HomeMy WebLinkAboutMiscellaneous - 58 MAY STREET 4/30/2018 i -58 MAY STREET
210/018.0-0008-0000.0
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Town of Noz-th Andover !
D.B.A.—Zoning Compliance Form
�9S•,T.o r E��y 978-688-9545
SACHUS
This form must be reviewed with the Inspector of Buildings.
Office Hours are Monday-Friday 8-10 am,and 1-2 pm Monday-Thursday.
Applicant Name: � /* Name of Business:
Address of Business: Zoning District : I
Map / V Lot
Phone: Email �— f
i
Nature of Business: J-&-21L–
Do you own this property?Yes No
If no,written permission is required from your landlord. G'4(J E C)/–D LA
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t
Will you have clients coming to this property? Yes No C
Will you have any employees? Yes - No i
Will you have any major deliveries? Yes No
i
Description of Business Activity(Must be Completed)
Signature of Applicant
For Signage Refer to North Andover Zoning Bylaw Section 6 if
The prop us s in this zoning district.
- t
Issued By . ftt0--Q 3 Q9
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i
2.40 Home Occupation (1989/32)
An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal
address,which is clearly secondary to the use of the building for living purposes. Home occupations shall
include, but not limited to the following uses; personal services such as furnished by and artist or
instructor but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the
conduct of retail business,or the manufacturing of goods,which impacts the residential nature of the
neighborhood.
4. For use of a dwelling in any residential district or multi-family district for a home occupation,the
following conditions shall apply:
a. Not more than a total of three(3) people may be employed in the home occupation, one of
whom shall be the owner of the home occupation and residing in said dwelling.
b. The use is carried on strictly within the principal building;
c. There shall be no exterior alterations, accessory buildings,or display which are not customary
with residential buildings;
d. Not more than twenty five (25) percent of the existing gross floor area of the dwelling unit so
used, not to exceed one thousand (1000)square feet, is devoted to such use. In connection with
such use,there is to be kept no stock in trade,commodities or products which occupy space
beyond these limits;
e. There will be no display of goods or wares visible from the street;
f. The building or premises occupied shall not be rendered objectionable or detrimental to the
residential character of the neighborhood due to the exterior appearance,omission of odor,gas,
smoke,dust, noise, disturbance,or in any other way become objectionable or detrimental to
any residential use within the neighborhood;
g. Any such building shall include no features of design not customarily in buildings for residential
use.
L 2h
12
Signature Date
Locat en
No. Date
TOWN OF NORTH ANDOVER
3? �:, •• roc
' A Certificate of Occupancy $ p
Building/Frame Permit Fee $ G..—.--
^ Foundation Permit Fee $
s�cNust
Other Permit Fee $
Sewer Connection Fee $
` Water Connection Fee $
TOTAL $
wilding Inspector
C93C
Div. Public Works
r _
�>. T ..i - i _`°� -f�Ly�.w�Y _ ',��' .v.�.4s- r:-+�'!�'k• ...�;n•+:�e .'i�.c.�.�.;L.J,�•w 1u�• r..r .Y`._.
311T NO.
- AFFUCATION Fo! !lRMIT To SUa ._ Nps ANOOVEl� MAW-
LOT
MAP X10. LOT NO.. , PAGE
- -
ZONE Sun DIV, tOT NO f8A
RECORD OR OWNERSHIP DATE
BOOK PAGE
OCATION. %S T ;. ..
sa cw fou1Lo1Na
- OWNER• NAME
A� FoJ�T •SKF` BTORIES:
owNEa B ADDRESS, slzs_
y ENT OR B/.A�
ARCHITECT•! NAM! _ 4 o
F FLOOR TIMBERS 1ST t2ND
fU1LDER'B NAME ]Rd
OleTANC[TO NEAREST BUILDINGS ------------
•
FROM STREET 10NS OFSILLS
-404FAMCK FROM LOT LINES-slogs POSTS
REARAREA OF LOT GIRDER•
FRONTAGE OF FOUNDATION -
IS BUILDING NtW THICKNESS
IS BUILDING ADDITION SIZE OF FOOTING
x
IS BUILDING ALTERATION MATERIAL OF CHIMNEY -
IS BUILDING ON LID O
WILL BUILDING CONFORM TO REQU pEMENTf OF COO[ SOR FILLED LAND
I�S tB BUILDING CONNECTED TO TOWNWATER FS
BOARD OF APPEALS ACTION. IF ANY
_ 10 BUILDING CONNECTED TO TOWN ftWER
_ �s
10 BUILDING CONNECTED TO NATURAL GAB LINE ��S'
INSTRUCTIONS f PROPERTY INFORMATION
SEE BOTH BIDES LAND COBT
PAG[ I FILL OUT BECVIONS 1 • ] EST. BLDG- COST t��T
HR
PAGE 2 FILL OUT B[CTIONf 1 is EST. SLOG. COST SQ. FT.
