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HomeMy WebLinkAboutMiscellaneous - 80 SANDRA LANE 4/30/2018I Date .......,l..."� .� . �.. .) TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.......... ... .C' ..........- Ji ......... ..- . has permission to perform ......5 t pvr. E................................ K�(............ wiring in the building of................4'................................................ at......................................... North Andover, Mass. Fee. .2 Lic. No. .�-�..'�r..l. .................................................. ....... y' ELECTRICAL INSPECTQ�R Check # 11,717 Commonwealth of Massachusetts Official Use Only Permit No tC `7L' Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 7 -to - / � 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) gv SAN©014 t'.-Qnl-C Owner or Tenant P4,A m,"c&,tikh Telephone No. LLSfJf-G7P Owner's Address SA A,** -c 10 Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building Utility - Existing Servicea o 0 Amps I Ow 4=2 Y 0 Volts Overhead ❑ New Servic 94o Amps IVolts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Lf (Check Appropriate Box) Authorization No. jj�q.2qJ40 Undgrd ©� No. of Meters Undgrd No. of Meters Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches No. of Gas Burgers No, of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number " ' Tons .""""" KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent adr o. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: 7 119 -(3 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 [r BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: o. b' „ CO< LIC. NO.: / Licensee: 6 ®' Signature LIC. NO.: Cj� %tom (If applicable, enter "exempt" in the license number line.) us. Tel. No.: 7?t- 77r-.f3� 7 Address: ��{ �_ C tb ..� S; 4vt-a 1a,,., Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. � 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 waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comme Inspectors Signature: Date: PARTIAL ROUGH INSPE TION: Pass R Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed (] Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass V Failed Re- Inspection Required ($.) ❑ Inspectors Commen s: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street .Boston, MA. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): off)• � a� '�C �t( C Aitf _ t.4,- Address: 1Y 9, L 2 bq,,,, s y- City/State/Zip: �lA Idily Phone #: M — 7 7r" an employer? Check the appropriate box: AFI Type of project (required): 1. am a employer with _� 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• E] Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation its 9. ❑ Building addition [No workers' comp. insurance and 10. Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] it employees. [No workers' 13J]Other comp. insurance required.] I *Any applicant that checks box 01 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name; Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). FaMure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. G 4VJ, Date: 7—/o—/ Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - 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 a 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 retumed 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 number listed 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 0.2111 Tel, # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 __WWW-mass.govfdia E Location No. Date i pORT►r TOWN OF NORTH ANDOVER: "so t ••,�OOA O:O• ,.: n 41 Certificate..of Occupancy $ Building/Frame Permit Fee $ ` CM� Foundation Permit Fee $ Other Permit Fee $ 41 Sewer Connection Fee $ Water .Connection Fee $ TOTAL $ NR i 2v'9, 10 09:33 25.E Building Inspector NR ail' PAID Div. Public Works Location i No. Date i gORTN TOWN OF NORTH ANDOVER `•o '•,�O O?O•,, Rl . - p u Certificate of Occupancy $ 1 Building/Frame Permit Fee $ ,ssACNU9E�� Foundation Permit Fee $ i Other Permit Fee $ •¢ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ,. r ^ ^ Building Inspector M 00 PAID Div. Public Works W z V) J z O 0 u W z ° U z J_ G m H F a i ` u u G m m w w z W a O m, Ln LLJ z m i � c LW ti h ry W O w � � N O z � o Lw ° o 1 F F a O ag LLJ o wi o LLj O �Ln o Ln v� rn r. o 0 La. a W 0 o 0 0 zz W N 4 C J J J LZtI lZ1] C7 FW- m m m N a Z m N vai G G Q n ^W 0. O z 0 U � z o Cr LIJ U W t ix ¢ z F z ° r cn cLij F W ro LLJ a O = O W LLI ¢ uj W o o W G LLJa F V b �I z z a '� z d • �N Z Z < ^� O W , y`.