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HomeMy WebLinkAboutMiscellaneous - 74 WENTWORTH AVENUE 4/30/2018Location -� No. ! Date .014 TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ ��s��•�;S t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 60, Check # /,7Y7 17 20 8 7 Building Inspect r ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR. RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: j `DATE ISSUED:' SIGNATURE: BuilTn—g Comri6sioner/IEERector of Buildings Date SECTION 1- SITE INFORMATION - .... ' . '. - - I k 1.1 Property lAddress: 1.2 Assessors Map and Parcel Number: _ Map Number Parcel Number 1.3 Zoning Information: keSeC�,y 1"4 Zoning Distrid Proposed Use j 1.4 Property Dimensions: 2 000 /4)7 Lot Afea s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 ° 50 , 1.7 Water Sugply M.G.L.C.40. 54) 1.5. Public IRI Private ❑ Zone Flood Zone Information: Outside Flood Zone 1.8 Sew pp Disposal System: Municipal On Site Disposal System 0 SECTION 2- PROPERTY OWNERSHIPIAUTHORIZEDAGENT Historic District: Yes No 2.1 Owner of Record Mame (Print) Address for Service:0410 Signature Telephone 2.2 Owner of Rec9rd-7 Address for Service: 3.1 Licensed Construction Supervisor: GARY IVIpAN Licensed Construction Supervisor: / SL Address I Signature Telephone 3.2 Registered Home Improvement Contractor Company Name Address = Not Applicable ❑ ozq qq 3 License Number /o- S - Zoo3 Expiration Date ReAJe,J A / //V f -42C7 ce.5S Not Applicable ❑ Registration Number Expiration Date 00�.�q I,1 X z O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildipermit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check applicable) New Construction ❑ Existing Building V Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief, /Description of Proposed Work: / // /YEW 14 �eR/o2 � �.vls'rtes I 64VIII C�'OORS /�iC�'lP.(/ T2P�/9C g,4iA rix'T✓2" S Tiles L✓M //S CortS-tRv�t Z Gc�ooc� 4Leks (�p ReIYA -- 12-"X ze (mcl, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant �OFFICIAL'USE ONLY } "=s 1. Building(a) / p) O 0 v Building Permit Fee Multiplier 2 Electrical Z ) O C' D (b) Estimated Total Cost of Construction 6 j O D 3 Plumbing pQ Building Permit fee (a) X (b) QZ �p Q 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 O O © Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,d'" ` _ e L G1 c e� /� C 6� /(//, as Owner/Authorized Agent of subject property Hereby author' 447 *' G` tB dtiy- to act on My beha all Iia 've t work authorized by this building permit application. Y y Si ature -Owner Date SECTION 7b OVVNERJAUTHORIZED AGENT DECLARATION I, L=7 AJ as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief+ U lei &J Print Name Signature of Owner/ ent Date a. d ,7 NO. OF STORIES SIZE BASEMENT OCSLaIV SIZE OF FLOOR ERS N 1 2 ND3 SPAN DUVENSIONS OF SILLS DUvIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE No J�iE V�J`%iL'%%PP`%ITI%C�X-�UL 6�✓�7,Q'd:NX,��lfOCN4 BOARD OF BUILDING REGULATIONS 4r License: CONSTRUCTION SUPERVISOR . Number: CS 029993 Birthdate: 10/05/1952 r:onstruction - CS. Expires: 10105/2005 Tr. no: 23833 Restricted: 00 GARY A MANN 6 GLLENWOOD ST BURLINGTON, MA 01803 Commissioner �•P.r2� FORM - U - LOT RELEASE FORM 7�e' 9—at INSTRUCTIONS: This form is used. to verify that all necessary approval / permits from Boards and Departments havingjurisdiction. have been obtained. This does not relieve the applicant and` or landowner from compliance with any applicable requirements. Owens among aamaanaan... APPLICANT M i Ch �} e. CST 1 i S HONE 77 % ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION / LOT NUMBER STREET vV � ail �� c� � "�- L► STREET NUMBER 7 'L % �eeesssers:■ssasssarsss.esssas.eWON -s.■sesssssss ss ss a Its no sass■ cess■ OMCUL USE ONLY �ssss.■essss.