HomeMy WebLinkAboutMiscellaneous - 87 SUGARCANE LANE 4/30/2018876
Date//V 7,116
�'.' •� ;..�ao TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
• i, ; r
s
,SSACMUS� �j
This certifies tha/A/R... t�-� �% {/</lc j /� ... �� ..
has permission to perform ... !l(it� /�%K S �.. ................. .
plumbing in the buildings of ..../'rf'if�.�'1...............
:..-, North Andover,
a4 ---'-f ..... �'✓!.... Muss -i Lic. No.I0 . ........ I .
r PLUMBING INSPECTOR
Check # _i�r
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS jLcp-ojo
tDate
Building Location 4g7 54.E &#- C wf_ (oye-Owners Name Or -;L `rm h Ii"G ), Permit #
Amount
Type of Occupancy
New Renovation Replacement U Plans Submitted Yes 0 No U
FIXTURES
(Print or type)
Installing Company Name 11y Qo./iwb)e—
Address
Check o
81"c-orp-
rlPartner
11 Firm/Co.
Name of Licensed Plumber: ?w a L r &i4 &,-j5Z
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 9 Other type of indemnity E] Bond a
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent 11
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 Massach PI �odeand Chapt 42 of the General Laws.
By: wgn or-mcenseu PlumDer
Type of Plumbing License
Title
City/Town icense 7Num5er Master EZ Journeyman ❑
APPROVED (OFFICE USE ONLY
•
'
14
.�
0 MIT "167-1
(Print or type)
Installing Company Name 11y Qo./iwb)e—
Address
Check o
81"c-orp-
rlPartner
11 Firm/Co.
Name of Licensed Plumber: ?w a L r &i4 &,-j5Z
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 9 Other type of indemnity E] Bond a
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent 11
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 Massach PI �odeand Chapt 42 of the General Laws.
By: wgn or-mcenseu PlumDer
Type of Plumbing License
Title
City/Town icense 7Num5er Master EZ Journeyman ❑
APPROVED (OFFICE USE ONLY
7455
�1
Date . !! / ' 6 .....
pv
ar ° TOWN OF NORTH ANDOVER
' PERMIT FOR GAS INSTALLATION
�9SSACMUSEtt /
1kThis certifies that . � � (� ....... �?.
has permission for gas installation .. ,� f. .. &'/6f 1...... .
.-' hin the buildings of ....... f -tnz l( .0 .......................
at .... � . ..... 5 tl ... e&wt - IA,,,I.A North Andover, Mass.
Fei0lli Lic. No.. J6 fo .... /ll/11��.: 42,1. z��
e
G,71S INSPECTOR
Check # t
MASSACHUSETTS UNIFORM APPLICATON FOR PERMTI' TO DO GAS FITTING
(Type or print) Date V—/P- p Q
NORTH ANDOVER, MASSACHUSETTS// .
Building Locations 5s7 5i � G4 -e- 6tll - Permit #
Amount $
Owner's Name rfG A
New Renovation Replacement ED Plans Submitted
1V.
(Print or type) Check one: Certificate Installing Company
Name 4Y Lf1;Gzb,%P�wmbe'� SNC:. ® Corp.
Address E] Partner.
Business Telephone Firm/Co
Name of Licensed Plumber or Gas Fitter 4 pta- fc/ rz�(—
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3No o
If you have checked y s, -please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 0 Bond 0
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:
Signature of Owner or Owner's Agent Owner 0 Agent 0
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 Massa se s to GaVC A and Chapter 142,Of the General Laws.
ICity/Town
IAFFKU V bl) (OFFICE USE ONLY) I
'gignature of Licensed Plumber Or Gas Fitter
Plumber 10,6 c f4
Gas Fitter ]cense IN imt er
Master
Journeyman
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SUB-BASEM ENT
SUB
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type) Check one: Certificate Installing Company
Name 4Y Lf1;Gzb,%P�wmbe'� SNC:. ® Corp.
Address E] Partner.
Business Telephone Firm/Co
Name of Licensed Plumber or Gas Fitter 4 pta- fc/ rz�(—
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3No o
If you have checked y s, -please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 0 Bond 0
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:
Signature of Owner or Owner's Agent Owner 0 Agent 0
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 Massa se s to GaVC A and Chapter 142,Of the General Laws.
