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HomeMy WebLinkAboutMiscellaneous - 45 WEYLAND CIRCLE 4/30/2018cation_. 4-5-- leu t� �/_ 1L'� -M, Flo. Datele O� Ci "°"T" TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $- Foundation Permit Fee $ .. Other Permit Fee $ m Sewer Connection Fee $ /500.0j-Ch� Water Connection Fee $ l o77, 50CM TOTAL ` 904: Div.. is Works Location f No. 1 `7 5 _ Date NORT TOWN OF NORTH ANDOVER f p Certificate of Occupancy $ +� # Building/Frame Permit Fee $ ,^°'''tom Foundation Permit Fee $ ., a JACMUSE Other Permit Fee $ Sewer Connection Fee $ a Water Connection Fee $ TOTAL �,j 6�k X173 u ing Inspector .�.... J Vi 4 Div. Public Works r Location A � CZ No. �� Date a t' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ a 0 Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 5- �-7 S� wilding Inspector o� (p� F. - 9 6 A"3 Div. Public Works PERIIIT NO APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KVO., LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK ;PAGE ZONE {� �✓ SUB DIV. LOT NO.� I ME IF — LOCATION PURPOSE OF BUILDING OWNER'S NAME/%<'I /'1_ 2 [ '�j NO. OF STORIES SIZE Q OWNER'S ADDRESS I BASEMENT OR SLAB j� ARCHITECT'S NAME Z, 0,` SIZE OF FLOOR TIMBERS IST n/��I 2ND a !/f� 3RD BUILDER'S NAME FO.XCot OQ Cj SPAN DISTANCE TO NEAREST BUILDING A r UDIMENSIONS OF SILLS -_ --_ POSTS /,- DISTANCE FROM STREET DISTANCE-7e Jr DISTANCE FROM LOT LINES - SIDES `jyj REAR 1 t7 r GIRDERS6—,k,/c9- /� ( AREA AREA OF LOT (� FRONTAGE f HEIGHT OF FOUNDATION 1^/ 4 THICKNESS /^ e-' IS BUILDING NEW i -e C 7 J SIZE OF FOOTING p y X 29 IS BUILDING ADDITION /�/ �— `v MATERIAL OF CHIMNEY 'k Y•, IS BUILDING ALTERATION �(' IS BUILDING ON SOLID OR FILLED LAND 545-/, Q/ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER S BOARD OF APPEALS ACTION. IF ANY / 1�/) IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES 7/:/�� PAGE 1 FILL OUT SECTIONS 1 - 3 `� �D PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR r DATE FILED �/�! 7 (+ SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED / 19 c I MAY - 319% v — M-7 4 1 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. -11 A 4 APPROVED BY NUILDINO INiP[CTOR OWNERTEL.# CONTR. TEL. # .. lit 0 CONTR. LIC. # H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY,, a "STORIESJV— MULTI. FAMILY OfF)CES APARTMENTS = '� CONSTRUCTION--,—, 2 FOUNDATION �' S' INTERIOR 3 PINE HA DW D PLASTER DRY WALL UNFIN. _ FINISH I C ^ 2 13 CONCRETE CONCRETE BL'K.EE BRICK OR STONE PIERS _ 3 BASEMENT AREA FULL 11,4 FIN. B'M'TAREA _ '/, 1/2 1/1 FIN. ATTIC AREA NO 8 M HEAD ROOM FIRE PLACES `MODERN• KITCHEN 1 -F _ 4 WALLS ( 9, FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES 8 1 2 �_ 3 _ _ _ _ CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARD1!J'D COMAAGN ASPH. TILE VERT. SIDING STUCCO ON MASONRY FLOOR STUCCO ON FRAME - .. ATTIC STRS. & BRICK N MASONRY BRICK ON FRAAklf"' CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE bN FRAME•. SUPERIOR I I POOR ADEQUATE NONE ;�--' 5 ROOF 10 PLUMBING GABLE HIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUM81NG _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING WOOD JOIST .i l HEATING PIPELESS FURNACE o ' FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS._ HOT W'T'R OR VAPOR WOOD RAFTERS i ':+ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd r ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF. BUILDINGS. WITH PORCHES, GA- RAGES, ETC. SUPERIMPOSED:'THIS REPLACES PLOT PLAN. ' + x�y�['S kY-Rr.w. �r�.i •.