HomeMy WebLinkAboutMiscellaneous - 77 WEYLAND CIRCLE 4/30/2018;email .�...._� __.. �..._.....
.:
SCOTT MACMILLAN <
To: Alon Schatzberg <a
date 5 8 2014
Alon schatzberg
/'�/Z--
Schatzberg <aschatzberg@gmail.com>
NCONTRACTINGQ)m . oinet> Thu, May 8, 2014 at 8:12 AM
Mac MILLAN CONTRACTING
invoice
job
Contractor installed 34 2x 8 rafters sistered to existing 2 x 8 rafters held on by specified nail pattern.
(16 penny 16 inches on center)
Contractor installed 2 x 10 On the flat Specified by structual engineer with specified screws and pattern .
All Metal straps were installed according plans
All work was done to specifacations according to plans
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..'.. !� .. t .` .T..�� ...............
has permission to perform
plumbing in the buildings of ...................
at ../y...�-j �- .. j--�R-���!.. North Andover, Mass.
.'� U /� J
FeeLic. No.......... ,/-!..............
/ u� PLUMBING;INSPECTOR
Check # ef/ /P3d U U
7 5 *1 5-
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) g
,Mass. Date 2007 Permit #
1
Buildingr
Location �,.,c/i� Owner's Name
Owner's Tel # � tp�/ l �' � 9 Type of Occupency �5j 1 tO
New 1:1 Renovation M Replacement Ef Plan Submitted: Yes ❑ No M
Installing Company Name Addario's Plumbing & Heating LLC. Check one: Certificate
Address 20 Cooper Street x Corporation 2720
Lynn, MA. 01905 Partnership
Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Insurance Coverage:
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ex No M
If you have checked rte, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 0 Other type of indemnity 1:1 Bond E]
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:
Owner F-1 Agent
Signature of Owner or Owner's Agent
I hearby 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 the permit issued for this applicatio ill be in mpliance with I pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License: ,
Title X Plumber
City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter
Approved (OFFICE USE ONLY) X Master
Journeyman License Number 13106
•
:
:
•
Installing Company Name Addario's Plumbing & Heating LLC. Check one: Certificate
Address 20 Cooper Street x Corporation 2720
Lynn, MA. 01905 Partnership
Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Insurance Coverage:
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ex No M
If you have checked rte, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 0 Other type of indemnity 1:1 Bond E]
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:
Owner F-1 Agent
Signature of Owner or Owner's Agent
I hearby 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 the permit issued for this applicatio ill be in mpliance with I pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License: ,
Title X Plumber
City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter
Approved (OFFICE USE ONLY) X Master
Journeyman License Number 13106
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Date..7 ....
HORT1y
pf "I,- ,°,':'O
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..... •.. ... • • • • • .
has permission for gas installation
"
in the buildings of ..:..:.!-!..........................
at .. ,�... � � - -- "y • K, t - 0 North Andover, Mass.
Fee. -{? °'... Lic. No. k :! 'M .. '�.,! . .........
GAS'INSPECTOR
Check # 19 o
6160
G
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
SA4-, Mass.
Date v 2007 Permit # '
Building Location2
Owner's Tel #4zz?4( (7
New F-1 Renovation 1:1 Replacement 0
Owner's NameI -924AL&
Type of Occupency -:�-4f e
Plan Submitted: Yes F-1 No
Installing Company Name Addario's Plumbing & Heating LLC. Check one: Certificate
Address 20 Cooper Street X Corporation 2720
Lynn, MA. 01905 Partnership
'Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Insurance Coverage :
have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch., 142.
Yes ❑x No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑x Other type of indemnity ❑ 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:
Owner El Agent F1
Signature of Owner or Owner's Agent
I hearby 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 the permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License:
Title X Plumber
City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter
Approved (OFFICE USE ONLY) X Master
Journeyman License Number 13106
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Locatl,on
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ <�o
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
1 Building Inspector
08/27/96 16:11 150.00 PAID
/D -o
/Sc)
Iyj _/., 0 `" Div. Public Works
Location
7
No.Datef� G -
NORTH TOWN OF NORTH ANDOVEq
Ot,t•tD ',�0
p Certificate of Occupancy $
* ' Building/Frame Permit Fee $
i. ,SJACMUSEt Foundation Permit Fee $
i
�/ r-
Other Permit Fee $
Sewer Connection Fee $.
ALIfZ, Water Connection Fee $ 10bz--co
TOTAL $
Id' ng ins or
l .�
A c�� Div.publfc Works
` P08/27/2 `6:14 1,000.E PAID
PERliPC' O.^;
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP M.10.
I LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK :PAGE
ZONE
SUB DIV. LOT NO.
—
LOCATION)^
PURPOSE OF BUILDING
/ a V"l s,
OWNER'S NAME p f ad --p
NO. OF STORIESri
SIZE S�T�
d / 11
OWNER'S ADDRESS
I 4 S'
O
BASEMENT OR SLAB
ARCHITECT'S NAME
O �f'Ou
SIZE OF FLOOR TIMBERS
IST 2ND �A// (� 3RD
BUILDER'S NAME
®d�'v� ,� / r
[ '/
SPAN /
DISTANCE TO NEAREST BUILDINGyo
DIMENSIONS OF SILLS
POSTS
L, x�
✓(�'1/
DISTANCE FROM STREET <l.[ d
DISTANCE FROM LOT LINES - SIDES �® REAR
v
" GIRDERS
J ^�f
AREA OF LOT �% /
G/i / FRONTAGE
d'(1
HEIGHT OF FOUNDATION
THICKNESS ! O
IS BUILDING NEW
/O S
Y/)
SIZE OF FOOTING
/nA " X
V
IS BUILDING ADDITION
J 0
v
MATER:AL OF CHIMNEY
A4 li o h
IS BUILDING ALTERATION
0
IS BUILDING ON SOLID OR
KILLED LAND S
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE .(% S
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 yr
INSTRUCTIONS
SEE BOTH SIDES
PAGE I 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 " Z' T
FEE
' Z
PERMIT GRANTED
mum/d
k/<� 19 C, n M Mm Lz Y -z -
T P +
AUG 19 1996
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
/oo
GUILDING INSPKCTOR
OWNER TEL.# l0 341
CONTR. TEL. M foG
CONTR. LIC. k /16 94
H.I.C. #
I OCCUPANCY
SINGLE FAMILY STORIES
MULTI. FAMILY OFFICES _
APARTMENTS
CONSTRUCTION
2 FOUNDATION I 8 INTERIOR FINISH
CONCRETE X 3 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE P —_
PIERS PLASTER
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'T' AREA _
'/, 1/2 r/, FIN. ATTIC AREA
NO B M -T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE K�_
WOOD SHINGLES EARTH
ASPHALT SIDING HARD\!J'D _
ASBESTOS SIDING _ COMMCN _
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FRAME 71
WIRING
_ a
BUILDING RECORD
12
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.,
SUPERIOR1 1 POOR
ADEQUATE IZ NONE
TIMBER BMS. & COLS.
5 ROOF
10 PLUMBING
GABLE.E
HIP
WOOD RAFTERS
BATH (3 flX.)
GAMBREL
MANSARD
RADIANT H'T'I
TOILET RM. 12 FIX.)
FLAT
ELECTRIC
SHED
WATER CLOSET
ASPHALT SHINGLES
V
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROIL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
_ a
BUILDING RECORD
12
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.,
FORCED HOT P
TIMBER BMS. & COLS.
STEAM
STEEL BMS. 6 COLS.
HOT W'T'R OR
WOOD RAFTERS
_
AIR CONDITIC
_
RADIANT H'T'I
7 NO. OF ROOMS
B'M'T 2nd _
1st 13rd I
UNIT HEATERS
GAS
OIL
ELECTRIC
NO HEATING
_ a
BUILDING RECORD
12
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.,
FORM U - VERIFICATION 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 :7�)LOQQ / Ar 0l r Phone
LOCATION: Assessor's Map Number Parcel
Subdivision J-t�5 kCtIC ® 0/ Lot(s)
Street LPv4a /rCIP St. Number
************************Official Use Only************************
RECO NDAT_t NS F OWN AGENTS
Date Approved d" 7
Co ervation dministrator Date Rejected
Comments
owl Int
90 M-ALLLAA Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector -Health Date Rejected
Septic Inspector -Health Date ApprovedDate Rejected
Comments
Public Works - sewer/water connections _ -q6
- driveway permit
Fire Department - C }
Received by Building Inspector Date
AUG 91998
i
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S�.
1 �
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Opp •
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21�
� ii.cZ' P.2oFosE� i
2Z' 7 33 '
I �0 ;3s'
. r
AUG 1 91996: .4 AID
L.OLgr/O.l,/!,
O Wit'iV FO.P
JEFFREY
13t3 1
i
. /NE�P.P/rf1.9G(' E.vG�•s�EE,P�•t�G SE.PI���'ES
6 � P-4•P,(� ST,PEET ,
A.t/OOYE.C°, �Y/,4SSAlf///SETTS O/8/O
Growth Management.Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as rsted below.
NLa e of Applicant on Building Permit (below) Address of Property for Permit (below)
Map and Parcel : Purpose of Application (check below)
Phgne Numb � Applicant: X Single Family _ Two Family
O I -the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the reclbirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
&The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
yl
This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section "senior" shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland. The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
i nare of Owne or Authorized Agent who signed the Attached Building Permit Date
tu
This form must be attached to the Building Permit upon application for such permit.
AUG 1 .0 199
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Iding Permit Number 406 (1996) Date FEBRUARY 10,1 997
THIS CERTIFIES THAT
BUILDING LOCATED ON 77 WFYT AND C.TRCT.F (Lot 17 )
Y BE OCCUPIED AS SINGLE FAMILY DWELLING IN ACCORDANCE
'H THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
;H OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Foxwood RealtyCo
.'.. -•...oc� rp.
p 733 Turnpike St.
r ADDRESS NOrth nrinvPr _ MA
„14
u5 Building Inspector �'
12
634
Date ....�.✓�...,,t//l ���
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Cx
CL
This certifies that ....... .......... 47 ..........
has permission to perform ......... ...... /Iv!'},1„e
......
.............................. CU
wiring in the building of .........?..J
.......
at ........ 77 ... (Wc
........ ....... . ... . ...
......................... North Ando�..........
Mass. cu
Fee ... Lic. No. 174
...... CU
k.,Z
ELECTRICALINSPECTOR
2-,
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
011t &MJJJDJJWtdJtJ1 Df tt� tttljU ett�
illcpartutatt of 1Jublic iWctU
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only 2 L,G
Permit No. �/
Occupancy A Fee Checked -36q '
_
3/90 (leave blank) 'Ad
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) Dater '%/- !�
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) L 1- -( /—/-2�z /� _t,, /�0. it l r4 (?-(,
Owner or Tenant
Owner's Address
Is this permit in conjunction with q building permit: Yes No ❑ (Check Appropriate Box)
Purpose of Building NG �R (_A )Q ULj , Utility Authorization No. U l 13
Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters f
New Service 2_00 Amps 17-t> / Z-k(d Volts Overhead 4 Undgrnd q No. of Meters 1
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑ ❑
grnd. grnd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
s
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local Municipal ❑ Other
❑
No. of Dryers
Heating Devices KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability insurance Policy including Compl ted Operations Coverage or its substantial equivalent. YES NO El
have submitted valid proof of same to the Office. YES NO O If you have checked YES, please indicate the typ of coverage by
checking the ap ropriate box.
INSURANCE ) BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $
Work to Start 44:-//-7K
Signed ur
FIRM NAI
(Expiration Date)
Inspection Date Requested: Rough 12!CZ Clc11 Final
C. NO. -,/1L�Z?
Licensee L/ ,t_ -n 4 t3 iAJ ihQ /J r2 Signature I LIC. NO.
Bus. Tel. No.
Address A6,, 1,41. Z�Qe All. Tel. No.
OWNER'S INSURANCE WAI ER: 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)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
x-6565
j TO6 3 3 Date.....��`� .
Y ,-
NORTH Q
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................
Ac . ........ CU
has permission to perform .........n,l..............�.,ti.zA �....
wiring in the bui ding of ......... J! 1C. p
Cu
at ......... �Gc_{� ... �/t.�,,,. North Andover Mass "
Fee 2.�) q LVNo..1. � ............... ... ..............11.. W.
LECTRICALINSPECTOR
1�� ,
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Of C MIJIouwettltll of tt� tttllu�ett�
0cpurttucut of Vublic thfct0
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No. _ �3
Occupancy ,& Fee Checked -5o• f!!�
3/90 (leave blank) ttj it t-7��.L
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 /ZA// �6
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below. /
Location (Street & Number) L 6 2� /&_, --#- ?'� CA,1`
Owner or Tenant
Owner's Address
'0-a
Is this permit in conjunction with q building permit: Yes No ❑ (Check Appropriate Box)
Purpose of Building _ i tic �i _ t Q (, � 669.3y e
Utility Authorization No. -,
Existing Service Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service 7-00 Amps /_ZQ 1._Vclts Overhead Undgrnd No. of Meters _
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑ ❑
grnd. grnd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners v
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Healing KW
Detection/Sounding Devices
LocalMunicipal ElOther
❑
No. of Dryers
Heating Devices KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Cor2 p}? ted Operations Coverage or its substantial equivalent. YESNO ❑ 1
have submitted valid proof of same to the Office. YES NO ❑ If you have checked YES, please indicate the type Ccoverage by
checking the app�ppriate box.
INSURANCE /� BOND ❑ OTHER ❑ (Please Specify)
(((///��` (Expiration Date)
Estimated Value of Elect al Work $ /
Work to Start �o Inspection Date Requested: Rough �� /fl��'Q,l� Final
Signed under the enalties of perjury*
FIRM NAME
LIC. NO.l
Licensee 4 Signature _LIC. NO. l
a��r � Bus. Tel. No. e C&W— f-�LFiy�l,
Address !Y_ / �Lt� 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)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
x-6565