� V 5 Q v1 v1 W w V U U LJ� LL W Z Z Z U y m ". Z Z �¢ ° o o a m o- 3 m o¢ W z V) J z O 0 u W z ° U z J_ G m H F a i ` u u G m m w w z W a O m, Ln LLJ z m i � c LW ti h ,r. DEPARTMENT OF PUBLIC SAFETY ;. f F ; CONSTRUCTION SUPERVISOR LICENSE i Nuaber: Expires: Birthdate: 1' r CS 869613 8616112681 8616111918 7 . Restricted To: 86 JAMES M BISNOP � t 368 SALEM ST BRADFORD, MA 81835 y: r ' r i 9 1 i ♦ t 0U LW 1 L.l1J LCIL L llli� LLI= auv owner. of the above property: -45 , l.� Name pa to Ow er PFLEMING d %77- �oTi P,vyEsSey— -� & McCARTHY MORTGAGE INSPECTION PLAN LAND SL'RMIORS This plan was not done with an instrument survey 38 POND, STR££T FAX and is to be used for mortgage purposes only.136 STON.£HAM, MASS. (617) 279-0725 DA TE. 12-28-97 SCALE.- 1"— 40' l certify that this dwelling is located opprox/mately as shown and conformed to the zoning bylaws of the Town of NO. Andover, MA o 0 when constructed and is not located in a flood plain hazard zone. °a Deed & Plan Reference E.,�sex County Reg. of Deeds BOOK 3270 /PAGE 98 PL. NO. 7021 I� ry N N147 TOWN OF NORTH ANDOVF_R 130.00' LOT >0 _ 28,68&S.F. AV.flp L =130.00' R==500. 00 SANDRA LANE LOT 9 F � v CllOFE V R H to.to.9537 O / ,FNV7 VoYff.1VVS ^l 2f-:MO0NV HMON -40 NM01 A/N IWZ ON •7d 86 3odd / ocaf )Jooe spaap jo -bay A"Iunoj xasU VOUP-R;arl UDId -8 P"0 v E -auoz p/DZDq ulD/d pooy D ur pa}Doo/ jou sl puD pa/oruisuoo uayM c°yry uanopuy ON jo uMol ay; jo sMDrfq 6uluoz oyl of pauuojuoa puD uMoys so 11ojDwlxo ddD palDao/ s/ 6ul/laMp sly! .!Dill Ajlpao l ,o- =F,l -37VOS L6-8l—Z1 "3L VG SILO-6Lt (LIR) 'SSM *MVH3M0JS MO -8i'* (119) -Xluo sasodind abobpow uoj pasn aq of s► puD XV -4 1334Y.L5 GWQd 8£ ,fanjns juawn ysut uD qpm auop IOU sDM uDId spa S21011"YZ7s ffAM NV7d NOl1O3dSNl 30 Vol &on AH L UVOOK Z? OATINXIJ �' 7 `l�S's.�/w'd l�'6'd'✓ - 77-7/7-7 puos08 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 FILLS OUT THIS SECTION*********************** f r/APPLICANT i9�vi� PHON 97 3?3 i LSlwi' LOCATION: Assessoes Map Number � _ PARCEL 048_I SUBDIVISION LOT (S) VSTREET_.�=/1! ST. NUMBER ***OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED � COMMENTS AR)Je Pl ,, �U�b�S UJ �( l� 1 0 c Kaq (uKht dA I vetua TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE �1 O ,Z O FM4 0 a z a a z a w a z a a w y c/)m v cn W m or. ea� o w o a4 U x a w W w z v � 5 0 1�O N I� +„ C O O _v V CL c i M s� X1:00 Yx,J WCD : •+ 1.. h . ' � �►. � Q / .74E c I r�Q 0 („I,NC,OP Py C �0 r' IO.L m e a E ID ? CcJ43 JA 21, co VIMMI �C� •o W N N W O �• N cm =t O CD 4: :cm 0 c Q; C H Q 32 • dCt �O co _2 m V N Z p A � O 0! V d0 C o= o CD N LU y C ea Z rr m r •fy MD I:L C"=O C Z W E v�vN o O H CLC3 a CD m -5o: g 0 m ` H � c H r 8 CL 4- m T 0 coO co • oc z o, O y c C CM i O O y O O 'E m m Z O� � o 0 CL cma 0 ccc C Z CL V y � c c C — CO2 Im Location No. (j S Date q0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ s Building/Frame Permit Fee $ Foundation Permit Fee $ s Other Permit Fee It 4er.Connection Fee $ W t onnection Fee $ TATAL $ %n,or) \. r, -00 liif�n �C. , itw-�-•-S.w. r�--- Building `Inspector Div. Public Works PER'Mh NO. 1 - S - APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 1O 2 RECORD OF OWNERSHIP IDATEI BOOK 'PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING cc�� t.e-ti . )r\ (A3,TV U � OWNER'S NAME �_ r� L) C (����T 'I�` NO. OF STORIES SIZE OWNER'S ADDRESS 08 d 1.