Loading...
HomeMy WebLinkAboutMiscellaneous - 54 MILLPOND 4/30/2018 54 MILLPOND _ 210/095.A-00540000.0 w i ' _...•!�,�air-" �-...v is ,� ..,.. .. .� .• .� ...Y ... .. .. �t.,.. r� �,..����- � �� .� 6151 Date. :.l�?� ° .... NORTH TOWN OF NORTH ANDOVER 4 PERMIT FOR WIRING ass^cHusf� Thiscertifies that ............................................................................................. r has permission to perform ...... ........... <...... ....:.!:............ ....................... i� wiringin the building of..................................................................................... at,A.-4 ...�4a...... -t ........ ,North Andover,Mass. Iry �3'a Fee ..... Lic.No.`.... .�'.�,_. .......................... .. . ..... ELECTRICAL INSPECydFOR Check # DIF AMMWOMBUMFEIY Permit Na. BQ4RDOFFzREPREVF1vnwRBoELulOmS27am,am Occupancy&Fees Checked APPUCATTON FOR PERMIT TO PERFORM ELEcnuCAL WO ALL WORK To BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE 27 CMR 12:00 y I O (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Da (� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street dt Number) 5q — 5 5t 41 Pot.-NA CO J O A SS Owner or Tenant - C O V\-d,y ASS Owner's Address is this permit in conjunction with a building permit`: Yes No � (Check Appropriate Box) Purpose of Building -c � 41 �GR,i ASW t Q ^-,tA fl-le Utility Authorization No. Existing Service Ampa...L.Volts Overhead [:] Underground No.of Meters New Service Amps olts Overhead CM Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hat Tubs No.of Transformers Total KVA No.of Lighting Fixtures / Swimming Pool' Above Below ammtms KVA (® ad No.of Recepucle Outlets No.of Oil Burner No.of Emergency Lighting Battery Units No.of Switeh Outlets No.of On Burners No.of Renata No.of Air Cad. Total FIRE ALARMS No.of Zones Tag No.of Disposab No.of Heat Total Total Na of Detection and PUMP Tons KW Initialing Devices No.of Dishwasher Space Ara Heating KW No.of Sounding Devices No.of Self Contained Detecti Devices No.of Dryer Heating Devices KW Localmunicipa � Other Connections No.of Water Heaters KW No.of Na of Sign Baibsb No.Hydro Manage Tuba No.of Motor Total HP OTHER' �r�eCo�Ph®irattbdEla}Sara�cfMe®dilseO Iowa 7" haneaaa�tlie6rYylnsi�iaeFbicYr�ldr$CI�C�ir� or ste�r�dEgiYaiQt YES NO fhmembrr>ybdvaidpwaf ==1DdVGfik a YM ifyouhmedmdedMpl= d etypetfcoympby BGMrl OUM a /� ValletfiSbctticalwak S WcdcbStait f 0 Ittspac` DaleRMrsfad Rc* �l Cay( aw Sigledtrtder Pt�iestfptsjiry. � FMMNANIE Lic8laeNa ► I�t/N e d�• �'D�/�'SSwan tQ-(/'� � lical�No 5D / Bus insTdNia. /- 6/-S -7 / ALTdNa Owl�It'SAlSURAIv�w •lamawaiedletiheLicelre iheinluanaeeo►er�aritts�bs�r�alegiivalaltasie�iedby'Me�rhz;eleaCralnalLawa atdifiettrasigmllrerndinpem�tppicahrnvwriwsfiere� (Please check one) Owner Agent aignuare or Owner or Agent Telephone No. ...PERMIT FEE JA Location No. Date IDS-- MORTM TOWN OF NORTH ANDOVER 0 41 Certificate of Occupancy $ Building/Frame Permit Fee $ JACNUSEFoundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18,543 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVA^T OR DEMOLISH A ONE OR TWO FAMILY DWELLING 15!11"1' ._'." n .ShE" 'I• f".,, .,n( ' .,k� F{ Y g x i g 3 vyY`k fi� �N? K� Sy�.+4 e BUILDING PERMIT NUMBER. DATE ISSUED: C ` Q W a©� M / c^J SIGNATURE: Building Commissioner/Ingwor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 7 / r F 12 y aD 5 r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �l Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v I d Z Flood 000ne nformation: 1.8 Sew e l em: 1.7 Water Supply M.G.L.C.40. 54) efa8 > S yst Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Nisforic IS CIC : Yes O m 2.1 Owner of Record j � c .moi Name(Print), r� Address for Service: Signature Telephone 2.2 Owner of Record: \ ► tName Print Address for Service: O M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: / Not Applicable ❑ Licensed Construction pe sor: ( ` Q 0 License Number V Address ExicExptrahon kate I., � Signature Telephone r J 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name ■\���' n M Registration Number r•. Address AUG 2 6 2005 Expiration Date2 Signature Telephone BV I LDING V^ f r SECTION 4-WORKERS COMPENSATION(1VLG.