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HomeMy WebLinkAboutMiscellaneous - 55 GLENWOOD STREET 4/30/2018 (2) 55 GLENWOOD STREET J 210/007.0-00040000.0 i i PERMIT NO. ? 7 APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS PAGE i MAP KBO. �O LOT NO. M L:— IIS%/ RECORD OF OWNERSHIP DATE BOOK iPAGE ZONE I SUB DIV. LOT NO. LOCATION �I OF BUILDING OWNERS NAME a / iOw I� yep TORIES 1 I F'l�y� S 1 SIZE OWNERS ADDRESS /�_ �flrP TV t;.- BASEMENT OR SLAB ARCHITECTS NAME 1177 SIZE OF FLOOR TIMBERS IST! MIND 3RD BUILDER'S NAME IC4 ",;� Ti'vey e0-.-; SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES —SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION ^S IS BUILDING ON SOLID OR FILLED LAND - WILL BUILDING CONFORM TO REQUIREMENTS OF CODE '�/ IS BUILDING CONNECTED TO TOWN WATER - Y I/ BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES LAND COST EST. BLDG. COST L 3 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE.2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEP6 MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FIL 81Gt4A RE 6F OWNER O AUTHORIZED AGENT ■UILDINI3 INSPECTOR FEE OWNER TEL.k (.O l O PERMIT GRANTED CONTR.TEL.# --;>f✓ O /i✓ CONTR.LIC.N DS U DC7 H.I.C.# 1 QG cap a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SIORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE a I 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER T _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B"M'T" AREA _ 1141/t % FIN. ATTIC AREA _ NO B M T FIRE PLACES - HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD11,O ASBESTOS SIDING COMMON _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I—J POOR _ ADEQUATE l NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX() _ GAMBRELMANSARD TOILET RM. I2TOILET RM. FIXE - FLAi SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 8 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. �• TIMBER BMS. &COLS. STEAM STEEL BMS. 3 COLS. HOT W T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC lrt 13rd NO HEATING Town of over No. `I 197 dover, Mass., '9"'COCHICHE WICK i�-A` S E BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................................................. G.(.iJ.L ........ .......................................... Foundation has permission to ereet....... ........ buildings on ............ .5 .............. ..... c� .....:........................ Rough tobe occupied as...................................................b.!..l. .°:}................:5..�. ?.� .G........................................................... Chimney 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ............................. ......�:...!..... ...................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Final ugh No Lathing or Dry Wall To Be Done Until inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) K)OR1 I l AUI9C(-k —. Mass. Date_Z4 Permit # ` Building Locatio rOwner's NameL1 LLti I fl i.)1LLI AMS "" . ••`� -- � pTl-� A 1J DOUF n rlQ Type of Occupancy_2ES I DE K) �1� New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ N _ N OC SC W W N N V z ¢ N N rt N rL O N = f l LU JCr N W O U m ~ s n 0 N F- W W O O : yW.- W 4 x z f N a c asjcc W w aW N J Z Q T. M c cc W O W 1-_ _ J J Q C h• ? N O = z W z Q W 0 HI U3 x O x O �#A x �' SUB—BSMT. J BASEMENT G ' �p Y, 1ST FLOOR 2ND FLOOR 3RD FLOOR _ 1 TI- 4TH FLOOR �PS STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET �p Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone q 7$—6 8,7-110 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy P< 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in abo knowledge and that all plumbing work and installations performed under the permit issf r thislication applicationtrue will d In mpl ante with allmy pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene" S. ; T e of license: Title Plumber Signature of Licensed Plum er or Gas Gasfitter