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HomeMy WebLinkAboutMiscellaneous - 548 SHARPNERS POND ROAD 4/30/2018 (2) 548 SHARPNERS POND ROAD � 2101105.D-0126-0000.0 1 - I �10RTIi TOWN OF NORTH ANDOVER M° p Building Department i a 1600 Osgood Street Building 2- Suite 2-36 Building Dept North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: C7 � [ °r I - p TEL #:`° � 11 VK- 6 NAME OF COMPLAINTANT: ADDRESS: \JM+0,NAK COMPLAINT TYPE: Electrical: Plumbing: Gas: Building: Property Owner: �s 0-m � �6r-vi - Address: 1 ✓� � Signed: Complaint Form-Revised 6.2007 NORTH,� p�t«ee.'a• O TOWN OF NORTH ANDOVER Building Department 1600 Osgood Street * �' Building 2-Suite 2-36 Building Dept North Andover MA 01845 Tel: (978) 688-9545 Fax(978)688-9542 COMPLAINT FOR INVESTIGATION DATE: l? TEL#• NAME OF COMPLAINTANT: Kali ADDRESS: COMPLAINT TYPE: Electrical: Plumbing: Gas: Building: Property Owner: \N\i- �V13 iDL vvv r v, Address: Other: y S J r . 01 C ISL nd'A Signed: Complaint Form-Revised 6.2007 TOWN OF NORTH ANDOVER OFFICE OF TOWN MANAGER 120 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 Of vtORTh •4��ao�••1•G Mark H.Rees �? e•.: _ •• o� Telephone(978)688-9510 Town Manager k * FAX (978)688-9556 ��SSwcHus t� September 15,2009 Mr. Kevin Callahan 548 Sharpners Pond Road North Andover,MA 01845 Dear Mr. Callahan: I am in receipt of your letter dated August 29, 2009 pertaining to complaints you have made to the Building Department regarding your neighbor at 544 Sharpeners Pond Road. I have met with the Community Development Director to review and discuss in detail the issues you raise. I offer the following comments regarding your concerns of provisions of the Zoning Bylaw and Town's General Bylaws not being enforced. Zoning Bylaw, Section 5.6.2 specifically states: "Excavation,removal, stripping, or mining of aggregate quantities of less than fifty(50)cubic yards on any one general site requires no formal approval." This is a large amount of material not typically associated with single family residences. Normally this provision does not apply to private property homeowners doing limited work on their property. However,the work at Mr. Horn's property will be monitored by Building Department personnel to insure he does not exceed the capped amount. In regards to your concern that,Mr. Horn has two unregistered vehicles on his property,Chapter 175 of the Town's General Bylaw does state that only one unregistered vehicle is allowed. Due to the fact that a bulldozer is designed to have limited speed and is primarily used for off road work,neither the Commonwealth of Massachusetts,nor the Town of North Andover,requires that heavy equipment be registered. It is the responsibility of our municipal agents to investigate any and all complaints and to apply the applicable laws or regulations available. Although Mr.Horn's activities may be viewed by some as disruptive, he appears to be in compliance with the Zoning Bylaw and the Town's General Bylaws. Building Department staff will continue to address any complaints and/or concerns and will continue to monitor the property and all associated activities. If you have any further questions,you may contact either me directly or Curt Bellavance, Director of Community Development,at 978-688-9531. Sincerely, Mark H. Rees Town Manager cc., Curt Bellavance,Community Development Director i r.IV— RECEIVED TOWN OF NORTH ANDOVER � AUG)G 2009 VU 3?Ot 4N1O.1RDTqI6 �~OG FO 9 Building Department + - 1600 Osgood Street BUILDING DEPT. Building 2- Suite 2-36 Building Dept 'ssgose North Andover MA 01845 Tel: (978)688-9545 Fax(978)688-9542 COMPLAINT FOR INVESTIGATION DATE: CY�/�/O� TEL NAME OF COMPLAINTANT: ,�U�.�/ �'. C'i9 ✓�/�/,�it/ COMPLAINT TYPE: Electrical: Plumbing: i Gas: Building: Property Owner: S'W4 Address: /V0 `'�'�/QCsf/ i�//G'I • ® / tf Other: 6,e,6 AV4CI-W?P JW je441/Y®1eA1,4% S'Yle S'Hq�Pw�S /� �Q !!�' �.Y,G�yE/1 �A� �G✓D �/.t/��/ST�/1FD i✓�.,/it e���.✓ /.S &Aozem, Ave 190,4j "Env I-61gV R r Signed: < Complaint Form-Revised 6.2007 , �� REGrEIVED f �ORTy� z TOWN OF NORTH ANDOVER Building Department - 1600 Osgood Street BUIL-DING CL'EF'T. Building 2- Suite 2-36 Building Dept 4SSa�rwSE� North Andover MA 01845 Tel: (978)688-9545 Fax(978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: ��f/��g TEL #: 7,? NAME OF COMPLAINTANT: G°isi/` '. ADDRESS: ��✓�° �Sir9��i�/�'.