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HomeMy WebLinkAboutMiscellaneous - 42 WINDKIST FARM ROAD 4/30/2018N O O Q O O O O O O Y�M!.d' r V r r r r *• V,"focal Boards of Health. fluter forms may be used butt e DEP has provided this form for use by sprovided The Stem Pumping Redy here. Before using must be submitted to co must this iorm; Check �' You information must be substantially the some as that local Board of Health to determine the form they use. the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A, Facility Infolrmation Important S stem Location: _1 vuhen iiwng out y k- (xr t'1F1 formsonthe �N"` Yv.I�1�::+ IS —. computer, use ,( �(� only rheAddress lab key a u •� N) J U v r✓V( I - `A lip code to move your _ . _ state cursor • do not 76tyrrown use the return key. 2. System owner: CAA) UC. i -- - •- t�arr+e ,.j ., ,... _. ,,,,, ydtiress (it different from loc8tron) - - • Z'P code city/r'own 6'lS 5 b • - p one Number ---- B. pumping Record 1 2 ...1 1 - _ __ 2. quantity Pumped' Galms 1. Date of Pumping piee Se ❑Tight 7Tank❑Grease Trap 3. Type of system: ❑Cesspool(s) �tic Tank P ❑ other (describe): - -- No 4. Efituert t Tee Filter present? El1J Yes E?"No if yes, was it cleaned? ❑ Yes L✓J 5, Condition of System'- 6- System Pumped By. l 76 � G _— - • •-• .. _ .. -VehSde LrcenseNumber Name �pi.,►i1d ,� l V C,< _..�'�_v t cv ,� tm�n _�G1, t Company GLAD. 7. Location where contents were disposed* North Andover. M A bale -.. Stgrtature ai Hauler Date - Signature of Receiving Faddy 5ysldm PurnAtrg Record • Page t of 1 15form4.doc• 03106 Location, No. / a Date v N f NORTH TOWN OF NORTH ANDOVER .- �0'i*.•o ,•,gyp � , p A Certificate of Occupancy $ 5a. Building/Frame Permit Fee $ Z 9• '" Foundation Permit Fee Other Permit Fee Sewer Connection Fee /:14 Water Connection Fee $ /©�aZOD TOTAL 9255 1, 759.00 $ a "vrtk D v � Z a s c NIz _y 5 z x X `( z a _ _ - 4 y < = y w w 9 0 C L N p ZZ Z Z Z = it Si N H W W y i W u: J < Z v W< o m - �= m o . n N A 7 W is ti U t a 3. CA v � Z a s c NIz _y 5 z x X `( z a _ _ - 4 y < = y w w 9 0 C L N p ZZ Z Z Z = it Si N H W W y i W u: J < Z v W< o m - �= m o . n N A ti 3. CA N _ LQZ � c V J N t J \LLJ Tc C n A z ti V r N W V H w H � �! y 1 N x y w U y - Z A v � Z a s c NIz _y 5 z x X `( z a _ _ - 4 y < = y w w 9 0 C L N p ZZ Z Z Z = it Si N H W W y i W u: J < Z v W< o m - �= m o . n N A ti 3. _ � c V J N t J \LLJ Tc C n A V r N W V H w H � �! y 1 N x y w U y - Z A 5 t d' c VWI LED - [n I L4 _ _ __ J 6.C Z Ih 2 a, y _v H V I A G L 00 o x Jb . R� 'K K RSI o �► X X Rj CMAj s Ji b i � 0 -0 OD .c o0 0 x X x xx su al o 1j it 6 U1 �►, GI rJ .1 1 X '1 © `J -D 6, GI '� O o - c .C�►rR�o 0 O G 0 00 0 0 0 I A G L 00 Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of A plicant on Building Permit (bellow) Address of/Property for Permit (below) Map and Parcel :1O9/.ff urpose of Application (check below) Phone Number ofAppplicant: • 2L Single Family _ Two Family 6 0 Z. �-23 Z->� I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. 4The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Buil ' Department to issue a Building Permit. Sign ature oer or Authorized Agent who Signe--e Attached Budding Permit D afe This form must be attached to the Building Permit upon application for such permit FORM U - VERIFICATION FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ,��/UCC��/5��.�fC�ll LZ G Phone fZ LOCATION: Assessor's Map Number Parcel Subdivision�K Lot (s) Street Gf�iZ�C��i 5 0=i9� St. Number �- ************************ fficial RECO AT NS TO AGENTS: onservation Administrator Comments Planner Comments Food Inspector -Health Septic Inspector -.Health Comments Use Only************************ Date Approved 121Y2 Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved ���� Date Rejected Public Works - sewer/water connections 1 ( S / 3��� 7 - driveway permit Z97 Fire Department (Ui✓o.