City/Town Master License Number_374-5 APPROVE O FIC SE ONL Journeyman i BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPEC710N 1 FEE NO. _ APPLICATION FOR PERMIT TO DO GASFITTING I . I 1 IIS NAME Tf< TYPE OF BUILDING I a; LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. I PERMIT GRANTED DATE .19 I I I 1 GAS INSPECTOR 4 I I Lwwe" y State Gas ,))Bay A NiSource Company May 22,2006 Williams Virginia Account Number: 2453520082 55 Glenwood St North Andover MA 01845 Dear Williams Virginia: This follow-up letter is to inform you that your gas HA-1 located at 55 Glenwood St has been tagged due to a violation of state safety regulations. It is unsafe to use until the following condition has been corrected. Lock due to flood The Masachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737 Acts of 1960,requires that the condition be remedied. If you have questions or would like to discuss this issue, please call 978-687-1105 and ask for the Service supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Service or Meter Department Bay State Gas Company CRR: CRR# CAcisupdatedletters\236 05/22/06 55 Marston Street P.O. Box 869 Lawrence.MA 01841-2312 978-687-1105 Fax978-688-1875 Loc0ion S A WA f YU 4F— No. No. Z- Date 7�7 NORTq TOWN OF NORTH ANDOVER Ott �ao �,h O? �� •• O0 Certificate of Occupancy $ Building/Frame Permit Fee $ Z � 4 sACNUSEt� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ ` TOTAL Building Inspector 9724 J Div. Public Works PEa�tITjNO._ ,,.Z a Z APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE — ZONE I SUB DIV. LOT NO. FI LOCATION ,�`� �A/J O PURPOSE OF BUILDING OWNER'S NAME II L✓IL•L�� ( NO. OF STORIES SIZE OWNER'S ADDRESS Ire( BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �' }�Lv �U `tl�l. TN(-- SPAN --- DISTANCE TO NEAREST BUILDING /� DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES-SIDES 1 REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION /'?-��� HICKNESS IS BUILDING NEW SIZE OF FOOTING ! �V X IS BUILDING ADDITION �7MATERIAL OF CHIMNEY IS BUILDING ALTERATION E7 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 3 ) O(7 PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. ,PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ' ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BUILDING INSP[Mft GNA RE OF 6WNER OR AUTHORIZED AGENT FEE Z_� OWNER TEL.# L S 6 11 V PERMIT GRANTED CONTR.TEL.# 6 8 19 CONTR.LIC.# t ©S ~ H.I.C.# 1 o c 6 X 0 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY s:oL1 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M T' AREA _ V, 1/1 1/1 FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY 1�� _ STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I I POOR _ ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLE HIP BATH 13 FIX.) • GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO"PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 1_3r�dj NO HEATING h_1 oNNm of Notit N '_ Andova er No. 1 '3?. L/ 0 dover, Mass.,- 19 COC I C K "q RATE 0 P'V I BOARD OF HEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT..................... .............. BUILDING INSPECTOR Foundation has permission to erect........... ......... buildings on ........5.s. ........G.1– .. ... ............0.........t+. ..-O .Q iF.......... Rough to be occupied as...................................................... e5.1—.4F...........7C 4'(44.4. Chimney application on file in provided that the person accepting this permit shall in every respect conform to the�te-x­s o. e. 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 Final _'R 'NTJS ELECTRICAL INSPECTOR Service .. ........ ....... .................... LD ING INSPECTOR S S Rough ................ . ....... .... .. Final an(, "u"!