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HomeMy WebLinkAboutMiscellaneous - 4 BRIGHTWOOD AVENUE 4/30/2018N V �': Safety Insurance AdalkLW Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings City Hall N ANDOVER, MA 01845 RE: Insured: Property Address: Policy Number: Claim Number: Date of Loss: Company: Board of Health or Board of Selectman City Hall N ANDOVER, MA 01845 JAMES F LYONS and LISA K LYONS 4 BRIGHTWOOD AVENUE, N ANDOVER, MA HMA 0201303 BOS00045140 9/6/2014 Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Lisa Monette Claim Examiner Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (857) 233-8618 Fax: (617) 535-5833 Email: lisamonette@safetyinsurance.com 9/9/2014 'A Date ... �lqk� ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING . ........ ........... ............................... ....... ... ...... ..................... has permission to pei ... t-4— dlb,.f .................................................................... ..................... wiring in the building of.. ...................................................................... . ..... -4 ........ ................... 'North Andover, Mass. 2 1 IU5 ti 0 Fee..... ........ Lic. No . ................. .................................................................................... Check # � 7�51 .51 ELECTRICAL INSPECTOR A oc,ts�urcmxrt& oI ��,�, Id-I�+3 Occupancy and Fee Checked UV BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC), 27,CMR 12.00 PLEASE PRINT IN INK OR TYPE ALL IN1,Fq1RUA1,fATION) Date: q��//V City or Town of: �/oA nr /� To the Inspector of Wires: By this application the undersigned giyes ngjice Qf his or heir mtption to perform the electrical work described below. Location (Street & Number) Owner or Tenant J Telephone No. Owner's Address »^� Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building --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 /'.,«,., loti.,H n{a— fn)lnu» no mh1P tnm, he waived by the Inspector of Wires. f/IlaCn aaa7UUnat uetuac y aestrcu, w cw icyuuc,. �y ...� �, y� •• •• --• Estimated Value of El ctr' 1 Work: &/0 % � (When required by municipal policy.) Work to Start: a % Y 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties of erjurv, the informatfon on this application is true and complete FIRM NAME: ! jS. ��c n td!� o �Io�1S GLc- LIC. NO.: �l -20S4 Licensee: • U Shad% Signature LIC. NO.: 74j (If applicable, enter "exempt" ip the 1 • ense number line. Bus. Tel. No.: �'� %'����/ Address: ' w� c1�c� N Alt. Tel. No.: *Per MG.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 agent. Owner/Agent Signature Telephone No. No. o Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Transformers KVA No. of -Luminaire Outlets No. of -Hot Tubs Generators KVA No. of Luminaires Above- Swimming Pool nd. ❑ rnd. ❑ o. o mergency ig mg Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond: Tons Nb. of Alerting Devices �TPtalp Number Tons KW.._._ .. Self-contained No. of Waste Disposers De ctof Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [I Municipal Other Connection ❑ No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or E uivalent . o: -o NaterKW No -of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP e ecommunications irmg No. of Devices or E uivalent OTHER: /`Q) _> >_._r,r �__._-a .. ,..,.7 A„rA., )N cnPi•Inr /1) YV IPPC f/IlaCn aaa7UUnat uetuac y aestrcu, w cw icyuuc,. �y ...� �, y� •• •• --• Estimated Value of El ctr' 1 Work: &/0 % � (When required by municipal policy.) Work to Start: a % Y 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties of erjurv, the informatfon on this application is true and complete FIRM NAME: ! jS. ��c n td!