- 6wkyj Received by Building Inspector Date MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 5-17-1999 DATE OF PLANS: TITLE: 42windkist COMPLIANCE: PASSES Required UA = 792 Your Home = 782 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 1946 38.0 3.0 54 WALLS: Wood Frame, 16" O.C. 3600 15.0 3.0 241 WALLS: Wood Frame, 16" O.C. 198 19.0 3.0 11 GLAZING: Windows or Doors 702 0.500 351 FLOORS: Over Unconditioned Space 1927 19.0 92 BSMT: 4.0' ht/0.0' bg/4.0' insul. 68 10.0 6 BSMT: 8.0' ht/7.0' bg/0.01 insul. 120 0.0 27 HVAC EFFICIENCY: Furnace, 86.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer Date FORM U - VERIFICATION FORM INSTRUCTIONS:This form is used to verify that all necessary approvals/permits from Boards and Departments having have been obtained. This does not relieve the applicant landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: .4 �15,�1 LZG Phone LOCATION: Assessor's Map Number Parcel Subdivision is �,42� • Lot (s)%b Street St. Number 4 ************************ fficial RE=T7NS TO AGENTS: onservation Administrator Comments Use Only************************ Date Approved Data Rejected Pd Date Approved E wn Planner Date Rejected Comments Food Inspector -Health _ J Septic Inspector -Health Comments Data Approved Date Rejected _ Date Approved Date Rejected Dt•^%erl s ya > 9 Public Works - sewer/water connections i� 7 - driveway permit Fire Department Ua2'i. ��GNT��� u'•L{�7 IF'�J�(s� iri Ciy_j�( 7 l eceived by Building nspector / / Date N2 744 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 19 _L— Application by the undersigned is hereby made to connect with the town water main in<�� r subject to the rules and regulations of the Division of Public Works. %� The premises are known as No. 4Z���� —�� �� Street or subdivision lot no. 16 Owner Address Contractor f A z.cv Addres Applicant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at f G subject to the rules and regulations of the Division of Public Works. Inspected by 4 00 2 cc.) rl+i 2- L C Street 21�dl d // �. Board of.Public Works � By Date See back for rules and regulations 7/ C)�-- 1 RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4'/z foot rod and brass plug type cover. GEORGE PERNA DIRECTOR 1 Date: f TOWN OF NORTH ANDOVER. MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET. 01845 DRIVEWAY PERMIT �?7 LOCATION: 47- �Ij BUILDER: phone: OWNER: Z - L. C phone: Telephone (508) 685-0950 Fax (508) 6884573 1/0 � Ile ��z-z2c0 The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: I w- Off a 51, 4.1 W-774 24. l r1 'l o'sfI 7 7 cr -04' E:' 41 I A . I A M%Mqwl� I 'g g" X. K. tilt, ""b. 7 IF -.004ON/A "0 A a 11, I w- Off a 51, 4.1 W-774 24. l r1 'l o'sfI 7 7 cr -04' E:' 41 I A . I A M%Mqwl� I 'g g" X. K. tilt, ""b. 7 IF a 51, 4.1 W-774 24. l r1 'l o'sfI 7 7 cr -04' E:' 41 I A . I A M%Mqwl� I 'g g" X. 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N o � x C „ol ��0'.6 ,sol 1.9-.4 o N flL z 21 I N R 0 N T X 0 N X N � X NCp J �I� >L A 1- fYl ml 01 N2 Date... .......................... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that /—f.' ....................................................... �-Z/ ......................... has permission to perform .....................s............................. wiring in the building of .............. at. 4. ...... ......................................... . North Agndover , Mass. 7'- Fee`A Lic. No. ............. AL'INSP*ECTOR 08/10/99 14:41 4M. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 323, Date . ����,1. � �• of N0 oT a ti TOWN OF NORTH ANDOVER A 3? o'PERMIT FOR GAS INSTALLATION � F F This certifies that ... ?. % �i.