�i tii6 t Jwf i 1st 13 d I " i L � + x�y�['S kY-Rr.w. �r�.i •.�i tii6 t Jwf i 1st 13 d I " FORM U - LOT RELEASE 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***************** __-1 1 C APPLICANT: _LLQ x 14J,,�3d APP alPhone _16// LOCATION: Assessor's Map Number SubdivisionoXGr)Oc� Street - l/y--2 \/ f a 1/1 �!y G/'e RECO DATIONS TOWN AGENTS: Con ervation Administrator Comments Parcel Lots) 14-1 St. Number Use Only************************ Date Approved Date Rejected Date Approved Q Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections 4-E,) 4-z-96 - driveway permit Fire Department Received by Building Inspector Date a w N . 0 r Ze r 2/, Bot o, SDog Ac, 8 211 S,to7' S8 r 7.33' r a, . �,PoPoS�D I ZE LOC,4T1-01V �LDT /04/-14AI /N ,(/O, AMOOI/ER, MASS, O,PAh�iV FO.P OF �vE,P��E'EEiS! N� C c��1fU -- Its r riEY cn r " R1„!dN yl �•, 1 .uo �r � N/v �L . S r DATE �E.P,P/�tl.9Gf' E.vGidEE,P��/G SE.PI�/lES A.t/DOYE.P, til,4S.S,4l.�/l/SETTS O/8i0 4 n -lTl -4 0 C) C') CIO C) Z cc W CD S.- =r -O 03 03 3 7D t CL Cf)64 CD =r W cn C, ['a fo, L f]7 ft7 C) z w lei 0 C.) CD 0 7 p CO) J=L Cr C,) L -L T -*\\ o: , 'I CD CD 01) CD CD T" CD co)" 0 b CD 'CIO,0 CL a) CO) CD CD ir CD CD tpLn > "A Cl) CD 77 C, .yi 1 ! : 4 ! i pool CD 171: n -lTl 0 C) ? Cf)64 0 J LD LU V L z ¢ 1 s1='- CV O Z U O LL- CD LO U LLI W .c v CO >� W M, l 1p,J j 9-+. c CD •• w O ° N Q © W CD ' m y w >, � U � x V m m m = a x . m m y m U --t W m U \. m 1 T � W 1--) 'z U CJ U X\ w O0 z C6z ` : v� 0 � G v Z Z��• U� ,\ A .. w u� o a a a c� w w °�° m w v o O v w cn E Q{� C7 O 0 w U w 0 C ci' O r� a� w L V CDco p r� ' i p i as c� cn T � W 1--) 'z 0 CJ - o cry m = Z co 0 � vV Opp¢.• R MC)d .... cam E Q{� C7 m CC C O L V CDco E E C : �O CO �'l1F o ry t 0 o V �m= a E CD m a C H N N 01 m O N J -p !�. C N R O N R m CD o mu L� m y m ; N O ' d C = m O C? • V N O L Z O Ly•>ar r•+ C o O C Q d c m c c 2 m m p N a ~ V) N CD m " ~ t to m y W o 4� A •«- S ea E c Z Oy• C U m p -0. C Q ti a m .— O: _ .a O y '� C a I— t ,m+ _ m i 0 r 4 � CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 175 Date AUGUST 29, 1996 THIS CERTIFIES THAT THE BUILDING LOCATED ON 45 WEYLAND CIRCLE MAY BE OCCUPIED. AS SINGLE FAMILY DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. NTM 1 CERTIFICATE ISSUED TO Foxwood Realty 733 Turnpike St. Andover, MA p ADDRESS �llAcHUsanspector q MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) J PO4T,q ass. Date Building /Location 1k0 / 6�C44 �V' (��� CI ✓c —/ -t1P1 New 19""' 9' Renovation Replacement ❑ J O. _ 19 L� Permit # _ �/ �� Owner's Name %li(% r T UC.. Type of Occupancy SINGLE FAMILY FIXTURES Plans Submitted: Yes ❑ No ❑ Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P . 0 . BOX 1701 HAVERHILL, MA 01831 Business Telephone 508-374-1743 Name of Licensed Plumber or Gas Fitter STEPHEN C. GALINSKY Check one: Certificate n Corporation 1906 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ye No ❑ 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 walves this requirement. Check one! Owner ❑ Agent r Signature of Owner or Owner's Agent I hereto certify that all of the details and information I have submitted for entered) in the above application are true and accurate to the best of my knowledge and that all plumbing Mork and inaallations performed under the permit issued for this application will be in compliance with al! pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Tyr* of License B, > Piumber GaOltter master Signature of Lic sed Plumberor Gas Fitter -� C journeyman License Nu,f, Q348 ■■■■■■■■■■■■■■■■■■■■■■■■■ off ,.