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HomeMy WebLinkAboutMiscellaneous - 89 MAYFLOWER DRIVE 4/30/2018-_ _ Q Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Department Building 20, Suite 2035 1600 Osgood Street North Andover, MA 01845 RE: Insured: Old Salem Village of North Property Address: 89 Mayflower Drive Company: Vermont Mutual Insurance Company Policy/Claim Number: BP28014146, B0001574 Date/Cause of Loss: 12/14/2017, Water/Pipe Break Our File Number: 35200-D Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Daniel Paul, Ext. 117 On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. 0-� a / i-7 Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Cc: North Andover Health Department North Andover Fire Department Building 20, Suite 2035 795 Chickering Road 1600 Osgood Street North Andover, MA 01845 North Andover, MA 01845 9 6 C/ Date .... /0... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. 5�e-IwI46...... Z .. �.�' r��!..0 ..................D ...... has permission to perform ............'.!s!.. C tJ ..f+..Q.�,l �"�.......................... wiring in the building of ............... .G..} IfCC. 4 ...................................... at .....1 14e— 1-7 a p, Z. ............................. . North Andover, Mass. Fee. -.12-5-:9F Lic. No..... (..1..33 ! EL RICAL NSPECTO / 1 Check # Z© Conlmonwealth Of MasSaCiluseftofficial Only Depar>tMent ©f Fire Servie permit No. _ es BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Kev. 1/071 leave blank} APPLICATION FOR PERMIT TO PERFORIN` ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (PLEAS' PRINT IN iNK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER �`� /L9By this application the undersigned gives notice of his or her intention to pe toren he e}ectrical wk dtescribed below. Location (Street &Number) X� f' �3 ��' Owner or Tenant X1 . / Owner's Address � �. /,.+L _ _ Telephone No Is this permit in conjunction with a builing permit? yes Purpose of Building� � /-<i NO ❑ ((Check Appropriate Box) // Utility Authorization No. Existing Service mps ! `Volts Overhead ❑ Undgrd ❑ No. of Meters New Service ZUd Amps Volts l ❑ Undgrd �� No. of Meters Number of Feeders and Ampacity Overhead Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers No. o Water Heaters KW No. hydromassage Bathtubs t0--- ion ofthe No. of Ceii.-Susp. (Paddle) Fans No. of Hot Tubs wimtning Pool gJU ri o. of Oil Burners o. of Gas Burners o. of Air Cond. o. Generators In- tvo. of Emergent g_-_�• _ Battery Units FIRE ALARMS Space/Area Heating KW --------------- Heating Appliances KW O. VA No. or— Signs Si ns Ballasts No. of Motors Total HP the Inspector of Wire, KVA of Zones o, of Alerting Devices Local :numcipat -w .. vrtinn No. of Del Data Wiring: No. of Dei Attach additional detail if desired, or as required by the Inspector of Wire., Estimated Value of Electrical Work (When required by municipal policy.) Work to Start: Pa pO y �6 - 1U 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. CIiECK ONE: INSURANCE OND 0 OTHER E] certify, vender the pains and penalties u r � (Specify:)f pe jury, that the information on this application is true and complete. FIRM NAME. LIC. NO.: Licensee,1_9, n /I Signature T<.... LiC. NO.:A p 9 3 3 l!J rtpplk•eehle. err r rxctrtpt min the license number line. j Address: 5 t Bus. *Per M.G.L c. 147, s. 57-6 1, security work requires Departm of Public Safer S License: Alt L cl. No. OWNER'S INSURANCE WAIVER: I am aware that the t_icensee clots nut have rthe liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement, t ane the (check one) ❑owner Owner/Agent owner's agent. Signature Telephone No. I PERMIT FEE.