� I. ! `t... . • ........... • ` , �in has permission for gas installation . ... . �. ............ in the buildings of .... ................. Q 1 at.:�.......f............... North Andover, Masi. Fee-). " Lic. GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0 MAP�_� MASSACHUSETTS or print) P-6)CA MASSACHUSETTS _ ,H--� TO DO GAS FITTING 3 Building Locations l/ Permit # ' 3 L Owner's Name New Renovation ❑ Replacement ❑ Amount $ Ste, XCT Plans Submitted ❑ (Print or type) Check one: Certificate installing Company Name Galinskv Plumbing & Heating Inc. r-71 Corp. 1906 Address P.O.Box 1701 Haverhill, MA 01831 ❑ Partner. Business Telephone 978-374-1743 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Stephen C Galinskv INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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: ❑ Signature of Owner or Owner's Agent Owner ❑ Agent i hereby certify that all of the details and information 1 have submitted (or entered) in above application are true ana accuranc LU UIC best of my knowledge and that all plumbing work and installation performe under P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S� Gas Coe td ter 1fthe General Laws. OVED (OFFICE USE ONLY) Signaiure of Licensed Plumber Or Gas Fitter ® Plumber ❑ Gas Fitter (cense Num er 0 Master ❑ Journeyman x :0RW#JF w z e CG 9 0.01 n F w C z C O F W e F Cn A. > n W C W v! m W V �'�.. U 't W w z x � W � C W O A F W. yV U F z F -. r W V C 'tt i w F Gard n H W W i r� W = Z x C C W > SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOG R STH. FLOGR 6T 11. FLOOR 7T 11. FLOOR 8T11. FLOGR (Print or type) Check one: Certificate installing Company Name Galinskv Plumbing & Heating Inc. r-71 Corp. 1906 Address P.O.Box 1701 Haverhill, MA 01831 ❑ Partner. Business Telephone 978-374-1743 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Stephen C Galinskv INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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: ❑ Signature of Owner or Owner's Agent Owner ❑ Agent i hereby certify that all of the details and information 1 have submitted (or entered) in above application are true ana accuranc LU UIC best of my knowledge and that all plumbing work and installation performe under P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S� Gas Coe td ter 1fthe General Laws. OVED (OFFICE USE ONLY) Signaiure of Licensed Plumber Or Gas Fitter ® Plumber ❑ Gas Fitter (cense Num er 0 Master ❑ Journeyman ThE COAMONRE4UHOFAIA (IUSE77 ' Office Use only / DEPARTMMDVfOFPLM1C&4FMY Permit No. /90 1 MAP OFMEPREVFIVMNREGUTA7iONS527C3Mi2.WO Lle p Occupancy &Fees Checked PARCEL PFI'MIT TOPFRF?�LECTRICALECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSODE, ��%CMR I �:d� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspec or of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address :�:: U!N PI £ Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) `S Purpose of Building S t N 5 1 A. ( L'/ al � L GC .VG Utility Authorization No. Yo5- - { q Existing Service qq Amps./_Volts Overhead a Underground No. of Meters New Service O fl D Amps `0 O l� o Volts Overhead r --J Underground No. of Meters ' lumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground and No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units 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 a Municipal _ 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 .�;.i: •MIT�i�".it:•I :•n: :stir .....i.a. - `I•. ill:♦ .1••N'•`:I 11"�II•• �► . . .