EST. BLDG. COBT Ian ROO/t
ELECTRIC METEPS MUST Bt ON OUTBID[OF BUILDING` Ila ITICP 11T
NO.
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4 APPROVEII BY
PLANS MUST BE
FILED AND APPROVED BY BUILDING INSPECTOR
DAT[ FILED
SIONATYMIIja OF OWNER OR THORIZEO AGENT R{lILa1Na /NB►tCrDq
• OWNER TEL E
PERMIT GRANTED
19CONTR.TEL
1
` - - CONTR.LIC.
------------
H.I.C./
NOR
�TT b.
o Of over
No.
dover Mass. 19�
* o f
S `G BOARD OF HEALTH,
PERMIT T - D Food/Kitchen
4
Septic System $
~ BUILDING INSPECTOR
THIS CERTIFIES THAT
Foundation
has permission to ........, I `' f�..... buildings on............. Rough
tobe occupied as.................................. ............. ............. .............................. ...... 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:,tu.the Inspection, Alteration and Construction of
Buildings In the Town of North Andover. PLUMBING INSPECTOR
VIOLATt.n,.,N of the Zoning or Building Regulations Voids this Permit. Rough
• Final
4 PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST T Rough
. ............................. ...... i
.... . .... .............. Service.............................................
B DING INSPECTOR
Final i
Occupancy Permit Required to Occupy Building GAS INSPECTOR
— Do Not Remove Roup, ! '
Display in a Conspicuous Place on the Premises Final
No Lathing or Dry Wall To BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector._
Burner
Street No.
Smoke Det.
a 1 • NORTH ANDOVER, Meet. Dale
eundlna Q
Penna
location`J� M 11 Sit.
Ownee
Name y ��n fe
New O Renovalion Q/11, Replacement O Plane Submltled: Yee Q . Nva,(j
i
FIXTURES .....
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F M J « O i s F • A
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.OIM rs e) K K O 06 O G s e. O -
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R r~ G • a • • R •0 • a
eAeIRYIMT
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ISTFLOOR
•' 3M0 'LOOR
SAO FLOOR
4TH FLOOR
FTM FLOOR
eTMFLOOR
tTN FLOOR
•T14 FLOOR
1E IA I A-
Check Orle: CerthIcate
j Installing Company Name--00- 04,)r, 0 W
Address C� S fii2",M s b. O Partnership.
Lv'�cq frit�� ..
- G?ffrm/Co.
Business Telephone S`(�
Name d Ucenaed Plumber---AE C����i p (�• Q�„��� , _
INSURANCE COVERAGE:
I have a current liabilityInsurance policy or U substantWeq uivalentec one
Yee •
If you have checked y". please Indicate the No ❑'
type coverage by checking the appropriate box "
A liability Insurance policy Other
_ .. . - - - - - - type d indemnRy, O Bond p
OWNER'S INSURANCE WAIVER: 1 am aware that the Ilcens'ee sines not have the Insurance coveragewrequlred by-
Chapter 142 of the Maas. General Laws. and that my alanature on thio
permN appNullon..wabes.thla.csc�ulreal�L__
Check one: .._
_.. _ . . Owner O
... a urs oec a er s an� 13---- - -.-
hereby c«tlfy that all of the detaMa and Inlamallon I have wbrt,ftted kx er,teredl In above
Inowladpe and Thal aI phnnbtnq Irak and Inr<IlJtat{a►a pMormad under the penM laved fa Uon acabue.aad.aoc�Iratal&W►ba*jg1,wy..
pw0nen provision•of the Massachusetts Slala Plumbing Cada and Chapter 112 of Qanelal ppc+Uon oomplanq wi(h W
:064
Tltla na We
Cltyfro*n Lama Number 3 3S
,. MPnOVED(OfnCE USE ONLY1 Typo of Plumbing Ucense:Maslen ❑
I
Journeyman ®/
i
Y
• Date. .
