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HomeMy WebLinkAboutMiscellaneous - 458 FOSTER STREET 4/30/2018 / 458 FOSTER STREETT 210/104,8 )0140000.0 i i Commonwealth of Massachusetts D City/Town of System Pumping-Record MAY 27 M5 Form 4 TO�NN OF NO�PAR F: MENT rgD _ DEP has provided this form for use-by local Boards of Health. O r orms 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. A. Facility Information 1. System Location: Left/ ' ht front of house ft/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Rig ront o building, Left/Right rear of building, Under deck Address , r ✓ City/Town C�`G,/� !T IV)State Zip CodeG 2. System Owner. Name Address(if different from location) CitylTown State �k--.jZip Code ; Telephone Number y ; _ f. B. Pumping Record P 9 -t 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 0'40If yes,was it cleaned? ❑ Yes ❑ No ' 5. Condition of Systern: 6: System Pumped By.- Nell y:Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc' Company 7. Location ere contents were disposed: LS. Lowell Waste Water SignAuJ6 9f Haul Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 1 Commonwealth of Massachusetts City/Town of System Pumping Record ApK 0 7 2014 Form 4 _ 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. A. Facility. Information 1. System Location: Left Zi ht front of hou Left/Right rear of house, Left/right side of house, Left Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address � -A City1rown l lL Y State c Zip Code 2. System Owner. Name Address(9 different from location) CitylTown State CS—j Telephone Number i B. Pumping Record 1. Date of Pumping date 2. Quantity Pumped: --T Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas No if yes, was it cleaned? ❑ Yes ❑ No. " 5. Condition f System: 6: System Pumped By. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Location where contents were disposed: GLL S. Lowell Waste Water 7- SignAtufe qt HaulwU Date t5fbrm4.doc•06/03 System Pumping Record•Page 1 of 1 WG � •, ,1, ' ficulATRus RM ,t.. l.,• oeP�{,.,,,,,,<',,5,',,y'� ` ', JUN — 4 2009 hay PI WOO {hl; loan for neo 00 ,,;• .0cof 30 +fdVrv�ml(Iod Io 0v IoCAl B^erc: cf oa,,n or Cin �46#NbRTFAAl6 VFX AMTH IDEPA RW T A, Faculty In(orMa(lon .�� Y Sys.s^� location: =•) ,;.; 1.1:.1,t r .,'611 Vim+, •'' h:•a :�•� ''','. SII 11 ----------- '. 4444 014Vffrinl lumping'Re�ord ' oalo o! Pumpin9'• ��-- �, .TY➢o vl +yilem;�.: oo( � r�;----. ' •Q�Othor (dosc�rib ' — 'S"I Emvanl Too;Flllo('Plpson(? [' Yoso '�';': `' �,�;lr,l•':'t,•:%;r'4)iy�+"+ `,I��i,,:: � — .. . , ; '�•''�" "�,• '11'�CO�dlyOri�o 9 !, � ' � ° `" Yes _ r.,>i���. r i r��,�r '�I I�1, ��� , .�,� fir;•r�;,': � . ., . ,••,,�;,,v,:,i � �• Q;l•• �s� �'' � �� � Y6nlua 'Jcenll n�,,T Sr m� . on.whor� gp�lonla:yrora d� p ,��.•.:.,+lal.� '•v•,..�,r v+ ;ill;.° 9 OS9o: o/h'Ivulyf,y,<.�. .., .. Y. :�n•r. 5.i,por/dorrYiaior/app�oYaJa%(b/orms,n:�naln9�acl � o►�r Commonwealth of Massachusetts City/Town of NUG 1 Z 2013 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTM2VT 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. A. Facility Information 1. System Location: Left/ ht front of house Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address "'v S� o��\ o / City/rown State Zip Code 2. System Owner. S Name Address(if different from location) City/Town State -,_Zip Cqde Telephone Number B. Pumping Record z - \7-k 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) O-Sepk Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes []No~ If yes, was it cleaned? ❑ Yes ❑ No. 5. Con v C) Sy 1 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location wh re content*were disposed: jSign3� Lowell Waste Water e Haule Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 Date...... ........................