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HomeMy WebLinkAboutMiscellaneous - 478 BOSTON STREET 4/30/2018 /L BOSTON T EET (/ 210/107.000 0 /S fff �y J Date.... OF r o3aTOWN OF NORTH ANDOVER 10 PERMIT FOR WIRING 88�cMuss This certifies that ...... ............ .................. .................................................................. has permission to perform ................................ t---A � wiring in the building of............11....... ............................................................................................ at .......... 41..K....-?b North Andover, ass. Fee..� .."'...........Lic.Nolw MI ..... ............. P= DNSPE rA--I Rf Check# 15% 7 2 Commonwealth of Massachusetts Official Use Only De artment of Fire Services Permit No. p BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occupancy (leand Fee Checked (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 PRINTW INK OR TYPE ALL INFORMATION) Date: C)C-T. 31 —20 l � 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) L411B 1B $05TOt,4 c;T REST Owner or Tenant AA Asa C._\A F_ ►"""[' Telephone No.1978 (082,7't88 Owner's Address S A 1!! 1 E Z Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. �- Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: R�v�/�RE eF ONE E.V�I DLL Completion of thefollowing table may be waived by the Inspector of Wires. f No.of Recessed Luminaires No.of Ceil: No.oTotal Susp.(Paddle)Fans Transformers KVA �. Ko.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o,o mergency �g ting 9 rnd. grnd. Batteiy Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones � No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.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.of Devices or Equivalent No.of Water KW No.of No.of 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 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: I O-3SA-13 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: 1NSURASICE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. G FIRM NAME: LIC.NO.: Licensee: �"_, W�jtVNE. Signature ��" LIC.NO.: 3IO-r,E (If applicable,enter "exempt"in the license number line) (V Bus.Tel.No. CM Address: _]I p(a aRaAjjlj)pkyAV fr *.ZU, M O 1A 3 Alt.Tel.No.: 1e221 *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 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' agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): \AJ Address:_ I i b(a S 1'3i)w 4 H A\t t_R H T L L City/State/Zip: MAy I P 32 Phone#: 62211 Are you an employer?Check the appropriate box: Type of project(required): 1. general contractor and I El I am a employer with 4. ❑ I am a g 6. New construction employees(full and/or part-time).* have hired the sub-contractors k. m a sole proprietor or partner- listed on the attached sheet.t ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition workers' comp. 5. e are a co❑ Woration and its [No P insurance � 10 Electrical repairs or additions q ] re uired. officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myseK[No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' comp.insurance required.] 13F1 Other Any applicant'that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site zformation. isurance Company Name: olicy#or Self-ins.Lic.#: Expiration Date: ib Site Address: D6 Bc,5mm s . N O KTt3_N WyIMity/State/Zip: MA O 18LI 5 .Bach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 I up to$250.0y0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify under lite pains and penalties of perjury that the information provided above is trite and correct. ignature: AI 1i) Date: CBCT. 31 -' W 13 zone#: 9'7 S 9 4 y 6221 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#: ' Date/ toRT" °t<"`° '•'"o TOWN OF NORTH ANDOVER t PERMIT FOR WIRING �'tSACMUSEt This certifies that ....11..r:..:�" -....z'.`.-�!'..s........................................ has permission to perform _:. ..... 1J :........................................... wiring in the building of....i'7. .........r-.. .. ........................... .:...: `............. ...,North Andover,Mass. Fee: .... ..... Lic.No��� �J/�:�......... �. LEINSPE `R t Check # 859 3" Commonwealth of Massachusetts Official Use Only r Department of Fire Services Permit No. IFY3 T BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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 C R12.00 (PLEASE PRWflV INK OR TYPE ALL INFORMATION) Date: Z City or Town of: NORTH ANDOVER Z. Z ir To.the Inspe .tor o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 7� ���j p., S/ Owner or Tenant Telephone No. Owner's Address Ql -� Is this permit in conjunction with a building permit? Yes �� !