■sssse.sssesesssssass:•sssss.s�sasse.asssses.ssssssesessssas.ss s.aOEM s.s■ REC 1VI11-ENBATIONS OF TOWN AGENTS now ssseanssssssssss■sessesess�ssssses�sses�eesssssarssssessseessseeseeeee■ ' DATE APPROVED �S AONSERVATION AD TOR DATE REJECTED COBS � 1 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COA�IMEEDTI�S PUBLIC WORDS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMERIT' DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR- _ nem X-� 4- `` o . P RAGON RESIDENCE - 9/30/03 Work list Thoughtforms Corporation This version printed: 10/2/2003 MBath case windows with pre -finished Maple TC MBath install vanity TC MBath install medicine cabinet TC MBath install storage cabinet with integrated controls TC MBath block for mirrors next to medicine cabinets (after Robern cab install) TC Dressing relocate switch and outlet and cut for sub -woofer (per cabinet drawings) TC Dressing install cabinets TC Dressing install 3/8" underlayment TC BsmtStair block for angle at East end of stairwell (per sketch) TC WStorage insulate West wall with 3/4" or 1" pink rigid TC WStorage install shelving and cabs (Saffron House design due) TC WStorage finish East wall with 1/2" MDO TC PoolEquip build and install door (Pemko weatherstripping due 9/4/03) TC AVHaII install cabinets TC AVHall maple riser into WStorage; set nosing 3/8" above slab w/ 1/4" eased chami. TC AVHall finish enclose area behind AV racks with MDO or drywall TC BsmtLav install vanity TC BsmtShower frame added soap niche TC BsmtShower insulation and teno-arm - partial TC FamilyRm silicone seal at window pans; turn up sides min. 1 " to tie into foam TC FamilyRm maple veneer panel at NE corner (57" w x typ ht.) TC FamilyRm frame step at platform TC FamilyRm complete underlayment TC FamilyRm maple casings TC FamilyRm maple trim at steel - (TC Shop?) TC Kitchenette frame for maple wall panels, East wall - coord. w/ shop TC Kitchenette frame out around duct, left side of Kitchenette - coord. w/ shop TC Gym install door frame and associated panels TC Gym install door #005 TC Gym install underlayment for 6mm finish flush with Family Rm bamboo TC Elec. Rm. install 3/4" MDO around electrical panels TC EStorage hang exterior door with weatherstripping (Pemko strips due 9/4/03) TC Roof clad large leader box with mahogany siding (?!) TC 030930 bell lap.xls 3 of 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: % Z - 7 � GUP.�/rwa2�`i City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers' compensation for my employees working on this job. Company name: AR i/AJ qle / UC ve /apAe^i JJ f T Address 2-17jA 2-e l wood C ii? Gle City: A /1/do vet /\/W O/ S/ D Phone #: Insurance Co. Policy # Company name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' impdsonment�w.elLas_civ� il..penaftiesin.Sheform-of_STOP WORK.ORDER.and.a.fine.of.(.$1AO.00)..a day against -me. understand that a copy ofthfs stet ment may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under theins and penalties of perjury that the information provided above is true and correct. SignatuFe / / Date Primrtame , ✓Ul v ,. / C G' ll Phone # 5-2Z ?-- 7 -77;7,4- Official 777d" Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department Other 16:30 APR 16, 2004 TO: MICHAEL GILLIS FR: CYNTHIA HOLLAND #82785 PAGE: 1/3 AMW 20116 Eastern Ulf./ A NL(Iff Insurance TO: Company Name: Recipient's Name : Michael Gillis Recipient's Fax #: 1(9 7 8) 7 4 9 6 6 9 5 Recipient's Phone # 233 West Central Street Natick, Massachusetts 01760 Main: (508) 651-7700 (800)333-7234 FROM: Sender's Name : Cynthia Holland Sender's Fax # : (508) 653-8089 Sender's Phone#: (800)333-7234 x2142 Total # of Pages : 3 Time Sent: Friday, Apr 16, 2004 04: 29PM Subject : Cert of Ins - Inside Paint Message Please see the requested certificate attached. Should you have any questions, please contact the Select Department at (800) 333-7234 ext 3102. Thank you. The WC certificate will be issued from Liberty Mutual. A request will be sent today. 