•.�\ - J KGs BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME c SO-\ ..Z\dV1� ••L� SPAN DISTANCE TO NEAREST BUILDING --- DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 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 INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 1 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONjORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 0 SIGNATURE'OF NER OR AUTHORIZED AGENT FEE PERMIT GRANTED d 19 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 WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD 1 OCCUPANCY 18 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE B 1 2 13 _ CONCRETE BL K. BRICK OR STONE _ PINE HARDW D PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/ 1/1 1/ FIN. ATTIC AREA _ N_O B M T HEAD ROOM FIRE PLACES MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 �_ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY HARDI!✓'D COMMON ASPH. TILE STUCCO ON FRAME _ BRICK ON MASONRY ATTIC STRS. &FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I J POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE GAMBREL FLAT ASPHALT SHINGLES HIP MANSARD SHED BATH 13 FIX.( TOILET RM. (2 FIX.) WATER CLOSET LAVATORY _ _ WOOD SHINGES KITCHEN SINK _ SLATE TAR & GRAVEL ROLL ROOFING NO PLUMBING STALL SHOWER MODERN FIXTURES _ _ _ TILE FLOOR TILE DADO 6 FRAMING � 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & COLS. _ _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. Of ROOMS B'M'T 12nd I _ GAS OIL ELECTRIC O HEATING 1st 3rd N -4 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. WOOD STOVE INSTALLAI 1011 CHECKLIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove r .t` A. New eC�cg _Used B. Type/radiant Circulating C. Manufacturer 5-\—bJ-f Lnb. No. Name/ Model No. COlar size Dimensions/ Height 30 _1_?ngth All a- Width Chimney A. New ---Existing Sy. vys B. Size (flue area) ;& r ? C. Other appliances attached to flue (Number and flue size) . D. Prefab (Manufacturer—name and type) E. Masonry/Lined ✓ Flue liner___ Unlined type 3 manufacturer) F. Height (refer to diagrams) cap aVEK for 2 MIK 3� Mlty 10' ! rJ,,Ep to n x �— CHIMNEY HEIGHT Hearth (non-combustible) A. Materials 2-;, B. Sub -floor construction C. Minimum dimensions (refer to diagram) Clearances and Wall Protectlon (see stove installation clearances chart) A. Type of wall protection provided < <-�- B. Clearances (refer to diagrams) FIREPLACE CORr IER 12�r �,tlra. 'MIN. \ Ig" h11N. C: 15) HEARTH WALL/CENTER 1I �J 00 O 0-0 o ro G N 0 O ro�U w 3 c o • ' 0'-0 .� 0 cz ro ct U i o o a W � ro , O ax W u � c= ro � f5 v r Z CL -ti van c o aj 0 00 v a O F% G �u aoro. �G .mo41 o � b •ro O G r. v " 4. -b s. O w"840¢-"3 41 O 0 z • on G& ro ao U4- F. O > u u b000 z0 2� +. • h w > 00 O 0 w 6J ' ' u R� a 0O �0>• O v - f �-dUa o ro W C o 1 cL�v ~W� > Lt, ro u¢ u y o <� ro GUrcn _ u.�W 0U v ro 0 -�� U w G u Q. h ro• � u � v u 2 w � o v 0 N 00ro -b v u� ono N 3� G.=vo�a 0 cl aE ro7 O Q ro O O Uci w cu o00N'OCG a 0 v ei 7 o= O Econ ov GIZZ�.r�. g:. v o 7 u p U u p U Q d_p§r 4-1 O C Ln C-4 cz M eV Q v u G-10 EEE a•• u E.L ro (3 CG (o cu o00N'OCG a 0 v ei 7 o= O Econ ov GIZZ�.r�. g:. v PENN COAL STOVE ACCESSORIES WARMING TRAY ATTACHES TO THE REAR OF THE STOVE & OVER FLUE PIPE M5.. IG TRAY CIRCULATING FAN J SHIELD 101 Heat circulating fan attachment — Mount.i on all Penn Coal heat shields. By adding the.' circulating fan to the "penn" additional heat- ing benefits are derived by allowing the air to pass over the heat surface of the stove and circulating this warm air into hard to heat areas. Heat Shield is easily installed onto all Penn Coal Stoves. With the addition of this shield, the heat is radiated toward the front of the stove and into the area to be heated. This shield keeps wall temperatures at the rear of the stove cooler & improves heating efficiency. The Penn Coal Warming Tray