HomeMy WebLinkAboutMiscellaneous - 74 BLUEBERRY HILL LANE 4/30/2018U-
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ ....... I ... ..... 15L-50 ...........
... ........
.................................
has permission to perform
.. ...................................................................
wiring in the building of ...... .............................................
/Y 14 -
at .................................................. .... �—L
....... North Andover, Mass.
oz
Fee n ...... Lic. Noe-�,41?.'d . ...........
Check #
IV
1�
R
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
[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 IN INK OR TYPE ALL INFORMATION) Date: , ? •— a �-- O ?
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform l e e,)�trical work described below.
Location (Street & Number) f) y
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes [�No ❑ (Check Appropriate Box)
Purpose of Building b (,��f,, L , 117 G- Utility Authorization No.
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
Location and Nature of Proposed Electrical Work: �' �-y, t , If
;e)l — a AV mach aaatttonai detatt j desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal 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 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:)
I certify, under the pains and penalties of perjury, that the information on this application is true and completes
FIRM NAME: ��� C,t//i+'2i G9 2 LIC. NO.:
Licensee: A n� Signature LIC. NO.: f
(If applicable, enter;`exe-mpt" in the h e n mber e.) J , 00 Bus. Tel.
Address: �/! ,t/ C� C/ Alt. Tel. No.: r41F'—
*Per M.G.L c. 147, s. 57-61, security work requilies 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
Signature Telephone No. PERMIT FEE: $�j�
�.. uJ me vuv wut
pante may oe watved by the inspector or Wires.
No, of Recessed LuminairesNo.
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
nd. rnd.
Battery Units
No. of Receptacle Outlets
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. Tonal
No, of Alerting Devices
No, of Waste Disposers .
Heat Pump
..
Number
Tons
KW
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal El other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Water
No. of Noof
No. of Devices or Equivalent
Heaters KW
. Signs Ballasts
Data Wiring:
.
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
TelecommunicationsWiring—:
No. of Devices or Equivalent
OTHER:
;e)l — a AV mach aaatttonai detatt j desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal 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 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:)
I certify, under the pains and penalties of perjury, that the information on this application is true and completes
FIRM NAME: ��� C,t//i+'2i G9 2 LIC. NO.:
Licensee: A n� Signature LIC. NO.: f
(If applicable, enter;`exe-mpt" in the h e n mber e.) J , 00 Bus. Tel.
Address: �/! ,t/ C� C/ Alt. Tel. No.: r41F'—
*Per M.G.L c. 147, s. 57-61, security work requilies 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
Signature Telephone No. PERMIT FEE: $�j�
rwa ekc
Y- 291k -e
A
The Commonwealth of Massachusetts
I!, ! Department of Industrial Accidents
,t
Office of Investigations .
••'" % 600 Washington Street
s;1t t r
i Boston, MA 02111
C-; www.ntassgov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Alaolicant Information Please Print LeAbly
Name
City/State/Zip:
/ / e e7f2v
Phone
Are iu an employerY hec the appropriate box:
al
1 I am a employer with �
4. (] I am a general contractor and I
mployees (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
These sub -contractors have
working for me .in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No -workers' comp.
c. 1.52, § I (4), and we have no
insurance required.] t
employees. [No workers'
comp, insurance required..]
*Any applicant that checks b -I # l
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. Q Demolition
9. El Building addition
10.7 Electrical repairs or additions
I LEI Plumbing repairs or additions
12.(] Roof repairs
13.[] Other
o must so 1116 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 mustattached an additions! sheet showing the name of the sub -contractors and their workers' comp. policy information.
I sin an employer that isproviding workers' compensation insurance for my. employees. Below isthe policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lie. #: Expiration Date:
Job Site Address: City/State/Zip:
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 hereby cer under the pais nd en jperjury that the information provided above is true and correct
Signature. Date: t/
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. Plumbing inspector
6. Other
Contact Person:
Phone #•
1
c,
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 local 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 at 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-contractor(s) 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 entertheir
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 bum 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE
Fax # 617-727-7744
Revised 5 -26 -QS www.ma.ss.gov/dia
Location `7
No. Date
MORT1y TOWN OF NORTH ANDOVER
Of �•.o �,ti0
� 9
` Certificate of Occupancy $
♦ i ;
CMUs Building/Frame Permit Fee $ �?
