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HomeMy WebLinkAboutMiscellaneous - 655 MIDDLETON STREET 4/30/2018 dS� �1�c�a(t�faN S� _., Date..... ....... TOWN OF NORTH ANDOVER 1 0 PERMIT FOR WIRING HU A, This certifies that k has permission to perform....... 70 �........................................................................................... wiring in the building of... el .....j 9&�p",' 5 ............................................................................. .............. .... . .. ...... h at .... . ... .. Wort Andover,Mass. Fee........ 74W ................Lic.No. IA54............ IC Check# 1195.6 0Commonwealth of Massachusetts Official Use Only a Department of Fire Services permit No. 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 INMK OR TYPE ALL INFORMATION) Date: l t City or Town of: NORTH ANDOVER To the I spec or of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. - Location(Street&Number) /7�01 AfCf Owner or Tenant z7STelephone No. Owner's Address y i �j Is this permit in conj unction with a building permit? Yes �No ❑ (Check Appropriate Box) Purpose of Building 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: u//',p ?��� Completion of thefollowing table may be waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Cell: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 7f No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting i rnd. grnd. 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat PumpNumber Tons KW No.of Self-Contained Totals: "" "'"""""..""................ Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection [:1 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent � KW Ballasts Data Wiring: Heaters 4� Signs 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. Estimated Value of Electrical Work: �j J�jJ (When required by municipal policy.) ,< Work to Start: 101� <G0�O 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:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. 12 FIRM NAME: . r/21 g �j, ?;7e C,7/ G LIC.NO.: ; lV of Licensee: _/�jt C7�ll,/ / �°'�(ti Signature ` LTC.NO.:/7D A1,,," (If applicable,enter "exempt"in the license number lirye.) Bus.Tel.No., ;e`���jL/ Address: //Z� hCr/dAHr S�L�fiL��`1�9�/ 0/4� //Yt�� Alt.Tel.No.: *Per M.G. 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 signature below,I hereby waive this requirement. I am the(check one)[]owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed r on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an Y electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 1fl Re-Inspection Required($.) ❑ Inspectors Com nts: Inspectors Signature: Date: SERVICE INSPECTION: Pass❑' Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: r Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: PassK.M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signat re: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Indit,strial Accidents Office of Investigations qV 600 Washington Street .Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): Address: -t e City/State/Zip: fi 4/ 41_14/.Q� Phone#: 25,/— �Lfj=4:5m/ Are you an employer?Check the appropriate box: Type of project(required): .1.[4Kam.am a employer with_6;1 4. ❑ I am a general contractor and I 6 ` ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. F1 We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' ' comp.insurance required.] 13J]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 hire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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.#: �(/ ' k Expiration Date: 'L4 Job Site Address: City/State/Zip: �df-�� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. Ido hereby certo under thepain dpenalties ofperjury that the information provided above is true and correct. Si azure: Date: Phone#: 7V "V 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.PIumbing 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 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 Ideal 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 required to carry workers'compensation insurance. If an LLC 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,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 