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HomeMy WebLinkAboutMiscellaneous - 46 RUSSETT LANE 4/30/2018 46 RUSSETT LANE 210/104A-0004 0000.0 i 9063 Date. .'. �T 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,S$ACHO ff This certifies that . . 4. ! M„ ,� _u!.�t,y. . . _ +. . . . . . . . . . . . . . . „ has permission to perform . . . . . . . plumbing in the buildings of . . . . . . . ... V S�. . . . . .. . . -. . . . , North Andover Mass. Fee�. Lie. No..j.2. . . . . . . . .. � . . . PLUMBING INSPECTOR Check # 5Z I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:"D. 4�4 t-'� MA. Date: / I f� Permit# Building Location:_� I�U.S. / f f—�� Owners Name: � Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation: Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED z SYSTEMS w 0 V) >LU z H H aLn Z 15 Y Q U 1y-� W O D Q Q)Ln 1ji Lu L C' O = Q w D Q Z c� Y (n G O3 c � a y Q LL F- 3' N W 0 0 0 W Z W Ln _j Z U d Li. 2 J Q U F=- y Na 00 U.O p a Y Z h H H w o f O rn H a m ca o o LL = Y g 3 0 = g a it a a a o � a h Ln Ln 3 3 3 o a -SUB BSMT. a 3 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR " sT"FLOOR 6T"FLOOR 7'FLOOR 8T"FLOOR � Installing Company Name: -J w— q() Check One Only Certificate# Address:/(Q_v`�� � El Corporation � City/Town: f� t)� State: ❑Partnership Business Tel:' Fax: Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ® No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's A ent Owner ❑ Agent ❑ hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By \� Type of License: Title Plumber gnature of Licensed Plu ber City/TownMaster APPROVED OFFICE USE•NLY) Journeyman License Number: /��7(3 xAORTFy 0 of � � o0 OA ver No. ori dover, Mass., • O = LAKE COG HIC H£WICK ti �Ao'�'A r_E o �S; U BOARD OF HEALTH Food/Kitchen I D Septic System PERMIT BUILDING INSPECTOR THIS CERTIFIES THAT.... {II .........................� ......... Foundation has permission to erect.......................... ............. buildings on .... . `1.. ........ ..... .................................... Rough to be occupied,as......... .... ........... ....:. ®............................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in nnal7�, �3 2 this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of L� 2( 1 Buildings 1Win the Town of North Andover. PLUMBING INSPFkQTORg VIOLATION of the Zoning or Building Regulations Voids this Permit. Ro ® ► 7--k Final p PERMIT EXPIRES IN 6 MONTHS ELECTRICALINSPECTOR r3l UNLESS CONSTRUC ARM'S Rog pry � - �'-l_I m � l� ........... ....................:... ,°. . ..... Service BUILDING INSPECTOR Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on , T the Premises — Do Not Remove Final No Lathing or Dry Wall 1 o Be Done FIRE.DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 0220 Date..(53--.J.1...... IV I'd TOWN OF NORTH ANDOVER 04 0 PERMIT FOR WIRING 4K CHUS Ilc:::"lr�400 ooe�� This certifies that .......... ..........41:�. ................................................................ has permission to perform ... .................................. wiring;in the building of rl.V.V44..... .. ........................ 01 at.....�.�.... .�,/...v�k.T.....4tI2.Ir................P,,�rthh Andover,Mass. Fee..` ......... Lic.No.,,:.2 2,a...,. .7...... . .......... EL CrRICAL INSPECTOR Check # t C'ommonweakk of Majjac" Official Use Only i� cc�� C� -L pad...o/-7ire Jerked Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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 INFORMATION) Date: g 13/1 City or Town of: To the Inspector of Wires: By this application the undersigned givesnotice of his or her intention-to perform the electrical work described below. Location(Street&Number) C �(,�sG /l �o n Owner or Tenant %"y66 Had&aaZ Telephone No. K2 i-:FK Owner's Address SOur"e Is this permit in conjunction with a building permit? Yes ��No ❑ (Check Appropriate Box) Purpose of BuildingUtility Authorization No. �} Existing Serviced Amps (7i0�Volts Overhead G�l Undgrd❑ No.of Meters New Service Amps / Volts Overhead F1Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cc. ar C ©So. Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above. ❑ n- ❑ o.o Emergency Lighting 0?1rnd. rnd. BatteEy Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and —Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons W No.of Self-Contained Totals: ... """...... """"."""'"""" Detection/Alertin2 Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems:* No.of Water Kms, No.of No.of No.of Devices or Equivalent Data Wirin Deg Heaters Signs Ballasts No.of vices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No,of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ` 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 covera a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the aims and enalties of perjury,that the information.on this application is true and complete. FIRM NAME: rt LIC.NO.:0_XW-4 Licensee: � 111/�7/tj Signature LIC.NO.: (Ifapplicable,enter "exemptin the lice(t'se"number line.) Bus.Tel.No.: (./7- Address: Alt.Tel.No.: Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I amw a are 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: $ O r The Commonwealth of Massachusetts Department of Industrial Accidents Off ce of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): tJ Address: �C, G,en � S7f' City/State/Zip: 5_&e, � /V ba r►���I�r, QZ j��hone #: C`7 9� 0-17 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I oyees(full and/or part-time). * have hired the sub-contractors 6. El construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• F-1 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. E]Building addition required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions comp.myself o workers' right of exemption per MGL y � p• insurance required.] t c. 152, §1(4), and we have no 12.