04/16/04 FRI 15:30 [TX/RX NO 85111 9 001 Liberty Mutual Group Liberty PO Box 7202 Mutual. Portsmouth, NH 03802-7202 Telephone (800) 653-7893 Fax (603) 431-5693 April 20, 2004 MICHAEL GILLS 2 HAZELWOOD CR ANDOVER, MA 01810 - RE: Certificate of Workers Compensation Insurance Insured: IVAN SILVA DBA INSIDE PAINT 36 MUNSFIELD ST #1 SOMERVILLE, MA 02043 Policv Number: WC5-31 S-347075-013 Effective: 8 /9 /2003 Expiration: 8/9/2004 Coverage afforded under Workers Compensation Law of the following state(s): MA ` Y� Employers Liability: Bodily Injury By Accident: $ 100,000 Each Accident Bodily Injury by Disease: $ 100,000 Each Person Bodily Injury by Disease: $ 500,000 Policy Limits As of this date, the above -referenced policyholder is insured by LM Insurance Corporation under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions, and is not altered by any requirement, term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date, Liberty Mutual will endeavor to notify you of such cancellation. I AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those companies. cc: Insured: IVAN SILVA DBA INSIDE PAINT 36 MUNSFIELD ST #I SOMERVILLE, MA 02043 1.20 2004 Producer of Record: ALLIED AMERICAN INSURANCE AGENCY LLC 233 WEST CENTRAL STREET NATICK, MA 01760 1a_'.�M OPP 1r-- ' MMA Tr)-, MTr'WO17-1 f'_TI I TC PI7' rYNTWTO W01 I ONn AQ';]7QC' POf^_P! '7 i'] ACORQM CERTIFICATE OF LIABILITY INSURANCE DATE 04/16/2 4 PRODUCER (80Q) 333-7234 FAX (508)653-8089 Eastern Insurance Group LLC 233 West Central Street Natick, MA 01760 Select ext 3102 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED IVAN SILVA DBA INSIDE PAINT 36 MANSFIELD ST #1 SOMERVILLE, MA 02043 INSURER A: Northern Ins Company of NY 19372 INSURERB: Liberty Mut.-WC Pool INSURER C: INSURER D: INSURER E: rrniccer_Ge THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTIR A SD'L TYPE OF INSURANCE POLICY NUMBER P L CY EFFECTIVE POLICY EXPIRATION ATE (MMfDDNY) LIMITS GENERAL LIABILITY SCP042439902 07/03/2003 07/03/2004 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED c. $ 300,000 PREMISES (Fa occuren I CLAIMS MADE a OCCUR MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 X POLICY JET LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND CER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE IFICATE TO BE ISSUED FROM CARRIER 08/09/2003 08/09/2004 WCTOY STATU- ER LIMBS ER E.L. EACH ACCIDENT $ DFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Michael Gillis 2 Hazelwood Circle Andover, MA 01810-5884 ACORD 25 (2001/08) IFAA: (978) 749-6695 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Corinne Rogers OACORD CORPORATION 1988 04/16/04 FRI 15:30 [TX/RX NO 85111 Z 002 O� -Cowwwnawaild ol BOARD, OF BUILDING REGULATIONS License: 'WNSTRUCTION SUPERVISOR Number. C5',. 029993 B 1-0/65-1952 i' Tr. no: 6625 Reii(tr j00 GARY A MANN 0 Administrator M-4 C� �Se � V C I eeAJPW,4 3 'EYT 2S-ZO7 p-ec-ie\-1ecl / �- -7, 1 Aver—A I e- W- elu kv C 00 35,000 cf enclosed space (MGL C.112 S.601-) 1A - Masonry only IG -'11, 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. i .DIG SAFE CALL CENTER: (888) 344-7233 co O CD z O 'CO) co MI O CL 0D C O CD .Q _m CL CA O M CO) C O cc C _cc �. CO) 3� O o r.L Q. cm< C O O di Z CD CO)CL C uj 0 IIaww v/ LLI U) 19W W 19 W U) r a a a O N O C a x :•�;�C1 ' O w E c a Cc w cn cn co O CD z O 'CO) co MI O CL 0D C O CD .Q _m CL CA O M CO) C O cc C _cc �. CO) 3� O o r.L Q. cm< C O O di Z CD CO)CL C uj 0 IIaww v/ LLI U) 19W W 19 W U) r O N O C a :•�;�C1 ' O E c Cc 16,m N y L�3 ` �u•�v h C N �: il av m O Of O•C= mom V N O w �. :opo O. cm C a m �L®3 _ ® C, o JZ o mcc S N Z •N O C dt o•y z O C.3 4D CS COD CL = l�0 N •O O F- t Ems IS 5 co O CD z O 'CO) co MI O CL 0D C O CD .Q _m CL CA O M CO) C O cc C _cc �. CO) 3� O o r.L Q. cm< C O O di Z CD CO)CL C uj 0 IIaww v/ LLI U) 19W W 19 W U) Date ..... . O..... NoRT#1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING A This certifies that ...