�' �o ❑ (Check Ap opriate Boz) Purpose of Building Utility Authorization No. 9 ����� Existing Service �� Amps ZO/ et4b olts Overhead n �Tnd rd U g ❑ No.of Meters New Service U Amps IZO/Z� V Number of Feeders and Ampacity olts Overhead E9----Undgrd ❑ No.of Meters Location and Nature of Proposed Electrical W rk: � /r fe— Com letion of the folloud table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No•of Tota! Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above11In- o. o mergency 4 n d• rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARrdS No. of Zones p No.of Switches No.of Gas Burners No.-of Detection and No.of Ranges No.of Air Cond. Total Initiatine Devices Tons No.of Alerting Devices No.of Waste Disposers Heat Pump NumberTons KW No.of Self-Contained Totals: —------..-_......... Detection/Ale rtin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal A Connection ❑ Other No.of Dryers Heating ppliances KW Security Systems: No.of water No.ofo. No.of Devices or Equivalent Heaters KW Si s Ballasts Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec 'cal Work: /3� (When required by municipal policy.) Work to Start 2 LZ— Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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:) ify, p p �'') I cert under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: � LIC.NO.: Licensee: J/ Ile,,�d �h10`� Signature �/�/ (If applicable, enter"exempt"in the lice a number line.) LIC.NO.: 7Z�Y 7 Address: f t-� /� � Z Bus.Tel.No.:_�Y SSS"-�.� *Per M.G.L C. 147,s. 57-61,security work requires Department of Public afety"S"License: Alt.L c.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 Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts k- ! Department of Industrial Accidents ' Office of Investigations 600 Washington Street 41/ Boston, MA 02111 www..nass.gov1diaa . Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Plumbers ApnLcant Information Please Print Le�biy Name(Business/Organization/individual):- �i1 h�,•t (i�v� f �e�%� Address: - /D`/ %G�/ r�C�n �� /�l lt�r✓f� ,A-AL Q/577 I City/State/Zip: Phone #:_. �')� t tilf Are you an employer?Check a appropriate box: Type of project(required): 1.2'fam a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have tared the sub-contractors 6 [3 New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet.x 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity, workers' comp. insurance. • .insurance 5. 9. Building addition [Na workers'com p ❑ We are a corporation and its required.] officers have exercised their 10. ctrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions I myself. p g1(4), Y [Nonworkers'comp. c, t.52, and we have no 12.[] Roof repairs insurance required.]t employees. [No workers' comp. insurance required_] 13•❑Other 'Any applicant that cheeks boz#I must also fiat out the section below showing their workets'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. ;Contractors that check this box musrattached an additional sheet showing the name df the sub-contractors and their worE_e_•s'camp.p-.!.* 1 enc an employer that is providing workers' infotrnatinn. compensation insurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Z/ —�Z Sob Site Address: ©�y '��5iy si City/State/Zip: / � .0 y 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 e. 152 can lead to the imposition of criminal penalties of a II fine up to$4500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andp allies ofperjury that the information provided above is true and correct Si lure: � �-c Date: Phone#: F only. Do not write in this area,to he completed by city or town official a: Permit/License# hority(circle one):health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspectorson: Phone#: r 4 Date.)�.—.�? -� ...... • NORT/� °ft"`° '•�"° TOWN OF NORTH ANDOVER 3: �•,� .... .• of PERMIT FOR WIRING qL ,SSACHUSf This certifies that ............................................................