- S ao_u�.�lz T-%6 S v CA C � CA Cl) co Ca CA O O 'fl r C c� O_ C � � C d _• CO) a co -v O o p CD o Q /w�`` � = CD C O CCD C CD CA O.v y O O I ca CD v CO) O 'v Z CD O CD 6 CD c r n O V V J n � O cn c?�O d a O m H y. m C) O to CD c Z =r -O y CD .O.r = , m CL C T =r maim ,� O CD .4 O m (A O O Cm w n = O � C7 --1 U2 �� O ' 1 O H� C) Cl) c n H n � o ca o n,... to O �o CD co) CD m �n-0. co 0 CDm O y H ; N n d � CCL CD C92 ,,.►O H CO) O_ D CD 01 N 1 o CD CD 0 C 0. Go CD o m CD d CD m m ni 0 0; H O.: c o o A) rA q p p d N � 9n9 C\ ti f N 0 c It 2009 :ECC OVERALL BUILDING UACOMPL ANCE Date: December 21, 2010 Rating No.: ABA831 Building Name: Lot 13 Rating Org.: Advanced Building Analysis LLC Owner's Name: Phone No.: 603-343-8901 Property: 89 Mayflower Drive Rater's Name: Paul W Panish Address: Noirth Andover, MA01845 Rater's No : ERM -001 Builder's Name: Key Lime, Inc - Ben Osgood Floors Over Uncond Basement: 32.7 Weather Site: North Andover, MA Rating Type: Based On Pians File Name: ABA831.big Rating Date: 67.4 Elements insuiation Leveis Duct Insulation R -Value Check (Design must be higher -403.2-1) Unconditioned Basement, Supply: 6.0 6.0 Unconditioned Basement, Return: 6.0 6.0 Attic, Suppiy: 8.0 8.0 Attic, Return: 60 80 WindowU-Factor Check (per Section 402.5) Window U -Factor (Design must be '.ower): 0.480 0.303 This home MEETS the overall thermal performance requirements and verifications of the international Energy Conservation Code based on a climate zone of 5A. (Section 402, international Energy Conservation Code, 2009 edition.) Building Elements 2009 IECC As Designed Shed UA Check Ceiiings Ceilings: 44.1 392 Above -Grade Wans: 129.5 144.2 Windows and Doors: 170.8 142.4 Floors Over Garage: 17.8 23.1 Floors Over Uncond Basement: 32.7 40.0 Overall UA (Design must be -ower): 394.8 389.1 Duct Insulation R -Value Check (Design must be higher -403.2-1) Unconditioned Basement, Supply: 6.0 6.0 Unconditioned Basement, Return: 6.0 6.0 Attic, Suppiy: 8.0 8.0 Attic, Return: 60 80 WindowU-Factor Check (per Section 402.5) Window U -Factor (Design must be '.ower): 0.480 0.303 This home MEETS the overall thermal performance requirements and verifications of the international Energy Conservation Code based on a climate zone of 5A. (Section 402, international Energy Conservation Code, 2009 edition.) Building Elements Type U -Value Area Ceiiings Roof R38,BFG1 YJ 0-16 0.027 1469.8 Above -Grade Wa-!!s Wall R1 5,FG2,4-16,+Crane 0.064 1921.3 Wall R21,FG2,6-16 0 064 1594 Wall R21,FG2,6-16 0.064 67.4 Wall- R21,FG2,6-16 0 064 794 Joist band cend arab 0.052 111.2 REM/Rate - Residential Energy Analysis and Rating Software v12.9 This information does not constitute any warranty of energy cost or savings. CD 1985-2010 Architectural Energy Corporation; Boulder. Colorado. a f Building Elements Type U -Value Area Windows and Doors Window 1-1:0.30, SHGC:0.29 0.300 67.2 Window U:0 30, SHGC:O 29 0 300 1178 Window U:0.30, SHGC:0.29 0.300 87.0 Window U:0 30, SHGC:O 29 0 300 648 Window 0:0.30, SHGC:0.29 0.300 46.0 Window U:0 30, SHGC:O 29 0 300 44 Window U:0.30, SHGC:0-29 0.300 40.5 Window U:0 40, SHGC:O 30 0 400 126 Door Steel-urth w/brk 0:187 20.8 Door Steep-urth w/brk 0.187 20.8 Door Steel-urth w/brk 0.187 20.8 Door Wood 0.341 18.6 Floors Over Garage F-voor R30,FG2,X-16 0 040 4780 Floor R21,FG3,X-16 0.061 62.0 Roors Over Uncond. Basement Floor R30,FG2,X-16 0 040 9910 REM/Rate - Residential Energy Analysis and Rating Software v12.9 C 1955-2010Ardiiiecturai Eneroy Corporation. 