HomeMy WebLinkAboutMiscellaneous - 77 BRUIN HILL ROAD 4/30/2018N
Date......7.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
.
This certifies that ........... 4Rg . ............ ; .................
has permission to perform .......
wiring in the building of ........................ R .............................
at.77-43.6.ov ..... A k 1, 1�b' ....................... . North Andover, Mass.
Fee ..-? .... Lic. No. f:7.? -.W ............ ...... F ....... ...
-j EVIECTRICAL INSPECTOR
Check # 3 74/ 7-
4
�arrtrnaawaatlh o
` `*mal r�clls i?IBc-Q-11j, se rJnly
c•-� Permit No. �bg, 9
1Japarlttsttr..l o�..rtra �grlicas
--y' BOARD OF FIRE PREVENTION REGULATIONS r Occunancy and Fee Checked
.Mev- i I199J ticav
e anit,
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Aft wQ-k to be perforz:eu in accorda"ce with the Ma=c'husc is Elcctricat Cade ,A,,-C� 527 CiSI1't 12.00
(PLEAS,, PRUYT hV INx OR TYPE .4Li /X�*O&&L,l770N)
City or Town v: ,_r�>7�o To the lt.spe— c o ojl-I-Vil-es:
By this application the uttderigtre,� gives notice as tzis or her ituertiou :o Fc;S'ortn the electrical work described below.Locatitttt (Street �C fur;tber) -j'2 firt,�`n 1/;// /til%
Owner or Tenaut iyl� / /T'Iws /? 'f
Owner's Address Telephone No.
Is this permit in conjunction ivith a building permit? Yes —
Purpose or Building
Exrsitnt Serotcc Zt'J�Q. Anil s LLolzz�20 vatts Overhead
gess• Service limps / Volts 0- erhend
Number of Feeders and Antpacity
No E (Check Appropriate Box)
Utilily Aufhori7.ati,n No.
Undgrd Na. of Meters. t
Undgrd Q No. of Meters.
Location a;:d Nature of Proposed Electrical Work- /�i�_a ,�'� /� _ ,__ . J.'L• 1 -
No. of Recessed Fi ctttres
I6
.ore: ....-- c1 Me Wlatri-ig
Nu. of Ceii.-Susp_ F'aus
table tarry be i an•ed 6—V the lits' cctor of IVires.
r o. o
.
(Paddle,
ora
TrwLsformers "A
No. of Ligating Outlets
No. of Not Tubs
Generators KVA
t o. a. mergency ag :ting
No. of Lighting Fixtures
Swimming eve—, !r•.'
Swimmin pool
g rncl, K; d.
Batierti Units
No. of Recept;.cle Etutleis
iNo. of Oil Burners
FIRE ALAJLIIS
_
No. of Zones
No. of Swiiilles
IN✓, of Gas Burners
NO. oDetection and
---
�-
I'ntttatin-Devices L
-o. of Rattaes
- -�
otp.'t
No. of fir Cantle roes
No. of Alertiuo
p Devices
I 1
Via. o£lVaae i.tsposers
eat un:p
Tolzis:
Number ons
t o. o e antatnt'd
Detection/Alertin-Devizes
! `^�
ko. of Dishwashers i iSpace/Area
_
Keating KV
__
Local ®� ttutCtpa Other
Connection
I.No. of Dryers Heating Appliances K W
r o. at iter _
Kis% i'a. o�� r a. o
Security vstenis: .
No. ofD-2-6ces or E uivalent
Wiring:
IIeatc:.s Si--i Ballasts
-
No, of &vices or Ealtuvale:st
- -�
i'e econtmuntcaTtons
Na. H�'rlrotttMsssge I3athtnbs Nc. of Motors Total lip I
Wiring: f
1
No. of Devices or Equivalent
O TFIEIt: S} �h,l f r� tr�ir-- i
/
r U Attach add_tional detad ff desired, or as required by t/te fnspec, or gr:Vires.
INSLTRAi NCE COVEIZAGE.' 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 is substantial equivalent. The
undersigned ce.-ti?res that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK O; N E: INSURANCE Q BOND 0 OTHER HER []- (Specify:) *tEpi
ion Date)
Estirna.ted ' a,ue of Electrical Work:' 6QM, 4a (When required by municipal policy.)
Work to StarrpenInspections to be requested in accordance with MEC Rule 10, and upon completion.
I Certify, rattilcr JApa—L—aldes 0fpetlury,111111 t/re ire, ertitadon on this application is trite and complete.
FIR I NAAM A?'el Elertric,,LIC. r'O.-'--l72.38k__
1-mensee: Richard J. Arel * Signature LIC, NO-- 27514E
(lfaopli-vabie, enter "eYw,:pt' •"a i1ie:'icet+sc mu,rherfine.) 978-372-1601
Bus. Tel No.;_.
Address:_ 773 Wasb�i_ngLnn�rraPt , ua .Pet,;17 , MA DIA'12-442-1— Act. Tel. No.•-�78-302- 187
OWNER'S iNSURA�;CE WAIVEil: 1 ant aware dw the Linormal dots not have the liability insurance coverage norm
required by ia:v, 0v my signature below, I hereby waive this require ,zc::t. I am tiie (check one) [j o-.vncr owner's a+_:ent.
Owner/Aoeut
Signature � Telephone IND. PLIfITFEE: $ �
1. C� " ---- -- -, -,, - --
�-,/O-OL43 /�
) N;
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
• i a
,SSACMUS� /J
This certifies that`... ��'!! � r'. . . �,Z.: f/ ...............
has permission to perform ....... . .` ......... .
plumbing in the buildings of ......... .. .................. .
.......... , North Andover, Mass.
Fee .A 7... Lic. No..Z !/ C �
..............
I
MBING INSPEC OR
Check #
=1
P
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
J
Building Location 7 ,�!^y: Date ' L Owners Name Permit
Amount i L
Ty
pe of Occupancy
New r Renovation Replacement Plans Submitted YesNo
FIXTURFR
(Print or type) / Check one: Certificate
Installing Company Name [„ 0–/4 Q°L�ih r( J= y El Corp.
Address X'/-
❑ Partner.
uB ssmess Telephone rq-.Firm/Co.
Name of Licensed Plumber:
Insurance Coveraze: Indicate the e of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 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
Mg—nature Owner 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 Massac etts State Plumbing Codand Chap
tet 142 of the General Laws.
By: %ana ttrP 0tr nc
Type of Plumbing License
Titleps—
City/Town icense IN umber Master ❑ Journeyman
APPROVED (OFFICE USE ONLY
r `4
Fire Tower Engineered Timber
60 Valley Street Unit #1
Providence, RI 02909
To: John Taylor
Howell Design & Build, Inc
360 Merrimack Street, Building 5
Lawrence, MA 01843
April 10, 2008
Re: Repairing second floor framing in the
Reddick Residence
77 Bruin Hill Road
North Andover, MA 01845
Dear John;
I have appreciated your keeping me informed of conditions at the Reddick home. Your
firm is performing some remodeling there, in the course of which you have revealed
some overly aggressive framing remodeling — done apparently by the original builders.
They added a doubled 2x10 header to support both new ends of the butchered joists that
were cut into two shorter spans. That header is adequate and adequately supported. The
added header is, in turn, supported on joists that they doubled. Those doubled joists are
adequate, so long as they are well interconnected — the new header has to load both of the
paired joists at each end.
With the help of your sketches and photos, I have prepared the attached proposal for
remedial work to be done on the second floor joists, before you cover them back up for
the next remodeler to find. Basically, I am having you reinforce the area around all the
notches in the six joists with vertical, long and thin lag screws. For those three joists that
were both drilled for the pipe and notched for the duct, I am having you reinforce the
butchered section with a sheet of OSB, glued and screwed to the joist, intended to ease
the tortured transfer of forces around the damaged areas.
Please feel free, to reach me with any further questions you may have, or which this may
have raised.
i'Ours truly, j
r � f
: t
Robert L. C'Ben") Brungraber, Ph.D., P.E.
Atta j ents
2-d
daS:io Bo of ter
< Ali
�.� �.,
Y7
C-cl das:To so of inr
Fire Tower Engineered Timber
60 Valley Street Unit #1
Providence, RI 02909
To: John Taylor
Howell Design & Build, Inc
360 Merrimack Street, Building 5
Lawrence, MA 01843
April 10, 2008
Re: Repairing second floor framing in the
Reddick Residence
77 Bruin Hill Road
North Andover, MA 01845
Dear John;
I have appreciated your keeping me informed of conditions at the Reddick home. Your
firm is performing some remodeling there, in the course of which you have revealed
some overly aggressive framing remodeling — done apparently by the original builders.
With the help of your sketches and photos, I have prepared the attached proposal for
remedial work to be done on the second floor joists, before you cover them back up for
the next remodeler to find. Basically, I am having you reinforce the area around all the
notches in the six joists with vertical, long and thin lag screws. For those three joists that
were both drilled for the pipe and notched for the duct, I am having you reinforce the
butchered section with a sheet of OSB, glued and screwed to the joist, intended to ease
the tortured transfer of forces around the damaged areas.
Please feel free, to reach me with any further questions you may have, or which this may
have raised.
Yours truly,
Robert L. ("Ben") Brungraber, Ph.D., P.E.
Attachments
Apr 09 2008 1:28PM Fire Tower Engineered Tim 401-654-4600
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L,pcation7 14�e
_ �No. Date �
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
'�s'•^°•;<�' Building/Frame Permit Fee $ lip �d
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ '7P7 e°
Check # yG/
�, )��/ L
15 ,i 1-418 /, Building Inspec
•��•"��.�.. .. A A 1J ��1�L'14J111C/MlI, 1'taV1C1l�7!iIJ ALTl;lr_j -
2.1 Owner of Recor
t�
me (P GG. Address for Service:
�vP—,,3r
1 eieptione
2.2 Owl%er of Record:
Name Print
,.,o \�,p
Address for Service:
- - acic llVLG
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
111- 01
�icensed Construction Supervisor: 5 U l
License Number
�.
1dd Z
IL
� o -
6 61 -,S-3 Expiration Date
ignature.. Qj Telephone
.2 Registered Home Improvement Contractor
ompany Name 10
Not Applicable ❑
kat9-1-1Li
Registration Numbe
Expiration Date
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION- TO CONSTRUCT. REPAIR, RENOVATE, OR -DEMOLISH A.ONE OR TWO FAMILY DWELLING
g rte`
M, - .•
BUILDING PERMIT NUNMER:
DATE ISSUED:
SIGNATURE:
Building CommiSSio er/I for of Buildings Date
SECTION 1- SITE INFORMATION
Property Address:Q
1.2 Assessors Map and Parcel Number:
{�1.1
Q
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District ProposedUse"
Lot .Areas Fronts" e ft
1.6 -BURRING SETBACKS ft
a
Front, Yard
Side Yard Rear Yard
Required Provide
R "red Provided R red Provided
1.7Wat SupplyM.GLC.40. 34)
1c5. Flood Zone Info®ation. 1.8 Sewerage DisposaBSystem:
Public Private ❑ zone Outside Flood Zone Municipal ❑ On Site Disposal System'
•��•"��.�.. .. A A 1J ��1�L'14J111C/MlI, 1'taV1C1l�7!iIJ ALTl;lr_j -
2.1 Owner of Recor
t�
me (P GG. Address for Service:
�vP—,,3r
1 eieptione
2.2 Owl%er of Record:
Name Print
,.,o \�,p
Address for Service:
- - acic llVLG
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
111- 01
�icensed Construction Supervisor: 5 U l
License Number
�.
1dd Z
IL
� o -
6 61 -,S-3 Expiration Date
ignature.. Qj Telephone
.2 Registered Home Improvement Contractor
ompany Name 10
Not Applicable ❑
kat9-1-1Li
Registration Numbe
Expiration Date
4 1
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 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 building permit. '01 7
Signed affidavit Attached Yes ... No:,.-. -o
p
SECTION 5 Destrip-tio-n' 6 Pfbp6iM Work'(ciieck alivable
New Construction 0 Existing Building 0 Repair(s) 0 Mterations(s) 0 Addition
Accessory Bldg., El Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
— -/� J� 2_-(1 q -
A
I SF.CTION6-F.qTTMATRnVON4ZTRIFTVTIFON.VnQT4Z I
Item
Estimated Cost (Dollar) to bey
ffT
Ya
K
Completed by permit applicant
1.
Building
(A) I Buildi . ngPermit Fee
-so CR-)
multip'lier
2
Electrical
Estimated Total, Cost of
-Construction
3
Plumbi4g_
Building Permit fee (a) x (b)
4
Mechanical QHEAC)
5.
Fire Protection
6
Total (It2+3+4t5)
-11 r1Z V I/ D - - ----
3Z%-119JA 1a%JWAEKAU1ff1UKtLA114Un 1U1$EUUMrLET_E1)WJMf4
OWNERS AGENT OR CONTRACTOR APPLIES FOR BU11DING PERMIT_
as Owner/Authorized Agent of subject property
tho
to act on
y lf, i ail i tte elf veto L atlthfiffzed by this building permit application.
St2Qftn-9of'5w,ne�-\---' \,7 Date
ECTION�7b OWNER/AUTHORIZED AGENT DECLARATION
11 , t as Owner/Authorized Agent of subject
property I F�
Hereby declare that the statements and information on the foregoing application are true.and accurate, to the best of my knowledge
and belief
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION r)t THICKNESS
SIZE OF FOOTING k X
MATERIAL OF CHIMNEY _7TIZZE
IS BUILDING ON SOLID OR FILLED LAND ., -t- L;
IS BUILDING CONNECTED TO NATURAL GAS LINE
t
FORM U.- LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT QLL,$ QU F THIS SECTION***********************
APPLICANT�iy vJ J p PHONE
LOCATION: Assessor's Map Number \ CP 4 f \ PARCEL Q a
SUBDIVISION VV \ LOT S
STREET ---)S ,` . LJ --,f ST. NUMBER—...'I--?
I*****************************************OFFICIAL USE
ONLY***********************************
RECOPMENDATtONS,OF TOWN AGENTS:
ATION ADMINISTRATOR
TOWN PLANNER
COMMENTS
INSPECTOR -HEALTH
i
,TH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED i
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECT
Revised 9\97 Jim
DATE
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Ulty 1v4-1-
F] am a homeowner
all work myself.
01 am a sole proprietor and have no one working in any capacity
y am an employer
providing workers' compensation for my employees working on this job.
�Comoanv name:��-
Address ).-OL �d -`+'2j (
_City lam' Phone #: 3
Insurance Co. V�� ��as �(� POlicy # /" i� ��- ���-✓a
Company name:
Address
City Phone #:
Insurance Co Policy #
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 $1,504.00
and/or one years' imprisonm civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy of t>g statement tRay be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herb' ced)(v unO�r the�Wns and penaAies of periuryVhat the information
Signature.
Print
Official use only do not write in this area to be completed by city or town official'
❑Check if immediate response is required Building Dept
Contact person: Phone #.
FORM WORKMAN'S COMPENSATION
is true and correct.
Date U � L, (
Phone # 6 O—S-3,7,)r
❑
Building Dept
❑
Licensing Board
❑
Selectman's Office
❑
Health Department
❑
Other
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No. f - Date
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TOWN OF NORTH ANDOVER
-a dika
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Bui10ind/F ame Permit Fee $ / / G / L�
,SSACHUSE
'Foundation Permit Fee $ l 2-
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Conn bn Fee $ —J -
Water Connection Fee $
TOTAL
-
)4�- Building Inspector
Div. Public Works
Location ' ` i' r1 77
,No. ;;� t r Date %?
TOWN OF NORTH ANDOVER
r/J
Certificate of Occupancy $ -5-/)
Building/Frame Permit Fee $
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Other Permit Fee $
'I'ECE/V&DSewer Connection Fee $
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Y NO'.ARdover�
( l ! U jolleCtor
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t.' (• .Building Inspector
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Locations,:
No. r��� Date
f,
f NORTN,TOWN OF"Q�l�/I�[/�7 u ANDOVER
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or ~
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant �fills out this section*****************
APPLICANT: _G�,��- 4 �/-e-/, cun j a��® 0,3Cj
Phone
LOCATION: Assessor's Map Number Parcel
Subdivision �J�l �'��' Lot(s)
Street Ow�'1 !tel f 1 St. Number�
************************Official Use Only************************
-RECOtPEWDATI� OF TOWN AGENTS
Date Approved IC�
Conservation Administrator Date Rejected
Comments
Comments
" - ,A�
Health Agent
Comments
Public Works
Date Approved
Date Rejected
Date Approved
Date Rejected
sewet-/water connection ffierml S
driveway permit
Received by Building Inspector Date
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Date ....1. -.31� . 0 .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Ais certifies that � .� �... C �'r
.........................................................................................
has permission to perform ..... G C. V`\ ~ b C>�'",
............................n.............
.........................
wiring in the building of j � � i V �cl c
((��.........((...............................................................
at ..........!..._.�.�.......�. �.!.qq...... �....... ,North dove ,Mass.
Fee........:.L. .... Lic. No.. 3 1.9 .l t ................ 1.. ....1
ELRICALINSPECTOR
Check #
Utticial Use Only
Permit No._r5J
*00-6--C 4;D—A`S" Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date )131
To the Inspector ofMines:
Town of North Andover
The undersigned applies for a permit to perform the electrigal work described below.
U
Location (Street & Number / / /:) 9=11AL r/ i I 1 /-
Owner or Tenant , al �& d %1 <
Owner's Address ' ON e -.
Is this permit in conjunction with a building permit Yes t2r, , No ❑ (Check Appropriate Box)
Purpose of Building i n �`v" ` l / VJ4-\., i h c1 Utility Authorization No.
Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters
New Service Amps Voits
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
Overhead ❑ Undgmd ❑ No. of Meters
tA)Xf C°nArcte M n�
ER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
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
INSURANCE = BOND = OTHER = (Please Specify)
9. (Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
FIRM NAM(E� (� \ LIC. NO.
Licensee c' K `N + GC -S Cl Signature � � .-r/`'� LIC. NO. :�SYDL l
Bus. Tel No.'Y%J 3a.t 1-rJ 37 S
Address5t M c-,. dt-y--, Alt Tel. No. / Qf rL!J -I -7(eo
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITTEE $
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑ In ❑
No. of Lighting Fixtures 7
Swimming Pool
gmd ❑ gmd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets 0
No. of Oil Burners
BatteUnits
No. of Switch Outlets
No of Gas Burners
FIREALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di sal
No.
Pumps Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of'Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
ER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
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
INSURANCE = BOND = OTHER = (Please Specify)
9. (Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the Penalties of perjury:
FIRM NAM(E� (� \ LIC. NO.
Licensee c' K `N + GC -S Cl Signature � � .-r/`'� LIC. NO. :�SYDL l
Bus. Tel No.'Y%J 3a.t 1-rJ 37 S
Address5t M c-,. dt-y--, Alt Tel. No. / Qf rL!J -I -7(eo
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITTEE $
(Signature of Owner or Agent)
,ion
Date
oT" TOWN OF NORTH ANDOVER
p Certificate of Occupancy $
> Building/Frame Permit Fee $
•no•
:,C„Us t� Foundation Permit Fee $
4-1
Other
Other Permit Fee $
Sewer Connection Fee $
A i--
f4vV ?Vater Connection Fee $ --
TOTAL $ l /i• 0 c
Building Inspector
� N
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Div. Public Works
Water
nn � n Fee $
AL
L
,le,fs Building Inspector
Div. Public Works
Location
No. `'1 7 `7
Date
TOWN OF NORTH
ANDOVER
A
Certificate of Occupancy
$
/
4
}
Building/Frame Permit Fee
$
9� (.
'SsAcMusE`
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
---'—!�
Water
nn � n Fee $
AL
L
,le,fs Building Inspector
Div. Public Works
L16cation ! -;4 i— ��aq)/
No. Date
r
OF NORTH ANDOVER
>f Occupancy $ s�
ime Permit Fee $
Permit Fee $
t Fee $
ection Fee
ection Fee
Building Inspector
Div. Public Works
LocationriJ�,,J t`�//� �'�_ •'�
No. ,�1 1 Date
TOWN OF NORTH ANDOVER
'r... , _ 0
p Certificate of Occupancy $
Building/Buiiding/
441 Permit Fee $
0
�ssAcHusE��' Foundati//ffP��e.Fee $
Otlr Permryree �A� $
Sew er9•�nnect' e��j
$
/JrWater Co tion WO ! M3D_LY0
TOTAL/`o $
/(�l>��'
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s/z Div. Public Works
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
************/*,***Applicant fills out this section*****************
APPLICANT: 0,iLd� C 0'k5z!5� Phone 6- 6-7-1 o 3 ri
LOCATION: Assessor's Map Number
Subdivision ZOZGrh
Street "excli` -.1
Parcel
Lots) S—
St. Number
************,************Official Use Only************************
RECOMMENDATIIOON�S OF TOWN AGENTS:
Conservation Administrator
Comments
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Date Approved 2 "
Date Rejected _
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Comments
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Health Agent Date Rejected
Comments
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- driveway permit
Fire Department l ( tJ -e�Xk L/ � �,� �Or�i� (�/%er� �i. �.✓r n L?�✓
-,-.Received by Building Inspector Date
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