�S ✓©!1 �. �1�. ,� >�, COMPLAINT TYPE: Electrical: Plumbing: Gas: Building: Property Owner: `���f Si�i9�r�i>✓�, 5 /� Address: I Other: dc-6 A/;I/YC drAl //1')/A/ J Vil` � 5 Signed: �--- August 12, 2009 Investigation of complaint. Observed 1 unregister vehicle,one(1) backhoe/loader used for personal land care. No violation observed. Brian Leathe, Building Inspector Date...lfJl....................... _ AORTIJ iz Ot4�.w{a'�M TOWN OF- NORTH ANDOVER o :. PERMIT FOR WIRING ;,ssACHUS� This certifies that ...1.1.1dr........./.................kU4-.Ar:T41..... ................. has permission to perform ......... wiring in the building of.... Gc . .!Glt` ................................................ at........ .... ya�'�Il"��� ,North Andover,Mass. . ........ ........................ ...... y. Fee.. ................ Lic.No... ... ................ . . .jay/"�h!......... E ECTRICAL INSPECTOR �F : J Check # — 844 14( CN Commonwealth of Massachusetts Official Use Only ' Department of Fire Services Permit No. jclq 4 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( Q,,5;7 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: %® q 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) j,&%_pw�s W k0 Owner or Tenant R r_ 6 149-01` Telephone No. 12,6 6,0J Owner's Address — Is this permit in conjunction with a building permit? Yes 19 No ❑ (Check Appropriate Box) Purpose of Building 'F ,� 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: I Completion o the ollowin table maybe 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 ❑ In- F-1o.o mergency Lighting rnd. rnd. Battery 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 a Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers eat Pump Number Tons ......KW.......... No.of Self-Contained I 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 Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: 1 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: a5O (When required by municipal policy.) Work to Start:_101)cl I U6 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 liabilityinsurance including"completed'o eration" coverage or its substantial equivalent. The g q 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: - Licensee: L4"A 1 `,1, i� Signature LIC.LIC.NO.: (If applicable, enter"exempt"in the license number line)- Bus.Tel.No.: s Address: -� PIEASAAA S}eepA 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 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my elow hereby waive this requirement. I am the(check one)❑owner iM owner's agent. Owner/Agent Y17�y�9 fy�� Signature Telephone No._ PERMIT FEE: $ ���, e '� v� �. . Y The Commonwealth of Massachusetts k i Department of Industrial Accidents .. Office of Investigations ilk r 600 Washington Street yak; Boston, MA 0211 c: www.mass.g ov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A�plicant Information Please Print Ledbiy Name (Business/Organization/individual): Address- City/State/Zip: Phone #: . Are you an employer?Check the appropriate box: Type of project(required): I.❑ i am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.X I am asole proprietor or partner- listed on the attached sheet. modeling�. ❑ Remodeling ship and have no employees These suis-contractors have S. [] Demolition working for me in any capacity. workers' comp.insurance. q. Building addition. [No workers'comp. insurance 5. ❑ We are a corporation and its 10 Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGC. 11.7 Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees.-[No workers' �? comp,insurance required.] 13'❑Other *Any applicant that checks bo)e#I must also fill out the section below showing their workers''compensation policy information, r 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. I am an employer that is providing workers'compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip; i 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 I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature: 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 apamnents 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 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 not 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 Please fill,out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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. 8e 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 nurnberlisted below. Self.-insured companies should enter their i 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. 