NORTH G.
•'tic TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING41
.3
,SSACNU`+�
A
This certifies that t
. . .- . � .
fU
has permission to perform,-�a- . . . �
# plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r
E �
a at. . . `� ` . . . . . . . , North Andover, Mass.
iFeelz. '. Lic. No.:— I? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
Date...�.....` .. 9........
HOR71{
TOWN OF NORTH ANDOVER
FO 9
PERMIT FOR WIRING
,SSACNUS�
This certifies that -^ � ��^^-'Q�+-�
...........................................................................
has permission to perforrh .......................... .................................................
wiring in the building of
.......... 'z ............................................
at. a 1......�LEC
,North Andover,Mass.
_ Ll
c
Fee--*6 �......... Lic.NoN a.c....�.............
TRICALINSPEC'M
Check 11
899 ;
_f
Commonwealth of Massachusetts Official Use Only
91VDepartment of Fire Services Permit No._ 8 f
BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked
[Rev. 1/07] (leaveb]ank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
W
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR,12 00 WORK
(PLEASE PRINT IN INK OR TYPE ALLINFORMATION) Date: - p
City or Town of: NORTH ANDOVER
By this application the undersigned gives notice of his or her intention to perform the To the Inspector
of-Wires:
abed below.
Location(Street&Number)
Owner or enan C - o (l� C d W �2
Owner's Address �'� ,,,cy �� � _-
ephone N �r l A3
Is this permit in conjunction with a building permit? Yes
Purpose of Buildin F —7 ❑ No (Check Appropriate Boa)
1/W l_i.1N 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- /AVN n�e�A /1/ �U r Llt- C
Com letion o the ollowin table m be waived b the Ins ector o Wires.
No,of Recessed Luminaires No.of CeiL-Sus No.of Total
y�.(Paddle)Fans Transformers TVA
No.of Luminaire Outlets No.of Hot Tubs
Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- 0.0
mergency lg g
d• rnd• ❑ Batte Units
— No.of Receptacle Outlets No.of on Burners
FIRE AI ARMS No.of?nnes
No.of Switches No.of Gas BurnersI'M.of Detection and
No.of RangesInitiatin Devices
No.of Air Cond. Total
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons Self-Contained
Totals: Deteetion/Ale!#ng Devices
No.of Dishwashers Space/Area Heating KW Local El Municipal
ti
No.of Dryers Heating Appliances KW Security Connecon ❑ Other
Systems:
No.of WaterNo.of No.of Devices or
IC+�' E uivalent
Heaters No.of
Si s Ballasts Data Wiring:
No.of Devices or Equivalent
No.Hydromassage Bathtubs
No.of Motors Total gp Telecommunications Wiring;
OTHER: No.of Devices or E uivalent
Attach additional detail tf desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
Work to Stark 7' (When required by municipal policy.)
= - Inspections to be requested in accordance withMEC Rule 10,and upon completion.
INSURANCE OVERAGE: 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 o
ce.
CHECK ONE: INSURANCE El BOND ❑ OTHER 3-(Specify:)
I certify,under the pains and penalties of perjury, that the information on this
w� ���1c~ �
FIRM NAME: i PP tion is true and complete�ilE
Licensee: CSignatu
j`�jp�0�DN r LIC.NO.:
--•-t-�. � l�/� LIC.NO.: l
(If applicable, r exempt"in the license number line. o°l t7
Address: �� 7- �y ,jam TeL No.: - a
Per M.G.L c 147,s 57 1,s� ecurity work re uires D Alt.Tel.No.:
q epartment o
o.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee doles not have the�li liability insurancecense: Lic. coverage normally
required by law. By my signature below,I hereby waive this requirement I am the(check one) 2'-owner ❑ owner's agent
Owner/Agent
Signature Telephone No. PERMIT FEE: $ r
�e.
�'
,.
� �
7
1
f
The Commonwealth of Massachusetts
kj j! Department o.f'Industrial Accidents
! Office o,f'Investigations
40 41j
600 Arashington Street
{\ Boston, MA 02111
www mass.gov/dia .
Workers, Compensation Insurance Affidavit: Builders/Contractors/Eiectt icians/Plumbers
Applicant Information
Please PriDtLeglibly
Name (Business/Organ ization/individual):
Address:
City/,State/Zip Phone#: .
