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HomeMy WebLinkAboutMiscellaneous - 61 WHITE BIRCH LANE 4/30/2018Date. R .7-.� . This certifies that ..41-T..111i-;L��!?!. rT......... has permission to perform ... rwe.<<! .A%'l. �.............. . wiring in the building of .....S4p P ............ I ......... at . %% /' I?r,171. t4V ....... orth Andover, -ass. �v ►' Fee. Lic. No. I f:3.3 y. ..... . . .V ELECTRICAL INSPECTOR Check # i 0 0 �J-D--s- Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] 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: B - r) — 4Z City or Town of: 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) Cp k W kA, --S 1 P,\,,RCJ LA i-Jr Owner or Tenant S(„©pcv2 Telephone No. Owner's Address (aMe Is this permit in conjunction with a building permit? Yes ❑( No ❑ (Check Appropriate Box) Purpose of Building S l NC, L >C r -A rn I Q-< Utility Authorization No Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Completion ofthe following table may be waived by the Insnectnr nfWirec. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures AboveIn- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Baftery Units No. of Receptacle Outlets 10 No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number I Tons KW No, of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kit Security Systems: No. of Devices or Equivalent No. of Water KW Heaters o. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 [Z BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 2SC O oGI (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of pedury, that the information on this application is true and complete FIRM NAME: /N - L ©t l - LE C N R1 C. 1 1'4 LIC. NO.: 1 f-:�Z31' A Licensee: C t4 R t, N k 1,g0 t,3 zil- Signature C,�.�`%'ly� LIC. NO.: Z830SI`„ (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Qc- 3-(155? Address: I i ( �7:559-N g`t SwUGa�`� V1'1P ©��OG Alt. Tel. No.:iBl 6 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ I I w pe -4"}R. PK T -T (2- 06�4 F4�1 Cp-/-c tv"- 1, tZ f; i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Print Form www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A & J Nelson Electric INC. Address: 171 Essex Street .Saugus, MA. 01906 Phone #:781-233-1257 Are you an employer? Check the appropriate box: 1.0 I am a employer with 4 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 5. ❑ ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.: We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' insurance Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑✓ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. i Insurance Company Name: Norgard Policy # or Self -ins. Lic. #:AJWC344441 Expiration Date:03/03/13 Job Site Address:61 White Birch Lane City/State/Zip:North Andover, MA. 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 herebv certify under the Pains and Phone #: that the information provided above is true and correct. Oficial 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 #: a Location "77- 0 -0 Date ZLZI �It TOWN OF NORTH ANDOVER Certificate of ,Occupancy $ A Building/Frame Permit Fee i $ a Foundation Permit Fee $ C> "- Other Permit Fee $ Sewer Connection Fee $ 3�J Water Connection Fee 6950 TOTAL tOz),O_ ,1,4 U 0 Location)) f '� — 6 / 101-1/71 g1g,°11 No. /00 Date 7//3/,W NORTM, TOWN OF NORTH ANDOVER �t 11,90 '• �O Certificate of Occupancy $ Building/Frame Permit Fee $ / U U Foundation Permit Fee $ �cHu— /vim r-tJ ss sE Other Permit Fee $ Sewer Connection Fee $ N Water Connection Fee $ TOTAL $ /( U� Building I pecior / ¢ 07/13/94 09:33 I'M. 00 PAT>1 �-' 7433 Div. Public Works r Location A No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ d•v C) Building/Frame Permit Fee $ Foundation Permit Fee $/ U• Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ —� TOTAL $ / Building Inspector 71315"' 150. 