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HomeMy WebLinkAboutMiscellaneous - 781 FOREST STREET 4/30/2018 (2)/I 6170 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... .......... . .................................... has permission to perform ...... ......................... wiring in the building of ...�411-4e1............................................................. at ... ,7f ......... ............. ................ . North Andover, Mass. F W -W ..... ee,t., R . .15 . Lic. 4zq�? ' ........... ELEc-mcAL INsts'croR-J— Check # 9 No. -70 mcy & Fey Checked APPuCATTONFOR PERMIT To PERFORM ELECTRICAL 1 All. WOlttt TO BE PERFORMED IN ACCORDANM WrrN THE MASSACHUSSTS MICMXAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 9,/ , O'�p,eV.<-r S7— owner TOwner or Tenant A'W'eo Owner's Address ez Is this permit in conjunction with a building permit: Yes No Purpose of Building A Q' Existing Service 40�0-2W� Amps42QL.Volts New Service Amps Volta Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (Check Appropriate Box) :,S! the Inspector of Wires: Utility Authorization No. Overhead Underground C3 Oveduead Underground C3 No. of Metas No. of Meters Na of Llgttft outim Na of Hot Tub. No. of Tnnalheoes TOW KVA Na of t.igbdM R itures Swimming Pool' Above aw ondupand Below KVA No of Receptacle OutWs Na of Oil Burners No. of Emergency Lighting Battery t hdti Na of Switch Oudsu Na of Oas Burners FIRE ALARMS No. of Zone No. of Rangn / Na of Air Cond. TOW Tone Na of Dnectioo nd Na of Disposals TOW Na of Po Ton KW g DevicesNo. Na of So. ofsotmdittg Devices of Dishwashers Space Am AHewing KW No. Of Self Coohhnd Local W DevicesN a,,, a of Dryers Hesdag Devices KW EDmwddiw Connections a No. of water Heaters KW Na of No. of signs Bailaals No. Hydro Massae Tabs Na of Mown TOW HP OTHER• �ids.�L� g&7Z-Ar ,--ae ,��//Gi.S7rov� :-,-- SrWleG ®����.e �' " 1hnesutrriikdv&po1ofsame1Dth00ffion YM ® (' NKRANC9 r7l am am [3 /.i�GL iea Lr WodclDSmt O /d al lraptsointDateRga �NA11 E 19141�'61 Z'6e� do YM IVO Fyou1'te1tedt1 YEKphwhJ*gCqpc(coVWVby Ami 10 BrpolionDttb R."vs�afHecHialWodr s ,� Rao aw UmveNa g6 Sema„ �i.�s /j']iiO. P AdIM A& ' BvlinesTl�lNa _9`78=777--dS'9P Al�F.s7s T , d 4� ��s� ovfys AtTdNo, L'7fi 777-o11V'- oiwIVER'S irsURAN�WAIvrx;lamawatbatdlelxaBeQleiraaauaeco�egaori�eglivai�taare4�b!':�Gauakll�is arddtetmyseteaaeondiapeantappfc�l� oil (Please check one) Owner Apo a Telephone No,'Nignan or Owner or Agenv— pgR, FEES C f► y;, :41� iLV, 1 f - i :�.,�f r:• y f �r i.Y..r� r�, Permit Na / %0 Occupancy d: Pea Checked APPLICAHONFOR PERMIT TO PERFORMELECTRICA.L WORK ALLWORK TO BE pFRpORMED BV ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODS, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date le l/ Bl as' Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant /(�D Owner's Address Is this permit in conjunction with a budding permit: Yes[M No 6 Purpose of Building ill Ile Q` Existing Service / --� /� Amps? D��Volb Overhead C New SAmp. /Volts Ovedwad C Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work y"✓lam To the Inspector of Wires: (Check Approprift Hos) Utility Authorization No. Underground M No. of Meters Und C3 No. of Meters Na of Lighting outlets Na ONO! Tubi No. of Taes"Me TOW KVA Na of Usbdit Rit" Swimming Pad' Abouts Below Oeeeratan KVA .rtd Na of Receptacle Oudgs ` �P Na of On Bttrnas Na of Emaasnep (,fatting Battery Unto Na of switch NOW Na of Oas Bornere ME ALARMS Na of Zones Na of Ranges / Na of Air Coed. Total Toes Na of Debwoe and No. of Dbpoasle No. of Had Total ToW Pangs Tots KW leidadog Dwk= Na of Souoding Drdon No. of Dishwashers Space Area Healing KW No. of Self Cootdnw Delection130001110, Devices Local munic4d Othj Na of Dryers Heating DrOcas KW Cotmectlono No. of water Heston Kw No, Of Na of 31100 Boil" Na Hydro Massage Td o Na of Motors Total Hit pTyg�. ��/.siLL���%Tl,�-to,� .p�//Ersr���� : �-.trs-T.a�e e�c�?