6ou;der. Coiorado 2009 ;ECC ANNUAL ENERGY COST COMPLIANCE Date: December 21, 2010 Rating No.: ABA831 Building Name: Lot 13 Owner's Name: Heating: Property: 89 Mayflower Drive Address: Noirth Andover, MA01845 Builder's Name: Key Lime, Inc - Ben Osgood Weather Site: North Andover, MA File Name: ABA831.b1g Rating Org.: Advanced Building Analysis LLC Phone No.: 603-343-8901 Rater's Name: Paul W Panish Rater's No : ERM -001 Rating Type: Based On Pans Rating Date: Annua-1 Energy Cost ($) Home Infiltration per Section 402.42: PASSES Duct Leakage per Section 403.2.2: PASSES - This home MEETS the annual energy cost requirements and verifications of Section 405 of the 2009 International Energy Conservation Code based on a climate zone of 5A. In fact, this home surpasses the requirements by 6.3%. Name: Paul W Panish Signature: Organization: Advanced Building Analysis LLC Date: December 21, 2010 Design energy cost is based on the foiioWng systems: Heating: Fuel -fired air distribution, 109.0 kBtuh, 95.8AFUE. Cooling: Air conditioner, 42.0 kBtuh, 13.0 SEER. Water Heating: Conventional, Prop, 0.67 EF. Window -to -Floor Area Ratio: 0-18 Blower door test. Htg-. 1498 Cig. 1498 CFM50 REM/Rate - Residential Energy Analysis and Rating Software v12.9 This information does not constitute any warranty of energy cost or savings. ©1985-2010 Architectural Energy Corporation, Boulder, Colorado. 3 2009 IECC As Designed Heating: 3717 3470 Cooling: 206 169 Water Heating: 587 587 SubTota'- = Used to Determine Compliance: 4510 4226 Lights &Appliances: 1061 1050 Photovoltaics: -0 -0 Service Charge: 72 72 Totan 5643 5348 Duct Insulation R -Value Check (per Section 4052) Minimum Duct insulation (Design must be higher): 6.0 6.0 Window U -Factor Check (per Section 402.5) Window U -Factor (Design must be ;ower): 0.480 0.303 Home Infiltration per Section 402.42: PASSES Duct Leakage per Section 403.2.2: PASSES - This home MEETS the annual energy cost requirements and verifications of Section 405 of the 2009 International Energy Conservation Code based on a climate zone of 5A. In fact, this home surpasses the requirements by 6.3%. Name: Paul W Panish Signature: Organization: Advanced Building Analysis LLC Date: December 21, 2010 Design energy cost is based on the foiioWng systems: Heating: Fuel -fired air distribution, 109.0 kBtuh, 95.8AFUE. Cooling: Air conditioner, 42.0 kBtuh, 13.0 SEER. Water Heating: Conventional, Prop, 0.67 EF. Window -to -Floor Area Ratio: 0-18 Blower door test. Htg-. 1498 Cig. 1498 CFM50 REM/Rate - Residential Energy Analysis and Rating Software v12.9 This information does not constitute any warranty of energy cost or savings. ©1985-2010 Architectural Energy Corporation, Boulder, Colorado. 3 2009 1ECC ANNUAL ENERGY COST COMPLIANCE Lot 13 Page 2 in accordance with IECC, building inputs, such as setpoints, infiltration rates, and window shading may have been changed prior to calculating annual energy cost Furthermore, the standard reference design HVAC system efficiencies are set to the "prevailing federal minimum standards" as of January, 2009. These standards are subject to change, and software updates should be obtained periodically to ensure the compliance calcu!ations reflect current federal minimum standards. REM/Rate - Residential Energy Analysis and Rating Software v12.9 This information does not constitute any warranty of energy cost or savings. © 1985-2010Architecturai Energy Corporation, Bouider, Colorado_ e/ O 43 m N Z m 0 3 R R O 3 a DID F cm =' D m a 0 c ao p a m G7 � c n 3= 9 c O m o n (D— is m ao co a 3 m ro *:* m o m m S -n W 0 s0 Q no w. w co >�Z ;a ;a .-z> 70 =0 m W O 0 -O 1 W I Q7 N N � m to 's 0 A.O. m 3 a 0 amc Ci,a 3 m m aCL � O C W caw 2 M 0 o 2 m a Po a to � m 0 C 3 tC 3 t0 O U3 O C 0 Q. 0 06 w imp o Dcc�; =:3 43 0 < n O °) O 0 a m CL m 3fAw mm o 3 O m n O on CL 0 m a is CL 00— ° m o (D (D O 3 in ID a rm+� N 3 C) O W 11 0 0 .