ICity/Town
IAFFKU V bl) (OFFICE USE ONLY) I
'gignature of Licensed Plumber Or Gas Fitter
Plumber 10,6 c f4
Gas Fitter ]cense IN imt er
Master
Journeyman
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ILL
Location` o
'+ No. Date -/ e7
�oRTN TOWN OF NORTH ANDOVER
0 s
` Certificate of Occupancy $
Building/Frame Permit Fee $
s�c14
Foundation Permit Fee $
Other Permit Fee C $
TOTAL
Check # t`�U
Building Ins46tor
COMMONWEALTH OF MASSACHUSETTS
TOWN OF NORTH ANDOVER
1600 OSGOOD STREET
Building 20 Suite 2-36 �}
APPLICATION OF CERTIFICATE OF INSPECTION
2007 /
V
j ( ) Fee Required (Amount) $100.00
Date: (2 0 () No Fee Required
Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby apply for
Certificate of Inspection for the below -named premises located at the following address:
Street and
Number _ I (�
Name of�� T VY)
�
Premises 1 -
Purpose for^hich Premises is
Used S-}
Licenses (s) or Permit s) Required for the P,ises by Other Go ernmental Agencie :7 _ ��r
Contact Person ele hone (cc,
License or Permit A enc
uemricate_ZQ be issued to
Address 411114S EAaLpl 'A_
Owner of Record of Building
Address ! ' ) .��:14 �Sw
Name of Present Holder of Certificate
Name of Agency, if any
1;. l
SIGNATUk� OF PERSONS TO-WM
HO
/S /SSOR HIS AUTHOIRIZED AGEN
INSTRUCTIONS:
T
tt (4b 4
SLE
UAIC
c
1) Make check payable to: Town of North Andover
2) Return this application with your check to: Building Dept.,
PLEASE NOTE: 1600 Osgood Street, BLDG 20 STE 2-36 North Andover MA 01845
Application form with accompanying FEE must be submitted for each building or structure or part thereof to be
certified.
3) Application and fee must be received before the certificate will be issued. ~
4) The building officials shall be notified within ten (10) days of any change in the above information.
CERTIFICATE # EXPIRATION DATE:
Application for Cl. revised 5/07 jmc
INSPECTION REPORT FORM
CLAS 'FICATION PASSES INSPECTION YES NO DATED
OWNER
BUILDING NAME OR NO
STREET LOCATION
TYPE OF OCCUPANCY - Day Care ❑ Auditorium ❑ Restaurant ❑ Cafe ❑ Gym ❑ Apt ❑
School ❑ Common Victualer's ❑ Liquor ❑ Place of Assembly ❑
OPERABLE
EXIT SIGN yes ❑ no ❑
LIGHTED EXIT SIGNS
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS
NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STOREYS
yes ❑ no ❑
ELECTRIC EQUIPMENT VIOLATIONS
FIRE RESISTANT CURTAINS OR DRAPERIES
EGRESSES LAWFULLY DESIGNATED
HANDICAP ELEVATOR
STAIRS PROPERLY RAILED
HALLS AND STAIRWAYS LIGHTED
yes ❑ no ❑
UTILITY ROOM — CLOSETS
RADIATOR GUARDS
COMPLIES HANDICAPPED PERSONS LAWS
unobstructed ❑
yes ❑ no ❑
yes ❑ no ❑
yes ❑ no ❑
yes ❑ no ❑
yes ❑ no ❑
yes ❑ no ❑
yes ❑ no ❑
yes ❑ no ❑
HOW HEATED NO. FIREPLACES yes ❑ no ❑
BOILER ROOM CONDITION:
INSPECTOR: BRIAN LEA THE:
91
if
64
Date.'!�.-. 5�?
3,469
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
X
This cL'tifies that........................ .................. .
has permission for gas installation
...................
in the buildings of ..................................
-e-e _'
at ...... ,North Andover, Mass.
Fee 2 ......
GAS INSPECTORV'
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
1
-, '* Type or print)
NORTH ANDOVER, MASSACHUSETTS
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS F=
Building Locations
Permit # 2 9
Amount S
Owner's Name
Ivo Fra.'l-►l �c�'1
New ❑ Renovation ❑ Replacement 9 Plans Submitted ❑
(Print or type) Check one: Certificate Installing Company
Name Andover Plbq. & Htg. Co.. Inc. ❑ Corp. 9199
Address 20 Agean Dr., Unit -10 ❑ partner.