doubles the size of the cooking surface to allow slow cooking or food warming at the rear of the stove. This shelf also receives additional heat from the flue pipe located beneath the warm- ing shelf. HEAT SHIELD WITH CENTER SECTION REMOVED TO SHOW POSITION FOR FAN i i 1r.y S OFFICES OF: BUILDING CONSERVATION HEALTH PLANNING �• NORTH Town Of • NORTH H L aNDOV,EE •y�ss�cwusesh DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR July 11, 1990 Mr. & Mrs. Robert K. Morris 80 Sandra Lane North Andover, MA 01845 Re: Coal Burning Stove Dear M/M Morris: 120 Main Street North Andover, Massachusetts 01845 (508) 682-6483 As a result of my inspection of your coal burning stove, please be advised that the addition to the hearth and the metalbestos piping conforms to installation require- ments. Yours truly, D. Robert Nicetta, Building Inspector DRN:gb c/K. Nelson, Dir. Office Use Only� ;7 014e (fommonattalt4 of filmar4usttts Permit No.LO ` l3quirtment Of Pubur ftfetg Occupancy & Fee Checked ,PIC (leave blank) BOARD OF F1RE PREVENTION REGULATIONS 527 CMR 12:00 +�J! APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK/ All work to be performed in accordance with the Massachusetts Electrical Cod(k 527 CMR 12:0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date - A�V/ T& or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the ele trical work described below. AAI �. Location (Street &Number) SQF1%LA,Q' l✓ Owner or Tenants 1 a eSSe- Owner's Address 5-,19/7-2 Is this permit in conjunction with a building permit: Yes El No 4L5�-�Check Appropriate Box) Purpose of Building el� L A, -a Utility Authorization No. Existing Servicer!220 Amos _ 2� acro Voits Overhead ❑ Undgrnd -O- No. of Meters New Service Amps- louts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work C_110�u Ig C f Irl t i- QYtCX No. of Lighting Outlets i No. of Hot Tubs I No. of Transformers TotalNo. I No. of Lighting Fixtures Swimming Pool Above. In- grntl. gmd. '_. Generators KVA No. of Emergency Lighting No. of Receptacie Outlets No. of Oil Sumers I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Ranges No. of Air Cond. Totat No. of Detection and No. of Ran 9 I tons Initiating Devices No.of Heat Total Total No. of Disoosals Pumps Tons KW No. of Sounding Devices I No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Other No. of Dryers Heating Devices KW Local Connection i No. of No. of Low Voltage No. of Water Heaters KW I Sions Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the reauirements of Massachusetts general Laws I have a current Liability Insurance Policy including Ccmoieted Operations Coverage or its substantial equivalent. YES NO = I have suomitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the typ of c verage by checking the appropriate box. �� /1' et A (`!j -�, _ Q 3( INSURANCE OND = OTHER = (Please Specify) (� H F "L/T (Exp) tion Date) Estimated Value of E!ectrical Work S Work to Start _ Inspection Date Requested: Rough Final- t Signed under the Penalties of perjury- FIRM NAME Cert` Ntc r r C2G r �r LIC. NO. Licensee j e9A%P �c�� Qr�,% Signatures LIC. NO.c3'51120 r' �© �V11,4 . Bus. Tet. No. _ 0 Address «`-c KI) A � r 1,4 y) $'�4 Alt. Tei. No. 4' X Yl OWNERS 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 (P!ease check one) (Signature of Owner or Agent) C 0(,k)L5'6 0,)-r Telephone No. PERMIT FEE 5 x-6565 Date....`!..... lk TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... It..... .. / If- (— 1� .. ............................ has permission to perform ...... ( ...... wiring in the building of ......... ................. I f r' C4 f -�'( ( ............ / ...................................... at .............. ............ ............................ L ...... .............. . North Andover, Mass. Fee.... Lic. No A. .......................................... ELECTRICAL INSPECTOR O(xo j- & '1' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File