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies I has permission to perform ....... wiring in the building of ....... ......... North Andover,Mass. q ...... Zj///o /J-///,/ Fee.....!.. ....... Lic.No. .......... ....... ELECTRICAL INSPECT01t ,heck # L 7 Commonwealth of Massachusetts RCNo City/Town of System Pumping Record JUN U 5 c02 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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. A. Facility Information 1. System Location: L / hou , Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address qP1 Citylrown c State Zip Code 2. System Owner: Name Address(if different from location) City/rown State i ode Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) D-1`eptic Tank ❑ Tight Tank ❑ Other(describe): 4. EffluentTee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition qf'System: \j 6. System Pumped By:' Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locat*tDprwhere contents were disposed: G/ S. Lowell Waste Water X I Sig* ig t e Haule Date I t5form4.doc•06/03 System Pumping Record•Page 1 of 1 VVIIIIII VIt I7GY1.4I v. INIq a JO<.II IJ..1=4" ^" Z Permit No. Department of Fire Se ices >/ Occupancy and Fee Checked5 Ind BOARD OF FIRE PREVENTION . EGULATIONS [Rev. 11/99] (leave blank) APPLICATION FOR PER IT TO PERFORM ELECTRICAL WORK All work to be performed in accordan with the Massachusetts Electrical Code(NEC),527 5AR 12.00 (PL"3E PRINT IN INK OR TYPE ALIAINFO TION) D ate: 1-3 2-1 v s City or Town of rl; O C✓ To the 1 ect r of Wires: By this application the undersigned gives notike f his or her intention to perform the electrical work described below. Location(Street&Number) �� /VS ��h Owner or Tenant Ayt A n n IC cue J Telephone No. Owner's Address a- Is this permit in conjunction with//a building permit" Yes No ❑ (Check Appropriate Boz) Purpose of Building �t�JFi/��N S Utility Authorization No. Existing Service Amps r / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of deters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: SC w,r.' y -{- A L COmDletion of the following table may be waived by the Insaector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp.(Paddle) Fans No. of Total Transformers KVA No.of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ - ❑ o. o Emergency Lighting mrd. mrd. Battery Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. oDetection and Initiating Deviccs No.of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No.of Waste Disposers eat Pump Number Tons No.of Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers SpacelArea Heating KW Local ❑ Municipal Other Connection No. of Dryers Heating Applianceslit (Security Svstems: No.ofbevices or Equivalent 7— No.of Water KW o.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additionai detail tf desired or as required by the Inspector of Wires. 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:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with'NEC Rule 10,and upon completion. Icertify, under thepains and penalties of perjury, that the information on this application is true and complete FIRM NAME: American Alarm & Comarnnications, InW. LIC.NO.: 1212C Licensee: Richard L. Sampson Signature LIC.NO.: (Ifapplicable, enter "exempt"in the license number line.) Bus. Tel.No.:781-641-2000 Address: 7 Central Street, Arlington, MA 02476 Alt.Tel. 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 ti Signature Telephone No. FPERMIT FEE: S x { * Date.... .../!......../ Of�..•o �e,ti0 �: �•� ,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� - ^' This certifies that `� ' In T`.:4 1 ��c .......................... .......... ............. ................................ has permission to perform ....../ �.... .....�H ���P. .............. waging in the building of ...........................X�................................... at ......S dv......................... J.... .............