Methuen. Ma. 01844
Business Telephone (978) 685-8383 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter orge LaRote
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Q No❑
If you have checked ves. please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ 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 eneral Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certifv 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 pertormed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Wcode and Ch&�f the General Laws.
By:
Title
City/Town
APPRO'vED (oFnce USE ONI. Y)
P:gnature ofiLlcensed Plumber Or Gas Fitter
lumber 9983
❑ as
Fitter License Numoer
vil Nlaster
❑ Journeyman
13R D. FLO OR
(Print or type) Check one: Certificate Installing Company
Name Andover Plbq. & Htg. Co.. Inc. ❑ Corp. 9199
Address 20 Agean Dr., Unit -10 ❑ partner.
Methuen. Ma. 01844
Business Telephone (978) 685-8383 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter orge LaRote
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes Q No❑
If you have checked ves. please indicate the type coverage by checking the appropriate box.
Liability insurance policy ❑ 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 eneral Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certifv 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 pertormed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Wcode and Ch&�f the General Laws.
By:
Title
City/Town
APPRO'vED (oFnce USE ONI. Y)
P:gnature ofiLlcensed Plumber Or Gas Fitter
lumber 9983
❑ as
Fitter License Numoer
vil Nlaster
❑ Journeyman
Location, 0 SbG4uAwc_r, Lo
No.Date
TOW F NORTH ANDOVER
�
• n Off,
-
M
C?
„
.����
Cate o Occupancy $
�S,SSACNUS t�
uildin /Fe it Fee $
a atio�n� mit Fee $
J
Otfmit Fee $
1
Ower Connection Fee $
&`
ka.
Water Connection Fee $
TOTAL $ -1-
.4
Building Inspector
s - .9.4 85 Div. Public Works
1 a
9484
150.00 PAID
Div._ Public Works
N°RTM
TOWN OF NORTH
ANDOVER
{ p
Certificate of Occupancy
$
k" •
Building/Frame Permit Fee
$
E
JCMS t
Foundation Permit Fee
$
t
AU
t
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
Building Inspector
1 a
9484
150.00 PAID
Div._ Public Works
t ocation/ lam_ /C.c�r-r C K�
`Date
N`o.
NORTM TOWN OF NORTH ANDOVER
11 Certificat6 of Occupancy $
i3ulldinglFrame Permit Fee $
Foundation Permit Fee
Other Permit Fee $
Sewer Connection Fee $
F
Ala. Water Connection Fee �� Sa
' TOTAL $
B ild g In ect r.
07.
.t.7.
�' W Div lic Works
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FOW( U - IAT RELEASE FOR14
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: WL//ONr4Z_i'i11094A ��� C001- Phone vlkZ-a-.324)
LOCATION: Assessor's Map Number !o i/% Parcel �y
Subdivision �`}'6CS Lots) 3
Street S'US'A2 G9-�y� L -4 -Al e- St. Number_
************************Official Use Only************************
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Comments
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Septic Inspector -Health
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Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
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Received by Building Inspector Date
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SEPTIC AND A
CERTIFIED PLOT PLAN
LOCATED .IN NORTH ANDOVER, MASS.
SCALE: Y'=40' DATE:6/10/96
Scott L. Giles R.P.L.S.
50 Deer Meadow Road
North Andover, Mass.
LOT 3
20.50
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LOT 5
TABLE OF ELEV. .
OUT OF HSE.=131.60
INTO TANK =131.11
OUT TANK =130.94
INTO BOX =130.56
OUT OF BOX =130.40
END PIPES =130.10-130.12
I CERTIFY THAT
OFFSETS SHOWN ARE FOR THE USE
tM
THE OFFSETS
OF THE BUILDING INSPECTOR ONLY
SHOWN COMPLY
AND SUCH USE IS FOR THE
WITH THE ZONING
DETERMINATION OF ZONING
BY LAWS OF
CONFORMITY OR NON -CONFORMITY
NORTH ANDOVER'
WHEN CONSTRUCTED.
WHEN CONSTRUCTED
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Al
r��.rluat 115 UNIFORM APPLICATION FOR PERMIT TO DO -GAS FITTING
"nt or Type)
NORTH ANDOVER `
Maas. Date �
vv
Building Permit #__ �3U
Location
Owner's
Name
New n—,-' Renovation ❑ Replacement p Plans Submitted:. Yes ❑ No ❑
Check one: CeftNicaCe
Installing Company Name
Address
P Corp.
d Partnership
❑ Flrm/Co.