� o �Io�1S GLc- LIC. NO.: �l -20S4 Licensee: • U Shad% Signature LIC. NO.: 74j (If applicable, enter "exempt" ip the 1 • ense number line. Bus. Tel. No.: �'� %'����/ Address: ' w� c1�c� N Alt. Tel. No.: *Per MG.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 agent. Owner/Agent Signature Telephone No. �/ fir �;�,� ,� ,,..�g,,.�r6j6 Commonwealth of t Division of Regi stra Board of Electrical AMALMICHA 9 WAVE NORTH A Master Elect' 21705-A 07/31/2016 License No. Expiration Date. 008772 Serial No. Location JAJOC40' No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ AN Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # " uw (�- 5t,60 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s« m x,.''=''�.'��'Z BUILDING PERMIT NUMBER: DATE ISSUED: > SIGNATURE: V 1 Building Commissi ner/I for of Buildings Date J➢m1,11VP1 1-JIIE ENFUKMAIION I 1.1 Property Address: ,61e1611%w0ap Atte 1.2 Assessors Map and Parcel Map Number Number: Parcel umber 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BURDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required ProvidedRe qui 'red Provided 1.7 Water Supply M.G LC.40. 54) Public 0 Private 0 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �!M Ly0/vs Name (Print) yah/Gti?woad �v�, Address for Service: qq8 a-ji Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone bhul1ON 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ A 4 K c' ht /,oA t D 0 � rf�1 SO r< Licensed Construction Supervisor: /a A ve '. License Number Address V/ q 7-4 p g g //? /0� e t '" ` f (LP cx 4) A ( Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �ompany Name 10119 9 If /A7 O EA) T /d /ci' y r/ c�tjn 4 UP , Registration Number address 6 AL 40 Expiration Date SECTION 4 - WORKERS COMPENSATION (NLG.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 ....... 0 SECTION 5 Description of Proposed Work (check all annlicable New Construction 0 I Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition 0 I Other 0 Specify 11AyU/ C.4 P /PV A-1? Brief Description of Proposed Work: pres.ruae 7'1?ea7'ed Ila kdiCap /rA.,.e To I SECTION 6 - ESTIMATED CONSTRUCTION CnCTC I Item Estimated Cost(Dollar) Dollar) to be Completed b permit applicant k. y,i»d,'� �—,'g SE 19VIL g� yR S 1. Building(a) °k d 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 coJV,.,iivi. is vvv11MA AU In%JKJZAl1VN 1V 13E UUMYLEIEll WHkf4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1> 'A �C- ��c— as Owner/Authorized Agent of subject property Hereby authorize 7)'1 a't-c- to act on My behalf, in all matters relative,to work authorized by this building permit application. 7-l',a t. -t- ib VoI 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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1ST 2ND 3 RD SPAN DMIENSIONS OF SILLS DIMENSIONS OF POSTS DM ENSIONS 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 r- ' �IA�cP�cq P ' FORM U - LOT RELEASE FORM RAA P INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT 11 y t S PHONE "' �'2 ' -3(// G LOCATION: Assessor's Map Number.109—PARCEL SUBDIVISION LOT (S) ST. NUMBER *****************************************OFFICIAL USE MENDATIONS OF TOWN CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS CTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm TE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: AArt C. !UA49 1, A O Location: 6,V I61i'7 Woo 0 City F 10y0 0 V?