$o�v ��t 7—/1 f L 1—� .............................. ... has permission to perform ..........�4- i H� ................................................................. wiring in the building of........�..1..4�.r ..1............................................ at.... 7S o.. ,North.Andover,Mass. Fee....�0."""� Lic.No./46��....... . �r..... : a�. ? '. ELECTRICAL INSPECTOIE Check # 8452 ,. Commonwealth of Massachusetts Official Use Only • Department of Fire Services Permit No. ^'92- ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),52 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: / City or Town of: NORTH ANDOVER To the Insecto of ices: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address Telephone No. Is this permit in conjunctioq with a building permit? Yes �o Purpose of Building �� _ E] (Check Appropriate Box) y y1 11 Utility Authorization No. Existing Service/�Q Amps / P A701ts Overhead Q'Undgrd❑ No.of Meters New Service Amps / _Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table ma be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus No.of Total p.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o mergency ig g rid. nd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No. No. of Gas Burners of Detection and Initiatine Devices i No.of Ranges No.of Air Cond. Total No.of Alerting Devices N Heat Pum o.of Waste D' Num isposers P Number Tons KW _ No.of Self-Contained Totals: __ _..._.._...._._..._._.. . Detection/Alertini,Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal CoEl Oma nnection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or E uivalent Heaters KW No.of Data Wiring: Si s Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications iring; ' OTHER: No.of Devices or E uivaleat Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec 261 4'cal Work: (When required by municipal policy.) Work to Start /j 7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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 S--1Y0-NTD ❑ OTHER ❑ (Specify:) I certify,under the pai and enalties o p ) p ofperjury,that the�n orma[ion on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: l/7,(0,7 Signature (If applicable, enter "exempt"in the licgnse number lne.) LIC.NO.: Z Address: 0 p�.�sC N Bus.TeL No.: ) - e?rl S f f `� �l 1g Z/ Alt.Tel No.- re6-a2y-7��'7 *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 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:$ i The Commonwealth of Massachusetts k� ! Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelbiv Name(Business/Organiza6on/Individual);_��/�5�� Address: City/:State/Zip: Phone #: . 7 Are you an employer?Check e appropriate box: 1-12-1-ani a em to er with 4 Type of project(required): P Y ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am.a.sole proprietor or partner. listed on the attached sheet.i 7 modeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me.in any capacity. workers' comp.insurance. [No workers'com .insurance 5. 9. ❑Building addition P ❑ We are a corporation and its required.] officers have exercised their 10. ectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.�] Plumbing airs or addition m self s Y o-worke'rs co � mp. c. 152, §I(4),'and we have no 12,Q Roof repairs insurance required t employees. ] o workers [N comp. insurance required..] 1317 Other *Any appiicant that cheeks bo>lr#1 must also fill out the section below showing their workers'77 compensation policy information ?Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-conhwtom and their workers'comp,policy information. I am an employer that.is providing workers'compensation insurance for my employees: Below information. is the policy and job site Insurance Company Name: i Policy#or Self-ins.Lie. Expiration Date: r Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the oiic _ �J�Ovti� 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 andpe7taftles of perjury that the information provided abov is true and correct Si afore: Date: 4 Phone 4: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Lieense# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Date „O .o o TOWN OF NORTH ANDOVER t�. ° �ti oL p PERMIT FOR PLUMBING SSACHUS� .� �� This certifies that .l��R!':4�. . . . . . . . . . . . . . . . . . has permission to perform . . (' ! {. . ��Pk.