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 23c av
Check #9'I
17648
Building Inspect&
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
-1 q 31,j4e 3�ta(14'%1
L„v
u .% Co o 0ly
AMap
Name(P t) Address for Service
Number Parcel Number
1.3 Zoning Information:
Signature Telephone
1.4 Property Dimensions:
Zonin Distrid Proposed Use
2.2 Owner of Record:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Name Print Address for Service:
Front Yard
Side Yard
Rear Yard
Required Provide
R red Provided
Re aired Provided
3.1 Licensed Construction Supervisor:
Not Applicable
1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
1.7 Water Supply M.41 -.C.40. § 54) Zone
outside Flood Zone ❑
Municipal ❑ on Site Disposal System ❑
Public ❑ Private ❑
`-!C7r-: Y!n lir.+:-;..+. \/., ... w,_
SECTION 2 - PROPERTY OWNERSMP/AU'l110d(1LED AIiLPI 1
�. l Owner of Record
Name(P t) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Si nature Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable
❑
pQrv\c 5 Ao �
s
Licensed Construction Supervisor:
License Number
�.
� J� A P(J t'e o.•v 5+
Address
'
�5 - CoC- ^ 07 3
Expiration Date
Sign re Telephone
3.2 Registered Horne Improvement Contractor
Not Applicable
❑
Company Name
Registration Number
5 p---
Addres
o
a,"=, `11% -. G a - a oa 3
Expiration 13ate
Signature/ Telephone
SECTION 4 - WORKERS COIORPENSATION (MG.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 buildinpermit.
—Signed affidavit Attached Yes ....... ®--'""No ....... ❑
SECTION 5 Description of Proposed Work check alt applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s)
l
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
a,,
ot1 3 4 y 1 N rR Q t -e z- 4
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item .
Estimated Cost (Dollar) to be
Completed by permit a licant
OIC 1FIIAi. gISE O,y
r=
1. Building
�J _A 5 q
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee tel x (b)
J
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
3 7c Sia
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, �� ✓ti. --e S-� S 1 as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, •e.9 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
5 A -Te- 51r A
Print Na
Si acme of weer/A ient Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TI 4BERS I s 2 ° 3KD
SPAN
DIMENSIONS OF SILLS
DIN ENSIONS OF POSTS
DIMENSIONS OF GMDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY _
IS BUILDING ON SOLID OR FLL,LED LAND
IS BUILDING CONNECTED TO NATU12t•T GAS LINE
)i
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
holoy
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name: _5 A e S
Location:
City IIJ0 Phone
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
F7I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City: 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' imprisonment_as wetLas_civil..penattiesin.theformjcf a..STOPWORK_ORDER.,nd..a.fine of.(.$100.00).atiay against -me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
i do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Print name _J vo ^--e s ) -e S � ^
Official use only do not write in this area to be completed by city or town official'
�IIOi o
#
City or Town Permit/Licensing
0 Building Dept
[]Check if immediate response is required Licensing Board
p Selectman's Office
Contact person: Phone A 0 Health Department
❑ Other
0
Building and Remodeling
5 Appleton Street
North Andover, Ma. 01845
(978) 682 2023 PHONE / FAX
Proposal
September 3, 2004
Proposal Submitted To:
Paul LeBrun Home Phone: (978) 685-2743
73 Blueberry Hill Rd.
North Andover, MA 01845
Job: KITCHEN
Job Description:
Permit
Complete removal of all demolition and construction materials
CONSTRUCTION:
Remove the cabinets and place them in the garage .Remove the Brick wall around the cook
top and the oven. Gut the Kitchen down to the studs. Remove the wall between the kitchen and the
living room. Remove the flooring in the kitchen , bath room and the living room . Install new 3 %
red oak in the kitchen and the living room. Tile the bath room floor and the area over the stove .
Owner to supply tile for bathroom floor and the tile over the cook top. Remove the baseboard heat
around the kitchen and living room wall and install two Kick space heaters. Add a central vac dust
pan outlet. Remove and replace the window over the sink with an Anderson bay window. Remove
the window in front of the table and build a bump out bay area to enlarge the table area . There will
be three Anderson windows in this bump out. Patch the siding as needed and remove the old vents
on the back side of the house. Skim over the walls in the living room to make them smooth. Re
insulate the walls in the kitchen . Hang new blue board in the kitchen and skim the walls ands the
ceiling smooth. Install hood fan and vent it to the out the back of the house. Install al new appliances.
A finance charge of V/2% per month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity is required the
customer shall be responsible for all costs associated with collection, including reasonable attomey's fees.