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 pennitflicense 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, 4 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 Investigaftions 600 Washington Street Boston, MA 02111 Tel. #617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-115 Fax#617-727-7749 www.mass.gov/dia Date. - f NOR7h .�� TOWN OF NORTH ANDOVER' p PERMIT FOR PLUI B[NG • _ V SS , CM This certifies that has permission to perform . . . . plumbing in the buildings of . `". . . . . . . . . . . . . az . . . � �( .�. . .Si?!'�t'�.'.`'`. . . .�J� �. . ., North Andover, Mass. � X. Fee. Y. . . . . .Lic. . . . . . . .1P�. IN&P CTOR . . . . . . . Check # nn nn �k 7901 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS <� ,y� /� Date Building Location c, y� ✓✓k►�1Zpmnc Owners Name/�/AV� t..�+j//� q Permit 9 -17�a Type of Occu anc e- f / Amount _ 1 New Renovation Replacement '� Plans Submitted Yes ❑ No FIXTURES � o a q O F x Un o � o rn o U � IBM Q Q Q q �• BASKYE � - 151;]tiIJJQt M +KOCit 4IHHOM SM HOCR 6M FLOCR SJ;fi FIIJQt h (Print or type) Check one: Installing Company Name Certificate Corp. Address R MADS YM 30 7 0 Partner. Business 151ephone F1 Firm/Co. Name of Licensed Plumber: fi7AVY4fbJ 4f00K Insurance Coverase: Indicate the type of in urance coverage by checking the appropriate box: Liability insurance policy F1 Other type.of indemnity ❑ ❑ Bond Insurance Waiver. I th dersigned,have been made aware that the license three insuranc e of this application does not have any one of the above atu Owner ❑ 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 for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By. ignaure o "cens um er Title Type of Plumbing License City/Townf�� cense umber Master ❑ Journeyman APPROVED wRcE usE orir_.r //. /G�' Date �j` ••• :• f or °` TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION y CHU ~iThis certifies that . . . �. . . . .R c' S c� �,?. , , , . , � t has permission for gas installation . . . in the buildings of . f`� ��. ti. . . .. . . . . ... . . . . . . . . at 3.6. . !�l . . . . . . . ..�: . . . . . . !1, h Andover, Mass. �Fee.'.ca _ ••- tic. No. ./,r . ... . . . . . � . . . . GAS INSPECTOR Check# o 656 ; MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GAS Fn-nNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations IZ'51 Sjg l Permit# � 2- Amount$ r Owner's Name New Renovation ❑ Replacement ❑ Plans Submitte ❑ C v� U F CL � , .Wd rn W O UO m rA F x C it w a O O O F z v w v, Z Fd x > w C W F F CZd d W Q a F >. r O > W �W„ W .� F W C O x a Q d O O w O w SU B-BASEM ENT 3 O 0 U cc > °+ O BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 1 STH . FLOOR (Print or type)- A? Check one: Certificate Installing Company Name__ Oe �S CX ❑ Corp. Address a r C7-c--I/1"&Z J �' ae r✓ p e y ❑ Partner. usmess a ep one ') E3—Eirm/Co. Name of Licensed Plumber'or Gas Fitter �/�,e� i S�/ 7Q yy� �• INSURANCE COVERAGE Check o e: I have a current liability Insurance,policy or it's substantial equivalent. Yes IM No❑ If you have checked Yes,please indicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Waiver: l am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature r si u e on thisermit application P PP waives this requirement. Check one: Signature of Owner or Owner's Agent Owner. ❑ Agent ❑ 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 for this application will be in compliance with all pertinentrovisions of the Mas P Bach se State Gas Code Chapter 142 of the General Laws. By: Signature of Licensed Plumb r Gas Fitter Title ®—Plumber City/Town, ❑ Gas Fitter icense Number DMaster _ APPROVED(OFFICE USE ONLY) Journeyman 4 �� :g DatelU . . t TOWN OF NORTH100ANDOVER d PERMIT FORS PLUMBING M 6 ,SSACMU`>� �This certifies that has permission to perform . . . . . . . . . . . . . . . . . . . . . . . 3 f plumbing in the buildings of u s fi at.,. . . . . . . , North Andover, Mass. Y ,Fee.�U. . . . .Lic. No.�/�..