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 Descrition of Proposed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify P, Brief Description of Proposed Work: l UG��af 1� 1 .�,j to ' �� � �1 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 41- (a) Building Permit Fee 8-co Multiplier 2 Electrical (b) Estimated Total Cost of 1 ® � Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical HVAC 0`J v 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 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION , a I, P as Owner/ th�Agentsubject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Z Z Print me �Signature of O r/A ent Date�7 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVMERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHFANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i 4 _ , �� Jf1C ZrJG99UYY7.G7Gt1 V✓AfXdifA,(Atdf.JP.�d BOARD ARD BUILDING REGULATIONS 4„ License: rQNSTRUCTION SUPERVISOR Number; CS. 048040 `3 - .f Birthdate: 10/29/1955 'C Tr. o: 8109AEx ire§ 10/29/2005 '1 Restricted: 00 TADEUSZ DOWGIEERT 171 BRADY AVE SALEM'; NH 03079 Administrator I I �Itsv\ -- -- -- ----- bepartment of Indiistriial Accidents Office of InveMAWons 600 Washington Street Boston,MA 02111 www.massgovIdle Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Apiplicant Information PleaPlean Print Legibly Name (Business/or Ar Irzl Address: 9'z P 4!Ec .5!� �7� /� � , C-elr--r- City/State/Zip: �> _� �' = //Phone Are y an employer?Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I Type at Protect(required): employee's(full and/or part-tine).' have hired the sub-contractors 6 ❑New 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 s. ❑ Demolition working for me in any capacity. workers' comp. insurance (No workers'comp.insurance 5. C1Weare a corporation and its 9' C] Building addition required.] officers have exercised thea IO-❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4�and we have no 12. Roof insurance required.]t employees. [No workers' ❑ regain cWp.insurance required.] 13.❑ Odler 'AnY aMIkAat tM cbedu box#1 must d oo 811 oat the neflon below sbo aiq their warters oompeosetioa Policy iaforrnetion t Homeowners wbo submit this atBdevd xW a*g they we dome all wwk end thea hire outside eoahwars must submit a new e8'devs"caRigg suck tConuactan tM deck this box mist attached an add itiorW deet altowiq the Weare of the wb•coapacoots and theQ wohm'corny policy information. I am an employer tint!s providing workersconi pensadon insurance for sty enipinym Below L the paJlty and job alts Informa"L Insurance Company Name: Policy#or Self-ins.Lic.#: /06 r6Z 9"''65L Expiration Date• d i Job Site Address:. S�� --��/! ���D � r City/Statcaip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and e>rpiratlon date). Failure to secure coverage as requiref 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 5250.00 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 vaificadon. Ido hereby veno ander the pains it o rr pe ilial the In f y ry onrtatlon f pt ovlded abom b ttrtrs correct Si s Phone#: 2 2- �L r-® 4 Fc6o�ntandel use only. Do nil write in this area,to be completed by civ or town 0,Q7clal Town: PermWLkeuse# Authority(circle one): d of Health 2.Building Depart at 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector Person: Phone M: 11111U1 11169LiVli "jj%i iAAO%rA Mv%#avaav Massachusetts General Laws chapter 152 requires all employers to provide workers' compensa u for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of'lure, express or implied,oral or written" as ,an individual,partnership,association,corporation or other legal entity,or any two or more An employer>s defined 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 152,125C(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." Applicants e Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractol(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies 01.07 or Limited Lubu7ity Pwmorsbips(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 of be returned to the city or town float the application for the permit or license is being requested,not the Departtn Industrial Accidems. Should you have any question 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 OAlcials 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 die Office of Investigations has to contact you regarding the applicaft Please be sure to fin in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license application 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 location in (city or town)."A copy of the affidavit�been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid a is on file for future permits or licenses. A new affidavit man 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a can. The Department's address,telephone and fax numbs: 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-MASSAM Fax#617-727-7749 Revised 5-26-05 wwwmm.gov/& 08/17/2005 02:38 FAX 9785215520 EMG 16001 DOWGIERT CONSTRUCTION CO. INC. 616 ESSEX STREET LAWRENCE,MA 01640 978 685-0300 fax 979 685-1290 EST/MATE _ Customer Name Miller Condo Association tate 7/19/2005 Address Esimate# A05071901 City N.Andover State MA ZIP 01845 Job Name Unit 54&55 Phone 2 Car Garan 1 _ Description Unit Price TOTAL_._— Supply necessarymatenmaterials,labor and dumpsters and remove existing damaged two car garage. (Foundation and concrete floor to remain.) Supply necessary materials and tabor and build a nm t w car garage on existing foundation,to match the dimensions and specifications of existing. Walls to be built with 2X4 construction,plywood,and shiplap cedar siding to match existing. Roof to be built with 2X8 rafters and plywood. Install IKO roofing shingles to match existing with _ a drip edge and necessary fleshings. Paint exterior to match existing color. Install two entry doors to match existing_ Install two garage doors w/openers(style to match existing). Install electrical lighting and outlets to replace existing. Build storage area above ceiling height to match existing. Build new storage shed attached to garage. General cleanup and removal of construction debris. i 1 Total Contract Price' $24,800.00 $24,81:0,00 i "Price includes building&electrical permits as needed, i SubTotal $24,81:10.00 i Shipping&Handling $0.00 Taxes _ TgTAL $24,8;iC1.00 _ Office Use Only t Min 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 or requirements. r;****************************APPLICANT FILLS OUT THIS SECTION*�'"`* APPLICANT /W, Ce)is J6 &51C cW....PHONE LOCATION: Assessor's Map Number 0 � PARCEL SUBDIVISION LOT (S) STREET �� S S� ST. NUMBER (�,,� � . OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: 4agPl CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH , DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT --- J FIRE DEPARTMENT Ot ��//�iw.� �:�L��.��- RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jm NORTH ANDOVER BUILDING DEPARTMENT i Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility ignature of Permit Applicant Fire �Department Si off: � eP � DumP ster Permit Date Workers' Compensation and Employer's Liability Policy C/G UARD AmGUARD Insurance Company - A Stock Company I� INSURANCE Policy Number DOWC542507 O , { � Renewal of DOW 3748] U NCCI No. 21873 [1] Named Insured and MailingAddress Agency 9 enc Y DOWGIERT CONSTRUCTION COMPANY, INC. ROBERTS INSURANCE AGENCY 616 Essex Street 1060 Osgood St. Lawrence, MA 01841 North Andover, MA 01845 Agency Code: MAROBE10 Federal Employer's ID 04-3438231 Insured is Corporation Risk ID Number 000288185 Locations Other Than Above (Ll) 8 Dundee Park, Andover, MA 01810 [2] Policy Period From October 26, 2004 to October 26, 2005, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident- each accident $500,000 