� ie Phone am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance Co. _- -- -_- Polio Company name: Address City: Phone #: Insurance Co. Policv # 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 herby certify under the pains and penaffies of perjury that the information prokiled above is true and correct. Signature % Date d F/0 Print name AA* e- 44 100 Phone # 0 U-6 J9 d, Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check d immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION ✓%te �ts»tmpnu�x%f % �.1{�.aA..sar�tt.,e1Q BOARD OF BUILDING REGULATIONS - License: CONSTRUCTION SUPERVISOR Number: CS 043801 Birthdate: 11/19/1952 Expires: 11/19/2001 Tr, no: 8333 - Restricted To: 00 MARC W RINALDO 12 KENSINGTON AVE METHUEN, MA 01844 rz--.4 ---4-4Z4-. Administrator Tim L.yonj �l /3iel GLtTi�+:d Aw • 116. ioti coma FoorG SEE DETAIL -N\ tv EXISTING WALK RETE TO REMAIN INTEGRATE CONC. W/RAMP EDGE — EL) E --LEVEL � p i 5,-O• LU DiN O 4'-C• • ims E --LEVEL � p i 5,-O• INTEGitATE CONC. W/ EXISTING ASPHALT ORIVEWAT PLAN OF RAMP r SCALE :1/4' - r -o• r LU DiN O 4'-C• INTEGitATE CONC. W/ EXISTING ASPHALT ORIVEWAT PLAN OF RAMP r SCALE :1/4' - r -o• r . GENERAL NOTES L ALL 2M TO BE DONE SHALL BE SUBJECT TO THE MASS. STATE BUILDING, CODE LATEST EDITION AND THE REGULATIONS OF THE MASS. REHAB. COMM. ' 2. ALL DIMENSIONS AND MEASUREMENTS ARE APPROXIMATE AND ARE TO BE VERIFIED BY THE CONTRACTOR IN THE FIELD. 3. THIS DRAWING 15 FOR GENERAL DESIGN CONCEPT ONLY, CONTRACTOR REMAINS RESPONSIBLE FOR TECHNIQUES OF CONSTRUCTION AND FOR THE COORDINATION OF HIS WORK WITH THE WORK OF OTHERS. 4. INSPECTION BY THE ARCHITECT SHALL IN NO WAYRELIEYE THE CONTRACTOR TO FURNISH SATISFACTORY _ MATERIALS AND/OR WORKMANSHIP OR TO COMPLETE ALL WORK DESCRIBED OR INFERRED TO IN THS DRAWING. S. WORK TO BE REMOVED, ALTERED OR ADDED SHALL BE EXECUTED IN A CAREFUL AND ORDERLY MANNER WITH THE LEAST DISTURBANCE TO ADJACENT WORK AND CARE SHALL BE TAKEN NOT TO WEAKEN ANY PART OF THE EXISTING STRUCTURE G. ANY EXISTING CONDITION AND/OR SURFACES WHICH ARE DAMAGED DURING CONSTRUCTION SHALL BE PATCHED. REPAIRED OR REPLACED BY THE CONTRACTOR TO MATCH EXISTING. AT HIS OWN EXPENSE ALL MATERIALS SHALL BE NEW AND BOTH MATERIALS AND WORKMANSHIP SHALL BE OF THE BEST QUALITY. 1. THE CONTRACTOR SHALL: L EXAMINE THE PREMISES AND SATISFY HIMSELF' WITH EXISTING CONDITIONS, LATER CLAIMS FOR DIFFICULTIES ENCOUNTED WILL NOT BE RECOGNIZED. b. PROVIDE ALL LABORIMATERIALS AND EQUIPMENT TO SATISFACTORILY COMPLETE THE WORK INDICATED AND REQUIRED. c CARRY ALL INSURANCE REQUIRED FOR THE PROTECTION OF EMPLOYEES. THE OWNER AND THE PUBLIC. d OBTAIN AND FAT FGR ALL Bs:ILOFRG P'.:F57r RECL!'?_D. DO ALL WORK IN COMPLIANCE WITH ALL LOCAL, STATE PLUMBING. ELECTRICAL CODES. ORDINANCES AND AUTHORITIES HAVING JURISDICTION. a. GUARANTEE ALL WORK UNDER THIS CONTRACT TO BE FREE FROM ALL DEFECTS FOR A PERIOD OF ONE YEAR FROM THE DATE OF ACCEPTANCE OF THE WORK, AND THAT HE SHALL REPAIR AND/OR REPLACE. AT HIS OWN EXPENSE, ANY WORK. MATERIALS AND/OR EQUIPMENT THAT BECOMES DEFECTIVE DURING THIS PERIOD. B. 'PROVIDE' SHALL MEAN FURNISH AND INSTALL COMPLETE, INCLUDING CONNECTIONS. UNLESS NOTED OTHERWISE. 