00 PAID Div. 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CD n W C7 CO) c� no m z �-co v; o, �: CD o T W ��03 y co W W y o � o i RW W = = W p N• 0 CIDIoW s c H CL WIW '` y & ,rt .•� W W W y C7 fl c o. W O N d CO) y O. d mCLCLd CO) r W ,..,luco H ? HCD o C W H • =r co o U) W E Gm's '� o W Cl) CD Cc zc o y zc �= W m Cn Cn W C 'fir] gd O -n Cn ;7 CD O ':7 7d O :p O O M O 0 0 OM fD t7l n r D o. C C" ?5 bh (t x CD t7:1d z 9 �z o LS • y 0 0 c 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: APPLICANT: SC CC- Phone LOCATION: Assessor's Map Number Subdivision Street Parcel Lot (s) 1?1t� St. Number ************************Official Use Only*******************V*** RECO NDAT IONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments 1A 2) ( Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved / Date Rejected 1 - .ewater connections works SS /a /rA R 1 / 0ire�i 61 Received ] P - driveway permit .tvacx1tev" wU 11v yi l y Y ry Building Inspector Es APR -61994 �t, 01'I ,iG DEPAR e�r1 IN h \�,� � \ � • 1 tl v I ��i --•� ud•ie'dv J•o Dye—� \♦ II\� -" is \11� / 1 a •t� ! � �// / I\_,- - � \ 111 ,' �ge� _i / � ., ; e'1, 'I l i ��� � / I ��/u,• \\\ 1111 \Jim #i got tj lb �'3� !t \ \ p,�, i i II `\ \ ///// �/'tea• I 1 I�1 IS�� 1;� ili i �e 414 14, Pf 1� �� — _ ''a ° � `.i / `/ / \ / e � 4 mss• ��Q 8 Iq $ 8 g m oe-- _ \ �d�✓ / am134 — \ zY sro \ \ / I II of F \ \J C �•a a � 1 i SS• I � q — � r—d s RDn z a � 1 i SS• I � \ '•,l 'Q} 7tg ' is ,t� 7 x �•r t �a• 'K {�, j � � ��a tr s i i t r F i� f -� Ittp'1Ik +yylg�i9�'y PI •174} �' �r,ri i i r i�'. i�.. R .� sti t�' i I.' t i i 7 4.f Rsi , ------------ +• :iii` ��� � �N Y (�}£, CI�MMONWFJILTN DEPARTMENT OF PUBLIC SAFETY �ti 6p ONE nTON PLACE DUPLI �TE r FLy goAckuseTTS BOSTON, MA ��..��}y>�,.-{{..- /•�`Mzra*t� F-':r Cll l dfJtlATE nAi�Cl lr)'),J (.•�R11fli(?. lt_ll'��1�1)1f.1�� + t ( t ` FOR PROTECTION AGAINST,; K EFFECTIVE DATE UC -NO. THEFT, PUt RIGHT THUMB ,F A PRINT IN APPROPRIATE 4 g l ' BOX ON LICENSE.*,. ..z ul SAT BLASTING OPERATORS. t F! rdf TI ti-11t•I0013 RIl 'MUST INCLUDE PHOTO.f r" r. ti w �, `. r •! I t1DI, Will HH 03087 tyl�j NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY + y� ' Mill �h � �gµt' STAMPED • OR - SIGNATURE OF THE COMMISSIONE{i ' � - j �' 1' � st �• �T�dk iflAtuw L4' i + BIL1NAlUiffibf LlCt? II EN ,e•�„it(��h tLi tY' zY F A710N. � + 5 f �f71 l.W. 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OT 4 I CERTIFY MT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HOWONTAL SETBACK REQUIREMENTS OF THE LOCAL AMMABLE ZONING OY-LANS IN EFFECT WHEN CONSTRUCTED. (IRIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESM=ONS SUCH AS COVEHANMWETLANOS.EASEMDVTS. ORDERS OF CONO/TIONum) THIS DRAWING SHALL NOT LIE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN TTAT OuTimm ABOVE.EXCEPT WITH THE WRITTEN PERMISSION OF 000SIUKN N ! SAM MTC. FURTHERYORE THIS DRAWING 6 THE COPYRIGHTED PROPERTY OF CHR/SILWSEN 3: SERC) LNC. AND ANY uN4unsowE0 USE IS PROHLLI/TED.CHRISTWrdW & SEDC/ TAKE'S NO RESPONSIBILITY FOR THE UNAUTHOR/IED USE OF TILS DRAWING OR ANY M VR- AIAT1ON CONTAINED HEREON. LASED ON SCALED DATA ONLY TTIE, PRIMARY STRUCTURE SHOWN IS NOT LOCAYED IN A FLOOD /LIZARD ZONE AS SHOWN ON FEAR FLOOD M/SURANCE RATE MAP. i VOW ' LLI7E:6/2/93 DWG. NO.: 93067016 I.a• R HORTM o a • SACMUS�AO Date., � .'