�.` v - �a . plumbing in the buildings of {G j at. . `jf. . . S.C .. . . . . . . . . . . . ., North Andover, Mass. J'6 Fee. 7f.Lic. No. /d. . . . . . . . . . . . ., . . . . . . . LUMBING INSPECTOR Check 79't 5 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PL (Type or print) UMBING NORTH ANDOVER,MASSACHUSETTS Building Location 0 �O� OAI Owners NamDate f' 7/7 /�- Permit# Type of Occupancy Amount,42-�" 7 New Renovation ET' Replacement '13 Plans Submitted Yes ❑ No ❑ FIXTURES f~ � w O O a A a q 2ND KJOCIR 1SIr I+II,XR MIFOM ADM L'LJCR/ S1i MOM (Print or type) c Installing Company Name •-fAlE/C N Lt=-Y c Check one: Certificate Corp. Address L al 2 Y — 6 6,�'— o,;�6 Partner. Business Telephone _ Ftrm/Co. Name of Licensed Plumber: l� C��j(2,,�� Insurance Coverage: Indicate the type o 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 Owner13 ❑ Agent I hereby certify that all of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued compliance with all pertinent provisions of the Massachusetts State Plumb ode and Ch 142 of th applicaa tion ll be in r By ignature ul Zicensta p,u Title Type of Plumbing License City/Town /d—_7 icense umoer Master Journeyman APPROVED(OFt-10E USE ONLY 13 Date....5..1./.01/....7 N-u 22 � 7 cr NORTN n j °ft's'°;•'"° TOWN OF NORTH ANDOVER � p PERMIT FOR WIRING ' ,SSAcmUS� This certifies that ...... ..:.. .:....41.k!ta.�. ............................... ................... has permission to perform ... P wiring in the building of... 1..e-I.f'c.k.. G at......�?.. ....1..<�. .U??....... �1....'v ..:...... orth�ovass. �(qq � 1''ee.,;Q. j!Q Lic.No./��.3............ .. ... ...... LBCTRIC NSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only q G� _ �? uhP �IImmIIItlUPttl IIfA55c�rhu5Pf�5 Permit No. (�(� %partmrnt of Publir Eafrfg Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3110 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALJ- INFORMATION) Date City or Town of �� .�f iv.(/ �, To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work de ribed below. Location (Street & Number) _ y7� �O Sfo.✓ /� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes LT No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ZG0 Amps —J Volts Ov ead ❑ Undgrnd ❑ No. of Meters New Service Amps_J Volts Overhead ❑ Undgrnd ❑ No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /✓� �- ,.moo �� ���S GG t J r No. of Lighting Outlets I No. of Hot Tubs I No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle OutletsNo. of Oil Burners I I No. of Emergency Lighting Z Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No, of Ranges I No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals I No.of Heat Total Total , Pumps Tons KW No. of Sounding Devices No. of Dishwashers I No. of Self Contained Space/Area Heating KW Detection/Sounding Devices f(lo. of DryersI Heating Devices KW Local Municipal ❑Other ❑ Connection No. of No. of Low Voltage -- t�Jo. of Water Heaters KW Signs Ballasts Wiring , No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES C-4#er—z� I have submitted valid proof of same to the Office. YES � If you have checked YES, please indicate the type of coverage by checking the appropriate�box. INSURANCE iL� O OTHER O (Please Specify) Estimated Value of Electrical Work S (Expiration Date) Work to Start_�—/a�/ y Inspection Date Requested: Rough %'�' <1 Final Signed under the Pe (ties of perju - FIRM NAME ;- Licensee v '� f / LIC. NO. Signature C. NO.'� `�--��. Address ovd Bus. Tel. No. . 7 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner _ Agent (Please check one) Telephone No. PERMIT FEE S tS ry v (Signature of Owner or Agent) x-6565 Location 41 +No. oqa Date "� c �1 vio Tol TOWN OF NORTH ANDOVER p Certificate of Occupancy $ + ; Building/Frame Permit Fee $ SA�Mus t� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �Z )/ t 009 Building Inspector 21Q. 3 oi/99 09:42 45.06 PAID Div. Public Works Pl?RMIT NO. � APPLICATION FOR PERMIT TO BUILD**"""NORT11 ANDOVER, MA At u'NO. /09 D LO"1'.NO. r7 f7 2. RECORD OF OF1'NERSIIIP DATE BOOK PAGE ZONE /� SUI)DI\'. LOT NO. 1.0('A I[ON /`J PURPOSE OF BUII DING Ks L L OLE 44 OWNER'S NAME ` m � NO.OF S'FoRIL•S f 1 SI OWNER'S ADDRESS �L BASEMENT OR SLAB ARCI IITE(-I'S NAME SIZE OF FLOOR IIMBERS 1 ST 2 3 RD BIIII DEN'S NAME ' V1 SPAN DISI