�..t.... ../, ......G. '. t has permission to perform .../1} C. r:....................F................. 7 1 wiring in the building of .......f ......:..... �:�..... � ..�.J.��.�:�,......... at ...1 .-.7` `..(.[fl .'� � � :C -C, INortf�mdover, Mass. dFee.. �. Lic. No l�.� ....................................................... - ELECTRICAL INSPECTOR Check # j- 5412 .^ t�.(.oinnwnw.a[th o`%%%adea�tuda�l .. 1J.pa.�nwn1 a` }iia �irvicsa 1 BOARD OF FIRE PREVENTION REGUV (A4 WORK TO BE PERFO"ED WITH TfflE MASSACHUSETTS For Office Use 0� (Rev. 11/88) Permit Number_s Occupancy i Fee �� e Checked: PLEASE PRINT IN INKORTYPE ALL INFORMATIONDate: 8/2/04 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his dr h) intention to perforin the electrical work described below. Location: (Street A Number 72 — 7 4 W e n t O r t h Avenue Owner or Tenant: Michael Gillis Owners Address: 2 H a z.e lwo o d Drive, Andover, MA 01810 Is this permit in conjunction with a Building Permit? Yes o No 9 (Checl Appropriate Box) Purpose of Building: Utility Authorization #: Existing Service: Amps / Volts Overhead O Underground.0 # of Moters� New Service: Amps / Volts Overhead O Underground.0 # of Meters,_,,, Number of Feeders and Ampacity: Location and Nature of, Proposed Electrical Work: Add (1) post light & (5) recessed light's No. of Recessed Fixtures 5 No. of Cep -Susp• (Paddle) Fans No. of Transformers Total KVA No. Of Ughting Outlets No. of Not Tubs Generators KVA No. of Lighting Fixtures. Swimming Pod: Above ground o In Ground o N of Emergency Lighting Battery Units No. of Receptacle Outlets No. of 0Mmers s Fire Alarms N of Zones N of Detection ii INtiati% Devices N of Sounding Devices: N of Self Contained Detec"Sounding Oevicss oCel o MunidDal Connection o OtIw 0 No. of Switches No. of Gas Burners No. of Ranges No. of Air ConditionersTOTAL TONS: No. of Waste Disposals Heat Pump Totals: Number. TONS: KW: Security Systems: No. of Devices or Equivalermt No. of Dishwashers Space /Area Heating: KW Data Wiring, No. of Devices or Equivalent: No. of Dryers Heating Appliances KW Telecommunications Wirir►g: No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: N of Ballasts: OTHER; a of Hydro Massage Tubs No. of Motors Total HP 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 iswing office. CHECK ONE: •INSURANCE Xd " BOND o OTHER o Please specify: Estimated Value of Electrical Work $ (When required by municipal Work to Start: Inspections to be requested In accordance with I cwVfy, under the pains and penalties of penury, that Firm Name: Andover Electric Service's Inch Licensee: Robert J. Branca Signature: 2 0 A n d o v S V applkable, entw M In the Address: A n n n a r 91_I�� 6' eue. Tel. N t OWNER'S INSURANCE WAIVER: I'am aware that the Licensee dos not hs ,e the liability insui waive this requirement. I am the (Check one) Owner o OR Agent o Signature of Owner/Agent__ _. Telephones __.. _ 10, and upon completion. latlon on this application Is We and complete. LIC N 14302A .. i UC. t;_ ise number line) —49 5 Aft. Tel. 0 Coverage normally required by law. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING JJ , This certifies that .......!/C....... ..l...` .............................. has permission to perform ....... P!!n... `r. ... ............................................ wiring p the building of ...... ' ` F � %` S ...................................................................... at .................... N h o ass. Fee ....