■■■■■■■■a■■■■■■■■■■■■■■■■ r.. ■■■■■■■■■■■■■■■■■■■■■■■■■ Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P . 0 . BOX 1701 HAVERHILL, MA 01831 Business Telephone 508-374-1743 Name of Licensed Plumber or Gas Fitter STEPHEN C. GALINSKY Check one: Certificate n Corporation 1906 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ye No ❑ 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 walves this requirement. Check one! Owner ❑ Agent r Signature of Owner or Owner's Agent I hereto certify that all of the details and information I have submitted for entered) in the above application are true and accurate to the best of my knowledge and that all plumbing Mork and inaallations performed under the permit issued for this application will be in compliance with al! pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Tyr* of License B, > Piumber GaOltter master Signature of Lic sed Plumberor Gas Fitter -� C journeyman License Nu,f, Q348 344 HOR7H pt t.ao ,a ,ti0 Oiswak9 IP �,SSACMUSEt� Date....�...:�.5.�(..t� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... k..... .................... has permission to perform ,"!. �3�n'j......u ' wiring in the building of ......0 ......................... at ... ........ ` p. G" -,North Andover, Mass. •....�........... Fee . 3.0.7-.6k. Lic. No. l.............................................................. ELECTRICAL INSPECTOR ��� ft /6 7y 7 29196 09:12 309 00 PAID WHITE: Applicant CANARY: Building dept. PINK: Treasurer Office Use Only uhe Lf jj IIIUITtWraJth of 49550 1152ttg Permit No. i 13epartmEttt Qf �Uhtk -_*afEtg Occupancy & Fee Checked 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 13:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) [Date 7 (XK or Town of NORTH AHnOVFR To the I Spector of Wires: The udersigned applies for ermit to perform the electrical work describedd�elow. ( { Location Street & Number) �`S or LT � + t/" �� /0—w",' ctrr o Owner or Tenant FO X GtrUG/� Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building �r � /,?vr C, 16/ ",ql Utility Authorization No. (2C) 1 0 q C/ Existing Service Amps _J -Volts Overhead❑Undgrnd❑1 �No. of Meters New Service � Ampsl�JC—Volts Overhead El Undgrnd L-1� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electripal Work' 1 No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. No. of Dishwashers t of Oryers Nu. of Water Heaters KW No. Hydro Massage Tubs OTHER: No. of Hot Tubs Space/Area H(,..ting KW Heating 0svices fwV No. of No. of Signs_ Ballasts No. of Motors Total HP Total No. of Transformers KVA Generators KVA No. of Emergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal El Other Local Connection LOW VOltade-- Wiring INSURANCE COVERAGE: Pursuant to the requirements of Mas�chusetts general Laws 1 have a cu6ent Liability Insurance Policy including Comp ted Operations Coverage or its substantial equivalent. YES NO h rustled valid of of same to the Office. YES — NO — If you have checked YES. please indicate the type of coverage by ave sup checking the aper riate box. INSUJ;ANCE , BONO _ OTHER � (Please Specify) — +i � Estimated Value of le rriiccal Work S Work to Stag `7 Inspection Date Requested: Rough Final c Signed under the Penalties of perjury: // !� FIRM NAME l�'�C{ hL U ��CAL' Cv• t . — C u (Expiration Date) 7 NO. /1 Licensee—L �f, t S _C, (4/- Cc/ r—� Signature ` b�, / us. Tel. No. !