number listed below. Self-insured companies should enter their 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 permit/license 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, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Gonuponwalth ofMassarhvsetts ;Department of.T.adustr.a1 Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 TQL#617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax#617-727-7749 v WW-mass.govfdia � III COMMONWEALTH OF MA.. SACHUSETTS o 0 0 0 JJ 801lf3b'Ol~ k i LECTR"IC"fiANS FSSUES THE ,-.FOLLOW ING 'LICENSE AS.:AL �fl � " REGfiSTERD MASTER.. E:"LECTRICIAN<.:. W PERtN CAMPBELL ELECTR"ICAL`CON, 4r� .Z i VttTOR PfRlN 128 N ': i, AHAIJT>ST ;w + " ..... fiELD MA 01880-3329 �J . 17031 A 07/31/,16 32964 1L. LO -Mil Lmoltnll rAurhIN-i i 0 `hu 0 111. 41 E m 0 G E T R APPLI ATION u DATE: b LOCATION. ofof wn/ fy)A 0 OWNERS NAME- S r C iLj zT, GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: �-e Y- r) t ca1 ry-o kc //I -ffr lec�4C.A -7 PHONE NUMBER: C ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR 0� *ZONING DISTRICT: b 4v je,'� 1,N- -*7 *CONSERVATION APPROVAL' 140,C), U/-o, N � 4 E ................F ou S fcY ` ✓ North Andover MIMAP October 22, 2013 �i I ic-, 011 16 r a t Y +r` - '• v ERy n ♦>3y `}r y,h' t r�, Andover. a� � � ��, rw• ^, t: y y, '±yz Interstates Interstate — l Datum:MA Stateplane Coordinate System,Datum NAD83, Major Roads Horizonte Meters Data Sources:The data for this map was produced by Merrimack Roads NORTFf Valley Planning Commission(MVPC)using data provided by the Town o ❑MVPC Boundary Of t`s o North Andover.Additional data provided by the Executive Office of •+e 00 Environmental A%airs/MassGIS.The information depicted on this map is for planning purposes only.It may not be adequate for legal boundary O. -- n definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ► THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY } + * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT #�o' c • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 9SSACHUS�t V=1357 ft '�° North Andover MIMAP October 22, 2013 GB' I G'B ' R3 114 GB� B4. QTR; R2 Andover Stearns Pone! —Rail Line Zoning Interstates C':Business 1 District Interstate C Business 2 Disinct Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Major Roads C Business 3 Distract Meters Data Sources:The data for this map was produced by Merrimack C Business 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads ®General Business District Of a° q� North Andover.Additional data provided by the Executive Office of Planned Commercial De v � 6. Environmental Affairs/MassGIS.The information depicted on this map is O MVPC Boundary 0 Corridor Develo ment Dist ? °� ° O p 3 L for planning purposes only.It may not be adequate for legal boundary C3 Municipal Boundary K3 Corridor Development Dist F ..—• 0 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER Zoning Oveday O Corridor Development Dist MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING OAdult Entertainment Industrial 1 District - THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY E3 Downtown Overlay District C3 Industrial 2 District ; t * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 0 Historic District O Industrial 3 District 04 , � 1 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ®Water Protection 12 Industrial S District °""""' THIS INFORMATION Residence 1 District �1 QO����o � C7 Hydrographic Features t1 Residence 2 District 9SSACNUS�t4°� — Streams 0 Residence 3 District 13 Residence 4 District 1 W Res 4�'QB Distnct .�. Rest ence Distract Ll Village Residential District ` Date.... ........................... ,j0RT" A TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS This certifies that ... 2 . ................................ has permission to perform ........ ......... ............................ wiring in the building of. .....5,'404.7-5 Ayeft/..& 6, ...... at.... ............." Orth Andover,Mass. 1 Fee..........2, ........... Lic.No../.Zu/;................ ELECTRICAL*I-NSP'ECT0i-/...... Check # -1:5�i�-77 V 9204 Commonwealth of Massachusetts Official Use Only Department ®f Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leaveblank APPUCATI®N 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: City or Town of: ,/���,y�y �y� To the In pec or of'Vires: By this application the undersigned gives notice her intention to perform the electrical work described below. Location(Street&Number)1� A61xQVWZ Owner or Tenant Awe ;�z /P Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) �G Purpose of Building M W, elbbUtility Authorization No. r. Existing ServiceAmps / Volts Overhead 00' Undgrd❑ No.of Meters New Service �jr0� Amps / Wd Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity y� el 3 e'O . �YiP P ��y � 4a �d2 Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus . addle Fans Tr s Total P (Paddle) Transformers I{VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above -In-__._- o.o Emergency ig mg No.of J uminaires Swimming Pool nd. ❑ rnd. ❑ Battery Units No,of Receptacle-0utlets No.bf Oil Burners FIRE ALARMS No..of,Zones Noy of Gas Burners=. i Y No of Detection-4A!'-,..&. No:of Switches r�� �� :r o,: _.,r c Initiatin -Devices - - w -4:1% tv e f , ;'Total-.. . No.of Ranges r,- v. No' of Air Condr Tons No.of Alerting Devices eat Pump - -. _ ..No.of Self-Contained umber Tons---WWNo:of Waste Disposers Totals:I Detection/Alerting Device`s KCW LOca1-❑_Municipal No.of Dishwashers Space/Area-Heating- ❑`Other Connection No.of Dryers Heating Appliances I{V4' Security S stems:* ry No.of Devices or Equivalent No,of Water- _- No._of_._ - ._.. No.-of_ - Data Wiring: Heaters 1K�' signs Ballasts No.of Devices or Equivalent l No.A dromassa a Bathtubs No.off Motors Total IIP Telecommunications Wiring:i y g No.of Devices or E uivalent OTHER: Attach additional detail tf desired,or as required by the Inspector of Wires. Estimated Value ofEtectricaf'Work: _ (When required bymunicipal=policy:) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,-no permit for the performapce•of electrical work may issue unless the licensee proviproof of liability insurance incruding soinpleted=operation-coverage or its-substantial equivalent. The undersigned certifies that suchcover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ;;BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRI�NAlO�IE: Perin - & _ - LIC.NO.: 17 0 31 A Cam b ' Licensee: Vl`GMr- Pep-h-7 - Signature /�, � LIC.NO.:9*Z12.9 (If_applicable,.enter "exempt"in the license number line). Bus. el.No.: 81 -2 4 5-0 9 21 Address:122-W. �„t e, Wakefield;' MA 01880 Alt :Tel.No.: *Security System Coiftractor-L-icerise required:for this work-.if applicable,enter the license number here: 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 PEPMIT FEE: S Signature Telephone No. ti i 'I �� D� � � p��-� � � �.. U� 5 Date.... ~�?::. , ..... NORTIy TOWN OF NORTH ANDOVER - PERMIT FOR WIRING .'t. SACMUS�� 'j This certifies that ...... ..... .. . has permission to ........................................... wiring in the building at f :- t" - ,1 .Gf ,North Antea.. . .... ....... doves,Mass. Fee. ........... Lic.Nod-+. . �/�., KE!..... 'l! -� ....... ELEcnicnc II e`tox SPe l ��. Check # 6840 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.0-0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: E-2 —06 City or Town of: To the Inspector of Wires: By this application the undersigne gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) le;710,7 Owner or Tenant a� j��j f) ��yytp,.l.g C� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ff (Check Appropriate Box) Purpose of Building C/oh Utility Authorization No. Existing Servicg,M_ 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: c // J ct l r c� ! x s Completion of thefollowing table may be waived by the lnspector 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- ❑ o.o Emergency 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.o Detection an Initiating Devices � No.of Ranges No.of Air Cond. TotalTonsNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.o Self-Contained Totals: .. ... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municippi ❑ Other Connection Heating Appliances Security Systems:* No.of Dryers g pP KW No.of Devices or Equivalent ' No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts 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 Mires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:X-5 -0y 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 OND ❑ OTHER ❑ (Specify:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: le LIC. NO.: —9%7 Licensee: Ap.7" Signature LIC. NO.: ; 7 (If applicable, ente 'exempt"in th license number line.) Bus.Tel. No.: Address: a�n1c"�,5T �yZ�d ",//,q a,2z? Alt.Tel. No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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. $ % ' �-- 1 l r y I N° 4 L Date..... /°� U. .... t NORTH °ft"`°;•'"o TOWN OF NORTH ANDOVER ° - p PERMIT FOR WIRING ,SSACMUS� This certifies that ....... C(..u.�.....�......r!........f=...SPC /l r.L................. has permission to perform ...... wiring in the building of 4-0 K!�I.) at �. �...... .� �t.l�°f�" ...... ,NorthAndov emass. ...... . ..... ......................... rFee...../.���....... Lic.No. .............. . .. -.......... .............. 1d3-`) (/ ELECTRICAL NSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwea[A o`titamacjtaaalfs --! Official Use Only c� c� Permit No. 1JaParfmanl o`.firs�iraicas UIV Q(�e BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked af7Rev. 111991 ticave blank) � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perrorntcd in accordance with the Massachusetts Electrical Code(Nt•C).5;7 ChtR 12.00 (PLEASE PRINT IN INK Olt TYPEALL ILL 1W01W 171019 Date: ly Q(7 City or Town of: v e,r- To the Inspector of Wires: By this application the undersigned gives notice of]tis or he i ttention to perform the electrical work described below. Location(Street& \anther) Owner or I'enatrt Telephone No. 9-76o Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility X ri7ation No. Existing Service Annps I Volts Overhead ❑ Undgrd� No.of Meters . New Service Amps / Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity 1 1 Location and Mature of Proposed Electrical1Vork: SS C/ecti,;C ieT o "T J t Com letion of the follot table may be n aired br the Inspccior of 1 Vires. ' No.of Recessed Fixtures No.of cem-Susp.(Paddle)Fans !No.of Total transformers KVA, 1 No.of Lighting Outlets No.or Hot Tubs Generators K-VA Above [IIn- Qot Emergency LightingNo.of Lighting Fixtures Swimming Pool rud. grnd. 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 . Initiatiin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices \o.of Waste Disposers at Pump IN umber ons 'W No.of - ontained p Totals: Detection/Alerting Devices No.of Dishwashers SpacelArea Heating K'W Local ❑ t unicipal El Other Connection No.of Dryers Heating Appliances KI V ecurity vstens: No.of Devices or Equivalent 1 No.of Nater No.o.of No.of Data Wiring: Heaters S>°us Ballas4�Ll No.of Devices or E uivalent No.Hydrome Bathtubs No.ofassag %lolors Total I;p Telecommunications'Vtiring: n b No.of Devices or Equivalent, OTHER: (0j � i7�s Attach additional detail if desired.or as rewired by the Inspector of;Vires. 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 cove ge is in force,and has exhibited pr000ff o-f�s�ame to the permit issuing office CHECI:ONE: INSURANCE >71 Rr BOND ❑ OTHER ❑ (Specify) t'P ejnl S. (Expirati Date} Estimated Value of lectrical Work: ®Q� 00 (When required by municipal policy.) Work to Start: 6 � ©® Inspections to be requested in accordance.with NIEC Rule 10,and upon completion. I certify, larder the airs acrd penalties of perJar}• that the information on this application is tine and complete. J F1101 N.%IE: l LIC.11O.:E-3-9741 � Licensee: Signatur LIC.NO.: /l (Ijapplicable,enter"crrmpr"irr rh Gce`�fr``e manger ae.) 13�,'I'e],No,-,;�Q�_ 5��3 aS/S/,� Address• .� ll v .� ry /O� Alt.Tel.No.• O«VEKt'S I VSU R�`CE�1 AI V Elt: i am snare that the Licetuee oes not tial a the liability insurance rn�era��e normally requireri by law_ B� :ny signature below,[hereby wane this requiremcut. I am the(check one)❑owttcr []o��ttcr's agent. Oa ncr/�►acnt P1sR3IIT FL-t: S /'Qt1 r Signature Telephone No. Lbcation l/'Vl D /691 ,C..�- '� n� 140, _ 01 Date qG^TM TOWN OF NORTH ANDOVER 3?O�t?