Are you an employer?Cheek.the appropriate box:
l.❑ I am a employer with 4. Type of project(required):
❑ 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.t 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me.in any capacity, workers, comp.insurance.
[No workers'comp. insurance 5. 9• ❑Building addition
p ❑ We are a corporation and its
required.] officers have exercised their 10.M Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself»[No•work=' 'comp, C. 152, 14 and we have P § e no
( � 12.[]Roof repairs
insurance required.]t employees. o workers'
CN
comp, insurance required..] 13-MOther
;Any applicant that checks bolc 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.
4Corttractots that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
1 am an employer that is providing:workers'compensation insurance for nr 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:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500,00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
I Si We:
Date;
Phone#:
Offtcia!use only. Do not write in this area,to be completed by city or town.official
City or Town: Permit/License#
Issuing Authori
g ty(circle one):
1. Board of Hesith 2. Sniiding Department 3.City/Town Clerk 4. Electrics! Inspector 5. Plnnsbing7inspeLlor
6.Other
Contact Person:
Phone#:
1
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written." ?'
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the
owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence-of compliance with the insurance'coverage required"
Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
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 requiredl to cavy workers' compensation insurance. IfanLLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,notthe 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 numberlisted below. Self-insured companies should enter their
self-insurane'e-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' gations has to contact you regarding the applicant
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permittlicense 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 bum leaves etc.)said perm is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Aacidants
Office of Investigations '
600 Washington Street
Boston, MA 02111
Tel.#617-7274900 ext 406 or 1-8.77-MASSAFE
Revised 5-26-05
Fax 4 617-727-7749
www.mass.gov/dia
N2 L i U 9 Date.............../.. ... ....
w NORTH
°f' :•�"� TOWN OF NORTH ANDOVER
3? • °c
PERMIT FOR WIRING
ACHUSE�,h
This certifies that '
...........................................:.................................................
.� has permission to perform '
..........................................................:z." ... .'
wiring in the building of......
.
............�..........:.......:.......:'................................
t
at.....:..........:...............................................................,North Andover,Mass.
Fee:` ................ Lic.No:.....f.. ................................................................
ELECTRICAL INSPECTOR
Check #
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
r 6194 Qt
Date..................................
1
NORTH
01
�"`°;•1"� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
SACNus�
This certifies that ......
. dPI'7'041W 4&-/-67-e740
..................................................................�....................
t has permission to perform !� �� T��
wiring in the building of... p/��.................
at......... ........M. ......................................... ... ,North Andover,Mass.
X-Fee..................... Lic.No.P .a9
'.e......... /a! .... . ...
.. .
Check # 10&a p ELECTRICAL INSPE�
Permit Na
BOWOFFMPREVF1V11MRD1RnA1Xa11 M70MIZO •�
Occupacy&Fees Checked -�.�--
QPUCATIONFOR PER ff M PERFORM ELECTRICAL WORK
ALL WORK To BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRDIT IN INK OR TYPE ALL I FORMAMON) pate MY
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) <k i l g y 5;7-
Owner or Tenant 2g (y
Owner's Address :5 4
Is this permit in conjunction with a building permit Yeses No (Check Approprime Boa)
purpose of Building 9 1�A Oat,ti,rV(:q-
Utility Authorization No.
Existing Serviceq OV� Amps
.2*/ .1,4 dVolts Overhead Underground No.of Meters J-
New Service
�p��Volts Overhead Underground C3 No.of Meters
Number of Feeders and Ampacity
Location and Nature of proposed Electrical Work . CA vVc 47Ae K FCeP i y7-
Na of Uahting Outlet Na of Hot Tube No.of 7tattflerrnM Total
KVA
Na of Uahtins Ritmes SwimrtdnB Pool AboveEl Below Omtarators KVA
No.of Receptacle Outlet Na of 011 Buten Ne.of Eampaey Uahtina Battery Ude
Na of Switch Outlet
No.of Gas Bornwe
Na of Ranaaa No.of Air Cold. Toll FIRE ALARM No.of Zones
TOW
Na of Disposals Na of Hod TOW � Na of Detection and
InitlWall Devices
No.of Dishwashers Space AHeatby KW ofSts
madift Devices
Am
Na Of SON Contained
No.of Dryers Hestim Devices KW Local �Devices
Mwddpd Other
No.of Won Heaters KW Na Of Na of Cororectiwrs
S Bsilssis
Na Hydro Massage Tuba Na Of Motors TOW HP
„ OTHER.
t
� 1�1,�acb�eta}imsmsdMa>sdra�rckmil�t.
