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HomeMy WebLinkAboutMiscellaneous - 667 WAVERLY ROAD 4/30/2018 (2)Location .tee No. 3 Date NORTN TOWN OF NORTH ANDOVER 3?0�,,`•D•,ho0 % Certificate of Occupancy $ * r' • Building/Frame Permit Fee $ _------� s JACMUS Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $$ ,�a /0 % G Building Inspector 1 U 94 11:51 15.00 RAID � t M Div. Public Works PERJ1iT NO. /�J �* APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP +40. I LOT NO. 1'J 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZONE SUB DIV. LOTNOI. -j� LOCATION /^/} PURPOSE OF BUILDING Q� OWNER'S NAME �rNN//CC 4 e NO. OF STORIES SIZE 7 OWNER'S ADDRESS (D (p je=d BASEMENT OR SLAB ARCHITECT'S NAME -- SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DIMENSIONS OF SILLS "' POSTS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES f REAR r GIRDERS AREA OF LOT S- .�. FRONTAGE ` HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 7 i IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY /1,0'� IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 +� PAGE 2 FILL OUT.SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNAT RE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED OWNER TEL. #--(4ff- CONTR. TEL. # 19 r�-- ? 1 �r j4 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST © Gy EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN - EUI JINv-INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY f STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION CONCRETE 8 INTERIOR FINISH PINE HARDW D a — 2 13 — CONCRETE 81. K. BRICK OR STONE PIERS PIASTER DRY WALL UNFIN. — 3 BASEMENT AREA FULL FIN. B M'T' AREA _ '/. 1/2 3/4 FIN. ATTIC AREA NO BMT HEAD ROOM FIRE PLACES MODERN KITCHEN _ _ 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 _ _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COMMON VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I�POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP GAMBREL MANSARD BATH )3 FIX.) TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ tar 13rd I ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1. v �1'� S UY I C�� 1a rat I 6 1' I �te- li •o�C. z 4k s•: � w A x v p Ll. p V) O z z 7 W IS m w° 7 C:4U v C w b w z � it7 w GG o w z uu U W r° E cin is w x O w z � c w z w w A C 2 y v cn 0 O U)ui M 0 G� O E coL Q O C) Z o Q O CO) � C CO)CD cm co p 'C m Ca CD O GD CLI.—L..• L O � O i CD CD Q L Ca O Q � a�Q CA C o cc .v J Q o a? C Z CD V CO) C Q— �C C _Q fl. is LUC) z 0 C.3 c c d c o O C c y 'C c t O O co Nk d Ea :D o A CL 3y E.S "ECO o� v$ :mom a. E mm a O s G1 co 3: >mk y C C 'O C C :Ec m75cm 0- V i Ci qPW "'� - c cm �_ C43 p,C� 31C �O m O O y O IS i -6: O.r- `: C O CI C F- m a CO) mC •O Q = m :m=3 N ~ coo w0+ y m CD t LLMD% .tn `�c C: .a r.+ m •y atLLI Z O 00 y C43 .� O - m OM= t- 0-a�m M 0 G� O E coL Q O C) Z o Q O CO) � C CO)CD cm co p 'C m Ca CD O GD CLI.—L..• L O � O i CD CD Q L Ca O Q � a�Q CA C o cc .v J Q o a? C Z CD V CO) C Q— �C C _Q fl. is LUC) z 0 C.3 • r , .n.ti, � -. ,. - r"' f". ' '-t.;i:.:., � . -- �ti%,^�rs.'.e'� , w ., f=A....,,;.:,,nn�pM,�� Location Wa\(rr,:Z-t M-� . � Date q3o4 A0 0A* TOWN OF NORTH ANDOVER 14!43/94 13:59 7534 25.40 PAID Div. Public Works Certificate of Occupancy $ * ; Building/Frame Permit Fee $ �SSACNUSEt Found P rmit F e $ —93kt,er Permit Fee $ Z, Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �, m Building Inspector 14!43/94 13:59 7534 25.40 PAID Div. Public Works PERMIT NO. - 14 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 Mn,I? 4-40. I LOT NO. 2 RECORD OF OWNERSHIP 'DATE BOOK 'PAGE ZONE SUB DIV. LOT NO. — LOCATION PURPOSE OF B BtNa^ /-41O 1�-m .f ,� ( �� V V OWNER'S NAME \ r./ JVA e- CU NO. OF STORIES SIZE OWNER'S ADDRESS % 6 7 e_ //1 Vr,p% ' �O b / K//1 lit ��(L BASEMENT OR SLAB ARCHITECT'S NAME -- SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' "' POSTS DISTANCE FROM LOT LINES - SIDES REAR "' " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FI zi r-,-1�� IER OR AUTHORIZED AGENT FEE � Q�l r PERMIT GRANTED r x # 1) S--,24 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 700 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer aulwlNri IN6PECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION CONC ETE 8 INTERIOR d PINE HARDW D PLASTER DRY WALL UNFIN. FINISH l 2 13 CONCRETE BL'K. BRICK OR STONE PIERS 3 BASEMENT AREA FULL '/, 1/1 1/1 FIN. B'M'TAREA FIN. ATTIC AREA _ _ NO BMT HEAD ROOM FIRE PLACES MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH HA -RDW D COMMON B 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR PCOR ADEQUAATE I -i ONE rj ROOF 10 PLUMBING GABLE I GAMBREL FLAT HIP MANSARD SHED BATH (3 FIX.) TOILET RM. (2 FIX.) WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. _ STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS B'M'T 2nd _ 1 13rd GASOI L ELECTRIC NO HEATING st 4 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and � installation inspection are limited to the stave installation and not to the stove construction. Stove A. New C Used" B. Typ iradian ' irculating C. Manu :;curer e L ab. No. 14AISX - UG - 737 UG /YM Name/Model No. Collar size Dimensions/ Height Length % r Width Ir Chim A P`N Existing 8. Size (flue area) C. Other appliances attached to flue (Number andusee) D. Prefab (Manufacturer—name and type) _, da E. Masonry/Lined Flue liner Unlined 'type A manutacturer) F. Height (refer to diagrams) Ir cap De jV xC CHIMNEY HEIGHT Hearth (non-combustible) A. Materials 9/ft- (-C 1t,f B. Sub -floor construction C. Minimum dimensions (refer to diagram) Clearances and Wail Protection (see stcve in;tallaticn clearances chart) A. Type of wall protection provided S. Clearances (refer to diagrams) FiRE:'LACE CORtIER HEARTH WALL'CENTER 13 C Location 4. -) � Date TOWN OFNORTH ANDOVER Certificate of Occupancy $Building/Frame Permit Fee )3-st $ / .`i . C UFoundation Permit Fee $ -� Other Permit Fee $ . 4J Sewer Connection Fee $ Water Connection Fee $ TOTAL $ - �io Building Inspector a'All- 6U27 Div. Public Works T pf, t�tiT �r�• .+ % �' APPXICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. AGE 1 MAP 4-40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE I ZONE SUB DIV. LOT NO. © I LOCATION /I./ PURPOSE OF BUILDING OWNER'S NAMEf G �— NO. OF STORIES SIZE Q OWNER'S ADDRESS /4 rl ,w'^ Ue^ �U rj � �/lD YVIT \.C� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST- 2ND 3RD ♦ gNJ BUILDER'S NAME 16 n ml► - A 1 1 i\ SPAN �.e)/ !� DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILL/X 2 POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION _/7� THICKNESS O IS BUILDING NEW SIZE OF FOOTING /! X IS BUILDING ADDITION y /� a 'C/`.! MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND _4 /1 f l T \•.11J WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER s BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER y LS W45 �4 IS BUILDING CONNECTED TO NATURAL GAS LINE No 24 INSTRUCTIONS - , SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 ,y PAGE 2 FILL OUT SECTIONS 1 - 12 Y ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING �y ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONSU j� , A `o PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECT {� #- D DA FILED 61 2r�� SIGNATURE OF OWNER OR AUTHORIZED AGENT gsl Vp' FEE !,Z5" 6) O PERMIT GRANTED OWNER TEL. # 19 CONTR. TEL. #-4/ Z1310- �� CONTR. LIC. DEP%.Ri I f1�� i41 CA y� /�oo�� 66a7 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM /®t SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR `�\ {�BUILDIQNG RECORD CCUPANCY 12 ,�\���\141 \ 4 SIN fA L STORIES _ MULTI. FAMILY OFFICES � APARTMENTS _ CONSTRUCTION e\v 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE t,, -_ 1 ^ CONCRETE BL K. BRICK OR STONE T t HARDW D PIERS PLASTER DRY WALL _ _ UNFIN. 