-,�.c� 4',ai,✓,s� hL=XeCbMF ROUND IhareattrrftdmMpWafs*adihe0ffionYM C MURANCE BCTD 13 UI><1FR [` WoikIoSeit a /�` �irapectiQlDseRaQrsted S�ptedurtdcr �dpa�i�r. dot YO a NO 1<youhnecltndoedYB4 Phwkdm29lNffldW, fib, �$c� ///iC�C+ � r..! Sixa�v✓S �rliD �5�,✓�s� � Fs6nebdVallecfF7eI' gmElift niorl Wak S Pao Find t.iomreNa --,6- . 59714 Umbb Urs'TUNn AMM�'�?�s� j� bl rpt/ ass c��ty} AtTdNa 717,7- %r 0Wi WSMRAIMWAMIsmawaitdrrtiheiicaw"fld teirss$taecvver,Heotibsut t+*k=ssrei}=byMt�rayttCaailI�ute ^�-� rdthatmystgiizcnthbpeQrdappialkit� fliivagdrearent . (Please check one) Owner Agent Telep me 110.MM1'I' F8>3 ! Date ... zd :� :..`.':�..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .........-r' .:�- o �� �c . ,rr�............ ..................... has permission to perform ..... ��":....:*.?....- ............................................... wiring in the building of ........t::"?..^... -4.. .......................................................... 7.../G`` �' ........................... . North Andover, Mass. ..... ......... Fee......Lic. No. ...............................................� ...... ELECTRICAL INSPECTOR; Check # 77.19 f. Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 7LI? Occupancy and Fee Checked a2: [Rev. 1/07] (ieavP hlanlrl 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: 1&1,-r1,0 7 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 the electrical work described below. Location (Street & Number) s7-/ r -- Owner or Tenant el Al Telephone No. Owner's Address /- Is this permit in conjunction with a building permit? Yes ❑ No [2" (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service ^Q7 Amps 200 Volts New Service Amps / Volts Overhead ©/Undgrd ❑ No. of Meters,,' Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity _/ny Location and Nature of Proposed Electrical Work:,4— table may be waived by the Inspector of Wires. KVA KVA N o. FIRE ALARMS No. of Zones o. of Alerting Devices o. of Self -Contained tion/Alerting Devices ❑Municipal CnnnPetinn ❑Other Data Wiring: No. of Dei No. Hydromassage Bathtubs No. of Motors Total Hp Telecommunications No of Devices or Attach additional detail if desired, or as required y the Inspector of Wires. Estimated Value of Electrical Work: �f (When required by municipal policy.) Work to Start: 1p% ,%p7 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 andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: /1//j L,c`4► ,� LIC. NO.• _ t" Licensee: j♦q e'94/ t'�>r' C Signature ,� c (If applicable, enter "exempt" in the license number line.) f �- -� LIC. NO.: �% Address: Bus. Tel. No.. *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl. No. t f OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Insu ce coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. Owner/Age Signature Telephone No. PERMIT FEE. $ c 5 Completion C;om letion o the No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Luminaire Outlets No. of Hot Tubs No. of Luminaires Swimming Pool Above 11In- nd. rn No. of Receptacle Outlets No. of Oil Burners No. of Switches No. of Gas Burners No. of Ranges No. of Air Cond. Total Tons No. of Waste Disposers eat Pump Numb Tons 1 Totals:1­­­----- .......................... ... No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Appliances KW No. of Water, Heaters No. of No. of Sims Ballasts. table may be waived by the Inspector of Wires. KVA KVA N o. FIRE ALARMS No. of Zones o. of Alerting Devices o. of Self -Contained tion/Alerting Devices ❑Municipal CnnnPetinn ❑Other Data Wiring: No. of Dei No. Hydromassage Bathtubs No. of Motors Total Hp Telecommunications No of Devices or Attach additional detail if desired, or as required y the Inspector of Wires. Estimated Value of Electrical Work: �f (When required by municipal policy.) Work to Start: 1p% ,%p7 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 andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: /1//j L,c`4► ,� LIC. NO.