>a° . . . . . . . . . . . p LUMB NGINSPECTOR - Check # 7870 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print). NORTH ANDOVER,MASSACHUSETTS Building Location rQ �.dM $`Owners Name Date W r►�y A .n/r4 Permit �-- Amount Type of Occupanc New Renovation Replacement 'El Plans Submitted Yes No El FIXTURES UD U � p O O .a U W v� W O W O O w a a w c V) o o r a a - A a ca M FLOCR 4]HFWM MROM j sMRIM _ 7ME[f= sMF,oC Pr (Print or type) Check one: Certificate Installing Company Name � Corp. Address j� r rwfx 'c Partner. Business I elephone /47 R'Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy f5q�. Other type of indemnity ❑ Bond ❑ Insurance Waiver: I the undersigned,have been made aware that the license three insurance e of this application does not have any one of the above Signature Owner1:1Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate best of urate to the my knowledge and that all plumbing work g p and installation erformed under Permit Issued for this application will be in compliance with all pertinent provisions of a sachusetts Sta lumbing Co d Cha ter f-t#e-�igneral Laws. By: r;1gnaLLflVCo tc Type of Plumbing L' nse TitleCity/Townnse um er ❑ APPROVED(OMCE USE ONLY Master Journeyman Date.................................. HORTM *;'f— TOWN OF NORTH ANDOVER 3? e0 0 1- PERMIT FOR WIRING CHU. This certifies that .... �W&.w...... has permission to perform .......... ................................................................ wiring in the building of..tF�.......... .......6 . . ......................................... 5 ...............P..'er ... ... orth Andover,Mass. at....S ............. ................ Fee.... Lic.No. ................. .r�........ Al�- LECTRICAL INSPECTOR Check # 7434 Commonwealth of Massachusetts Oficial Use only,�+ Permit No 7`-` 3'f ' Department of Fire Services / 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: 6 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) $� r' -e-r- Owner or Tenant /���/1 s{- nO Pcrv. 6,3/!1 hGi Telephone No. . ,69'2 Owner's Address -2a yri-e Is this permit in conjunction with a building permit? Yes ❑ NoXJ (Check Appropriate Box) Purpose of Building o 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: e F M Completion of the following table may be waived by the Ins ector Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of To Transformers A No.of -naire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o m ency ig mg rnd. rnd. Batte nits No.of Receptacle Outlets No.of Oil Burners E ALARMS No.of Zones No.of SwitchesGas BurnersNo.of Detection and Initiating Devices No.of Ranges No.of Air Co Tonal No.of Alerting Devices No.of Waste Disposers Heat Pum umber KW No.of Self-Contained P s: ................. . .._.... ......... Detection/Alerting Devices No.of Dishwashersace/Area Heating KW ❑ Other P g Municipal Connection r� No.of Dryers Heating Appliances KW Security No. fDevicer uivalent No.o Water KW No.o No.of Data Wiring: He s Signs Ballasts No.of Devices or Eiguivalent dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: Y g No.of Devices or Equivalent OTHER: p Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Wor /1��6. (When required by municipal policy.) Work to Start: 37- 310 6) 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: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: PIA S lur l�r-2tZ 1,G i Gp v1 LIC. NO.: Ob Licensee:�� AA-1-r.11 Signature , : Q, LIC. NO.: (If applicable, enter "exempt-in the license number line.) Bus.Tel. No.:5Z3 Address: I_T_) r�-t.�J Si-, 60 J, -Ad6 M-1 Alt.Tel. No.: (,I) -899-/1-415 *Per M.G.L c. 147,s. 57-61,security work requires Department of ublic 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. $ Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CMUSf This certifies that-'. . � � all has permission to perform f . . . . . . . J plumbing in the buildings of /. . . .-/�,(.'�. . . . . . . . . . . . . at `}�. :.:�:1.� ,`z .: l 1 > ort3i�irrSover, Mass. Fee:�,��.. . .Lic. No.. i`r! 7 ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 r PLUMBING INSPECTOR Check # 6G71 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER,MASSACHUSEQd _ �[rJ Date Building Location Owners Name //0 ��✓ Permit t � Amount . Type of Occupancy, n"Y"j es NewID Renovation �j Replacement PlansSubmitted YNo ❑ FIXTURES H w w FOR cc A SLSB4VIC RWVJENT I51C FI�OOI2 FmFIDm FLOOR M FLOOR 6M Ftp 7M FLOOR 9M HJ00R (Print or type) Check one: ❑ Certificate Installing Company Name /" Corp. Address ILI ❑ Partner. Business Telephone Firm/Co. �- Name of Licensed Plumber: 610b P)tZAAg," Insurance Coverage: IndicatE&type Olinsurance 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 Owner ❑ 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 i all ' 'sTTffzqned under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa tate Plu in Cod and Chapter 142 of the General Laws. By: igna r cense urn er ypeof Plumbing License Title h City/Town tcense um er Master Journeyman APPROVED(OFFICE USE ONLY. a M