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HomeMy WebLinkAboutMiscellaneous - 437 WAVERLY ROAD 4/30/2018C r Z ,�.. r-- Commonwealth of Massachusetts W City/Town of North Andover ° System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q t5form4.doc• 03/06 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from thPU Fq dW 7 accordance with 310 CMR 15.351. A. Facility Information 1. System Location: 437 Waverly Rd Address North Andover City/Town 2. System Owner: Waverly Condos Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system ® Other (describe) 5/14/11 Date Ma State State Telephone Number 2. Quantity Pumped: uulr — ( Lu I I TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 01845 Zip Code ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank Pump chamber 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Aurthur Mitchell Zip Code 1000 Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No Name Vehicle License Number Stewart's Septic Service Company 7. Locat' where contents were disposed: S Zrt's-Rre.treatl,9�ant, 20 So. Mill Bradford, Ma 01835 Pignature of Habler ZA - — Signature of Recei ' Facility Date �5 - I" - I 1 Date System Pumping Record • Page 1 of 1 (Ad es °ry w � y WO Z NV7eb 7i CIO anif , I —i. ,."I, ." BI L W R � til �. W'- ! wa0.m�i ���� •rCt o� �v q� d a (Ad es °ry w � y WO Z NV7eb 7i CIO anif , I —i. ,."I, ." BI L W R � til �. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that /I/ . ................................................................................. has permission to perform--- ....................................... wiring in the building of ..... . .............. ......................................................... at . . ................. . . North Andover, -Mass. F 6r*. ee.. ............ Lic. No.-- ..... ............. . .. .... . . ..... LECTRICA R Check # 7848 a _� .......... mow......,..-•Q��ocra�tuserts Department of Fire Services VVj BOARD OF FIRE PREVENTION REGULATIONS umciat Use Unly Permit No. � Occupancy and Fee Checked [Rev. 1/071 ,ave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 WLEASEPRINTININK OR TYPE ALL INFORM4TIOA9 Date: � i _ --3y —c, _ City or Town of: NORTH ANDOVER 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) { Wavv rA y �,> j Owner or Tenant 0, Owner's Address Telephone No. Is this permit in conjunction with a buildin permit? Yes No ❑ (Check Appropriate Boa) Purpose of Building -: n i S �^LS r..--�-✓� Utility Authorization No. Existing Service OW Amps % a / oLyu Volts Overhead ❑ Undgrd � No. of Meters New— Service Amps / Volts Overhead ❑ Und rd g ❑ No, of Meters Number of Feeders and Amp acity Location and Nature of Proposed Electrical Work: 20_ej`1 ova-1-e'f,S i � T?��- trstnnated Value o Electrical Work: �j . ` J uesirea, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start : -A% _ 3 -t1Z 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 certify, under thepains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: Licensee: LIC. NO.: Old S"a�r�� 3r�„�/� �� Signature (If applicable, enter "exempt " in the license number line.) LIC. NO.: Address: "D q"44 4V14 j -4-t n to e -3 y s Bus. Tel. No.: *Per M.G.L c 147, s. 57 61, security work requues Department of Public Safety "S" License: Alt. Lich. 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 I a requirement. am the (check one) ❑ owner ❑owner's agent Owner/Agent Signature Telephone No. PERMIT FEE. E77 B`C / 2.1/-© rc-11-tj x- If-owv A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 r www nsass.gov/dia . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers anlicant Tnfnrmaf4nn Name Address: 0`2 acy o s6 ,� vie , rear , c t✓ vr,t]T VaaKq1A- OD d S7 City/:state/Zip: r -r- lc,,/Lc: -` 11,, 0-36 "Phone #: Are you an employer? Check -the appropriate box: 1. ❑ 1- am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. 1 Ma.sole have lured the sub -contractors listed proprietor. or partner- on the attached sheet = ship and have no employees These st.&contractors have working for mein any capacity. [No workers' comp, insurance workems' comp, insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all workright of exemption per MOL myself. [No -workers' comp. c. 152, § 1(4),'and we have no insurance required.].t employees. [No workers' comp. insurance required.] *Aviv onn1;nn .40......L__t._ t__.I". - Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [J Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.(] Plumbing repairs or additions 12.