HomeMy WebLinkAboutMiscellaneous - 79 BLUEBERRY HILL LANE 4/30/20181o3 3 , C1 Date ...�, h
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TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that ....... �?` ���% `�' f f� l J
............................................................................
has permission to perform No YC' ' � ( /-,`{ r ' c
..............................1...................................
wiring in the building of ......
at ........7..... r%.1..`.'.k? ..�� �Ji�r'..��.f�v.... , North Andover -,-Mass.
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Fee ... �j/Ci(i.... L>,c. No. �tr.�:�:......lf P
/ELECfRICALINSPECTOR
Check # Alc(
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
The Commonwealth of Massachusetts FOR OFFICE USE OtLLY
Department of Public Safety PermicNo.
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Receipt No.
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work will be performed in accordance with the Massachusetts General Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date q-, 1 % S/��
City or Town of �/ o r A 4 ✓t o 1'e- r- To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below:
to
Location (Street and Number) ` 9/U e_ e_1r_f_ 1(J I Lq, vie, Map: Lot:
Owner or Tenant C � r` S �up .. r-- CSUv��'�'6s Zone:
Owner's Address Sa.w�
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service U Amps Z Zo / '�'' Y ' Volts
Yes ❑ No B---' (Check Appropriate Box)
Utility Authorization No. 036 J-37/
Overhead ❑ Underground P" No. of Meters —�
New Service Amps / Volts Overhead ❑ Underground ❑ No. of Meters
.1
Number of Feeders and Ampacity
Locatio4i and Nature of Proposed Electrical Work �'e 001-
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total KVA
No. of Lighting Fixtures
Swimming Pool Above grnd. ❑ In-grnd. ❑
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emerg. Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self -Contained
Detection/Sounding Devices
No. of Ranges
No. of Air Cond. Total Tons
NO. of Disposals
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No. of Total Total
Heat Pumps Tons KW
N . of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
Net. of Water Heaters KW
No. of Signs No. of Ballasts
Local ❑ Muncipal Connection ❑ Other
No. of Hydro Massage Tubs
No. of Motors Total HP
Low Voltage Wiring
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts Genepi Laws I have a current Liability Insurance Policy
including Completed Operations Coverage or its substantial equivalent. YES ff NO 111 have submitted valid proof of same to this
office. YES O ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE 13'9OND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Wo k $
Work to Start oI Inspection Date Requested: Rough Final
Signed under the enalties o perjury:
FIRM NAME C / C (�o C LIC. NO. 411'?1 '
Licensee 66 nLZ.1,,�l — Signature LIC NO. F_ 25 %U y
Address lD a9 -% n tYzb 51 MA- .019L3 Bus. Tel. No. C1 %�'- %2-�
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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. PERMIT FEE $ /t5_(Signature of Owner or Agent)
Date....-. . c'c-
N° 43J2
TOWN OF NORTH ANDOVER
° PERMIT FOR PLUMBING
This certifies that . • • • / ? •'�/ .......... • • • •
has permission to perform ....//?.,. ./f. 4.(: e'!. .....
plumbing in the buildings of ...... ......................... .
at . ` ./.� .r . a��!r!'.;� f'.'. �. �.... , cNorth Andover, Mass.
Fee 3 Lic. No. fl rl,?.:! ..... �. �... ( ... , . -a. ...... .
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PLUMBING INSPECTOR
WHITE. Applicant CANARY: Building Dept. PINK: Treasurer
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO
(Print or Type)
Alf" Anddv- - Massachusetts Date
_2,19 A Permit #
Building Location 179 461ut &.rrl )Jdj Owner's Name
Type of Occupancy fid✓
PLUMBING
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BASEMENT
1ST FLOOR
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2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
TTH FLOOR
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Installing Cornpa Name // 1 /ICs/f/' )!LA
Address � l ,, —LS �1
Business Telephone --V/ ,�2YJ`s —1;77"f
Name of licensed Plumber or Gas Fitter
Check one Certificate
7 Corporation
P-ra-rtnershIp
Firm/Co
INSURANCE COVERAGE:
I have a currentity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch 142
Yes No ❑
If you have checked yes, please Indica a the type coverage by checking the appropriate box.
A liability Insurance pollc 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`_' Agent ❑
Signature of Owner or Owner s Agent
hereby certify that all of the details and inlamatror, I have submitted (or entered) in ab aprlicatro a if d curate to the best of y
knowledge and that all plumbing work and installations performed under the permit i d for this plic n in complia a wit1 1,
pertinent provisions of the Massachusetts State Gas Cede end Chapter 142 of the ial Laws
By T e of License
F lumber 1 a ure o rcense lumber or as
Title _'1 Gaslitter
Master License Number
lily/TovwE �_ Journeyman
AF`f' Inspection Date Requested