Ihateaaaterl LmbIlyin=zeFdgkEkdngCom0 arb2*dffM IVdtnt YBS NO
Ihmesubrri1lslveidpraddssnebfre0mm Y19CT I)whonecleimdYBS�pkzai�d�el�typed
NSURANCE BCND[jam � �fnaeSpedyj
F�gislioBlQeTl
-- j Do d � F�timebdvakieafHectdca we
WodCbStat FMS�Ta MLbr Telb'�dP
fMMNAME FoNT�<,y� LLC-C i,e c� C2 C 7'r'P—� 1�oereeNa ? E
Li. Yw'gab �ah7Ai.il�
�� ,:, Jaz LioeneNo (���P�{ A
Bud=TUNn
ALTeLNo,T"
OW?�WSII�SURAI�WAM-lamawa todiei�ae iheiannoectna ari+sa ridtx}ivalataeel}iedbyMee®dss�Crslaidlsnw
atdthetrrp�s9g�easeonihbpt� a IiregtriQrleSt
(Please check one) Owner Apo D
Telephone No.
PERM FEE
DEDUU t MOMMMSAFEry Permit No. l %
BQ41tD0FF=PRE'VFM1WRBZi91nV 527GR,UV9 �-
oc"Pancy Fes Checked 'moi
APPUCARONFOR PMW M PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS E1.Bt MICAL CODE,527 Chttt 12:00
(PLEASE PRINT IN INK OR TYPE ALL MRMATIOIh Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number)
Owner or TenantA 41 y 0At 5 (y 7",,4-
Owner's Address s.�
Is this permit in conjunction with a building permit: Yes M No Q (Check Appropriate Boit)
purpose of Building �( f"/ � c(G� � p� - Y 1 17
Utility Authorization No.
Existing Service q OV Amps Volts Overhead Underground No.of Meters
New Serrtsa< Amp...I.V olts Overhead Underground Q No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work KCA vV :2,1 K F c 77 i �}lgtz.-ray nr 7-
No.of t.iabling Oedua Na of Hot Tube No.of Trwberopa Told
No.of Uabting RUM Swbm drg Pool Abu" KVA
NOW
KVA
o.or Receptseta Oudsla Na Of OB Buenas No.of Emaaeoey UghrinB Botery Units
No.of Switch Oude s
No.of On Burners
No.of Ranpa Na of Air Cad. Told FIRE ALARM No.of Zona
Topa
(�J, No.of Dlspaala No.of Hat TOW Told No,dD"ection uW
palm Tony KW Lddaft Dak
No.of Dishwashers Space Area Hating KW No.ofSounding Dal=
No.of Sw Contsinm
ices
Na of Drym Hestina Device KViI Detectiod3onrrd�Dw
_.. � locr Mauddclp
sl � Other
No.of Wna Heaters KW Na of No,of C0° ftdom
Sim Baitesis
No.Hydro Muscae Tube Na of Motors Told HP
1`
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TREC0MMONWF.ALTHOFMASS4CHU.'SE77S Office--
_ DEPARTAMWOFPUBLICSAFETY Permit No. 69
BOARD OFMEPREYEMONRWMTIONN527CUR120 "-av
' Occupancy&Fees Checked
APPUCATION FOR PIJZW TO PEUORM ELECITZICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant .�y/`f j�,�� p A(7(d,(-
Owner's Address Sf*-1 f5
Is this permit in conjunction with a building permit: Yes M No M (Check Appropriate Box)
Purpose of Building �f.��'G L. ( /V 6- Utility Authorization No.
Existing Service Amps / Volts Overhead 1:3 Underground ID No.of Meters
New Service Amps Volts Overhead r-1 Underground Q No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
groundg1:1round
No.of Receptacle Outlets r ( No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.of Disposals No.of Heat Total Total No.of Detection and
Pumps Tons KW Initiating Devices
`No.of Dishwashers Space Area Heating KW No.of Sounding Devices
1 No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal Other
Connections
No.of Water Heaters KW No.of No.of
Signs Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
t OTHER. 66 ft P ACV( 47U C-
Iha%,eaomutLj&kharmmPchcymdudffgCarpi&Opw&nCeAWcrtsabixtdeWakit YES NO
Ihmest>fxnadvalidpoofbfsartebtheOffim YES M NO If}uuhmdtadWYES,pkmmdic*tietypeof'ooMag:trydakirgthe
appLpi*
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md"tmyse«tflrspairappl +6onwa'mthstagttitartat.