I propose hereby to furnish material and labor complete in accordance with above
specifications, for the sum of:
$32,592.00 Thirty Two Thousand Five Hundred Ninety Two dollars
One- Third to start, one -Third once insulated , final third when kitchen is complete.
Authorized signature,
I reserve the right to cancel this contract if not accepted in -30_ days
Signature
Signature
Proposal `
PLUMBING:
Run three new gas lines from the propane tank to the cook top , the gas dryer and a new gas
log insert for the fire place. Install a new bar sink on the in side wall of the kitchen. Install new sink in
the same location. Plumb new appliance Ice maker and Dish washer.
Install a new sub panel next to the exsisting Panel for new circuits. Run a new line for the
double oven. Add an outlet for the cook top. Wire all the countertop outlets to code. Put an outlet in
the island and run power for all the new appliances. Wine Ref. Ref draws, Warming draw. Micro
Wire new appliances. Remove and reuse Recessed lights in different locations. Add lights to the
glass cabinets. Wire and install 5 under counter lights all controlled by one switch. All switches that
control interior lights will be on dimmers. Run wires and switches for the pendent lights over the
Island . Move the location of the light over the table.
E
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Date .:F.261...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ i? .......
ti
has permission to perform ......
....... ....................................
wiring in the building of .... .... .......................................................
at ..... 2V ...
.. ..... ................ rth Andover, Mass.
Fee':736...'� . ....... Lic. No.'..'. ... ........................
�,E,LEcTRICAL INSPECTOR
Check 1
5478
C� ee
cco��rnmonwoa[(fi o� c
1JeparfmsnE o�.}irg
BOARD OF FIRE PREVENTION
APPLiCATIOU FOR P
All work to be pwrorntcd in :c
(PLL:ISEPR 1Vr11V NK OR TYPE'ALL
City - - . of: AL
IIy alis application the undersigned kivccs o
Location (Street �C N tuber)
Owner or Tenant %
Owner's Address .
Permit No. azf
TiONS Occupancy and Fe! Cliecked __TS "w
Rev. 111991`�--
TJTO PERFORM ELECTRICAL WORK
h the Massachusetts L•lcctrical Co a (MEC), 52� Cht 1? Oo
f.!7ION) Date:
To the Inslaector o
or her intention to perform a electrical wok described below.
wcl-r
Telephone NO. 6,f.2-.26
Is this permit in con' a tion with a puildinb permit? ye, ❑�
Purpose of utiliding No (Cluck Aj)p'ropriate BOX)
Utility Authorisation yo,
Existing $Ct'YIL'C �\111 )5 / Yo1lS
1 Overhead ❑ Utadgrd ❑ No. of ttiIeters .
Nen Service `_ 'Amps / _volts Overhead
❑ Undgrd L] NO. oflyIeters:
Number of Feeders and Ampacity
Location and Nature bf Proposed Electrical Work;
Cunr letlon a%r/ie ollotriar�►table eta ba tiraiv/b • r/re !r Mor o 1Virer.
R tYo. of Recessed Fixtures No. of Ccil,-Suss. (i'addie) Fans °• ° L'
Tansformers KV
No. of Lighting Outlets No. of Hot Tubs Generators I�'VA
No. of Lighting >sictures Swimmiug fool eve ❑ All- ❑ t o. o tnerger,n ce twig
s ted- rad. Batte Units
1 No. of Receptacle Outlets L4 No. of On Burners
FIRE ALAA.Rj'vj,No, of Zones
.Cl No_ of Siritcltes No. of Gas Burners No. o De eetton 75nd
Initiatina Devices ?
No. of Ptanges No. of Air Cond. oral No, of Alerting Devices
Tons
\o. of Waste Disposers tient mp um er ons t o. o elf ontarttcti
Totals: Detection/A•lertan cipa Devices
No. of Dlshi� ashers Space/Area Heating K1y Local ❑ Nlulli;
Conn,ec ion ❑ Other
No. of Dryers Heating Appliances KNV Security psterxts•
t o. of ater t o. o No. of Devil orEquivalent
Heaters KW r las Data 1virina-
Suns Ballasts No. of2�evices or E trivalent
No. Hydromassage Bathtubs No. of 1lotors Total HF 1'eleconlnlutucations Wiring:
OTHER: No. of evir•es or $ uivalent
Atradi additional detail if desired, or as mrjuired by rite lruFector of Wires
INSUP-4,NCE COVER kGE: Unless waived by the owner, no permit for the performance of electrical work- niay issue unless
the licensee provides proof or liability insurance including "completed operation' eovet•agc or its substlntial equivalent. The
undersigned certifies that such cove is in force, and has e:thibiced proof of some to die permit issuing orrice.
CHECK ONE: INSURANCE BOND ❑ 0TI3ER_ ❑ (Specify:)
Estimated Value of Electrical Worl._ (When required by nwnicipal policy.) (Expiration Date)
Wori: to Start: —0 V Inspections to be requested in accordance with MEC Rule 10, aild upon completion.
I car rlfj•, ntrrlcr t/re pains air Pei ries ofperil8q, llrat the information oft this application is trite acrd eotttplere jj
I;II2a\I NAME- &��� 6. flrZ LIC. NO.: 63
Lii enscc: Signatur �-
(IfaPPlicablr, mer ••csr fpr'• 'a the /iCci a rr oil r li>,c LIC. Ni 0.:
97 2i
Address:_L260 13us. Tel.
OWNER'S INSU A CE W.AI • I2: I am awar that the Licensee dors not /rave the iobility insuraarc No.:
normally
required by law. S% ,ivy signature below, I hereby %vaive this requircmcttt. I ant kite (clicek one
Owner/Agent ❑ 0-Wr ❑ o%vzicr's agent.
Signature Telepbone No. P.l:RITHT F -E•: •S ` �
Official Usc Onov
Permit No. azf
TiONS Occupancy and Fe! Cliecked __TS "w
Rev. 111991`�--
TJTO PERFORM ELECTRICAL WORK
h the Massachusetts L•lcctrical Co a (MEC), 52� Cht 1? Oo
f.!7ION) Date:
To the Inslaector o
or her intention to perform a electrical wok described below.
wcl-r
Telephone NO. 6,f.2-.26
Is this permit in con' a tion with a puildinb permit? ye, ❑�
Purpose of utiliding No (Cluck Aj)p'ropriate BOX)
Utility Authorisation yo,
Existing $Ct'YIL'C �\111 )5 / Yo1lS
1 Overhead ❑ Utadgrd ❑ No. of ttiIeters .
Nen Service `_ 'Amps / _volts Overhead
❑ Undgrd L] NO. oflyIeters:
Number of Feeders and Ampacity
Location and Nature bf Proposed Electrical Work;
Cunr letlon a%r/ie ollotriar�►table eta ba tiraiv/b • r/re !r Mor o 1Virer.
R tYo. of Recessed Fixtures No. of Ccil,-Suss. (i'addie) Fans °• ° L'
Tansformers KV
No. of Lighting Outlets No. of Hot Tubs Generators I�'VA
No. of Lighting >sictures Swimmiug fool eve ❑ All- ❑ t o. o tnerger,n ce twig
s ted- rad. Batte Units
1 No. of Receptacle Outlets L4 No. of On Burners
FIRE ALAA.Rj'vj,No, of Zones
.Cl No_ of Siritcltes No. of Gas Burners No. o De eetton 75nd
Initiatina Devices ?
No. of Ptanges No. of Air Cond. oral No, of Alerting Devices
Tons
\o. of Waste Disposers tient mp um er ons t o. o elf ontarttcti
Totals: Detection/A•lertan cipa Devices
No. of Dlshi� ashers Space/Area Heating K1y Local ❑ Nlulli;
Conn,ec ion ❑ Other
No. of Dryers Heating Appliances KNV Security psterxts•
t o. of ater t o. o No. of Devil orEquivalent
Heaters KW r las Data 1virina-
Suns Ballasts No. of2�evices or E trivalent
No. Hydromassage Bathtubs No. of 1lotors Total HF 1'eleconlnlutucations Wiring:
OTHER: No. of evir•es or $ uivalent
Atradi additional detail if desired, or as mrjuired by rite lruFector of Wires
INSUP-4,NCE COVER kGE: Unless waived by the owner, no permit for the performance of electrical work- niay issue unless
the licensee provides proof or liability insurance including "completed operation' eovet•agc or its substlntial equivalent. The
undersigned certifies that such cove is in force, and has e:thibiced proof of some to die permit issuing orrice.
CHECK ONE: INSURANCE BOND ❑ 0TI3ER_ ❑ (Specify:)
Estimated Value of Electrical Worl._ (When required by nwnicipal policy.) (Expiration Date)
Wori: to Start: —0 V Inspections to be requested in accordance with MEC Rule 10, aild upon completion.
I car rlfj•, ntrrlcr t/re pains air Pei ries ofperil8q, llrat the information oft this application is trite acrd eotttplere jj
I;II2a\I NAME- &��� 6. flrZ LIC. NO.: 63
Lii enscc: Signatur �-
(IfaPPlicablr, mer ••csr fpr'• 'a the /iCci a rr oil r li>,c LIC. Ni 0.:
97 2i
Address:_L260 13us. Tel.
OWNER'S INSU A CE W.AI • I2: I am awar that the Licensee dors not /rave the iobility insuraarc No.:
normally
required by law. S% ,ivy signature below, I hereby %vaive this requircmcttt. I ant kite (clicek one
Owner/Agent ❑ 0-Wr ❑ o%vzicr's agent.
Signature Telepbone No. P.l:RITHT F -E•: •S ` �
(JJ/ LV/ LVVV 4 L . LL
EO
1Jr�vartnrer:E o�JirQ
BOARD OF FIRE PREVENTION
APPLICATION FOR PE
All work to be perrormed in occ<
(PL -r ISC PRINT irV INK OR TYPE: I. L i
City or.
By this application theuttdersigtied �ivcs/ t
Location (Street SM N
Owner or Tenant f
Owner's Address _
it •...•• vV•iV•.n�. ,dL.l\. iVV
LOccu
ermit No. __�'
TIONS pancy,andFe•: Checkedv. I Il9g] It—.,.
7TO PERFORM ELECTRICAL WORK
- h the Masr;.ciruscus Cluctrical Co a (NIEC), 527 Chi 12.00
t.1710N) p
To the ' ISPector of PVe,�,•
or her iuteatiou to perform a electrical work dej'r>t d belo��I
Telephone No. kf ..�i,6`
Is Ulis permit in toll' tion with a puiidina permit? YesPurpose of 13utlding NO (Check Appropriate Box)
Utility Authurixgtion No.
Existing Service �\mps / , Vohs
Overhead ❑ Undgrd ❑ No. of ttileters .
Ne�ti- Scr�•icc Antps / V°1ts'
Overhead C3 Undgrd ❑ Nr,, ofi�Ieters:
Number of Feeders and Ampacity
Location and Nature bf Proposed Electrical Work:
No. of Recessed Fixtures
No. ofLlghcing Outlets
No. of Lighting Futures
o, of Receptacle Outlets l i
No. of Switches
No. of Ranges
\'o. of W=e Disposers
No, of Dish« asliers
No. of Dryers
t o. of ater
Heaters KW
No. Hydronlassa•ge 13atiltubs
OTHER:
No. of Ceil.-Susp. (paddle) Fans
No. of I•lot Tubs
Sivintnting fool overl_
rnd. [jrnd.
No. of Oil Burners
iYo- of Gas Burners
No. of Air Cond.otal -
ihieat m Tons
p cum er "ons v
Totals;
SpacelArea Heating KtiY
Heating Appliances Kyy
t o. of 0.01'
S'wns Ballasts
No. ofllotors Total HP,
-_-•••�•• � -rue nrr eClOr
0.0 Kya1
ansformers
Generators XVA
❑ t o. o met•gericpcy ce ru�'T- lig —
Batte Units
FIRE Al-AltAIS No. of Zones
Ivo. o De ecttortd
Inevfees
No. ofAn?
Devices
_ Lo-Oo cit ontained
Detection/Alertin Devices
Local ❑ I4luni,cipa Othe
onn,ec ion f r
Securitysterps:
No. otxDevir:es or Equivalent
nota tiviri„d• —
No. o!]�evices or Equivalent
1'elecomn�unacpttons Wirino:
n sac, aaaueorrat de,ait if desired, or as rat -tared by rite l upeetor of Wires. '
11"SURA+'YCE COVER -kr -E: Unless waived by the owner, no permit fur the performance of clec�c;,l work n>ay issue unless
the licensee provides proof of liability insurance including "completed operation" cove�gc or its subsrintia] equivalent. lite
undersigned certifies titan such cove is in force, and has mbibited proof of some to the permit issuing ofree.
CHECK ONE: I\,SURANCE BOND ❑ 07HL•R" ❑ (Specify:)—
Estimated Value of Electrical Work-' (When required by municipal policy.) � (Eip►ration Date)
Work to Start: _ / -pV Inspections to be requested in accordance with IVIEC Rule 10, all upon completion.
I cc/r rlfj•, utrrler t/re amts an perraltivs ofperjur�•, rJru[ thr infornrad,01, nrr this application is true rtn,1 eorrrpletr
I;Ilttl[ NA1�IE• � �•• fl
Liccrtscc:LIC. X10.: 3
Signator LI C. NO.: �--
(/jappllrablr, mer ",sr rpt"'nlholicer —:04c"I'M rlin�1101
"—'-----
O Address: 00 Bus. Tel.
OWNER'S INSli a`iCE WM • R: I am a�vat that the Licensee drave the iabiliiy insuta�cee coVemee normally
required by law. By my signature below, I hereby Nvaivc this requirement. I am file (Cheek one
Owner/Agent 0 owner ❑ o%Vncr's ag enc.
Signature Tclepltonc No. Pr�Rt1II
r
Q
4
Date.� � � -�. v
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ? . . . `............................. .
has permission to perform ..... �.�'.�:� 4 b'`'�!� ..........
plumbing in the buildings of . ...f? .' `
......................
at..;.`. �...1 � <.. �.d`!`!. ��y. � ...., North -Andover, Mass.
Fee. U } Lic. No..././. S t,
PLUMBING INSPECTOR
Check # l
6191
MASSACHUSETTS
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location / y3j ga✓ry
New 1:1 Renovation
NIFORM APPLICATION FOR PERMIT TO DO PLUMBIP
j Date � j j - a 0 o
)wners Name i / �{'�y permit # g
Amount 4 L S,
of Occunancv
Replacement
FIXTURES
Plans Submitted Yes No ❑
(Print or type)i� Check one: Certificate
Installing Company Name /S v V's / "V'- e "' j rp
Address `u O /S // J� � `I
� � Partner.
�-�-
T-� S ►/lc, a Q)/E-73
Business Te ep one nj ? � -= y 7 - .7/7 G Firm/Co.
Name of Licensed Plumber: / l�� �S ✓�
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
\ Liability insurance policy - ■ Other type of indemnity 0 Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
threeinsurance
r
Signature Owner 0 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 Massachusetts Sta�g�.Pllumbin ode Chapter 142 of the General Laws.
By Signature o nSeU rIUMDel
Type of Plumbing License
Title • / � g yCity/Town icense um er Master Journeyman 0
APPROVED (OFFICE USE ONLY• — •
Date .. c? . Z:
/.o TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
„�,� JSACMUSE
i
ii
This certifies that ....L .� .'z. 5 r 7 s .... .'.�................... .
has permission for gas installation ..., R!,%/ ' '. R < t f :.- .F,.�'.
in the buildings of .. � f t ° �. ^ ..........................
at ....� .`!.`! !? `t� North Andover, Mass.
Fee. Lic. No.
GAS INSPECTOR
Check #'
4856
rMSSACHUSEM UNIFORM
(Type or print)
NORTH ANDOVER, MASSA
TON FOR PERMIT TO DO GAS FMT*4G
Date ? - -?- a' _ a % o `1-
Building Locations / )� �e `� �"' C�` Permit # it
Amount$ (� Y
Owner's Name �-7 �// Z - V
New ®. Renovation ❑ Replacement 1:1 Plans Submitted 11
(Print or type)
Name _19u �-S-e-
/v ("L J.s , le%�
o %,,/ /fie ,� s // 9-/
.3S V5,v-o k"-9 O/ c- 7 i
Name of Licensed Plumber or Gas Fitter fj
hec o Certificate Installing Company
Lc-rcorp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes � Noo
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ED----- Other type of indemnity 13 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:
Signature of Owner or Owner's Agent Owner 13 Agent 0
I hereby certify that all of the details and information 1 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 Massachusetts State Ga
.s Code and Chapter 142 of the General Laws.
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
13-151tuber //F) y
Gas Fitter r7censeNuml5er
ED--M-aster
Journeyman
• •
6TH. FLOOR
(Print or type)
Name _19u �-S-e-
/v ("L J.s , le%�
o %,,/ /fie ,� s // 9-/
.3S V5,v-o k"-9 O/ c- 7 i
Name of Licensed Plumber or Gas Fitter fj
hec o Certificate Installing Company
Lc-rcorp.
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes � Noo
If you have checked Les, please indicate the type coverage by checking the appropriate box.
Liability insurance policy ED----- Other type of indemnity 13 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:
Signature of Owner or Owner's Agent Owner 13 Agent 0
I hereby certify that all of the details and information 1 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 Massachusetts State Ga
.s Code and Chapter 142 of the General Laws.
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
13-151tuber //F) y
Gas Fitter r7censeNuml5er
ED--M-aster
Journeyman