HomeMy WebLinkAboutMiscellaneous - 63 HIGH WOOD WAY 4/30/2018 r 63 HIGH WOOD WAY
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120 MAIN STREET TEL. 682-6483
�9Ss1CHUSES�S NORTH ANDOVER, MASS. 01845 Ext23
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15. 354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
This form must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a copy of the sewer connection permit.T
Name�C �m i- Lvette E h ,Wh S• Phone
Address IX3 9C4 brIc�
Contractor hired for work:
Name CQ(-\r-o n ky��tok-\ Phone 4K4j- �{
O
Address
Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) removal sandfill crush other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
I ecti g A` ent Date
Comments
0
Office Use Only-_ 01 4C C�AritIItD1t1UEtt1I IIf40, ttSaLl�uSES Permit No. y�fyy
ftis triitiit laf Puhlit —aIIftttj Occupancy& Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank)
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 ``\C-:J -26 lGc�f �1
City 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) 3 �A( W o o
Owner or Tenant ►">> n 5 2 "O d—S
Owner's Address o\
Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No. S O J 7 S
Existing Service Amps Volts Overhead h❑ Undgrnd El No. of Meters
New Service Amps ���Volts Overhead u Undgrnd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work �� � S���t �-� �� W.1%/1 l lll,
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures Swimming Pool Above In-
grnd. ❑ grnd. ❑ Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets No. of Oil Burners Battery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges No. of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of Disposals No.of Heat Total Total
Pumps Tons KW No. of Sounding Devices
No. of Self Contained
No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices
No. of Dryers Heating Devices KW LocalMunicipal
❑ []Other
Connection
No. of No. of Low Voltage
No. of Water Heaters KW Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
i
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
1 have a current Liability Insurance Policy including Comp�d Operations Coverage or its substantial equivalent. YES 0, NO C 1
have submitted valid proof of same to the Office. YES NO C If you have checked YES, please indicate the type of coverage by
checking the app priate box.
INSURANCE BOND C OTHER G (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Requested: Rough Final
Signed under the Penalties of perjury:
FIRM NAME 01-\kA C ZZ9f�
Licensee Z� LIC. NO.
�CRr Cam��� Signature "�- LIC. NO. A12357
B �
Address Alt. Tei. No. .5'y 7-hJ
OWNER'S INSURANCE WAIVER: I am aware that 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$
(Signature of Owner or Agent)
x-6565
Date..:.. .. ... ?...
HORTM
TOWN OF NORTH ANDOVER
o p PERMIT FOR WIRING
,sSACMUS�
gt'"
This certifies that ..........:.. .... ...... .......:: :?.. ::. ..:..............
�. .
has permission to per ......
.. rs9 t....... .. .... '"r''
wiring in the b i d g f....��f!t� i..�..... � !. �. ...3. ..1 ,''r !'
r
at 4... ...�. �.... ... "..:.
....>r? � � a�r� �� -��............. North Andover Mass.
cry �.
Fee.. .... Lic.No.% ..r. .' ..r ..........................................................
ELECT RICALINSPECTOR
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WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File