• _ t" Licensee: j♦q e'94/ t'�>r' C Signature ,� c (If applicable, enter "exempt" in the license number line.) f �- -� LIC. NO.: �% Address: Bus. Tel. No.. *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl. No. t f OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Insu ce coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. Owner/Age Signature Telephone No. PERMIT FEE. $ c 5 fa/ C9 /-t J ) _ 2 - -7 QP� �J. The Commonwealth of Massachusetts Department of Industrial Accidents E. • to Ogee of Investigations 600 Washington Street Boston, MA 02111 3 www.nzass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aanlicant Information Please Print Legibly Name (Business/Organization/Individual): Address: % City/.State/Zip: /11%�Tf�/�/ /??5 Phone Arse you an employer? Check the appropriate box: rk rc' L ❑ I am a employer with 4. ❑ 1 am a general contractor and i Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. New construction el 1 am a sole proprietorr or partner. listed on the attached sheet Remodeling .)2. ship and have no employees These sub -contractors have 8. ❑ Demolition working for me .in any capacity. [No workers' comp, insurance workers' comp. insurance, 5. E3 We are a corporation and its g Building addition required.] officers have exercised their 10. [3 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself. [No -workers' comp. c, 1.52, § 1(4),'and we have no 12.E] Roof repairs insurance required.] t employees. [No workers' l3•❑ Other comp. insurance required.] *Any applicant that checks bort it l must also fill out the section below show- th ' ng ear wo a compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. ;Contactors that check this box must attached an additional sheet showing, the name of the subcontractors and their workers' comp. policy information I ani an employer that is providing workers' compensation insurance for ray employees: Below is the information. policy and job site Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address:_ 7,r'% 1rla eor.7 ' 6 City/State/Zip: fJ if Attach a copy of the workers' compensation policy declaration page (showing the policy Failure to snumber and expiration date). ecure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $4500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORT{ 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. ! do hereby certify under the pains_ d penalties of perjury that the information provided above is tate and correct. — - I r . Zze *09 Phone #: FFOffxicialumse only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. 6. Other Plumbing inspector Contact Person: Phone #: 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 license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of 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 -contractors) 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 numberlisted below. Self-insured companies should enter their 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 burn 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. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-115 Fax # 617-727-7744 www.mass.gov/dia �. . Date ....... �.` ... TOWN OF NORTH,ANDOVER ' PERMIT FOR GAS`iNSTALLATION 3 • �• SSACNUSE This certifies that ............-- ..'�' ..... + ....... . has permission for gas installation -r--'54'4 in the buildings of ...... at ...... ............. :.......... , North Andover, Mass. Fed. Lic. No G"A IN CToR Check # 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) - c . A J V c�r� , Mass. City, Town Building AT: Location / O l Fare)17 S1. Date N-AO-a7-- Permit O-U 7 -- Permit # Owner's {� m ro Name a� Type of Occupancy: New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ trent or 1 ype) Installing Company Name Tojmcanrl ni r� Tnr Address 27 Cherry Street i)anvar } A 01924 � Check One: ® Corp. ❑ Partnership ❑ Firm/ Company Business Telephone 978-777-0701 Name of Licensed Plumber or Gasfitter Certificate dose h r- (-- i'rr3Z 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 State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coveraee. ❑ By Title City/ Town APPROVED (OFFICE USE ONLY) fie of Li se2� Ml r or Gasfitter License Number TYPE LICENSE: ❑ Plumber . ® Gasfitter ❑ Master ❑ Journeyman fie of Li se2� Ml r or Gasfitter License Number -'6195 "I Date. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ............ ............................. has permission to perform ...... ............ wirinID .g in the building of ... .... ... . .......... .. . . ... .. ......... at,�Y ,17 ....... ; North Andover, Mass. / . .. .. ... 07 .55- Fee .— .... . ..... L i c. N o. - ELECTRICAL IN, v Check DIFAl1U11 W0FRIBUC34i T Permit No. BA4RDOFF=PRLVFNIwRFX;UiATXw517(Ba12* Occuponey & Fees Checked APPUCA77ONFOR PERIVITTTO PERFORM ELECTRICAL WORK ALL won To BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMB 12:00 (PLEASE PRINT IN INK OR TYPE ALL WORMATION) pa p S� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below, Location (Street d Owner or Tenant Owner's Address Is this permit in conjunction with a building permit; Yes [M No Purpose of Building Existing Service .iGncl— Amps /s / Volts Overhead C New Service Amps �� Volta Overhead Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A -r - - (Check Appmpride BoI)bW B � Utility Authorization,,,,. 0' Underground M No. of Meters Underground Q No. of Meters Na of Lighting Outlets No. of Hot Tubs No. of roaWbnwo Total No, of Lighting RMIN 3whWing Pool- AboveKVA Bei, rl KVA No. of Raceptscle Outlets No. of OB Bneoen No. of Eaergency Lighting Battery jay Na of Switch Outlets No. of On Bonen FIRE ALARMS NM Of Zones Na of Ranges Na of Air Coed. TOM Taos Na of Detacd. sed No: of Dlapossle No. of Pot Total TKoMW Iai W d of S Devfes Sauoding Device No. of Dishwashen Space Ares Heathy KW Na Of Sem Coni bw l rA= LOW Movie ° - No. of Dryer Heating Devices KW do D Corolections 0 No. of Water Heaten KW Na d a d N Sims Baiiuis No. Hydro Manage Tabs Na of Moon Total HP hL=%eQNWP Al�letblta�ilmie�dMtsdiselkGbleotllaiM IhaveamntnLnbRyia==FbLynditC mmnr0ftWor*wbftMqm*t YES Ihavesttrtrilbdvaidp �dstrntolre0'.Am YM )fyauhrve l doedYBS, W �P�, p� typedtxratpby UZLM 11 WSURANl3 (�'� BOND ORif�R O �ImreSperiM ,e ��/S La+ dVAzdFltn W Wady S WadcbStat ;f o j���:sbd �� Sgredurd>c Ptz i Fhd f ARMNAIv18Limme Liot:seNa �'3s�� �e.TKNn - _a Ar+iaer /yi�S 1. n/ /tg OWI 'SMRANCEWAMR-lammmtatdL-Limes Anem AwaWarilr2hWMe�ivdbtasrequiesdbyMaesadssrd�CarastlLawrs acddretrr�s�laraeondispeQriappicadandilna mit � (Please check one) Owner Agent a Telephone No, pgHMff FEE t Date... ..e.:.�.".. TOWN OF NORTH ANDOVER PERMIT FOR WIRING s1 "This certifies that R" t has permission to perform ..E. ........ wiring in the building of ...�..,--► ............................................................ ...........................:.,.. , North Andover, Mass. ,Fee'�?