ANC E TO NEAREST BUILDING Y DIMENSIONS OF SILLS DIS FANCE FROM S FREEI' DIMENSIONS 01:POSTS DISTANCE FROM LOT11NES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE IIEIGI IT(N=FOUNDATION THICKNESS IS BUILDING NEW =SIZE OF.F(X7IING - X IS BUILDING ADDITION MAI ERIAL OF CI IIMNE Y IS BUILDING ALTERATION �� IS BUILDING ON SOLID ORTII.LED LAND W11.1.BUILDING CONFORM TORFQ01REMENTSOFCODE IS BUILDING CONNECI'ED'IOTOWNWATER S J BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECIED TO"TOWN SEWER IS BUILDING CONNECTED TO NA(URAL GAS LINE (� INSI'11('I'IONS 3. PROPER-F1'INFORMATION LAND COST + EST. BLTxi.COST PAGE 1 FII.I.00T SE(--TI(NIS 1-3 EST. BLDG.COST PER SQ.FT. EST. BLDG.COS I PER ROOM EI EC-TRIC NIETERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. AI-1 ACHED GARA(;LSMUST C(NJFORMTOSFATE FIRE RE(i1)1.A'11()NS a -.-k1'PilovEp BY: r PLANS MUST BE FILED AND APPROVED BY BIIILDING INSPECT(N( BUILDING INSPEC'FOR DA'I1:FILED �I� � I� l OWNERS'1'El/�.: �c � t� 7 11 C( I'R."I EI Ill a - NF C'INJTR.I.IC'N AGNA Il IRE 01:OWNER OR AU I I IoRIZIiD A61141' + j' I'I RMIT(MANITI) 3 19 `�' -- Town of North Andover MORT►t OFFICE OF 3�of., OLD COMMUNITY DEVELOPMENT AND SERVICES ° .: 27 Charles Street WII LIAM J.SCOTT North Andover, Massachusetts 01845 �4SSgcHUSE��y Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: o (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through-the-Office-of the-Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNiG 688-9535 i F c►ORT 0VM Of _ Andover No. 04 Z m * C) 'T LAKE Mass., 3 1911 LAKE 'AA_C0CH1CHEWICK OR4rED S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System r BUILDING INSPECTOR THIS CERTIFIES THAT........G..,...a........ .............M'4411�ke............................... .......................... ............ Foundation 4!k. g .4 .......... 0has permission to erect.. rn O �. buildings ........... ......... .. .. .. .. . .................................. Rough a.te. . . ... l V S �Re be CI� Chimney . ..r ............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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough R0. Or PERMEXPIRES IN 6 MONTHS Final 50IT ELECTRICAL INSPECTOR ag UNLESS CONSTRUCY ST S 12 Rough .... ........................ ........................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. Date--?-. 3960 NORTI{ �<<��•°;.�tio TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING &S Mu r f) This certifies that has permission to perform . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .. . . . . . . . . . . R at. . .' 7�F. ./.��-r,l.�. .l?. . . , North Andover, Mass. R Fee/7/f . .Lic. No. .v.J.�. " �/ � _ 4i P� LUMBING INSPECTOR •� I WHITE:Applicant CANARY: Building Dept. PINK:Treasurer ; (Type or Print) ... . . •'.:. .";;" .,;• ....w'aa��V ; • ,� NORTH ANDOVER �'` Mass. :,l_• • Date."' Building Location L/,7Or- 57th x.. /2 ^ . Permit E..3 ,,�►d Owners Name - 7/Lr• I 4 Nal New JD Renovation Replacement Plans Sybmitted ❑ - ��. F U TF • N 2 Y < � o z F W J } U < z W W W Y .J o ..a h to a C Q It X 4n a ac tL = z p 2 W a 0 W F- tai ¢ U z o n °C a a 'c a w _ Q a In Z ¢ a or, �. w Q W r- t^. W 0 .J 0 cc Q J Q s 'c W Z < T. 0 X T Y a p H a > r- o x ° ' �, h z 0 Q o u r Y J m W o a ., = t- h ri v o < .az o 0 SUB-nBSMT. BASEMENT IST FLOOR J 2ND FLOOR j 1 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR ' a 9TH FLOOR (Print or Type) Check one: Certificate Installing Company Name Corp. Address C) 6Z J S f ❑ Partner._ `XU NU V..P� /�}- Uf Fvr � Firm/Co Business Telephone _b Fb 00-0 Name of Licensed Plumber: ;�i 64k) Insurance Coverage: Indicate the type 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 i this application does not have any one of the above three insurance coverages. Signature of owneriagent of property Owner Agents% ❑ , !b =br a(tify Vaal all ai'dac dclailt and Woanaalion I lia.c tubmillcd(o(cnlucd)in alki-arplipliam ace 14at Zola to Int beat ei of �. ltwawkd t and that all luaHbin rack and inslaltaU na Irca(nan�cd undo fcro�il I�wcd(or this a Iia7lio�.1Q ro V r c rr � C cw+pWwa>, Jrlt W Yam N►y wLskm of 1!u Ma"achwcllt Sia/c Plumbiot Codc and(auptcl 142 of llic(;cncaal Lew � I By i Title Signature of Liceed Plumber City/Town: Type of P1 ing License JouZney ADDPr)VFZn 7OFFtrF USE ONLY1 License Number Master ❑