❑ Roof repairs employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information. Insurance Company Name: A Policy#or Self-ins.Lic.#: Expiration Date: y Job Site Address: 1 �� �4�5� 4 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signa re: Date: Phone#: 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 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 the.legal representatives of a deceased employer,or.the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than 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 a 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,MGL chapter 152,.§25C(7)states"Neither the commonwealth nor any of its political 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." s Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required 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. Also 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' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. 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. Z 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 current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been 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 future permits or licenses. A new 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 or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia ._.. . Date.. .©. . . s 40RT" TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING 41 / ! / This certifies that . .!. .C. .�....!---�:-t-�. �.�. . .'...:�.-i. (_L'.f�'.. . . . . . . . . . has permission to perform . . .-.-. . : . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of '. . . ... . . . ... . . . . . . . . . . . . . . . . L � . . . . . . . . . .. North Andover, Mass. Fee. Lic. No.. ./ .'�J . :A>: • :..�%:-�. . PLUMBIN INSPECTOR Check # `� � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: AI X;rN 40o!/E/L MA. Date: i 0/0,?/O 1 Permit# Building Location: LtS LSSE7 �!✓ Owners Name: Type of Occupancy: Commercial Educational Industrial Institutional Residential New: ✓ Alteration: Renovation: Replacement: Plans Submitted: Yes No FIXTURES z z y O Ul Y Z co U to to U) o. Z ~LU z 9rn z a a N z 3 w x a. W rn ~ W c i Y Wa X OQILL N G Q u 0 W y W J Z ac it lz tZ lx-- 3 0 p 3 Z a o o a Y a w w W a s ° a o O x ° Q a a a a m m o o ta. x Y g g rn y 3 3 3 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR w 3KO FLOOR 4 FLOOR 5 FLOOR -8m-FLOOR * 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Robby's Plumbing.Heating.Draincleaning,LLC. Corporation Address: 15 Dorian Drive City/Town Bradford State: MA Partnership Business Tel: 978-556-5617 Fax: 978-372-6139 Firm/Company Name of Licensed Plumber: Roberto Flaiani INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ✓ No If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy v/ 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owners Agent I hereby certify that all of the details and Information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ✓ Plumber Signature of Licensed Plumber r '(Cityrrown Journeyman Master License Number: 13471 APPROVED OFFICE USE ONLY i 'Location -.`--- 'No. Date �� NORT" TOWN OF NORTH ANDOVER Of .•o •,ti0 ' ~41 p I • ; Certificate of Occupancy $ ��s'•••o'E<� Building/Frame Permit Fee $ S�1CHU5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r" Check # i Building Inspector/ i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING EtIS°SCiIOI fb 'UffilC>t&�°U40lil'... BUILDING PERMIT NUMBER. a�� DATE ISSUED: ��va Q Q� M e9 ic SIGNATURE: I'( /� C --q Building Commissioner/inspector of Buildings Date z SECTION 1-SITE INFORMATION IO 1.11 Property.Address: 1.2 Assessors Map and Parcel Number: TMJ y-1 S ap Number Parcel Number t r 1.3 Zoning Information: 1.4 Property Dimensions: W Zoning Distnct Proposed Use Lot Areas Frontage(11) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reglured Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Infomution: 1.8 Sewerage Disposal System: D Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System E SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service Signature Telephone `).2 Owner of Record: Name Print Address for Service: z Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r t M< 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Address r z Expiration Date P1 Signature Telephone V� SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: A' ' oLC 4roLla r�U .51.