�O o� Address �`�� Q�1��y7�� � � C��` �� 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 aoplica"an waives this requirement. Oii�a Agent (Please check one) Telephone No. PERMIT FEE 3 (Signature of Owner or Agent) Y•9565 Swimming Pool Above grnd _- In- grnd. ❑ No. of Oil Burners No. of Gas Burners Total No. of Air Cond. tons TTN f Heat Total Total . . a P,,mps Tons KW Space/Area H(,..ting KW Heating 0svices fwV No. of No. of Signs_ Ballasts No. of Motors Total HP Total No. of Transformers KVA Generators KVA No. of Emergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal El Other Local Connection LOW VOltade-- Wiring INSURANCE COVERAGE: Pursuant to the requirements of Mas�chusetts general Laws 1 have a cu6ent Liability Insurance Policy including Comp ted Operations Coverage or its substantial equivalent. YES NO h rustled valid of of same to the Office. YES — NO — If you have checked YES. please indicate the type of coverage by ave sup checking the aper riate box. INSUJ;ANCE , BONO _ OTHER � (Please Specify) — +i � Estimated Value of le rriiccal Work S Work to Stag `7 Inspection Date Requested: Rough Final c Signed under the Penalties of perjury: // !� FIRM NAME l�'�C{ hL U ��CAL' Cv• t . — C u (Expiration Date) 7 NO. /1 Licensee—L �f, t S _C, (4/- Cc/ r—� Signature ` b�, / us. Tel. No. !�O o� Address �`�� Q�1��y7�� � � C��` �� 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 aoplica"an waives this requirement. Oii�a Agent (Please check one) Telephone No. PERMIT FEE 3 (Signature of Owner or Agent) Y•9565 Date....��,11..�.... . a 12 618 :te' °ON, TOWN OF NORTH ANDOVER p „ PERMIT FOR WIRING This certifies that .........�. e. �:! . f'�` ��. P 6� 1 ................................ has permission to perform ................ to.i2 of ... >..� 5 �w ................................... wiring in the building of ...... �� U ► U . :.............................................. . North Andover, Mass. F Fee .... .5...:JJ.. Lic. No. NN ELECTRICAL INSPECTOR 1� C 12/09(/96 2:19 35.04 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Ville ig QMR1110owfult4 of flanc4ul oB I)cpartment of Public bafq BOARD OF FIRE PREVENTION REGULATIONS 527 COIR 12:40 Office Use Only % Permit No. �y Occupancy ,& Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMA 12:00 (PLEASE PRINT IN INK PR TYPE LL NFORMATION) Date //I �'� /(�-6 City or Town of—KMy To the Inspector of Wires. The udersigned applies for a ermjit,to performs the electrical work(dies/crribe below. Location (Street & umber) w �i t �r� ``—�I Sentry Vendor COde�I4 Owner or Tenant � T1^ U6 -6r maOyri, �p fl Circuit # Owner's Address ✓ �/ l , r t l �— I'V ' / V 11Si� f Is this permit in conjunction will) et building permit: Yos ❑ No E (Check ppropriate Box) Purpose of Building Existing Service Amps _I Volts New Service Amps —J—Volts Number of Feeders and Ampacity _. Utility Authorization No, Overhead ❑ Undgrnd ❑ No. of Meters Overhead ❑ Undgrnd ❑ No, of Meters Location and Nature of Proposed Electrical Work LOW VOLTAGE ALARM SYSTEM No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ 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 Total No. of Air Cond. 