9. NEW CONCRETE WALK SHALL BE 4' THICK (MIN) W/W WWF REINF ON WELL COMPACTED SUB GRADE ALL CONCRETE SHALL BE 4,000 PSI I INSTALLED IN ACCORDANCE WITHI ACI AND MADE IN ONE POURING. IOALL NAILING SHALL BE IN ACCORDANCE WITH BEST CONSTRUCTION PRACTICE, ALL NAILSAPIKES AND BOLTS SHALL BE GALVANIZED. IL RAIL STOCK AND CUT EDGES SHALL BE TREATED WITH TWO COATS OF CUPRINOL WOOD PRESERVATIVE 12. CONSTRUCT WOOD DECK OVER M57TNG CONCRETE STAIRS.. AND PLATFORM. CONSTRUCTION OF DECK SHALL BE SIMILAR TO RAMP CONSTRUCTION AND MATERIALS. REMOVE PARTIAL STEPS IF NECESSARY IF THEY INTERFERE 13. CONTRACTOR SHALL VERIFY TOTAL GRADE DIFFERENCE BEFORE CONSTRUCTING RAMP. ADJUST RAMP LENGTH IF NECCESSARY. DO NOT EXCEED A Lal SLOPE 14. NOT SHOWN REMOVE EXISTING STANDARD HEIGHT IDATERCLOSET t PROVIDE NEW MGM- WATERCLOSET. KOHLER 'HIGHLiNE' OR EQUAL f ALL FITTINGS. TRIM AND SEAT. 15. PROVIDE 3 GRAB BARS (I) IL* LG (MTD AT 45' ANGLE AT WATERCL05ET 10 36' LG (MTD HORIL IN TUB) I V2' 0 GRAB BARS, SATIN FINISH W/PEENED NON SLIP GRIPPING SURFACE SECURE TO SOLID STUDDING. 4'-O' 1 3/4' lb IRe1L STOCK BROS= SLANT TOP OF 4X4 POSTS -� Q -*F- A EDGCHAE OF O LLAAG BOL LAG BOLT RAILS TO POSTS r- 5/4 5/4 x G DECKING BOLT PRAM 4- 2 x G THRU I'OSTB BOLT CONN.1 2 — 2 x L's iy 10' CONC. PICR¢ S TO FIRM BEARING 40 lu STEEL 1 ANCHORS > HANDRAIL GRACE DETAIL 3• - r -o - SECTION THRU RAMP 1/7 - r -o - NOTE ALL FRAMING LUMBER, JOKSTS. DECKING AND POSTS SHALL BE .40 CCA PRESSURE TK W TREATED SOUTHERN YELLOIMIKE Q a Q a d -1 z Kr 'Kn Q U ° N a � U QC U1 > d 2 a � p � U � 1K z EWU i0 OQ on U�p00 WOFa; t AN -USO O EO rm n WQ }r QLZao X00 QN=Q OL=iv= I- 1D OC �Z �e _ - to a . ;W oe _ 4. D U) W Q� �Z W1 ❑Q _ Zl H W to U tj lu2. o - K[ DATE d-02-01 A-1 SHEET I OR 1 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: To 01,t o /, 141e7� 1)u" (Location of Facility) %a,-�12�..�� Signature of Permit Applicant 9l ?/oi Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector m m 33 m 0 m CA 'O CD St Z O O ar Co d O � CZ a� o p C� Q CD O _no O O co CD CA CD a 0 O CO) 0 CO) d CD 0 r� CD a, y CD CO2 Im O 0 CD 0 CD 0 Q b O fZ I O �• N 5 O Q VJ LICo m .= COO�c _i = o c o Cl) � a � � m O ._•► .di O N T =rm �m = y O �OOy p O IF O N _ = m y . a O 0 O Z .. cm)) aoCD :D =r r=„ a aoCD CD �o CA m C-) c COL 7 _ co O so V) , Vf ad to G C C V W � O wG Vv � w- � fD C j yle � Z y0 N y = : Z p x a'- O m � O oGc m 0 j V -1 O R. O x ^� A O O CDCA -CD or :� H W C=* C rb e ate: Com: 2:. : g z 0 O o ^ ° to G H -x w � O wG z � w- � fD z O A-, � Z y0 � p'— z O Jii Z p x a'- n � � O oGc � O � CL O C) z 0 � �° ^�71 -1 O R. O x CL C W N No 2U' 8 1 Date.... 11 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ....... ............................... has permission to perform ............. Ln.J, ... F..(. �.qt& ....... .... h.. wiring in the building of ....... T..-� .... .............................................. et ...... ................ ....... . . ..... 2, North AndoveuMass. 'Fee Lic. No. ...... .... ....... ............................. ELEcrRicAL'1NSPEcr0R WHITE: Applicant CANARY: Building Dept. PINK: Treasurer LN) Cornrrl0nwCc,ltf4 0Derarlincrit of Public `�c(r•fV HOARD OF FIRE PREVENTION REGULL71ONS S21 C1.1R t -Cy) 3/•?0 ti—, bt—wt APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be periormtd In accotdance aith the Maeaachu:ecs Electrical Code, 5227 CMR 12:00 (FLE,ASE PRINT III I11K OR TYPE ALL IIiFORH&TI011) Date _1-3— City —13City or Town of/9�'/ Uvea To the Inspector of Wires: The undersigned applies for a per-uit to perform ,perform the electrical work described below. Location (Street S [lumber) tZ A!toLei 1'5AVO Lr / ✓ (/ Owner or Tenant / IY) � �/ em/s Owner's Address s %ice t:!:. Is this permit in conjunction with a building permit: Yes ffr Ila ❑ (Check Appropriate Box) Purpose of Building ..5eC-,e,4 F/Ov►c Utility Authorization NO. Existing Service Amps_ / Volts Overhead ❑ Undgrd ❑ Ila. of deters Hew Service Amps / Volts Overhead ❑ Undgrd ❑ Ila. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Uork No. of -Lighting Outlets Ila. of Lighting Fixtures Ila. of Receptacle Outlets No. of Switch Outlets No. of Ranges Ila. of Disposils No. of Dishwashers " No. of Dryers Ila. of Water Heaters KW No. Hydro Massage Tubs OTHER - No. of Hot Tubs Swisming Fool grnde ❑ grnd. ❑ Ila. of Oil Burners Ila. of Gas Burners Iota No. of Air Cond. tons No. of heat Total Total Fumes Tons 17a Space/Arca Heating KW Heating Devices 134 I40, of No. o Si: -ns Ballasts No. of Motors Iot,al 1[R Ila. of Transformers -,•yA- Generators KVA No. of Emergency Lighting Battery Units FIFE ALARMS Ila. of Zones No. of Detection and Initiating Devices Ila. of Sounding Devices 110. of Self Contained Detection/Sounding Devices Local 11ilunicipal ❑Other Connection Low Voltage LISUR.A:JCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Lia lily Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES [NO E] I have submitted valid proof of sanne to this office. YES ❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE OND ❑ OTHER ❑ (Please Specify)__ xpiration ate Estimated Value of Electrical Work "' '9d. Work to Start /—,?-00 Inspection Date Requested: Rough / AV•00 Final , Signed u"ler the penalties of perjur : FIRM NAHE LIC. NO. A � Licensee��O4e/t �7� /'4711f4141i Signature C. 140.2f f � l� .Address-/-, yi�sr/��L��+C C 121�� i�/��v�lr �'I/ . d3d�jQBus. Tel. No-2M6a3— frS�9; Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or is sub- stantial equivalent as required by Itissachusetts General-Iawj, and thnt my signature on this pe it application waives this requirement. 0—er Agent (Please check one) Tcicphnnc No. PERMIT FEE�- -- 41,12440 Signature of Owner or Agent -WA/ 4� � f 0 a — P 0? . -- 04911 n n Un Z n Z n z z w > z > Z '•' .N -f Q 0 rI V N Q OA•i y z L.J Q - z nvll •- Q n z K C A Ij O C7 J` All Li r z z r' n o v J N c o w r L n n o n o _ n Q O z n -+ ° 61 NO NO N O = n n O z- N en to N to N t•t N> r 0 o ..+ C Z Z z 2 t` N n n z C - n n -i n -i n - O 2 — C r A y C z Z gym, n n n NO m .� O .. 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Uc O r m mow « o :0 N ?3 r � ,°' a H � mm ca =r «a :.• • H ;0 o M: O Sc aI G� C O O � m 10 (n 9 �Xyz W21 :7��.Qrq ;oz 7" 17 ;00't7 ',U ;17 n p ",t7 "f9 c 171 ►� j � O E CA y v ■ 0 C CD PROPOSAL SUBMITTED TO STREET CITY, STATE AND ZIP CODE Proposal u rTvn RNTERPRISES ENGINEERS, CONTRACTORS ERS, MAINTENANCE MARC RINALDO Methuen, Massachusetts 01844 12 Kensington Ave. 508-688-6398 We hereby submit specifications and estimates for n A . w w 41/ PHONE (pia -3YI6 JOB NAME ------------ JOB LOCATION DATE ,7119 APR 1 5 l9g7 -- .... ........ --. / i � .�, •kms-��+.w�%r A�■s ��.tl . - V We Hereby Propose to fu.,nish material and labor- complete in accordance with above specifications, for sum r`.: dollars — ) Payment to be made as follows: /J 0 a Cot - 411c) C X) ot-4lvcn a n All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized )11 &,L --t- manner according to standard practices. Any alteration or deviation from above specifi- cations involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary NOTE: This proposal may be o days insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us If not accepted within Acceptance of Proposal - The above pries, specifications and conditions are satisfactory and are hereby accepted. You are authorized to Signature do the work as specified. Payment will be made as outlined above. Date of Acceptance: •_ l 1} 1 - emu- ` ¢ 7:17 10 // 7 i 0 Qf a O i N 1 1 1 N 1 ••+ 1 w_ � r• o o � I 1 S O N j N I I I � I 1 1