(Please heck one) Owner ® Agent
X
L) XYZ K Telephone NoQ'r �$G" 1 PERMIT FEE S
—i office use only
„ U�jl;.. Liam IiDmurait1 of - 5sar4 sitt5 Permit No.
& artattrrt of ublir fbaft:
• IJ � tq Occupancy 6 Fee Checked. 44
,__
BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 9190 peave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massacnusetts Electrical Code, S27 CMA 12:00
I
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ' /—'g�
%)Q or Town ot''--NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Numbed
Owner or Tenant
�r
Owner's Address
Is this permit in conjunction with a building permit: es No r (Check Appropriate Boxy
Purocse of Buildina �FLGf�(r Utility Autnonzation No.
Sxisting Service Amos _1 VCits Overread _ Unagrna r Na. of Meters
New—ice Amps _J Volts Overr,eac _ UncS:nd Na. of Meters
Numoee of Feeders and Ampactty
Lecaticri aria Nature of Prccosec Elec:ncal .`/crx L7z-7=(:rLW k1L1.PF
No, of !-:gntinq Outlets i No. cf pct 7•cs i Na. ct :ransfarmers -i
lai
1.
VA
No. at Lighting Fixtue�s !l_ Swimming ?_or
Above.— ;n-
grno. _ gine. _ ! Ganerators KVa
No. of Emergency Lighting
No. pr Receotac:e Outlets fl ` No. at O;t =urners I 3arery Units i
No. of Switch OutletsNo. :r .rias =urners I FIRE ALARMS No. of Zones
No. of Ranges No. c! Air Ccnc. Total No. of Cetaction ano
tons Initiating Covtces
No. of Oisao '4eat Total Total
sats � I Na.cf '
?ti-cs Tons KW No. at Sounaing Oevtces
No. of Sad Contained
' No. of uianwasners SoacerArea rieaunq Oetee::oroSounatnq Oevtces
No. of Or/ers I Heaving Qewces KW Lccai - Muntcioar —Other
I
' Connec:;on
No. cr NO. Jt Low voltage
No, of Water Heaters KIN i Signs 9adas;s Wiring . 40
No. 4varo Massage Tubs I No. of tifotcrs Total Ho
OTHER: '
INSURANCE COVERAGE. Pursuant :o the reoutrements at massacn"ers ;enerat Laws
I have a current Liaotiity Insurance Policy mcluctng Camc:eiea Oceraucns Crverage or :is suostantial eeuivaient. YES — NO I
nave suahnttea vatic -roof of same to the Office. YES = NO = If ycu nave cnecxea `!ES. atease tnatcate ;no type at coverage cy
checking !Me avorconate cox.
INSURANCE = 3CNO = OTHER = tP!ease'Scec:.y)
Esarnatea valve of E!ee:neat Work 5 (Excitation Oatei
Work :a StartInsoec:ion Date Racues:ac: Rougn Final
Stgnea unser me Penalties of perjury:
FIRM NAM UC. NO.
Licensee5'c- ..:re:re
` l9t1MDtqp FaNTAlK UC. NO.
AQitties Sus. Tet. No.
All. Tel. .Jo.
OWNErA'S INSURANCE WAIVER: I am aware !Mat the _xensee aces not nave the insurance coverage or its suostanual eouivalent as re-
atureo a Massacnusetts General Laws, ano that my signature on ::..3 zermit aepneauon waives this recurrement. Own Agent
lP!sa e eek crier � «
ISignature Of Owner or Agents
"cast
Date.. .!?...,( !�.../..c�.7
Ir t H07
NORTI♦
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
S^cMUSEt .
n
This certifies that ......,([ a.`�.mnn�`.1........�r......./.-.0 ..............
has permission to perform ...... ......... .
wiring in the building of.................
at.......�....?.........
I.. .Ll............^...,.................... .North Andover,Mass.
//ccy��
Fee.... 5..:00. Lic.NoJ.. Vlj7 ...............................................................
{{ ELECTRICAL INSPECTOR
C R # 3 /97 12:16 25.04 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer