HomeMy WebLinkAboutMiscellaneous - 78 SPRING HILL ROAD 4/30/2018 (2)It,
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N° JjJ./
Date..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... ��. �..C......... ��. .: u c�
..............
has permission to perform ....... S
...........................................
wiring in the building of ...... ..r?...'...1......../............................................
at .....7. .� ......11........jl...!..:...1.....f�........................ .North Andover, zr
assesFee...f��.. U.... Lic. No..I.�.?.r.... �". .
J` ELECTRICAL I{ISPECTO
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
r
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
(Rev. 11/991 Inve blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (IvfECI 527 2.00
(PLEASE PRINT' IN INK OR TYP ORMATTOT� Date: !Q
City or Town of: To the Inspector df Wes:
By this application the undersign-ix5 n05�&of his o her mtc�4 to perfoynth; electrical work described below.
Location (Street &
Owner or Tenant
Owner's Address
on
Telephone Na —
Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box)
Purpose of Building Utility Authorization Na
Existing Service Amps / Volts Overhead ❑ Und;rd ❑ Na of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters
Number of Feeders and Ampacity
_ w
+� Location and Nature of Proposed Electrical Work
i'nrnniolinn niri.efll.....:.,.. r..LL .... L_-�]-._J L-.t_r__—__-_. _nrrr•
No. of Recessed Fixtures lNo.
-- - - - - r ••�^••
of Cet1-Susp. (Paddle) Fans
Wim« ur uc r.u..w uv use frLroector pl rnreS.
No. of Total
Transformers KVA
No. of Lighting Outlets INo.
of Hot Tubs
Generators KVA
No. of Lighting Fixtures !Swimming
Pool Above ❑ !n- ❑
rnd. ornd.
o. o mcrgcncytgnung
Battery Units
No. of Receptacle Outlets lNo.
of Ort Burners
FIRE ALARMS INo. of Zones
No. of Switches
INo. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
lNo. of Air Conti. Torn
No. of Alerting Devices
No. of Waste Disposers
licit Pump Number Tons JKW
Totals
No. of cif ontained
Detection/Alerting Devices
No. of Dishwashers
Space/Arca Heating, KW
Local Municipal
Connection 11 Other
No. of Dryers
Heating Appliances KW
ecunty bystems:
Na of Devices or Eouivalent
No. o Heaters KW ater°'
ciz-s No. o
., Ballasts
Data Wirine:
Na of Devices or Eouivalent
No. Hydromassage Bathtubs
No. of itilotors Total HP
Telecommunications Wiring:
Na of Devices or E ui alent
OTHER "
Anadr additional detail ijdesired• oras required by the Inspector of ]Fires.
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 tdubited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work $ 13 7V ' (Expiration Date)
(When required by municipal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion.
1 certify, under the Phinsland penalties ofperjury, that the information on this appEcation is true and complete
FIRM NAME: ADT Security Services -.Dr -. .ol 1 is, NH 03049 LIC. NO.: 1533C
Licensee: John S. Bassett Signatu IC NO.: 1533C
(If applicable, enter '•exempt" in the licetuenumberGne.) Bus. TeL No.: -603 594-5900
Address: U AIL TeL No.:_603 594-5928
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 ivaive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No.PER1bHT FEE: S,3
t
Commonwealth of Massachusetts
City/Town of /Vjr To
System Pumping Record
Facility Information:
System Location:
/9
Address
—A" M
City/Town State Zip Code
System Owner:
Name:
Adress (if different from location of pump)
City/Town
State Zip Code
L?�k- Y1 C, - ///)L
Telephone Number
Pumping Record
Date of Pumping 46 Quantity Pumped j� �,�� gallons
Type of System—_X Septic Tank Grease Trap Other (what)
System Pumped by:
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
Location where contents were disposed:
Signature of Hauler
Date
Commonwealth" /of Massachusetts a
/�/G�, I'_�j 12 X012
City/Town of;
TOWN OF NORTH ANDOVER
System Pumping Record L HEALjH DEPARTMENT
Facility Information:
System Location:
Addre/]ss� ����4 &d6UV,4
City/Town State Zip Code
System Owner:
C.0
Name(
Adress (if different from location of pump)
City/Town State Zip Code
Telephone Number
Pumping Record
Date of Pumping /i % L% r Quantity Pumped gallons
Type of System�_Septic Tank Grease Trap Other (what)
System Pumped by: AC_cyz— 7 / Yl
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
Location where contents were disposed: 0
Signature of Hauler Date 0
Commonwealth of Massachusetts
City/Town of KOO ATI�wt K
System Pumping Record FJA,�
TOHEALi TMENV
Facility Information:
System Location:
S no
Address q8
om�- 6vp UI g�f5
City/Town State Zip Code
System Owner:
Name:
Adress (if different from location of pump)
City/Town State / 1, yZip Code/ wi I
-,3 . / 8- - 7
Telephone Number '
Pumping Record
Date of Pumping uantity Pumped�
1 cJVy allons
t
Type of System Septic Tank Grease Trap Other (what)
System Pumped by:
_:L) a 41-� ':1 ae-,J—
Company: ROOTER -MAN 12 East Dracut Rd., Methuen, MA 01844
Location where contents were disposed:
l�JSignature of Hauler � Date
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f AL T H U.-PARTMENT.
important.
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Date of Pumping':,*,..,,.Date 2. Quantity Pumped:
Type of system ❑ Cesspool(s) eptic Tank
❑ Tight Tank
❑' Other (describe); ;.: ' - ;
4 Effiuerlt Tee FOter present? . ❑ Yeso If yes, was it cleaned? ❑Ye* s ❑ No
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e of Hauler,; , t. Date
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ba subrrmltted to the.local'Board of Health
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of The System Pumping Record m,;s:
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TCVVN OF NORTH V
Z - -
State
Name
State
C7 ZIP Code
—50
Telephone Number
'PUMP1.n0:.R6.9mord
1 Dato; ot Pumpingoale 2.QU andty Pumpec.
G810n3
3,! .Type qfsystem:_❑ cess000l(
0eptic Tank ❑Tight Tank
Other
Effluent Tee Flltee ptiient?.❑ 'Yes. If1. yes, Was It c . leaned?
D Yes ❑ No
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umping Record Page I of
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City/Town of ��� �/
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System Pumping Record FOCT 14 2008
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Facility Information: u n .
System Location:
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Addr ~
ess
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City/Town d
State Zip Code
System Owner:
Name:
Adress (if different fromlocation of pump)
City/Town
State Zip Code
�oq - U L
Telephone Number
Pumping Record
Date of Pumpin
Quantity Pumped UV gallons
Type of System--Y—Septic Tank Grease Tra
P___.___Other (what)
IcUe System Pumped by: l `q e V
-
Company: ROOTER -MAN 12 East Dracut Rd., Methuen, MA 01844
Location where contents were disposed:
01
Signature of Hauler
Date
ii
Commonwealth of Massachusetts
City/Town of Nd Y+ andoVt'Y""
System Pumping Record
Facility Information:
System Location:
q3 601/4 dill
Address
City/Town State
System Owner:
n
Name: `
Adress (if different from location of pump)
City/Town
RECEIVED
JUN - 9 2009
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
0 I 1�1-1 s
Zip Code
State Zip Code —7
q-7R�-640 - Dq l 0
Telephone Number
Pumping Record
Date of Pumping �" Quantity Pumped 5d Ugallons
Type of System_�—(Septic Tank Grease Trap Other (what)
System Pumped by: I L r eq
Company: ROOTER -MAN 12 East Dracut Rd., Methuen, MA 01844
Location where contents were disposed: J�
f
Signature of Hauler Date'
Commonwealth of Massach se s
City/Town of 000h 0.1 v
System Pumping Record
Facility Information:
System Location:
Address
City/Town
System Owner:
Name: (�o oq
IVED
WAN ? `I 2010
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
or? (11PC(
State Zip Code
Adress (if different from location of pump)
City/Town State
Pumping Record
Zip Code
q _1 L0q-01(70
Telephone Number
Date of Pumping I -� f I -� (6 Quantity Pumped c4 �SV _gallons
Type of System Yseptic Tank Grease TrapOther
( what)
System Pumped by:
Company: ROOTER -MAN 12 East Dracut Rd., Methuen, MA 01844
Location where contents were disposed: --6. /_ `j t)
Signature of Hauler Date �� U�
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Cite/Town of IU6Mi N6W eI
System Pumping Record
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Facility Information:
System Location:
Address
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City/ own. State `Zip Code
System Owner:
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Name:
adress (if diferent from location of pump)
City/Town
Pumping Record
State Zip Code
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Telephone Number
Date of Pumping !/ Quantity Pumped J gallons
Type of System—)CSeptic Tank Grease Trap Other (what)
System Pumped by:... l
Company: ROOTER -MAN 46 Portland Street Lawrence, Mtn 01843
Location where contents were disposed: �
Signature of Hauler X Date
Commonwealth of Massachusetts
City/Town of go(�%dDvv
System Pumping Recor
Facility Information:
System Location:
Address
System Owner:
r +
Name:
'(OWN ur
Adress (if different from location of pump)
City/Town State Zip Code
Telephone Number
Pumping Record
Date of Pumping 4 Quantity Pumped LZ� gallons
Type of System__kSeptic Tank Grease Trap Other (what)
System Pumped by: -.6k4 bIL i1wD
Company: ROOTER-Jq 46 Portland Street Lawrence, MA 01843
Location where contents were disposed:
Signature of HaulerDate I l