`Worth And qo ' �' /y Fee.. .............. Lic.No. ..... ........... .,�......................../................... ELECPRICALINSPECTOR Check # / l 5293 THE COAD[VIOATHEALTHOFMASSACDTJSEYTS Office Use onlyo� DEPARTAMVT0FPUBLICS4FETY Permit No. B0ARD0FFIREPREVEN770NREG ON5527CMRI2M , Occupancy&Fees Checked � t I i APPLICATIONFOR PERMIT TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACH6SSTS ELECTRICAL CODE,527 CMR 12:00 ��11 (/ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date lfJ �S O 7 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work,descri ed below. Location(Street&Number) Owner or Tenant 7S�h„, Owner's Address Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building 1eJ 'riz\,P,c-2 Utility Authorization No. Existing Service Amps/&'C) / 251�Volts Overhead ® Underground M No.of Meters New Service Amps/ Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location anti Nature of Proposed Electrical Work fir•»urcl No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures / Swimming Pool Above Below Generators KVA CP I round ground M , No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No:of Ranges ' No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Np,of Sounding Devices No'of%Self Contained c.. Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Othe � Connections No.of Water i,eaters KW No.of No.of Signs Bailasis No.Hydro Ma age Tubs No.of Motors Total HP THER• AIL ;L==Covetaga Ptasua ttDdrmg mwrnNofNlasswhu- C-en�Laws aveaomentLiabi*h>svmm blicyiwbdElgGDn4) $e Coveiageorilswbsta Uequivaiatt YES NO awa nrmmdvabdpmofofsametothe0ffim YES Ff mbaNedrdodYES,pk=i KhcatetheM)eofooverigeby �tgtheappfuxaebbox. SURANCEBOND OTHER (PleaseSpecify) ExpnationDatE Estn7>atedVArofEktdcalWbik$ xktoStart �0 r It�sp�konDaeReque�l Rough \0- Fugal ned underlie Patties of petjuiy. '.MNANIE �. ��� E .L N L LEffise-No. l 3�o S 4 Signahn LcffwNo Business Tel No. QT(I--3 eo o -3 g B Z frece Alt Tel.No. Q�03- `18 9- t I y S 'NIIR'SINSURANCEWAVER;Iamawaiethatthelioensedoes nothavetheinsuanxoovaaeoritssubstantialegtnvalentastequaedbyMassaa usettsGeneralLaws that my sigma m on this permit application waives this Ott l :ase check one Owner ® Agent ® ` Telephone No. PERMIT FEE$ 3 , Signature 5T Owner or 77gent u a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston; Mass. 02191 Workers'Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. 6 Company name: Address City: Phone#: Insurance.Co. Policy# Company name: Address City: Phone#: Insurance Co. Policy# ` 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,penatties in the form of-a_STOP WORK ORDER.,and_a.fine_cf.(.$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. !do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing E] Building Dept ❑Check if immediate response is required p Licensing Board Selectman's Office Contact persona Phone#: Health Department Other 1� REFERENCES ESSEX NORTH DISTRICT REGISTRY OF DEEDS: TOTAL AREA 44,867 S.F. 100% AREA OF EXIST. BUILD.= 1,595 S.F. 3.6% DEED BOOK 4739, PAGE 253. AREA EXIST.. SHED 85 S.F. 0.2% PLAN NO. 6638 AREA OF PROP. ADD. = 672 S.F. 1.5% OPENS SPACE 42,515 S.F. 94.8% ASSESSOR'S MAP 1048 PARCEL 14 ZONING: R-2 IP FND 203.2' �-- I I I _ I . I I. I I I I NI LOT 5 I 1 .03± ACRES I t I I LOT 4as:e---- .::. rsrt 32_8'_ - #D '67:4• L S 1 1 1 1 1 lw 1 1 ' awl 1 1 1 1 1 1 1 1 1 I 1 � 1 1 i 150' • PRDX�MA�.'�� SNE) L PLAN O F LAND ��'�� .TAMES IN ' w• BO fouK/11c: NORTH ANDOVER•, MA • ` NO. 458 FOSTER STREET JAMES w. Bo s. DATE PREPARED FOR. JOHN J. & LEE A. ROGUS —2 FOR PERMIT QED: AHO BRADFORD ENGINEERING CO . AEU OF 1 OR�wN: A.H.O. Fm: BRM 3 WASHINGTON S Q . REVISIONS BY WJB HAVERHILL MA ., 0 .1 830 JWB PHONE: scams: 1" = 30' (978) 373--2396 ` ('978) 373-8021 �acRewaxDNEr.nrr.NEr DANMARCH 27ALE Nn�E PERMI NA32701.DWG LE NO: 115433 , 2001 a f Date Z....� .... .... a ' 1 3?O.,,40R7M TOWN OF NORTH ANDOVER } p PERMIT FOR WIRING 40 .y •e, •r�o•A�'h SSS MUSf j This certifies that ........................................:.................../ ............................... Y has permission to perform ... . r�� �—' j wiring in the building of......!'. . `, -!.................................................... t at.... .....?< -� .......................... ,North Andover,Mass. Fee... .�.n�.. Lic.Nor2.21?