�. ••:•R• •1`"I •IY.If"I •••••:n�'•• ♦:♦♦IL�1- A ♦1:\:�l��rn DpaBli riDate Etn *dValuedE1aobcalWctk $ Ro# Final T),—;1�48TeINo. AltTelNo. -7 1/12 —O 77 OWNERS]NSt1RANCEC: WAWE,Iamavmcdittbr,Lmsedoesmthavetheirrsuaano wmaFcrt3absatibalW,ElartastagtmedbyMa C=o[alLam an31>atmysigna=cnftPamrtapp)icionwaiwslhisieclumelivari (Please check one) Owner a Agent El Telephone No. PERMIT FEE $ Z/" Signature ot Uwner or Agent TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: �i �ic� 1 n K i S+ f:�a rm koa DATE REQUESTED FILED/READY FOR INSPECTION_ I I I I 1 4 CLOSING DATE ON PROPERTY: I I I S 199 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND PERMIT SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARD $20.00) .WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING 1 � LW dV\ (I I� l CONSERVATION ILE( PLANNING DPW - WATER METER NOTE: DPW MUST INDICATE THAT WATER METER HAS BEEN INSTALLED PRIOR TO SU MITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW 2z�� Signature AV f 4 Date. � .... C.'..... '7 4M��- TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �1.'•�•�r.o � i'~I 4L SS�CNUS This certifies that /tf !!'. 4.` l.. . f7 has permission to perform .... A14 � ............. C> ts plumbing in the buildings of ... T314 ............... '" at 14. �k..`.!.r............ (� North Andover, Mass. Fee„.? ULic. No./U.?.` J..... ......... p Y PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i "A"•\ r MASSACHUSETTS UNIFORM .ype or print) Building CATION FOR PEI pG / TO DO PLUMBING Date F720— 5 Permit # y ' Amount Owner's Name 12411 - New 411 - New ET,,- Renovation ri Replacement 1:1 Plans Submitted FIXTURES (Print or type) Check one: Certificate Installing Company Name Galinsky Plumbing & Heating Inc. ® Corp. 1906 Address pQx 1.701 HAyerhi 11 _ MA 01811- - --- - Partner. Business Telephone 978-374-1743 Firm/Co. Name of Licensed Plumber: Steyhen C Galinskv (Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy O , Other type of indemnity 1:1 Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Igna re Owner 11 Agent I hereby certify that all of the details and information I have submitted (or entered) in above best of my knowledge and that all plumbing work and installag;;;;�od&wyrCPA r Perm. compliance with all pertinent provisions of the Massachusetts ltic ity/Town PPROVED (OFFICE USE ONLY Type of Plumbing License 1LICCerW49 '�� Master11 tion are true and accurate to the 4 this application will be in 2 of the General Laws. Journeyman TN 2 1 u 19 4 Date ... s... � .. . /C'�...... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that,..:............ ..................................................... has permission to perform ... ...... .......�"�`- ..rf .............................................. wiring in the building of �...... .North Andover, Mass. Fee -6 ............... Lic. No..............-��...6-/................... ELECTRICAL INSPECTOR 08/10/99 15:06 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer \_ 01 Office / 04E (..OriiriiOnWealo Of4flaggar4ltSettq Permit No. i9partment of Public -Aditg Occupancy & Fee Checked� l BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 'iso (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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 6-- 11�)- I p1 City or Town of Al e, 4 IV J) a u F !L To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 14,Z �' w K� I! f > r WJ 17d / Owner or Tenant __ L) I 12S j e._ 1i i �1, J v Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building s 1 J`4 v, 11 t A Utility Authorization No. Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity (� Location and Nature of Proposed Electrical Work /?I CCA Pe. r � � /tet r y No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures AboveIn- Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ❑ Other ❑ No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: )3 Q r I e. Y INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES u% NO ❑ I have submitted valid proof of same to the Office. YES LFT NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE D,' -BOND ❑ OTHER ❑ (Please Specify) Estimated Value f Electrical Work $ M 0 0, &VWork to Start - 0 — 1 Inspection Date Requested: Rough Final (Expiration Date) Signed under the Penalties of perjury: n Q' FIRM NAME SU ' 1) a t, /-f n :4 r7"��� 1 � L- 0 LIC. NO. Y�C- Licensee �� f7 r:4 _ID �.0 of ) JA re /� 4< /E%"S CILC. NO. 2 Z 7 %yi / /� L /� Ad D �5' � Bus. Tel. No. lC ,r 9 1� - % LQ a� lT Address Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Od Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x-6565 CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number � 8 � Date THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS�iro�rle �rh��y ST��� ,42�c N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. '60 "' ; CERTIFICATE ISSUED TO _GUIlUo el6 r R -0 // L ADDRESS 1��% �vrvp<�� 7 ,�J„"USS Building Inspector O FEM4 L� o �v a 2ja —: -c o w p W z w a p w 4� w a z c \ z W q CA j2 vi v a v 7 °�° �'• o'n U � v c° V) w° U w ° v C 0 ° m cn cn L� U j v Co 0 co C: z 0 ' N co y V U �E O i O a. l 0 � v y v C3 ©- CO) 0 O � 0 co 0 0 L L o cm a � C Cc 0 CD 4.0z COCLy C 2ja —: -c o 'mac O N c I^..j�vv x co � ,0 me r ;0a CO E� Mo v C.. 0o : rn r •-i; N � N m co c co _ m M •' m O N m A : c oQ N 2 0 a o m UY ci o -ow O.2H La 0 , :5. 0 *a f- W N t c E o•N U 5.0 m i d m o _ m aim U j v Co 0 co C: z 0 ' N co y V U �E O i O a. l 0 � v y v C3 ©- CO) 0 O � 0 co 0 0 L L o cm a � C Cc 0 CD 4.0z COCLy C 3 J V J Date.1 /1 .... �f ,0RTM TOWN OF NORTH ANDOVER p`tao p PERMIT FOR GAS INSTALLATION a f This certifies that ....... `- . .................... has permission for gas installation :-e-. in the buildings of .:fir. :.. -*' `-'.: r - ....... at. �� ; . 1 ��- .-; .:: :.... , North- Andover, Mass. Fee:'�i...... Lic. No..7,:I .....-... .,�Y ����.✓ ...... ` GAS-INSPEC; j WHITE: Applicant CANARY: Building Dept. PINK: Treasurer • r 1 14 .MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO D ASFITTING (Print or Type)r � 03 d6Ver [VJ44\.MA Date l 19 IQq Receipt # Permit# I NbMes Building Location "r� �w � n �"/ ri O�wner'sName ' Map: Lot: Zone: Type of Occupancy cv-- New Renovation O Replacement O Fee: GY W Ui CC N N N V 2 F- Q W Q N Q O 0 W= H �. W Q O V. F -1 N W �.. m 2 Q = ST Z Q O W < ¢ Q 2 O o = F cc m N l - W W G 0 d N ¢ O W Q x = ca O¢> W U W 71 p� O W W Co J Z Q= 2 Q WO m W ~ W V = W m V' F Z J F 2 F W W O >• u- H y� J H W 2 Q W_ Q Q �' > N m Z 0 Z O N= Q W > tY W 2 Q Q Q Q O O W O W SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOORF:F I.. In stalling Company Name EAS{'t:rn Address la I - Lo T- —D anyEr s 7Yt ✓� c71 4 a EstimateValueof Work: BusinessTelephone 1= 4 00 — 3 Nameof Licensed Plumber or Gas Finer c.i o h n T. kA -,a ,' AJ S Wi Plans Submitted: Yes 0 No 0 Checkone: Certificate 01 Corporation 0 Partnership 0 Firm / Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ct No 0 H you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Or Other type of indemnity 0 Bond 0 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. Checkone: Owner AgentO Signature of Owner or Owners 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 performed underthe permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the a ral s., By Type of License: r Plumber nature 6&6e eor r Title Gasfitter Master License Number City /Town Journeyman APPROVED (OFFICE USE ONLY) D 0 z m '9 N m a p -ai m p Z n ml v 0 x s v m J N m 7 N m I C 9 D 0 z m N m n x m N •- a r � m z � O O a �+ � _ o m O � x � A 7 m C A N O 0 o 0 z s � N _T -1. � Q I Y Lo -r I G mita (4jt4,05(0 5F) cE.crifY m r le Il o. A N oo✓fie 6Urww6 P'1''!' T4Arr 714C fa�lgvk�,�r Lac.+r�-o o v T.yE e0r f -f 5,4VWA4 , .VO rwr/r vacs rr/ry rAW Tb1.1til a► -1.10, oWCOVEKzav�,ve . c-101, ,4r WS qWA4,601AV XerA4 rC f,rQM JT.CEt'TS SOT L/NEJ. 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