3 BASEM AREA FULL FIN. B'M'T' AREA '/ 1/2 1/1 FIN. ATTIC AREA N_O B M T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 �_ 3 DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ COMM D COMf+1CN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR CONC. OR CINDER ELK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ _ ROLL ROOFING MODERN FIXTURE��- _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. R COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd _ r NO HEATING THIS SECTION MUST SHOW XACT DIMENSIONS OF L T AND. DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. ..�\o �\ I* � I 1st 3d t,, -_ 1 T t -- mZWO FOLD ALONG LINE ��G (\J �G jpnz VJ J [u w m ��4 r 7 ~ w N iJ UOO N 0 aU) V-� uj z �0 i C, Q o0 cz -nm Ln a Q pj CC omo V+ J U) �0 z G goEg mw CL z _ U�aJ d0 OJ Ji V Qz 0 a O ? z m j °�Zm g� o = H10 0 CL m � LL. W p3CN, J F mZWO FOLD ALONG LINE ��G (\J �G jpnz VJ ~ [u w m ��4 r 7 ~ w N iJ UOO N 0 aU) V-� uj z �0 i C, Q o0 cz Z Ln a Q pj O p V+ J U) N z N a) C) z 3 Ji m j Ui= �n o = H10 0. � a -j LLl'_ W p3CN, `L- Q Y CS WG w N zu W J s cl r- 3 �CZ j �Q-J 0: U O �' ►- r' J Q O 1.. to Q G .z uj 0. r U) 7 LU = c*, 3 W0 O D r 0] O LL PC! O G V W . fol --., O BI - LINE J F mZWO W (\J �G jpnz VJ ~ w m ��4 O _ 7 ~ w N iJ UOO N 0 aU) V-� p z �0 i or V LU o0 Z Ln a rjcf) x 1 w o¢ Z k. mZWO (\J �G jpnz ~ w m O _ 7 ~ w N iJ UOO iii 0 O 0009 m� ❑ W S O r WO� LL 2 Ncc DG �cai�c� i r o0 Z Ln Z 1 O a O j N i C) z 3 N �n o = w o N a k. Suggested Affidavit for Home Improvement Contractor Permit Application For office Use only N E OF CITY/TO Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142Arequires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal demolition. or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units .... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other requirements. , Type of Work: Address of Work Owner Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 _Building not owner -occupied Owner pulling own permit _Other (specify) Notice is hereby given that: ESI. Cost O ego OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby ap ly for a permit as the agent of the owner: / Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Z-3 4a,. c, I, z,,, Date Owner Name I ril I � 111 y-�,, ,I Ld�A1� I N-O�VJpojw- , rte. OI$�{� 33go �ro 600 a eo X a Lz /ry lL IT-vo Z aN 01. rA 7.1 ERL* *t H �¢ x w A o ° w° ,u�, a cn o w z z 00 co c w° to w°' E U w w -+ o a c ti a a u a w o a: cn c u". v w d to o w c w w a w w w v w� cn o U) D J c o CO c c C.3 o � CL c+ o vv mco c =, Q co 10 . Ea m = ca m y y s E 0m cm m c E C." m O: O co y CA C:O,. 3 c> acm o r z VZCQ C y y M C 0 � y � dV � � = o rn o aV,co s 'o Q y O L C.) O O. O C m N O C C ~ �0.. y m w~ W 00 �._..�_ .r .y asev•c Z my. p C.3 CD om a g COD m� O. O.s = eyv -00y'a C H t y0.. 0. r=... m co o z U - CD L o ~ � ts LU co 0 G C a) cm zz LL, y� Q CO yLLJ � E m m � z � �_ o y.r O O' rx Cc Q. Q N� -p ea a 0 J � Z • O. O O U - CA Z C Z V N2 C C � LL CL N2 U F— C z z z cc LL a_ U. CERTIFICATE OF USE & OCCUPANCY Building Permit Number 121 (1993) Date March 15, 1994 THIS CERTIFIES THAT THE BUILDING LOCATED ON 667 Waverly Road MAY BE OCCUPIED AS 16 x 22' ADDITION (B. of A. #010-93k ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO 667 Waverly Road ADDRESS Nnrth Andoypr, , MA Building Inspector a. r O z O FM4 CN m c O :U J o i O Q c o z 0 z z U - co CDQ.�J O C wa o m Z Q. H . E ;o o C o w is 4.a O Q rt0+ h - � Q 3 0C:s y� U w m m z C) cc ,r s o a� c� o � cm v • CO Cco E — c m N "O 4 _ cm °' m Q L. D. � V Cc h cc o a O H R O QiQ H v y C O ' m e os •: act co O O O Q N m cc tm C3 CO C ti Q ' p _ CO) Z V Q Qct m C co z d LL. csCOO m•8Z O r C !�a — m N mCD CD CLO- cc I c W y.., c ++ c y CD _ m o � •dJ �G.Z � � Z O r.