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 _ o6a Municipal ❑Other connection ko6_V.o_Itage No. of Dryers Hosting Devices KW No. of No. of urg ❑ Fire No. of Water Beaters KW Signs Ballasts Wiring ❑ ardAccess ❑ CCN No. Hydro Massage Tubs No. of Motors Total HP OTHER: Met INSURANCE COVERAGE: Pursuan! to Pie requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ 1 have submitted valid proof of same to the Office. YES ❑ NO ❑ If you have chocked YES, please Indicate the type of coverage by chocking the appropriate box. INSURANCE f,X BOND ❑ OTHER L, _ (Please Specify) Royal Insurance COmpnY 10/8/9� l ( Estimated Value of Electrical Work S _ (Expiration Date)_ Work to Start Inspection Date Requested: Rough _ Final Signed under the Penalties of poriury: FIRM NAME SPnt=V SV,f-emST Tnr r3l .1a Sent-rV a- - LIC. NO. 1109 C Licensee James W. Lees /- ff // I LIC. NO. C�A000080 (PL C Bus. T.I. No. 617-388-9700 Safety) Address 110 McLane Street Maldm M Alt. Tel. No. 800=446 .5 50_ OWNER'S INSURANCE WAIVER: I am aware that Me Licensee uoo/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. droner Agent (F'leaso chock ono) .Telephone No. PERMIT FEET; ✓ ` U t� (Signature of Owner or Agent) Date ..... '7.`..3 .. D 3... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that l�liA r S u c ci, o Cj c�Q .......................................................................................... has permission to perform ... S . r, U 1 C -e Q-(- vIA t v-- ................................................................ wiring in the building of j....~ !.. p�. .. ..1 ................................... I.................... at ...... y. ... .... `ham X ' r ............... . North Andover, Mass. Fee.......... Lic. No. .... !�........�'U(A QELECTRICAL INSPEETOR a Check # 91 4b�3 The Commonwealth of Massachusetts FOR OFFICE USE ONLY Department of Public Safety J 03X5 PermicNo. f cReceipt No. f.. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 001 City or Town of /V0 V f/I lii h dai ¢.[i' To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described belov Location (Street and Number) 4�S &,)4,V Tr Map: Lot: Owner or Tenant 1999.4s Zone: Owner's Address Sc., en k Is this permit in conjunction with a building permit? Yes ❑ No Z? (Check Appropriate Box) Purpose of Building i��Si d.e.v C-? Utility Authorization No. Existing Service 4 0 Amps 2— Q /2L eV oVolts Overhead ❑ Underground No. of Meters New Service Amps __,.,_! Volts Overhead ❑ Underground ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work.. 4'2 C. w tiS` /'ki L' 0 0 61V C, a, No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above grnd. ❑ In-grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emerg. Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self -Contained Detection/Sounding Devices No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Total Total Heat Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No. of Signs No. of Ballasts Local ❑ Muncipal Connection ❑ Other No. of Hydro Massage Tubs No. of Motors Total HP Low Voltage Wiring OTHER: x IkTSURANCE 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 12WO ❑ I have submitted valid proof of same to this office. YES PING ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE GOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ kyy_ o 0 Work to Start _ 7 - �3 O 9 Inspection Date Requested: Rough �% � Final Signed under the penalties of perjury: FIRM NAME Walter B. Stockwood Inc LIC. NO. A4622 Licensee 11alter E. tOc`;t'•;00:7 Signature 2h'�-•Z— O, EE3344 31 Sixth P,o�ad, T,"o:�-,�.,-n, NIA 01801-B781-935-8181 Address us. Tel. No. 6. Alt. Tel. No. 7RI -729-0994 OWNER'S INSURANCE WAIVER: I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner ❑ Agent ❑ (Please check one) _ Sw Telephone No. PERMIT FEE $ � D G1 (Signature of Owner or Agent)