`•o •,h� M Certificate of Occupancy $ _ • ; : Building/Frame Permit Fee $ �'�s''•°''t�' Foundation Permit Fee $ s�cMust Other Permit Fee $ D Sewer Connection Fee $ Water Connection Fee $ ` TOTAL $ Building Inspector 12 6 268/98 09:15 25.00 PAIi, Div. Public Works r Location r No, I Date i'� 4? hi" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ SS CH SE Other Permit Fee $ Sewer Connection Fee $ i Water Connection Fee $ TOTAL $ Building Inspector - J J%108/98 09:15 25.00 """ Div. Public Works I'E-IZMIT N0. 20-�� � APPLICATION FOR PERM1"1' I'O BUILU**** 'NORT11 ANDOVI'R, MA LO T.NO. 2. HE( y RDOt OWNL-RSIIIP DATEDOOK PAGE _ SIIll DIV. 1.0 f NO. _ 1,0( A I I)N p PI IHPoSE()#:III III )ING 0,7 OWNER'S NAME C {+ -1 No . 01:STORIES SIZE OWNFR'S ADDRESS BASEMENT OR SLAB AR(I111 ECI'S NAME SIZE OF 1-1.0011 1IMIHERS I ST 2 ND 3 RD Ht)I Df--.R'S N.AMIEdG Czd& SPAN DISIANCFTONEARESI BUILDING DIAIFNSI(NJSOf-SII.I.S DIS I'ANCE FROM SFREE I DIMENSIONS OF PUS IS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FR(NJI ACE IIEIca fF OF F(AINDAI[ON THICKNESS IS BIIILDIN(i NEW SIZE OF FIX)I ING X IS BUILDIN<ADDITI(NN MATERIAL OF CI IIMINEY IS BUILDING ALTERATION IS BUILDING NJ SOLIDoR FII LED LAND V,11 1.BUILDING CONFORM TO REQUIRE EN'I S OF CODE IS BI111.DING CONNECIED'10 TOWN WATER 11 )A4(D OF APPEALS ACTION, IF ANY IS BUILDING CONNECT ED 10 TOWN SEWER IS BUILDING CONNEC`1'ED TO NALLIRAI.GAS LINE INS 1-11(-I*IONS 3. PROPER IX INFORNIA7ION LAND COST ESI BI IXi.COS7 PAGE I FII.I.CX TT SECTIONS 1-3 EST. BI.D(;.COS f PER SO. FT. 4 ES 1'. BI.D(i.COSI*PER ROO ELECFRIC ME FERS MUST BE ON(XITSIDE OF B01LDING SEPTIC PERMFT NO. A-ITACIIEDGARAGESMUSTCONFORMTOSTATEFIRE REGULATIONS 4. API'RO\'E )BI': PLANS MUST BE FII.ED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DA E FILED �� S��V OWNERS TET. CONIR.IELH bo CY)rfl R.1.1(Hr��6 P SIG l IRF OI�OWNER OR All N)F(I'LhD 'IvT- HAI n.LC-N R PERMIT GRAN!"E OZY Y4 19 C10RTjy �- Town of _ - _ Andover No. Z ;- _- = -- * Zo sA dover, Mass., 19 4 '9A_C _NICHEL KE WICK S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System (1 BUILDING INSPECTOR � oC) ` � .........THIS CERTIFIES THAT.......................... .............. uFoundation f�- on __ PLS,ID-Ak - ..........�. ( .' Rough has permission to-afarct.......1`.��..�....../.J .... boridtrtt�s- - ..p.................. .. .................................................. Chimney to be occupied as................................................... 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 h Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOk R Rough ..... ...... ................................. Service LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � �� � vAPPWC TION � } (F'l'int or Tyr,a) r b rl 41 ril Owner �l, . IC1Cr�h.LCt1T Css� �?�dd�l r` 1V-I!MaI .nGWct°/� ."`S(2z,C4"'�r� V 64,8 Type of OccuP4ncy: W EJ en o v a L G a�. � p�.�p I a c eln e n t P I a n s! subutitteti Yep D ;61 �� 0 y E�nE W til : W W ,�; X �1 1Cy as u u vi I .g. ua t o tlG l3 a Y G7 Z 0 3: i3 G9 If y i i 1J 0 0 u1k a` t� lii 1- S F ,R e.. lid 4 1 ,w w«wrw.rw R,r.. 4, iC F l FLOOR .�,. (P illi. L "tea j Oro Check C C In u:l.l ir.�r3 Cculupally Name 1701 ......s ""'".,�.a�....... Cror�a ¢ -? Partne�-sElip �{ IT 90 F �. _7, x �. z Btd:;3.T1E::sS `I`e ,ez) +�i» 4!3 S 0�3 9 Npiie of Licensed p11ai'rb�:x r G�tsfitt� 'R ' I hereby .wets that bd of 0,r,'Jcw!s and isf011nution F have t;tbt:dtted (Of enteted)In ab-ave ecppliratici't,tris Uuc!and aorrzwo ta the brat of mn Y , kntiwvlez,;c aad drat au ptamb.-s; www and inaullrtiaao ptiNrm4ej urid et peetnit issuW4 for t4i, appoe'a " wlit be in wt;iplianco v►itbs aL^p'�7tttte»t PSoriait 44 01 tPw jbg44Chk.;.i�tO Styes Gas Cade tnd L mpf®+c!v".or th40 GaJiestl;Awe, y z c 4 `F„iPE LICENSEBy r lumber Sigtlat y .0 1of L i i n ed z aster A PPRPYEP (OFFICE U$E ON. i T,lcet7Se �iturlber �Y,t+'•� '�� (t� n d f ! ) Date. . 9. . . . . t J* 2244 40°T•��c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SS�cMusEt This certifies that . . . .`. ... f ! . .t`. . . ?. . . . . .. . . . . . . . . .� . . . . . . has permission to perform plumbing in the buildings of . .�° t,.,.�, . . . CU at. . . . . ... .,: . . . . . .'. .f .�'a{. . . .11 . . . . . . North Andover, Mass"" Fee. . .'.'. . . . .Lic. No.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . // PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. 1NK:Treasurer GOLD: File