• . TOWN OF VMH ANDOVER PERMIT FOR PLUMBING Thic nprtifivc that i 'Y � C /'7 `t 1 c has permission to perform ... 7 ........................ plumbing in the buildings of 7� ...................... at ... North Andover, Mass. � r i Fee.Lic. No../ .?! .. ........ PLUMBING INSPECTOR Check # S Inspection of Plumbing MASSACHUSETTS U :NIFQRM' PPLICAT1W FOR -PERMIT TO' DO PLUMBING Mass. Date Permit # B,Ulldfhg Location f 4�A�Ale 401«i Owner's' N a in e f Occupancy. I Nil , 7,52 - 71 Type o 0 Now 0 Rienoya.tldn Repiacemint Cg-- 'Plahs Submifted: Yet- 0: No: 0. FIXTURES Installing Company Name LL(q. LLCC: heck one: Certificate. C-'(570 N� FNS Ad�ress .8usineu Telephone. &_7 1:1 Firm/Co. Name of UceruEed Plumber LlaAir, * I hive.a current liabllftyinsurance policy or its sulattontlal Pqu..lvalent which, there uirements of MGL Ch 142. , Yes CNo If you have 'cfiecked yam, p!eapq.in.d:iq;teth , . . - . p, type, ;qyer,ag!;. by ;4o*qkjn.g, the approp .A .11abillty Irtsurance policy Other iypei. of Inde m,n, fly q*nd 0 ..QWNER'.S INSURANCE WAIVER: I am aware that tha.kens" does not have. the, IqRqranqo poverage required by Chapter 142 0( the. Mass: Gcrierat' Laws, and: thaS .0yet th' y ;19 on -.this th s 0 pll;Atk waives -is requirement. Check one: OWner 0 Agent 0 I hereby certify that all of the details and infOrMation iif`ed* for entered) in above, ipplica(6aii knowledge and that 'ifM PlqMbjA2)kork ihd, . or 'h 010er - partl4nt Provlslonof Massachusetts. kunbiKdWddand'Ch Chapter t66 90 w;.. 10 SPlmer b -7. ignat u Title Type of bconse Mailer. Journeyman ❑ Cit /Town . ONLY) ucense Num,60f wurate to thi. best of lily in iiompliin6i,with all. X. 0 v) I- Z. Q x X : W U n is44 A 0 10, U Uj. 'A 0 xvi. .0 0 NO -S- 0. 0- t vj % 0 dC Q Installing Company Name LL(q. LLCC: heck one: Certificate. C-'(570 N� FNS Ad�ress .8usineu Telephone. &_7 1:1 Firm/Co. Name of UceruEed Plumber LlaAir, * I hive.a current liabllftyinsurance policy or its sulattontlal Pqu..lvalent which, there uirements of MGL Ch 142. , Yes CNo If you have 'cfiecked yam, p!eapq.in.d:iq;teth , . . - . p, type, ;qyer,ag!;. by ;4o*qkjn.g, the approp .A .11abillty Irtsurance policy Other iypei. of Inde m,n, fly q*nd 0 ..QWNER'.S INSURANCE WAIVER: I am aware that tha.kens" does not have. the, IqRqranqo poverage required by Chapter 142 0( the. Mass: Gcrierat' Laws, and: thaS .0yet th' y ;19 on -.this th s 0 pll;Atk waives -is requirement. Check one: OWner 0 Agent 0 I hereby certify that all of the details and infOrMation iif`ed* for entered) in above, ipplica(6aii knowledge and that 'ifM PlqMbjA2)kork ihd, . or 'h 010er - partl4nt Provlslonof Massachusetts. kunbiKdWddand'Ch Chapter t66 90 w;.. 10 SPlmer b -7. ignat u Title Type of bconse Mailer. Journeyman ❑ Cit /Town . ONLY) ucense Num,60f wurate to thi. best of lily in iiompliin6i,with all. A6.... o ca d c. c v cl r ` tc n Q m Z - w 1 a _ �. o. A11% u&mmonnif# of f assar4unl:##n . Itprtmrat of Publir %fttq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Officb Use On Permit No. Occupancy &Fee Checked �` ' 3/90 (leave blank) 1z.2,6 w. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date � or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a (permit to perform the electrical work described below. Location (Street & Number)L Owner or Tenant �6"lip P G'\tfAiLl Owner's Address c4'",. Is this permit in conjunction with a building permit: Yes ❑ No Ef (Check Appropriate Box) Purpose of 'Building '^-f `' "S� Utility Authorization No. Existing Service I pfl Amps 1/0 / 2-20 Volts Overhead ❑ Undgrnd ❑ No. of Meters r New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical .Work I/` ('Ag No: :of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ ( Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total /`Y No. of Ranges No. of Air Cond. 1 tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municiphl ❑ Other ❑ Connection No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage TLbs No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Comp 1e;ed'operations Coverage or its substantial equivalent. YES have submitted valid proof of same to the Office. YES Z,/ NO = If you have checked YES, please indicate the type of coverage by checking the app ro riate box. INSURANCE BOND �_– OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ 1 0 0 Work,tp Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: rr PIRM NAME ( 1"P na V 4rf ✓-r4 LIC. NO. � 6 3 3 Lf Licensee 04 Signature LIC. NO. 36 3 Sf 10, Bus. Tel. No. %'C --3&-V0:2 Address S 01 , Alt. Tel. No. _? '33.1 'fia�noz OWNER'S INSURANCE WAIVER: I am aware t t the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. -- — PERMIT FEE S (signature of Owner or Agent) Xl6565 Date.........�.�.. .� 966 NORTH °� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING :� �,SSACHUS� , A This certifies that .....:...:... $ .....�� ^:....... n......� .... has permission to perform ..... .,a�.�!/ - - . A..'�......�11...0 .......................... wiring in the buildin o d .. . ,:. ...................... at .....6-1 ...... � . .. J. ........Ze -,t ..... , North Andover, Mass. a �S' Fee .... ....-...... Lic. No.3........3.. �� L�... -.............. .................. ►— /� EL CTRICAL INSPECTOR N N IVIf ( f'j 8 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N- o 4 / 51 Date. .. ?... TOWN OF NORTH ANDOVER °0 PERMIT FOR PLUMBING This certifies that ... � .6 .>. r ' :�!���.G ..'.............. • .. . has permission to perform ... P .L... plumbing in the buildings of .................... at .......... ........... North Andover, Mass. Fee .l.Lic. No... .:. ......... .............. ....... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION (Print or Type Masi DateAn t _ / IN FOR PERMIT TO DO PLUMBING ;LG Permit # (6wner's Name///,r-s Type of Occupancii ,-1 C_ New ❑ Renovation ❑ Replacement t� FIXTURES Plans Submitted: Yes ❑ No ❑ Installing Company Name S4(rMA7Ae-0 Check one: Certificate Address Co Ac N ma k) rJ C3Corporation ir E / N i! EAJ- dl A E�3 Partnership Business Telephone -�^� -cls? 9--Firm/Co. Name of Licensed Plumber ,4 f r3 F?