Business Telephone
Name of Licensed Plumber or Das FRter
INSURANCE COVERAGE:.I : Check one
I have a current liability Insurance polcy or its substantial equWlent. 'Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy ❑ 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:
%nature o Owner or owner's enl Owner ❑ Agent ❑
I hereby certify that an 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 an 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 112 of the General laws,
Tof license:umb
Pler
Title Plumber Signature ° nae um er or as er
Cftyown Master
R❑Journeyman Ucense Number
11F'PIX7/ED (OFFICE USE ONLY)
C/
�3� 2319 Date... ./lv:.0010.0000.0�Y''.
i
CF NO 07 e 14, - TOWN OF NORTH ANDOVER
41
p PERMIT FOR GAS. INSTALLATION Q
�9SSACHUSES '
This certifies that . { : L"'. S �L. . -� f _ t,
:E
has permission for gas .installation
in the buildings of ..�
at ... . �. `/.. . .... P .. North Andover, Mass.
Fee. % . ' Lic. No.... �, '
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer _ GOLD:-File.
.��
Office Use Only
�111Umjat1WC iii of �4& SS l UjRfts Permit No.
i9epa tment of Public thfettj Occupancy & Fee Checked
a
- BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 X90 (leave blank)
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 V F�
(M* or Town of NORTH ANDOVER To the. Inspector of ires:
The udersigned applies for a per toyperform the electrical work
�described
/4elow.
Location Street &Number) / c�C} 6fiQ a �K i J 2 l Ld %
( •
Owner or Tenant C.,Lz, J 1/tt "ILL,%6i Old fCC `51n1;VL
Owner's Address / D 5 go "y 0,4-1.,)7-
Is
)7
Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box)
Purpose of Building c5,w6 C5. Fh,44iJ-1 �tW£Lt-"I& Utility Authorization No.
Existing Service Amps _I Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service 00 Amps -Z-A-A A69 Volts Overhead ❑ Undgrnd . No. of Meters _
Number of Feeders and Ampacity /
Location and Nature of Proposed Electripal Work' �CIA16 U/T-. IF -0,e I FL670H0124
�_ .- t I)
_
Total
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
No. of Lighting Fixtures I
Above In -
Swimming Pool grnd. i I grnd. El 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. n Cetection and
Total
No. of Ranges i
No. of :ir Cond. tons
Initiating Devices
'No.of
Heat Total Total
No. of Disposals
Pumps Tons KW
No. of Sounding Devices
No. of Selt Contained
Nt.. of Dishwashers
I Space/Area Heating KW
Detection/Sounding Devices
No of Dryers
Municipal n Other
I .Cor+n?anon J
L
Low Voltage -
iWaal
Heating Devices KW
—
No of No of -
No.
No. cf Water Heaters KW , _
i ._Signs, , .. Ballasts
Wiring
No. Hydro Massag Bibs
I No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a cuf,6ent Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO I
If you have checked YES, please indicate the type of coverage by
have submitted valid proof of same to the Office. YES JZ_ NO
checking the appropriate box.
INSUfiANCE BOND OTHER = (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work 5
Work to Start Inspection Date Requested: Rough Final
Signed under the Pe aloeqperu
s of j
FIRM NAME �vMrr `1ciC f "� LIC. NO.
Licensee NPL7 L% Signature
LIC. NO.
Bus. Tel. No. O
Address 52 d6l) 6ft��� ��6 ��� Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its s stantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. O&WL
Aent
(Please check one)
Telephone No. PERMIT FEE 3
(Signature of Owner or Agent) x-5565
glace Use Onty <.
T uh� �IIutuuln�u� i >zf �ga>hu�2� Reermit Na.