-ed to Gica(bN BuiLiffig GAS INSPECTOR vX- 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. ----------- 1. A ------- If le 0,74 R11) --77 1 L OIL L 10 Po • Lf FERNWOOD STREET N D 06 LLJ F- 0 O r O Q LL- old z Q J � LLI a 00 F- wQ J z — Z J J _ J J N40'00'00" E 75.00' N f MAP 7, PARCEL 4 a W RESIDENCE 4 DISTRICT O 1 Q 7500 S F O O w = o PROPOSED DECK O O Z RAMON J. & o o m -dw DORIS E. O o =0.° N x o <J ELBEERY 0 Z N to N y 45.0 "z O #55 c zz o 5 Q oit 4 .0' X 21.1'* 2 OVERHANG 21.9'* W 75.00' �- 150.00' S 40'00'00" W c40� WIDE) GLENWOOD STREET Town North Andover o 1tio NORTH /, er2 f1 of A. v OFFICE OF o? c. l! U9 NT AND SERVICES p - r DEVELOPMENT E ►. I'I'Y LEVE L. . MUN ' 146 Main Street �q"°•,r °..�t�h{ North Apdover, Massachusetts 01845 SsAc"use KENNETH R.MAHONY- Director ' p { (508Y tlfet tweMSl(�� ; e l�oiif filing4W9 F Date r: Any appeal sha'I be"filed rce r within (20) clays after the w Ta�vnc�edt. J date of filing of this I`.otice _ , APPEALS AP _ BOARD O F . f . in the Office of the Town NOTICE OF DECISION i r Clerk. 'ib" CIA Y t. Property: 55 Glenwood Street. Williams Date: 11-17-95 irginiaM-. VI 55 Glenwood Street Petition :057-95 - y 4,1 Date of Hearing: 11-14-95 ort Andover; MA 018 f The Board of Appeals held a regular meeting on Tuesday evening; November 14 J ' - 1995 upon the petition of Virginia M. Williams requesting Variances pursuant to Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw(Zoning Dimensions ). J The applicant is also requesting a Special Permit pursuant to Section 9, paragraph 9.2.1 of the Zoning Bylaw. The applicant is seeking to add an open deck to her CG ( house. The following members were present and voting: William Sullivan, Walter Soule, I John Pallone, Scott Karpinski and Ellen McIntyre. � : ,di LT eldU ` The hearing was advertised in the North Andover Citizen on 10.25.95 and 11.1.95 and all abutters were notified by regular mail. Upon a motion.b John Pallone and second by Walter Soule the Board voted UP y required unanimously to Grant the right side setback variance of 3.4 feet from the q I 15 feet, Vote: Unanimous. Voting in favor: William Sullivan, Walter Soule, John Pallone, Scott Karpinski i and Ellen McIntyre. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Upon a motion by John Pallone and seconded by Scott Karpinski the Board voted unanimoulsy to Grant the Special Permit to add onto a legal non-conforming. 9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Ii BOARD OF APPEALS 688-9541 BUILDING 688- Sandra Starr Kathleen Bradley Colwell Julie Parrino D.Robert Nicetta Michael Howard ' J _ ° y �-` - ✓�/ ; ��ei�-,�� , . . iii._ _ 43 • f -n - structure. 4. . Voting in favor:William Sullivan, Waiter Soule, John Pallone,.Scott Karpinski and Ellen McIntyre. The B h Board finds that the applicant has satisfied the provisions of Section 9, para. ! 9.1,of the Zoning Bylaw and'that-such change; extension or alteration shall not be Vit; J substantially more detrimental than-the existing..non-conforming structure to the neighborhood. _ BOARD OF'.APPEALS, _ Al :4 _ William Sullivan, EffaUiriman e i!% . n - . 2bvgn G'hri l; • - iI t ham`.. ��f-�'j1?F"t.,.•+•; •. .• ,4a. .a ti,..iu �f i °.�'�•' Ar•/ I I I Registry of Deeds Northern District of Essex County Lawrence, MA 01840 04/17/96 VIRGINIA WILLIAMS DR # 106 Rec:time 0221 Type DECK 10.00 postage 0.3 1 Total 0.32 # 107 payment Cash 10.3 . THANK YOU! Thomas J. Burke Register of Deeds - — -- F-7 HOME-' IMPROVEMENT ',ONTRACTORS REGISTRATION I '^ a BOarcf. of Building Regulations and Standards One Ashburton P1<:Jce - R(,,.)M. Boston , MassachUsetts 0210$ HOME IMPROVEMENT CONTRACTOR - Registration. 106620 Exp ration 07/2.4/96 Vr- Type - PRIVATE CORPORATION } 11POVEMENT CONTRACT Re ratQo 106620 �` Richard. Fleet Contracting Inc . =x T , PRIVATE 0 ON, Richard A . Fleet - F E virion Q7/ 102 Brkdle Path Lane - all , MethueA. MA 01844 Tel �' "I rd Flu afa ir d . Ao Qt 4 C` COMMOl11'.vEALTH I DEPARTMENT OF PUBLIC SAFETY � I -�Fallarsioplaas::sc�rrs�i ` \3 OF ONE ASHBORTON PLACE . MuaaaNasott:c+taYalditlso i ___:MASS BOSTON,MA 02108 Coda/a oaaaa for IvvadAtibb j o/thla Ilcme.wa, j L 2 %e y S F CAUTION EXPIRATION DATE Ctl.lSTR• `;UPFRVISOF i 4/ 2/ i FOR PROTECTION AGAINST RESTRICTIONS EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB L E /'3 / ,;7 7 i, [ 1 Q PRINT IN APPROPRIATE 3 ;;JT K �i_E P4TH LN ° BLASTPERAT . S " C1Hi1.