-`.r...6!'f ........... Lic. No��.....!,.... ELECTRICAL INSPECTOR C1heck #% 57; X JW tLULY1iVJU1V 11r ILd 11 Vr 1VV1 aara1,ntv.u.A i u DF.PARIlI WOMB KS4MY BOARDOF asim Permit No.y / 9a Occupancy &Fees Checked APPLICATION FOR PERIVIl'I'T PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH T MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Dat ,5- a 1,-,� WNWWMNNWWWM Town of North Andover The undersigned applies for a permit to perform the el( Location (Street & Number) -71/ A-7�e. Owner or Tenant Owner's Address To the Inspector of Wires: described below. Is this permit in conjunction with a building permit: Purpose of Building KI Yes M No Existing Service 2M Amps Zc//2 (� Volts Overhead New Service AmpVolts Overhead Number of Feeders and Ampacity /S,a O ,ce Location and Nature of Proposed Electrical Work • Zb,Peoirls 2 Lit (Check Appropriate Box) Utility Authorization No. Underground 1:3 No. of Meters Underground Im No. of Meters o.e .Qmc- No. of Lighting Outlets No. of Hot Tuba No. of Transformers Total KVA No. of Lighting Fixtures r Swimming Pool Aboveci Below Generators KVA Jground ground No. of Receptacle Outlets O No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Oas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Told Toru No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal ; Other No. of Dryer Heating Devices KW 0 Connections El No. of Water Heater KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motor Total HP OTHER• huffaeCbmW Pz&ntk)dz=#zeln fscfMasswh=ftG=dLaws IhawaanetLiahi&Yliurtar=R)riryxEkAVCMI*e cr*si legtivafat YFS[Ef NO Ihme&krr&dvAdpiafcfsar iodr0likeYI;S ff}whmdtadWYEsS,plemirtdr*dieMxofwvwgby the INSU ANCE BOND OTi�R �/o S— WodcbSlat °� hapecUonDaleRegrslod Sgred EMMNAME — /-11 d/" / ZE C Z6 �c Eslur *dVatreofEbcWd Wak $ j-6, 00 LioerneNa /,-?,16e%'1 6 9.7 "dz L ,` � Limmm BtsiressTdNa - -G OWNER'SMJRANMWAIVl3;IamawaethatlheLioersedmnotharelheaa==itsyubstarial AkT�Na a - O artdthatmys�grlatiaeonlh'sj�ritappBwticnwai�esthi�requierrletR 00��cregta�al�rttasrec}lffedbyCenetalLaws Please check one) Owner Agent f �, Telephone No. PERWr FEE r a rgna wUM Agent :51 Jim LUIMVIUty rrr filj n Ur 1r&L"M1L VLNUA i u �•••w �.- �.-, DEPAMWOMBICSOM Permit No. BOARDOFFIRMPRCVENTM 5l7Ci1'1R12i>b Occupancy & Fees Checked �-� APPLICARONFOR PERMIT ERFORM ELECTRICAL WORK J ALL WORK TO BE PERFORMED IN AccORDANcAwrrH T MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 / (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOn Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the elt Location (Street & Number) Owner or Tenant L i „/,b Owner's Address "% el57-- Is this permit in conjunction with a building permit: Purpose of Building�/��� 4'4,14 Q Existing Service .200 Amps Zc// C' Volts New Service Amps/ .V olts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ork described below. S-7' . 7 Yes 1:3 No Overhead C Overhead C /S-.4,47.fEXj' (Check Appropriate Box) Utility Authorization No. Underground M No. of Meters Underground C3 No. of Meters o,e 4777c - No. of Lighting Outlets No. of Hot Tubs No. of Tnutsfwners Total 13 KVA No. of Lighting Fixtures Swimming Pooh Above 1:1and Below rl Generators KVA ground No. of Receptacle Outlets © No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Had Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal other No. of Dryers Heating Devices KW Connections r7 No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP tts=oaseZ*0==orn=aaM=t er=laws JW==F0k7Mcitcfr>g(7 V#* crAs&btslantidegltiv do YBS .(Ef NO oaftfsancloft liim M ffyiouhnedrdedYES,pkw=**deWof wmmWby F301m OUMY)Od fZZ(.16's-E14ZMMD* Z )r>Spa donDoRec}Rai, FsfR tadVArcfEbctticalWc&$FM �arfrr,:.v LianseNo. /, 2 &tsil=TuNa - _d _ o�F -17 S% Q D /7�/'' AI<' % f' - O r r :'S ]NSURANMWAIVM- lammwedudeLizzedwrlatha dzinuammewcrjtltglmdegiiAhtasm9ndbY Cil WLaws rysigrtattaernthisp�appic�rndigtequiarat check one) Owner EDAgent Telephone No. p 18 w ....PERMIT FEE