�/ ...............1 , ................r ELECTRICAL INSPECTOR Y� Check # 1� 55 _ t ( 4 1HE(,ULVMUNVYPA :L 11 UP MAJn. HUJClIN Office Use only PA �} DFRTMFVIOFPUB0 mpfly Permit No. BOARDOFF&EPREVEMON ONS527C7!✓II212.W Occupancy&Fees Checked APPLICATTONFOR PERMIT TOP ORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASS CHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work de cribed below. Location(Street&Number) D S 7 Owner or Tenant p o t,/ Owner's Address J3"I E Is this permit in conjunction with a building permit: Yes® No 1:3 (Check Appropriate Box) Purpose of Building �A eq 6-E 9-- 6-Rtn7r (iC oo/1-/ Utility Authorization No. _ Existing Service AmpsVolts Overhead a Underground No.of Meters New Service Amps / Volts Overhead r--J Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work l /IV 0 ( 9LoU No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures /D Swimming Pool Above Below Generators KVA ` round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air ond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local a Municipal I--J Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP �[ OTHER �} U D G l 02 O l � G 1nv.ttanceCovaage Rutsi>a IDdiem maTuZdM mdusemGmmlLaws IbaNeacuautLd)7rtyhmuaocePbl yinchxingCorpletCoNwawcrils atepvalmt YES ® NO r7 IhaveAbmimdvatidptoafofsw1Dde0�YES Ifycuhavecxrl®dYES,plearic&thetyeofoDNwWbydrddrgCE BOND p MIEREVirationDaie p ) r EstimatedValreofElac lWak$ • WG(kroSW 1 - l d `o D&RWstod Rough Final sgrdurxixTie of FIRMNAME —W — LiDerrseNo. Lkff ee signahae LiCaM1 o G/ G BusmessTeL Na ~as tom/ a �)84/ k"I"C4 AkTel.No. - 62771-32 OWNER'S INSURANCEWAIVER;IamawaethattheLxawdoesnothavedie inst mxcuwWorilsalbs>arltialegtr4b1asIegtmedbyM C=edLaws and that my signahne cn this peurvI apphcabal waives this ragtmanmt (Please check one) Owner 1-1 Agent Telephone No. PERMIT FEE$ signature of Owner or Agent s ,` .I�� C7 `� rC c r---'� �% � �. �. R �;� �� �� � . Z� _� � R {y A aAA.;#%.%-A Lrlve v r r A va•IY"UJ N'X AAVL]JSl 1 J vuiw use wily DF.PARIARMOFPUBZIC PemtitNo. BOARDOFFIREPREVEMON ONSR7(MR12AO >, Occupancy&Fees Checked APPLICATTONFOR PERMIT TO P ORM ELEC MCAL WORK �\ ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASS CHUSSTS ELECTRICAL CODE,527 CMR 12:00 LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date l0 — U S Town of North Andover ` To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w4 rk de cribed below. Location(Street&Number) q5gp S Owner or Tenant o e t/ Owner's Address Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) a�� Purpose of Building CA FNo/3 6-E 9— 6-Rtn7l- X©0 ;1-1 Utility Authorization No. _ Existing Service Amp;_ �Volts Overhead 1-1 Underground � No.of Meters New Service Amps Volts Overhead =3 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t LU(J No.of Lighting Outlets L No.of Hot Tubs No.of Transformers Total JKVA No.of Lighting Fixtures /D Swimming Pool Above Below Generato KVA ` round ground No.of Receptacle Outlets No.of Cabumers No.of E ergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air o Total FIRE RMS No.of Zones Tons C 0.�fDis sposals No.of eat Total tal No.of tection and Pum s . Tons Initia g Deviceso. hwashers Space a Heating No.of ounding Devices No.of elf Contained Detec'on/Sounding Devices No.of Dryers Heati g Devices W Local Municipal Other No.of Water Heaters KW Connections No.o No of Signst B Iasis No.Hydro Massage Tubs No.o otors otal HP THER f}l� fel t� yl /•/E' f> D 1 0 l G I le Add CoMnW AuslarYatheragtmar,a>is�Gt3raalLaws �eaamaitLmbkyha==P tr,yirrltdrwcmvi&- Co critswbst rria movalmt YES NO havestbrrfWdvatid ofsameathe011iot~YES a P°0f �J ffywha�died�dYES pleaveii�tethetype�oobY the box C Expi afimDate Loikilosufft — �a `�� FstitrlamdVakleof axttital Wade$ urlc�Tie of _ � NAME W LicelMNa JcMsee Stglaae Lioa>seNo �7 G / I TeNo. 12�-3�y C,-N L— � vtJE H41 Alt Tel.Na 917,V•- Pu'NSFR'SINSURANCEWAIVER;Iamawaretha&IJWWdoes mtharethei Uancemrtia0e0rits8ubslN0ialegttival3ltasragXWbyMaMd1W1lsGaraalLaws I my sgnah ue on dlis pwrit appkabm waives this regtmerrlalt. Please check one) Owner 1:3 Agent 1 �� Telephone No. PERMIT FEE$ �' Signature o Owner or gen r �� �� �� � ^`.