
. C
This certifies that ........ ..................
has permission to perform .............
plumbing in the buildings of ....................
at. .13.�� ... �� 61.11—. AV
.. ... ..... .. .. . .......
North Andover, Mass.
Fel��.'. Lic. No ........... ...... .............
ZtNSPECTOR
F - L
Check #
5692
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 6�)
(Print or Type)
Mass. Date ; 2 Permit #o
Building Location 2Owner's NameNr A U aA d.e,
Type of Occupancy t S + 17 E i�) Tl AL—
New ❑ Renovation ❑ Replacement Nr Plans�Sub ted: Yes ❑ No ❑
FIXTURES
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Y
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•
16-161: 11111 11
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mom
Installing. Company Name 20MeT Q • -1,r0(rmA -TAe0 Check one: Certificate
Address_ L O" gCNmatJ iA ❑ Corporation
` IY) E l N 0 E� - Al (4 ❑ ,Partnership
Business Telephone -17 Z -c/7 1 9-Arm/Co.
Name of Licensed Plumber r5 f; r,3 Fie 7- sA,mm q req ter.%
INSURANCE COVERAGE:
I have a curregfiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑ 1
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 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 ❑
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,j4ormed under the permit!e"
application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' g e and apter ofws.
BY
Title re of Licensed Plumber
Type of License: Master % Journeymab ❑
city/Town
APPF1IIFD OFFICE USE ONLY) License Number C�3 j 5
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