— r fry • mQ r, -q 4P, INSURANCE COVERAGE: I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' If you have checked Vis, please/indicate the type coverage by checking the appropriate box. A liability insurance policy kd 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: 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 owned under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' gDde and Cbaptor of the oral Laws. BY. vL L Title VAR're of Ucensed PlumFer Type of License: Master jam/ Journeymah ❑ City/Town APPROVED 0 IC U ONL License Number 23.3 5 • - • • • • Installing Company Name S4(rMA7Ae-0 Check one: Certificate Address Co Ac N ma k) rJ C3Corporation ir E / N i! EAJ- dl A E�3 Partnership Business Telephone -�^� -cls? 9--Firm/Co. Name of Licensed Plumber ,4 f r3 F?— r fry • mQ r, -q 4P, INSURANCE COVERAGE: I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' If you have checked Vis, please/indicate the type coverage by checking the appropriate box. A liability insurance policy kd 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: 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 owned under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' gDde and Cbaptor of the oral Laws. BY. vL L Title VAR're of Ucensed PlumFer Type of License: Master jam/ Journeymah ❑ City/Town APPROVED 0 IC U ONL License Number 23.3 5 _r P op m m m Date ............ .-.. �... �. v o- ,. w _. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....../1 S C=cG & i1`, �c�f1l//f r S ......................................................................I............ has permission to perform ......6 C... .!n ... { . !` ! b ... S / .w'. wiring in the building of ...................5...,. ©. ............................................. at .... .U../..........:.../� .y � .................................... , North Andover, Mass. Fee ... 4.ls.--:..... Lic. No .............. .......... ..............h ELECTRICAL INSPECTOR r Check # i0' �,tr,lttOM:4�•0 � //1as•ttjJ4:•- .. ..LJ Jp�i�.J,r� a�J'irt �irViGd SOARD,OF FIRE PREVENTION REGULATIONS a - Offliciall LlOnly Permit No.- Occupancy and Fee 'Checked ,cv. 1/071 - (stave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ; All wpe to be performed in accordance with the Massachusetts Elccuicat Code (MEC), 527 CMR 12.00 pL.EA.S£PF,WrflI INKOR?YP£ALL INF0JZiWTI0Aj' Date:_ City or Town of �� 0%ir To the Inspector of Wires: By this applir ation.the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant 20� .-ftL� cS6D��iI'" Telephone No. f 7S- Yi*-_1�/2/ t Owner's Ad Pegs t Is this permit in conjunction with a building'peemit? .. Yes El =-jChec:; Appropriate Box) Purpose of Building Utility Authori7atien No. _ Existing Service Amps / Volts Overhead ❑ Undgrd C; No. of imetcrs - New Service Amps % Volts Overhead ❑ Undgrd L�1 No. of Meters Number of Feeders and Ampacity: 1 - Location and Nature of Proposed EIectric3l WorfC 14 ter rr !'n...nt.nn,e nrt{r. (n/Inwery tnili m�v ham• wervtd 5v the /rtro[dv/• [)%iY1K.L Estimstcd Valise of Electrical Wo �W, r%d (When required by.munici?al ,policy:) Work to Start: 45,410 Inspections td be requested in accordance with MEC Rule 10, and upon completion.. INSURANCE COVERAGE: Unless, waived -by the owner, no -permit for the performance of ckctrieal work may issue unless thglicensec provides proof of liability unsuianctr including "completed, operation" coverage or its substantial equivalent. The • tiridcrscgrtcd certifies thai'such coverage is in force, and has exhibited proofofsamc to the permit issuing office. CHECK ONE: MSURANCE ® BOND: ❑ . OTHER ❑ (Specify:) 1 ctriify, carder the pains -and penaltles vfpcdn.7, that thi: information on this appiication is true and comp e- 5 FIRM NAME- Ab -i Se-ctirt� S�rVtees LIC.NO.: l3 .e: Licenser. si -�7N Signature- ►+Iapplicable, enter -74 Of I I lic, I mtm e+ lure j Bus TcL No.;__ L /U'1 -m- .