� U` �,. � , C� � _ d._., S-� -- �� v ��� �� �� 6169 Date.................................. NORTH °�<�``°;•�"� TOWN OF NORTH ANDOVER 3j ��n• ,.. 'n °L PERMIT FOR WIRING ,SSAGMUSEt This certifies that ..... . has permission to perform-:w!.—nn . ................................... wiring in the building of .................. .North Andover,Mass. Fee-:s�r....�...... Lic.No�`���. . C .... ... ..... ..... y . ELECTRICAL INSPECTOR Check # �-+� /V! n TBE COMMONW LTHO AMMMUS Office Use only DEPARTA1&VT0FPUBIICS9FETY Permit No. 6 t!Ce I // 1 BOARD OFFDZEPREVEMONRF.GULA77ONS527CAV 12 00 —w Occupancy&Fees Checked � APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRIN /h T IN INK OR TYPE ALL INFORMATION) Date (/ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street&Number) Owner or Tenant . -9mit.1 4r [,&-LC-i4A,&1 Owner's Address Is this permit in conjunction with a building permit: Yes M No ©/(Check Appropriate Box) Purpose of Building Utility Authorization No.375- -71l Existing Service 7l5> Amps/Volts Overhead nderground No. of Meters New Service 24R--> — Ampsi 2-6/Z`f0 Volts Overhead M Underground [2--- No. of Meters -7— Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total r KVA No.of Lighting Fixtures Swimming Pool Above Below F1 Generators KVA round 1:1round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis N(�-`ydro Massage Tubs No.of Motors Total HP OTS. h>LMMCoverage.RUST 110theregutretwntsofM�ttsGenaalLaws IhaveaamaYLiabr3tyhmraroePo}icyirrch&gComplem aticm Coverageaitssubstantial egtuvaiat YES NO I have sulxru and valid proofof same to the Offim YES U lfyou have cheded YES,please indicate the type of ooverage by d INSLRANCE BOND OTIC a (else Spey) >> FVilation Date Wodc to Start /0' OEstirroled Value cfElecmcal Work$ Sigtled urlderSieR3laltiesofpajtry. HRM NAME vo Signattue BuwmTeLNo. _� ��� 5-7 arirhPcc r. �� sT L�cC / ¢ a At Tel No. OWNER'S INSURANCE WAIVER;I am awate that the Lioam dues nothave the MRTMoe coverage orits substantial eqw alent as m 4med by Masswhia .s Genual Laws and that my signature on this pemut application waives this requni m-0 . (Please check one) Owner 71 Agent F-1 erL Telephone Nor PERMIT FEE$ ✓ Signature of Uwner or Agent D f- 2 -o ��- TBE COMMONREUTHOFAMSACHUSETIS Office AUse only DEPARTA1EW0FPUBHCS4FM Permit No. PP G 1 BOARDOFFREPREVEAWONRF.GULMONSR7C11R12VO Occupancy&Fees Checked APPLICA71ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector Of Wires: The undersigned applies for a permit to perform the electrical work described below. s- Location(Street&Number) -®5�- Owner or Tenant JO- ffv F ,f ,�,�r� �7(,r�)I; Owner's Address Is this permit in conjunction with a building permit: Yes M No lzy (Check Appropriate Box) l� -? p Purpose of Building Utility Authorization No.J)S /` Existing Service Amps 126 Overhead nderground r—J No. of Meters New Service Z L7 Amps ZZ/2 11y Volts Overhead Underground [2— - No. of Meters Number 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 round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER kwatoeCovetaga Rus>anttnthe tagtmamtents�GalaalIaws I halve a amx t L+ab&y k awmx F bh y imhxmg Cample&Opaawm Cow.rer-orz sub=td eg rrdlalt YES NO I have atbm and valid of sante to the Offm YES P� ffyw have ched®d YIES,please indirale the type of covnage by checkingthe INSURANCE BOND OTHER (pl m Sp�'y) > Expiration Dat WodctoStatt S EsmnatedvalueofElamical Wak$ h'Spac�cxlDa�Re�>estad Rough Final Signed underTranaltiesof perjury FIRM NAME License No. Lienee �� � �✓'• signattze Lic=No BusirmTU No. 1;y .3 a rlchPcc � /� Si Ls% � G t 1 ✓'� � /� Alt TeL No. 1-7y C��'c Z--- OWNER'S INSURANCE WAIVER,I am aware that the License does not have the uwtrarre mvaage orits substai> equivalerl as mquited by Ivlassactarsetts Cerrd Laws and that my sgnaatte on this permit applicaticn waives This tt�terr>em (Please check one) Owner Agent Telephone No. PERMIT FEE Signature ot Owner or Agent