�E1IcZi11ItEIIL Qf 11hj(>: "SfP2ij Occupancl & Fee Checked
a!°d (leave blank) � 4 -
BOARD
' BOARD OF 'FIRE PREVENTION REGULATIONS 5527 CJS 12:00 (�JCJ
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he performed in accordance with the Massachusetts Electrical Cade, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Cate 7 '
or Town of I4ORTEI VF -R To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address 07 U•
Yes No (Check Appropriate Sox)
Is this permit in canjur.ctian with a building permit: GP-6=6-7-0
P"urocse of Building F;�A(—� Utility Authcrizatiart No.-
VCits Overi-e=_d Uncgrrtd No. of ytecers
Existing Service Amps _J _
New Ser�ic= Amos. �
j veils Guar ead _ uncgrnc I No. at meters l
Numcer of Feeders and Amcacity
_deaden and Nature of Frcdesed"ic.rx
No. of L:grnng Outlets
No. of Lig^ting F;XtUreS- -
Swimming ?rot 4^ a s= cmc.
I
'fOutlets I No. of Oil =umers
Tocat
No. of :ranstarmers KVA
IGenerators KVA
No. at Emergency Lighting
Sacery Units
No. of Switcn Outlets
No. ar Gas=urners
- I
Total
Na. -t Ganges
- No. of Air Conc. ;chs.
�ezt atal
ocai
:No. of Oiscosals
Nc.or Pun.os :ons
KV4
SoaceiArea -eating
No. of Oisnwasners -
Heating Cevices
CCN
No. at Orfers
Na, at No. Of
Nn_ of 'Nater Heaters F(V'1
i-Sicns- .Ballasts
No. Hvero Massae
OTHER:
INo. of Mctcrs Total �45i
'=RE ALARMS No. at Zones
No_ at I-ecection and. -
Initialing Oevtces _
Na. at Scuncing Cevices
No. at Sett Contained
Oetec::onrSounoing Oevtces�
Muntc:oai Other
Lccat Conned:ton
Law Voltage
'Nirnc
INSURANCE CCVERAGE: Pursuant :o the recutrements ct '.tassacnc:sa-.s general Laws NO _ I _
I have a Current Liaotiity Insurance Policy inc;Ucmg Car..o:etee Oderan` ncuv^aveage Or c. sexed YESsucS•p'easle,naica. en the Vae at cave age Cy
nave suamittea valid proet of same to the Office. YES '� NO — Y
cnecxtng the acCroenate oox.
INSURANCE JE SCNO = OTHER = (Pease Scec:fy) tEAatranon Oatet
Estimated Value of E!ectncal 'Norx S Rou n rtnat
werx :o Start Inseec:ion lata �acues:ec: g
Signed unser ine.Penaities at perjury: UC NO• %
-1RM
:NAME? Luc. Na. __--
Licensee o`G✓ S g at re� ��tf �L/
� --- Sus. Tal. No.
Address
e insurance coverage or its suostannai eeurvalent as
OWNER'S INSUINSURANCE`wAtVER: I am aware that ice tr.
:cesea toes riot nave m
eutreo ov Massachusetts General Laws. and :hat my signature an :n:s Cermu acoucattcri waives tuts reautrement. Owner Agent
g
(P!ease cnecx One) oS.?PtIT FE= S
etecncne No.
iSigrature of Cwner or .tgenn
Date ..... t�.. �..
472
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING.
�r2.......:..
This certifies that .............. ............ ... � . :. ..
?has permission to perform ... ... .. . .... ...............:....
0
4wirm in the b 'Iding-o .... .. ...... �..........
Cat .; .. ...:..�ne1��r?...... .f'1 ....................
. North Andover, Mass.
Felty&..� i......... Lic. .64. t %J ................
E RICAL INSPECT�fF���r1
- _ 41f G�6
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
"I
Date/.,) -. /,?. -. e.4 .......
IN, TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ;J.... ..... -r.( / .�/.- A/
.............
has permission for gas installation .t........
in the buildings of ... /1--. /1 e, � . � . � ' .4 ..........................
at 5/-,x-. r&'Xn .--:1 ....... North Arkdover, Mass.
Fee.o9J .... Lic. No. . --i......
......
Check # 2 S INSPEACTOR
4241
386 Date .........�
t NORTH 1
3r�•_':r``� •"_' "�o� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
Ss�cNusE�
This certifies
..that........�.... I
.. .
has permission to perform ..... ....................L.....
............
wiring in the building of C`.�J..10!^. ` ' .11L, tkt .. ..............
at ...... 7.... .4 N.'Q.. .......................... . North Andover, Mass.
Fee,,,—.--^Lic. No..c�+�.cj ......:. .............
E,L I SPE
CTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITnNG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations S� Sugals C�- Lown e_ Permit # ►/
—f 2-- Ci