�MnZZ) /000 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ' 0 ] # fy Y r Completed b permit a licant „ . ;. � I. Building (a) Building Permit Fee C D K C9 R 4'35 M Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I/ I, a r'k---- J co as Owner/Authorized Agent of subject property Hereby authorize to act on My be alf in alt er r ative to work authorized by this building permit application. 69—P-2-d s�6-Z Sigdahrrj of Owiir Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDABERS 1 SIT2 ND 3 RD SPAN DIMENSIONS OF SILLS DD,4ENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMVINEY IS BUILDING ON SOLID OR FILLED LAND IS BU9-DING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. I } APPLICANT O 5 ONE7 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISIO/N� �L�OT NUMBER STREET /C �Jr 5�. ���`7�- I REET NUMBER ZA/D OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS ............................................................................ I f � DATE APPROVED t d rf CO SERVATION AD STRATOR to DATE REJECTED COMMENTS 1 V d �'� l°� �.6 y/ I DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS .fir PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT r�DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE ,ORT, E Town of dover O sy goo/ - COCHIC�iQ dower, Mass., 4 - AD'QA T E D Py S H � BOARD OF HEALTH Food/Kitchen PERM .IT T D Septic System �� 3.Av.;fea ���t� BUILDING INSPECTOR THISCERTIFIES THAT... ... . . ... ..... .. ......... ........................ .............................................................. Foundation if has permission to erect.....�..�..................... buildings on .....�?.J.�.....�................................................................ Rough �d j 0 ut d 1.....#AD 1%c2 fids+' Chimney to be occupied as........................................ ....... ... ................... ............. ................................ ..... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M /0 VA /iss - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough mr4twthoo I ®� PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR "" 0 Rough ^^ Rough �9 11 Ir*r .•�a 1 9..� �+rZ T1 y 1,,n� Y}�r-,�,:..�..,�. .� Al ;. +� i Display in a Crumispi0ou-cus J 1,10s L40 t<dli. a f LittlJ; '� -" Lu l UL a du �U j� ' sinal No Lathing or Dry !hall To Be Dole FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. , <0 lot (41 cIO ' k D¢ y� W °r x l 'gyp ?y •,c � rya:.::h..�, QOF f 1 \ - / Ames \ 4` kr C Ifi0.9103 r ��/STf NOTE: THIS PLAN WAS DRAWN FOR MORTGAGE PURPOSES ONLY AND IS NOT TO BE RECORDED, OR CONSTRUED AS AN INSTRUMENT SURVEY. MORTGAGE LOAN INSPECTION DEED REFERENCE $K, 25(o PG. 14(o IN PLAN REFERENCE 'PL-�- I^)0. 54(q pjO�IFORD I CERTIFY THAT THE STRUCTURE ON THIS PIAN IS LOCATED AS SHOWN AND THE RTf-� J U o�/ E MASS. LOCATION CONFORMED TO THE.ZONING LAWS.OF THE CITY OR TOWN OF /Aj0�i WHEN CONSTRUCTED. E SS EX COUNTY I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN DOES NOT LIE SCALE: 1�� $� �(,� /p WITHIN THE SPECIAL FLOOD HAZARD AREA AS SHOWN ON THE F.I.S.MAPS FOR THE I CITY OR TOWN OF �Jp�T� .4�J7pVF DATED ✓a�YE /S, /983 CERTIFY THAT THIS IN ACCORDANCE •TECHNICAL STANDARIDS FORTION MOR GAGE LOANWAS PEnED INSPECTIONS AS ADOPTIED TH BYE JAMES C. VAFIADES—REG. LAND SURVEYOR THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS, INC. 256 WORCESTER LANE, WALTHAM, MASS. a l 11(el— 0 N° 6 j ! Date... '../...................... --- t NORTH 3j�•t;,.`��.."_�.."oo� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING D•ATID��"1' �,SS^CMUSE� This certifies that .......... ....... .....`.......I..................................... �( �, has permission to perform ............:..........:........An ..................................... ywiring in the building of ` ` t � f j L�✓ North Andover—,Mass:, Fee..f�.:..:. !.`:... Lic.No................ �.......... ............ _ ELECTRICAL INSPECTOOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Official Use Only Permit No. .S 7 ae� t Sam Occupancy&Fee Checked 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 R/1 0 (Please Print in ink or type all information) Date Town of North Andover l(0 To the Ins ecto of fres: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Ro Owner or Tenant &�;se � Owner's Address C � Is this permit in conjunction with a buil ing permit Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters NAmber of Feeders and Ampacity 441414 Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total N� .of Di osal No. Pumps .Tons KW No.of Sounding Devices No./of Self Contained Not of Dishwashers Space/Area HeatingKW Detection/Sounding Devices d ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW I Si nsBailases Win ng No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial eq valent YES= O = have submitted valid proof of same to the Office YES= NO = If you a ecked YES gle�s8 i�i?iF�e he type of cov ray by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) �/(V fU Estimated Value of Electrical Work$ (Expiration ate) Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties of perjury: FIRM NAME k LIC.NO. Lit,ensee U Signature LIC.NO. Address �!/ ((�,/(,e ��/ Bus.Tel No. 7 �,3�� Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aw that the I ire-rises 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) (Signature of Owner or Agent) Telephone No. PERMIT PEE $Z V