`�� Lic. No../ ELECTRICAL NSPECTOR Check # _�_ Z_ 52.38 ..L,JaParr`nunl 0`.,7`ira �en►icee BOARD OF FIRE PREVENTION REGULATIONS (A4 WORK TO BE PERFORMED WITH THE PLEASE PRINT IN INLC OR TYPE ALL INFORMATION City or Town al'.— North A NA o v e r By this application the notice of his or her For Office use oMy Permit Number.,_„ Occupancy i Fee 00 Checked: ELECTRICAL CODE $27 CMR 12:00) Date.. 5/18/04 To the Inspector of Wires: to perform the electrical work described below. Location: (Street 8 Numberl 7 2 — 7 4 W e n t w o r t 1 Avenue Owner or Tenant: Michael Gillis Owner's Address: 2 Hazelwood Drive, ANdover, MA 01810 Is this permit in conjunction with a Building Permit? Yes W No o (Check Appropriate Box) Purpose of Building: residence Utility Authorization #: Exiting Service: Amps / Volts Overhead 13 Underground.0 of Motors_ NG* Service: Amps / Volts Overhead 0 Underground.0 # of Meters:.,. j Number of Feeders and Ampacity: REmove and replace fixtures Location and Nature of Proposed Electrical Work: No. of Recessed Fixtures No. of Coil: Susp• (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures 12 Swimming Pool: Above ground o In Ground a tt of Emergency Lighting Battery Units No. of Raceptads Outlets 4 No. of OOriumars Fire Alarms s of zones 0 of Detection & Initialing Devices 0 of Sounding Devices: d of Self Contained Delec"SoundIng Devices Local a Municioal Connection o Other a No. o Switches 3 No. of Gas Burners No. q! Ranges No. of err Conditioners TOTAL TONS: No. of Waste Disposals Heat Pump Totals: Number. TONS: KW: security Systems: No. of Devices or Equivalent No. of Dishwashers Space /Area Hoating: KW Data Wiring, No. of Devices or Equivalent: No. of Dryers Healing Appliances KW Telecommunications Wirbg: No of Devices of Equivalent: No. of Water Heaters KW No. of Signs: li of Ballasts: OTHER; s of Hydro Massage Tubs No. of Motors Total HP 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 Xd( - BOND 0 OTHER 0 Please specify: Estimated Value of Electrical Work t 1 , 5 0 0 . 0 0 (When required by municipal Work to Stan: 5 / 13 / 0 4 Inspections to be requested In accordance With MEC I certify, under the pains and penalties of penury, that the Nam: Na: Andover Electric Service's Inc 10, and upon complation. ration orythls application is true and complete. uc.tf 14302A . LIC. II) (rr applloaoNe, enter "e�qs , In the license number line) Address: 2 0 �� A e r o v„ S Bus. Tel. r — Alt. l Tel. a 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. 1 am the (check one) Owner o OR Agent o 1 e a S Signature of Owner/Agent: Telephones._ — --- PERMIT FEE- S °f 4NORT1r 14, O 9 s � a ,SSAC NusE� This certifies that Date .... !.. ^6 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ..' :. . . . . . :-... . . . . . . . . . . . . . . . . . . . . 1-` has permission to perform .. ': !�'. ............ . plumbing in the buildings of ................ ................ a �y��.. ,.. at ...%.. '........... .. .. .... a North Andover, Mass. Fes. Lic. o Ny... L ...... . PLUMS N4 ,ZPECTOR Check #-� I �1 MASSACHUSETTS UNIFO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 72, -2 S" of TION FOR PERMIT TO DO PLUMBIN. / Date o/' d 7 Name Permit # 7O Amount New Renovation Replacement FIXTURES Plans Submitted Yes11 No ❑ (Print or type)Check one: Certificate Installing Company Name �e; (fG ��� ' �GG %E h . ❑ Corp. Address '2 D �%�'� ' O^� "r—C-1 Partner. Business Telep one p gg2, ,i''�i � � Firm/Co. Name of Licensed Plumber: ���i9,L r )Pe i C Insurance Coverage: Indicate the t pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner M 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass4husetV State Plum ng Code and Chapter 142 of the General Laws. �t' le /AY* -- BY Signature oi -Licensect YIUMDer Type of Plumbing License Title City/Townicense lNumber Master Journeyman APPROVED (OFFICE USE ONLY