[] Roof repairs I3:❑.Other �. _.V ,+u ou[ Me secnon oeiow showing their wotkert oornpenution policy information.. HameownM who submit this affitlavh indicating they are doing ail walk and then hire outside contractors must submit a new affidavit indicating euch. ;Comtractors that check this.box mustattatdmd an additional sheet showing the name of the sub-conhactocs and dMir workers, comp. policy information I am an employer that is protnding workerscompensation iMurance for my en;pinyees Below if -the o ' information, F and job site Insurance Company Name: Policy # or Self ins. Lie. #: Expiration Date: ------------- Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the.violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby pains and penalties of perjury that the infnrmatioR provided abOYe is true and correct 3 3-76 S 7'� �7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health Z Building Department 3. City/Town Clerk 4. Electrical Inspector 6. Other S. PlambinQ lttsoectnr Contact Person: Phone #: 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 enterprise, and including tate legal representatives of a deceased employer, or the receiver or trustee -of an individual, partnership, association or other legal entity, employing employees. 'However the owneir•of a dwelling house having not more thah 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 be 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 license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its,poliiical 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 necessary, supply sub -contractors) name(s), address(es).and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or, United Liability Partnerships (LLP) with ,.no employees other than the members or partners, are not mquired.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.. Aliso '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' eompensation.policy, please call the Department at the number. listed below. Self-insured companies should enter their self-insurance license number on the'appropriate Sine. 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,eurrent policy information (if necessary) and undw "Job Site Address" the applicant should write "all locations in (city or town)" A copy ofthe affidavit that has beim' 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 futare permits or licenses. Anew 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 of permit to bum leaves etc.) said person is NOT required fo •complete this affidavit The Office of Investigations would Iiice to thank you in advance for your cooperation and should you have any questions, please do not. hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 Ext 406 or 1 -977 -"SAFE Fax # 617-727-7744 Revised 5-26-05 www.mass.gov/dia i 7 -q -OG Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ...... O.V J40.= ............... This certifies that ....... ...... ....... has permission to perform ..... ............. 41 -:itI7 ... ?�A ....... ........... 3 ... wiring in the building of ............ . ........................................ at ...... '4.Z5 ..... I .v4t.. .0 ................ . North Andover, Mass. Fee.qf:�! A?:� Lic. No. .............. 8A ..' ELEmicAL INSPECTOR Check # 6 1)1 4 Z". M A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. _ 6q Occupancy and Fee Checked [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (,MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL WSRMATION) Date: t� � 3 `"0 - City or Town of: rrl IJ �/ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention o erform the electrical work described below. Location (Street & Number) �� at � fe `� � 'Y,3 7 - q3 q - 11411 - Y% f 3 Owner or Tenant Owner's Address M Telephone No. Is this permit in conjunction with a building permit? Yes [9'- No ❑ (Check Appropriate Box Purpose of Building V i - 6D ^ �-© Utility Authorization No. «i Yo tq Existing Service f14 Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps 1ct Volts Overhead ❑ UndgrdX] No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: `/U ; ,f ` U` `e LuV �rT Cmmntotinn nf'th, ill .-tttacn aaanronai detail y desired, or as required by the Inspector glVires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Y'-") 0& 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 ffj" BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and eh allies of per' drat he inf1prmation on this application is true and conhplete. FIRM NAME: \ �tv.ShL Ty �-`� ✓��° LIC. NO.: D�-?64/ Licensee: f� -3— Signature / LIC. NO.: (IJ'applicctble, enter " xenipt . in the lic ase number line.) A , Address: Bus. Tel No. �� 1��"(7(iV� Alt. Tel No. e)' *Security System Contractor License required f this work; if applicable, enter the license number here: 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(7ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ •. • •••s • .lu ue wuiveu Uy ure urs ectur u vvtres. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. ° ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑�o* o mergency Lighting rnd, rnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I Number Tons K o. 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. No. of Water No. of No. of Devices or E uivalent Heaters KW o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommunhcationsWiring: No. of Devices or Equivalent OTHER: .-tttacn aaanronai detail y desired, or as required by the Inspector glVires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Y'-") 0& 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 ffj" BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and eh allies of per' drat he inf1prmation on this application is true and conhplete. FIRM NAME: \ �tv.ShL Ty �-`� ✓��° LIC. NO.: D�-?64/ Licensee: f� -3— Signature / LIC. NO.: (IJ'applicctble, enter " xenipt . in the lic ase number line.) A , Address: Bus. Tel No. �� 1��"(7(iV� Alt. Tel No. e)' *Security System Contractor License required f this work; if applicable, enter the license number here: 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(7ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Sav 0-1-r- �'_ 1-04 P-w� ®C9 CERTIFICATE OF USE & OCCUPANCY TOWN 6F NORTH ANDOVER Building Permit Number 048 7/28/2006 Date: Aum 28, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 437 Waverly Road MAY BE OCCUPIED AS Single Unit Dwelling of 4 Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Stephen Smola& 762 Dale St North Andover MA 01845 Building Inspector O z ui om c o`� o J C h ��O C C3 U R e0 O C :Z O Cc � �Dc� 2��p E �t ^ u 06 cm ` CD c omIFE h � CD =m p CA O O H W oCD a.c `.0„ O cc No = p Co o dCZ �O N Z O Of +-� C 0. O C H o m c o _ m mmwCc 3 N W 0 V.�Z n.. : P y a�oc Z W E cj cmL3 4D, o COD d O� O.0 _ env J2 o� a O H t s is $ c0 9 O z 0 U •A m As CO2 CD E L CL O CL s C 0 as CO2 0 'fl. C40 O V R cc CO2 W O LLI U) 19 W LU W U) � � v co g � o � v o cin cn ui om c o`� o J C h ��O C C3 U R e0 O C :Z O Cc � �Dc� 2��p E �t ^ u 06 cm ` CD c omIFE h � CD =m p CA O O H W oCD a.c `.0„ O cc No = p Co o dCZ �O N Z O Of +-� C 0. O C H o m c o _ m mmwCc 3 N W 0 V.�Z n.. : P y a�oc Z W E cj cmL3 4D, o COD d O� O.0 _ env J2 o� a O H t s is $ c0 9 O z 0 U •A m As CO2 CD E L CL O CL s C 0 as CO2 0 'fl. C40 O V R cc CO2 W O LLI U) 19 W LU W U) APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # 0 V ? ADDRESS/LOCATION OF PROPERTY: y 17 Map Parcel Lot Number SUBDIVISION L/,�- 5 l./n,.,, DATE REQUESTED FILED/READY FOR INSPECTION r' CLOSING DATE ON PROPERTY: - _3 0 - e -7 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE Uuutb. Permit Issued to: Address SIGNED ROUTING X CONSERVATION �.-r- -(PLANNING DPW - WATER METER SEWERIWATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST Signature Fife: Application for OC form revised Jan 2007 V 0 I I 1 1 -wk Dat TOWN OF NO PERMIT FOR GAS INSTALLATION This certifies that .... /3- r.'O!� has permission for gas installation in the buildings of ...... ................................ at ...... ....... North Andover, Mass. Fee. . ... Lic. No.. . ....... GASINSPECTOR 3 Check # 5630 IMSSAUTSEIIS UNIFORM APPUCATON FOR PERNI TO DO GAS FITIING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations —W-4veyt v " Owner's Name New Renovation Replacement ❑ Date Permit # J^G v Amount $ Plans Submitted ❑ (Print or ty Ch k one: Certificate Installing Company Name ✓Z� La,�,� �g Corp. Address L Partner. Axl BusinessTelephone ,(„Q -;� -z Wa Firm/Co. Name of Licensed Plumber or Gas Fitter / d )e^ �i%�, 31 ---PG 44'c— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No O If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy[Er Other type of indemnity 13 Bond 13 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 hprl-hu P,-rti4w that oil nF th,> .a—A :—C-- I —C-- - -- ---- –.-,. I-1 -uv11111tcu kV1 ulnnuu) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the lblass etts State Gas.o le and pter 14 f the Ge�era, Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Pgnature of Licensed Plumber Or Gas Fitter lumber/ 0 Gas FitterLicense Number ED—Master Journeyman U zWz a zvl 7 O E w Gx x Cn z o p a A W C7 W FF v� Z F z F x cw� x W W O C4 O W , E W F F" , a Fes+ c4 1 ,� L x O 3 A a U a A a H O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4T 1.1 FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. F L O O R (Print or ty Ch k one: Certificate Installing Company Name ✓Z� La,�,� �g Corp. Address L Partner. Axl BusinessTelephone ,(„Q -;� -z Wa Firm/Co. Name of Licensed Plumber or Gas Fitter / d )e^ �i%�, 31 ---PG 44'c— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No O If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy[Er Other type of indemnity 13 Bond 13 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 hprl-hu P,-rti4w that oil nF th,> .a—A :—C-- I —C-- - -- ---- –.