Bodily Injury by Disease - each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, West Virginia, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Endorsements [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 24,876 Total Surcharges/Assessments $ 1,311 Total Estimated Cost $ 26,187 INTERNAL USE 4v Page- 1 - Information Page MGA : DOWC542507 10/27/2004 WC OOOOOlA Date : 16 South River Street•P.O. Box A-H•Wilkes-Barre, PA 18703-0020•www.guard.com NORTH T0VM Of 4 over O ..irf�w 1 r+4 •�, t No. 172oo ; - __ 2 CO �— = dover, Mass., •w{� COCKICKEWICK ,9 AERATED PPS\ S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT . //��� CN4 O.we. ....�.................... ......................:.. ..............�.... ...... Foundation has permission to erect.............2........................ buildings on ....$ ...S!5.....�..../�........... ��................. Rough to be occupied as....�* e t PI ACL R y X 2 q 6A r, ............. himney ............ ............ ............... ...... ... ......... 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 nspection, Alteration and Construction of Buildings in the Town of North Andover. X? PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ...... ...................... ..................... ........ ................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous -Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the -Building Inspector. Burner DEPARTMENT Street No. • SEE REVERSE SIDE Smoke Det. 1 3 9 8 Date... .! NORTq TOWN OF NORTH ANDOVER p PERM T WIRING 41 ACHUSEt This certifies that ........ Q.Y.. ........... ... ........... :........ .............................. has permission to perform .. ... . /...?Z��...... . ..�:C` � ...................... wiring in the building of......./.....(.... .................................................... .. ��JIB � `�i W ,North Andover,Mass. Fee. ............. Lic.No.�� 7` .. ... ........ ELECTRICAL INSPECTOR WHITE: Applicant CANARY:.9uilding Dept. PINK:Treasurer W:i The Commonwealth of Massachusetts °` `�l' x: Dcparinicnif of Public Sofety I. 17 �4 oceupincy S Fec Q+rcked �Q• -_ 33 130ARD OF FIRE PREVENT10N REGULATIONS S27 CMR 1200 3/90 (l,,.e ,i,nk) 'J H APPLICATION FOR PERMIT TO PERFORM ELECTRIC L WORK NI work to be ptr$ormcd In accordance with the Macaachuseru Uccirical Code, 527 MR 12:00 (PLEASE rRlirr Iii 11ZK OR apALL INFORHATIO1I) Da vTt - oan of Lo � mall To the Inspector ofWires7ewp The undersigned applies for a permit toa oo perform theectrical work described below. R w 1,Z-1tion (Street & lumber) r � /N P�� V � - 0---ner or Tenant e r -� Z u - G {/vmer's Address �O e Is this permit in conjunction with a building permit: Yes ❑ No [�] — M4.9s. err-cT Purpose of Building Utility Authorization NO. — Existing Service Amps / Volts Overhead ❑ Undgrd❑ 110. of 1"tars New Service Amps / Volts Overhead Lj Undgrd❑ 110. of Maters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work otal No. of Lighting Outlets No. of Not Tubs No..of Transformers TXvA. No. of Lighting Fixtures Swimmin g Pool Above ❑ In- ❑ grnd. grnd. Generators KVA -; No.,of Receptacle outlets No. of Oil Burners No, of Emergency Lighting BBCCCr Units �. 10 -'of SNitch'Outlets . , o" No. of Gas Burners FIRE ALARMS Ho..of Zones Total No. of Detection and No. of Panges No. of Air Cond. tons Initiating Devices >, Heat Total Total No., of Disposals�, 110. of PUMos Tons }.'W No. of Sounding'Devices No. of Dishwashers S ace/Area Heating }W No.Detectof.Selion/Sound Contained p g Detection/Sounding Devices NMunicipal Other o. of Dryers Heating Devices KW Local❑ Connection❑ 110, of flo. of Low Voltage No. of Water heaters KW Si ns Ballasts Wirin No, Hydro Massage Tubs No. of Motors Total H? OTHER: INSUP.kNCE 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 0 NO [] I have submitted valid proof of same to this office. YES❑ 110 ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the"penalti.cs.of perjury: _ F.IRt1 NAtt'E 45 �-C-- S�4yu �� LIC. NO.. /3!3S C Lice"nsce S , t^to P1U I,l Signature // LIC. NO. ,Address.- .33j" (7j 1C t� � Cz c.''k �`��ni�nt�i�F� a?r.4us. Tel. No. EVUF(,Jeans 2- Alt. Tel. No. _ oWNERISI14SURAIIC-E WAI.VER: I an aware that the Licensee does not have the insurance coverage or its sub- 5tantial equivalent is "required by Massachusetts General wsTa ,and that my signature on this perm,Lt �appl ation waives requirement. Owner Agent (Please check one) Q C�' f( �7 / C� O 0 ' Telephone No111 —6 N6_ . PERMIT FEE Signa re of 0 or Agent ■ .. t �: H a • N° 1 3 9 9 Date./:...c:?/.... J.... I NORTN, ° <�`'° '• "° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SsACHusf This certifies that 6r has permission to perform. . ..................................................... � r wiring in the building ................. ....................... ' .......... ,North Andover,Mass. Fee. .. '. Lic.No.............. ............................................................... ELECTRICAL INSPECTOR 01/22/98 14:32 10.00 PAID WHITE: Applicant CANARY: Building Dept. urer dOW Office Use Onlyq `� o59 f �>zmmnnwralth of assaousefts Permit No. p(( a,U _ i9evart ent Df Public 06 afttu Occupancy&Fee Checked s S 527 CMR 12:00 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATION C/Z APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK �� 0 All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12. 0 A (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date V ,lK or Town of NORTH ANDOVER To the Inspector o Wires: 7 T� The udersi ned applies for permit to perform the electrical work described below. �--- 9 PP Location (Street & Number) Owner or Tenant i"A y L_)__9(5 T'.J® Owner's Address Is this permit in conjunction with a building permit: Yes _ No V (Check Appropriate Box) Purpose of Building RKf2_ n -W—nAL-- Utility Authorization No. Existing Service Amps _J Volts Overhead 1:1Undgrnd I_ No. of Meters _ New Service Amps _J Volts Overhead n Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Gej�iUO'D IF K C4 Total No. of Lighting Outlets No. of Hot -ubs I No. of Transformers KVA No. of Lighting Fixtures Swimming P_ Above^- In- oi grno arnd. r Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cone. tons Initiating Devices No. of Disposals I No.of Heat Total Total Pumps Tons K'.V No. of Sounding Devices No. of Self Contained No. of Dishwashers SpaceiArea Heatino KW DetectioniSounding Devices 11 l j Municipal r Other Local No. of Dryers I Heating Devices KW _ Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Sailasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of '.lassacnusetts general Laws have a current Liability Insurance Policy inducing Co-101. Cperaucns Coverage or its substantial equivalent. YES NO _ I have submitted valid proof of same to the Office. YES V NO _ If you have checked YES, please indicate the type of coverage by checking the appr/o•riate box. INSURANCE Y! BOND = OTHER = (Please Soec:ty) (Expiration Date) Estimated Value of Electrical work S Work to Start Inspect:on Date Recuestee: Rough Final Signed under the Penalties of perjury: _ -�'9 Z A FIRM NAME_�AN0'7��1- � LIC. NO. � /'f LIC. Licensee ` � Siar.awre �e �{ -I2 Bus. Tel. No. �2� S i Address ' :Z= � Is�-k t v Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee aces net have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on s^.:s permit application waives this requirement. Owner Agent (Please check one) /� Teleonone No. PERMI;7e) s " (Signature of Owner or Agent) C Date... T-%TO 2653 NORTFr pL TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING SSACMUS� This certifies that ...... ............ C'Q ............... has permission to perform .......... ........... .'�.. ..�R�.Q,�,,.. wiring in the building of....hd.4v �.f.k ...�0 .................. ......... at..... ln..; ......h!1�.t. ...f'�i,4.1.a1... .......... .North Andover Mass. r F .. .. t/.. Lic.No.... —00 ELECTRICAN�i�CTOR l ;�- 125.00 PAID WRITE: Applicant GA y.. wilding Dept. PINK:Treasurer GOLD: File