+ .yuj O CJ m o m� Z OC co a cLU m - o :o aJ z _ .o ` H '� 5 W �k �� .� 0 x 0 W w ° w H w r'� U u ca W 'O C E r a -C W ►.i U s W zto v O w U) ° a' U w 7oD s —,z ° ac i v O cn n m c O :U J o i O Q c o z 0 z z U - co CDQ.�J O C wa o m Z Q. H . E ;o o C o w is 4.a O Q rt0+ h - � Q 3 0C:s y� U w m m z C) cc ,r s o a� c� o � cm v • CO Cco E — c m N "O 4 _ cm °' m Q L. D. � V Cc h cc o a O H R O QiQ H v y C O ' m e os •: act co O O O Q N m cc tm C3 CO C ti Q ' p _ CO) Z V Q Qct m C co z d LL. csCOO m•8Z O r C !�a — m N mCD CD CLO- cc I c W y.., c ++ c y CD _ m o � •dJ �G.Z � � Z O r.+ .yuj O CJ m o m� Z OC co a cLU m - o :o aJ z _ .o ` H '� 5 W 0 m c O :U J o i O Q c o z 0 z z U - co CDQ.�J O C wa o m Z Q. H . E ;o o C o w is 4.a O Q rt0+ h - � Q 3 0C:s y� U w m m z C) cc ,r s o a� c� o � cm v • CO Cco E — c m N "O 4 _ cm °' m Q L. D. � V Cc h cc o a O H R O QiQ H v y C O ' m e os •: act co O O O Q N m cc tm C3 CO C ti Q ' p _ CO) Z V Q Qct m C co z d LL. csCOO m•8Z O r C !�a — m N mCD CD CLO- cc I c W y.., c ++ c y CD _ m o � •dJ �G.Z � � Z O r.+ .yuj O CJ m o m� Z OC co a cLU m - o :o aJ z _ .o ` H '� 5 W 014t Lfammunwr# of Maggar4useto Mepartment of Publit jufetg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 57 Office Use _Onl , j fl� dV Permit No. oZ� Occupancy & Fee Checked 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 p (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (0-5- (X* P5-(X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical wort cipscribed below. Location (Street & Nu Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes El No Purpose of Building &� It�g1 +(_a l Utility Existing Service 16 6 Amps 120 1 Volts Overhead -, r-1 New Service � Amps r�o,�QVolts Overhead lad' (ChrnNo. ropriate Box) Authorizati�® 3 Undgrnd LJ No. of Meters Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �°S,Z L �2C t�f Ser✓2 ce J�r'a PIP-\ 1 020 AP—p +6 7-00 Aa4,0 I 11 Total No. of Lighting Outlets I No. of Hot Tubs I No. of Transformers No. of Lighting Fixtures I Swimming Pool gmd. 1 In- AbovNo. rnd. grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges I No. of Air Cond. 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 I Space/Area Heating KW Detection/Sounding Devices Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Sians Ballasts Wiring No. Hydro Massage Tubs i I No. of Motors Total HP 7_ OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws /IS I have a current Liability Insurance Policy including ComolQied Operations Coverage or its substantial equivalent. YES -O = I have submitted valid proof of same to the Office. YES _ NO ::: If you have checked YES, please indicate the type of coverage by checking the appropriate box. r i -27 INSURANCE &, BOND =_ OTHER _ (Please Specify) i ���`� L n� � l (Expiration Date) Estimated Value of Electrical Work S 5o6,— Work 06,—Work to Start . 9- 2(� Inspection Date Requested: Rough Signed under the Penalties of perjury: Final 6 1 (_ ?_J� FIRM NAME y -C LIC. NO. /�� c� Licensee i' ; LES ��-��P T�,/i/i( Signature L LICpNO./�1 f //%% Bus. Tel. No. 461 -?L 7'�3Y�R Address ��L i 1C %�rl! /\�r ,,li } A], Alt. Alt. Tel. No. 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) /cro Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-6565 a.{�.�.r'+..,.-.J�w-^-✓.a..eW..�u.�"�_--.w.:'-,.�,.-..,-,,,(yy3kA�,_J*.L.Rev..i4lfb^^'<1.�'.�.?i.ti�.�i-Y1�r,,,a• "..-.�.�,M,"`..'C TO 2657 Date..�l-rte Of No pT 6 ,tio TOWN OF NORTH ANDOVER PERMIT FOR "B INSTALLATION This certifies that 6w&4 e-% 64 &--?3 0 fj ....................... has permission for installation !!?� .c. /7'ct. Sit rw in the buildings of .... r9 dr!�. /?? /V/q [ �- .................. at . . . . .!¢... ,North Andover, Mass. �S Lic. NoM*gef.. i',o�►t* GAS INSPECTOR WHITE: Applicant CA NARY: Bui ing Dept. PINK: Treasurer GOLD: File