-,. I-1 -uv11111tcu kV1 ulnnuu) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the lblass etts State Gas.o le and pter 14 f the Ge�era, Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Pgnature of Licensed Plumber Or Gas Fitter lumber/ 0 Gas FitterLicense Number ED—Master Journeyman Date ........ ? . 'q— . 0.4.. ..... .......... ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ........ has permission to perform .......... C.o�.'Po ........ ay..! ........... wiring in the building of ............ 5114'.qh?�lr ............................................ ............... - ................... at ...... -42-6 ........................ North Andover, Mass. Fee4.v3.- 37-5- ';2 ..................... Lic. No. ............... / ... .. '.e ELEcTRicAL MpEcmijl Check# 6(1143 Commonwealth of Massachusetts I Department of Fire Services Official Use Only Permit No. 1� F 1-/ Occupancy and Fee Checked r BOARD OF FIRE PRFrVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PEWMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ('MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL NF 1l,1ATION) Date: �l —0,6 City or Town of: 4r� c p'1 e. ./ To the Inspector of Wires: By this application the undersign s n ice of his or her intention o , erform the electrical work described below. Location ( t Number) V • �,� Y3 % - Owner or e GL Telephone No. Owner's Address S G"". -4t LOe Is this permit in conjunction with a building permit? Yes No El (Check Appropriate Box) Purpose of Building i eA C-0 Utility Authorization No. ICO `!D 6 Existing Service IV x} Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Q22 Amps ,)0 /:)- ( Volts Overhead ❑ UndgrdE No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: bl Ve vu o,% i �- Conatlletion of the following tnhle n7ov by tmniwil h„ rho hioiartnr n/ Wirac No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above❑ In- ❑mergency rnd. rnd. Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number I Tons I KW I No. of SeIU-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters o. o No. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications ging: No. of Devices or Equivalent OTHER: .attach additional detail rf des•ired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:�00 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 ff BOND ❑ OTHER ❑ (Specify:) !cert/fy, under the pni is and! et n//ies of pert T, that tete infI/. rntatiott ntt t/tis application is true turd complete. FIRM NAME: ,. .�SP d i��v e LIC. NO.: Licensee: Signature I LIC. NO.: r/fupp/iccrb/e enter: •• xempt" in the /womse n:urrber line.) Bus. Tel No. Address: - ke-Cj-b�/�H Alt. Tel. No. > ,-. *Security System Contractor License required fof this work; if applicable, enter the license number here: 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. $ 17-0 _o6 PAZ" 1 0 D a t e TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ............................. has permission to perform .... i .......... plumbing in the buildings of ................. at ... Al. !� ..... North Andover, Mass. Fee. q 2.) Lic. No.. J. ....... .,::.)u M� .... . PL BING INSPECTOR Check# T6 7'� — )�-' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 5/3 % 0aAK �y Ir�wners Name Date e F' U G Permit #--2C3 v %. Amount t� Type of Occupancy es New Renovation Replacement Plans Submitted Yes ❑ No � FIYT1TDVQ (Print or type)��� Check one: Installing Company Name szj'LUj � Certificate ❑ Corp. Address C XVCOG AJ {2 Partner. NL' t.0 �Li i!J * D business' eiepnone Firm/Co. Name of Licensed Plumber: /06f--ol-fl Z , Insurance Coverage: Indicate the tv e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ® 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 Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have Submitted (or entered) in above application :ire true and aecurate to the }.�cst of my knowledge and that ;ill plumbing work and installations performed under Permit Issued 10r this application will he in compliance with all pertinent provisions of the `y• • • huscttS Stat IBy: Title . 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