%,e_ 1 /h3; ,UH 134? _ AIt T --'L No.: Address: �� 1'CO 6 ! 9 '"Per M.C,.L. e. 147, s. 57-6 i; security work cequu'cs Dcparuncn[ of Public 5afcry "S" License: Lie. No. - s CC OWNER'S INSURANCE WAIVER: I am avirarc that the Licersca does not have. the liability insurance coverage normally ovrner owner, agent. - required by law: By my signatt:re below; I hereby waive this requiremcnC I•am the (check one). ❑ ..❑ Owner/Agent-Telephone N.. =PERADT. FEE: Signature: .- _N-0.0 f o[a • No..bf Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans . Trznsformers KVA No. of Luminaire Outlets` No. of Hot Tubs Generators I KVA No_orLuminaires A ove .n- ❑ Swimming Pool= end. grnd_ 1 6. dt ❑tergency ig tint Ba tit.,y Units No. of Receptacle Outlets �' No. of Oil Burners FIRE ';LARMS No. of Zones No. ofSwifches (Yo of Cas Burners t o. of etectton and ;;iatind Devices No. of Ranges No. of Air-Cond. Tons No. of Alerting Devices 3 eat ump um er ons _ - ontaine o. o c • _[KW No. of Waste Disposers ' Totals: Cctection/Alertin Devices SpacdArca Heatirib KW _ N un�cipal E] Other Local C�,ronniectior. No. lo. of Dishwashers No. of Dryers- Heating A liantts a pp k"i7Y c:urit;!. ysterns:" I. No. of Devices or E uivalcnt No. of WaterNo- .heaters KW of No. 01 Si nSBallasts Data Wiring: No. of Devices c: E uivsl:nt No. -Hydromassage Bathtubs Na. of Motors Tota! HP c ecommunica,ttons inng. No. of Devices'or E uivalcnt �OTHSR: f JJ J / iJ J _:JJ 1... •l.� t..�nii•fnr A%t•Y/!LT_ Estimstcd Valise of Electrical Wo �W, r%d (When required by.munici?al ,policy:) Work to Start: 45,410 Inspections td be requested in accordance with MEC Rule 10, and upon completion.. INSURANCE COVERAGE: Unless, waived -by the owner, no -permit for the performance of ckctrieal work may issue unless thglicensec provides proof of liability unsuianctr including "completed, operation" coverage or its substantial equivalent. The • tiridcrscgrtcd certifies thai'such coverage is in force, and has exhibited proofofsamc to the permit issuing office. CHECK ONE: MSURANCE ® BOND: ❑ . OTHER ❑ (Specify:) 1 ctriify, carder the pains -and penaltles vfpcdn.7, that thi: information on this appiication is true and comp e- 5 FIRM NAME- Ab -i Se-ctirt� S�rVtees LIC.NO.: l3 .e: Licenser. si -�7N Signature- ►+Iapplicable, enter -74 Of I I lic, I mtm e+ lure j Bus TcL No.;__ L /U'1 -m- .%,e_ 1 /h3; ,UH 134? _ AIt T --'L No.: Address: �� 1'CO 6 ! 9 '"Per M.C,.L. e. 147, s. 57-6 i; security work cequu'cs Dcparuncn[ of Public 5afcry "S" License: Lie. No. - s CC OWNER'S INSURANCE WAIVER: I am avirarc that the Licersca does not have. the liability insurance coverage normally ovrner owner, agent. - required by law: By my signatt:re below; I hereby waive this requiremcnC I•am the (check one). ❑ ..❑ Owner/Agent-Telephone N.. =PERADT. FEE: Signature: .- J C) , c� C) n Q lU . T1 m V C) o z N J Yr W E (� 1 W m .0 1•- G _ OW 's to a -j ►.0 0 z _ 10 %0 i O L7 _Q u. %T �. 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