-i, '4 'A f'' P,44 Z � ' + 5 MUST INCINCLUDEPROT� }. PHOTO(BLASTING OPR ONLY) FEE: - - r• J U O 1 0 C s NOT VALID UNTIL SIGNED BVtICENSEE AND OFFICIALLY }- HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: U P 4�a 04/22/195 THIS DOCUMENT MUST BE -.NAM.— - � CARRIED ON THE PERSON OF « SQ!}NAME IN FULL ABOVE 91GNATURE UNE IG TORE OF LICENSEE er THE HOLDER WHEN EN- OTHERS- N-OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. VA- 1 NER ,g) . t�E • ti Office Use Only 233 01 4t \:Qmmonmr fth f�I of sCZ � Permit No. aepmnt Gf ViLbIu O=pancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 0 (leave blank) '7 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts EIectrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date — � (%X( or Town of NORTH A NnOVER To the Inspector of Wires: / The udersigned applies for a permit to-aerform, e a ectricai work described below. Location (Street & Number) /�/ Owner or Tenant �1 GA Owner's Address f- a Is this permit in conjunction with a building permit: Yes No C (C~eck Appropriate Box) Purpose of Suildina_ Utility Authorization No. Existing Service Amos _1 Vcits Overhead i! Undgrnd No. of Meters New Service Amps _J vcits Overhead Unegrne FE No. of Meters Numcer of Feeders and Ampacity Location and Nature of Proposed E!ect,'cai Wcn< f t Total No. of Lighting Outlets i I c: .. was I No. of Transformers KVA No. of Lighting Fixtures i Swimming Atcve.— In- wimmin Foci 9 9 j ;rro. _ cmc. Generators KVA No. of Emergency Lighting No. of Rececracie Cutlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. or Gas Burners I FIRE ALARMS No. of Zones I Tota+ No. of Cetection and No. of Ranges ` No. of Air Cana. tons Initiating Cevices F No.af Heat Tc:at Total No. of Disposals Pumas :ons KW No. of Sounding Devices !I No. of* Contained No. of Dishwashers ! ScacerArea r'eat:ng KWDeler:on:onJSounaing Devices Local - Municioai Other I No. at Dryers Heaunc Oevices KW Connec::on No. at `+o. or Low voltage No. of Water Heaters KW i Sicns Ballasts Wirnc No. Hydro Massage Tubs I No. of :lctcrs Totai HP OTHER: INSURANCE CCVERAGE. Pursuant to the reeuirements at :tassacn::sers yenerat Laws _ I have a current Uadiiity Insurance Policy inc:ucing C„rrt:eiee Ccerat+ons Coverage or its sucs:antial equivaient. YES Z� NO = I have suam+ttea valid proof of same to the Office. YES VC = It you have c:tecxea YES. -tease indicate the type of coverage any checxing the a oriate Dox. INSURANCE BOND = OTHER = (Please Stec•'-`.+! (Expiration Dater Estimated Value of E?ectncat Work S Want to Start Insoecuon Data Rac::estec: Rougn Final Signed unser the Penaltiesof erlu FIRM NAME UC. NO. Licensee Q mss Signat::re _ LIC. NO. (� / Bus. Tei. No. - S Address 4 Alt.:el. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee eoes not nave the insurance coverage or its suostanual edu+valent as re- _ Cuireu by Massachusetts General laws. and that miy signature on :r.ts term+t application waives this reowrement. Owner Age t {Please cnecx one► ��� _ Te+eanone No. PERMIT FE=3 (signature of Owner or Agent) s inn; • .� Date.................. TOWN OF NORTH ANDOVER GAJ 3? �•'� ... 'e �L Ln PERMIT FOR WIRING ,SgACMugEt F r -7 P This certifies that ..?..:. haspermission to perform ................................................i................................ G wiring in the building of ! r ie at......................................................T�...................... ,North Andover,Mass. Fee..................... Lic.No. ........ .... ............................................................... t t ELECTRICAL INSPECTOR i WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File