+ 3 N= O - O T O O i� m am m m o yac y m m a OF cis o CO 0(0(71 v D Cy C m- m 3m 0 0 w 0 N O 0 O 3 'O y� N 3 3a 0 O m s � m M CAD CD Q. CA r+ CD C CD .Q CD CD 0 3 CD N 0 0 to CD 3 fuO M CD tQ n O 3 Cis CD Sv O O^ O Q. CD 00 ic h CD mr �V■ D C� v 0 o� Z CD :3 O■ cis !r'f` 0 .�■ 0 CL D CL 0 V� y 0 3 M a c co irm O to ic zm -1n MM ;0;0 . Z.q OM zv r0 rnic Z MM X nM 0-0 z;u ca 0 M _C Cl) D0 i Z 0Cl) z ♦ ♦ ,n 0 —{ M M 2009 IECC Certificate 89 Mayflower Drive, Noirth Andover, MA01845 Ceiling Flat: Vaulted Ceiling: Above Grade Walls: Foundation Walls: Exposed Floor. Slab: Duct > Window. R-38 NA R-18, R-21 R-0.0 R-30, R-21 None R-6.0 0.300 0.290 HEAT: Fuel -fired air distribution, Propane, 95.8AFLIE. COOL: Air conditioner, Electric, 13.0 SEER. DHW: Conventional, Propane, 0.67 EF, 75.0 Gal. ily eoi�' es gr%. - �ofessionat€ T � _ - . Signature REWRate - Residential EnergyAmlysis and Rating So/t-- 029 4 APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit # 45`96 fl`v;�611 ADDRESS/LOCATION OF PROPERTY: Map Parcel Lot Number %3 SUBDIVISION Q DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: /off // r-0,//0 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THF STRI 1=1 IRF UUtb IVU I Mtt I ALL APPLICABLE CODES. _ c I�GIr/�1 Il I -SM-%j tom. �� (� Swt Address 0 �'h ��► �-4-�` c� e i �a J CONSERVATION J PLANNING DPW -. WATER METER SEWERNVATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW Signature Fite: Application for OC form revised Jan 2007 O z. M cd A u c � F m � oI CIO O C Q C5c� 'ate CD a= A :L O o � �E� Z C .: m O v' O O CD C L �N l c Q! O Cq Co a s r^ e.. 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CO) uj LLI N W W ix LUW U) MORIN X78 ACNU564 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 060-2011 Date: December 13, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 89 Mayflower Drive, North Andover, MA 01845 Key Lime Inc. MAY BE OCCUPIED AS new single-family IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY, Certificate Issued to: Key Lime Inc. 0 Building Inspector Fee: 100.00 Receipt: .4868 74Z G NORTH ' pL r • Date. ?•� 0 ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. .f'1AA C1�/�......��? �,... I� has permission for gas installation . L )J.dR .rnw.t l Q�� . /t P in the buildings of uow t ... t^ . ............. at North Andover, Mass. Fe)P �00 . Lic. No -DOT ....... �!� GAS INSPECTOR Check # C!� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date ZO 20 l0 Permit # Building Location Owner's Name J—,:t L Telephone Type of Occupancy?��,/,/ New Renovation El Replacement Plans Submitteld: Yes 1-1NoE] Installing Company Name EnergyUSA Propane, Inc. Check one: Certificate Address 100 Myles Standish Blvd., Suite 101 X❑ Corporation 132 C Taunton, MA 02780 El Partnership Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891 M Firm/Co. Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660 INSURANCE COVERAGE: EnergyUSA Propane, Inc. has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes D No M If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy X❑ Other type of indemnity El Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of th_eMass. General Laws, and that my sig a on this permit application waives this requirement. Check one: Owner El Agent Signature/of-owner oro ner's Ag nt X64�1 I herehv certifv that all of the details and information I have submitted (or entered) in above aaalication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code and Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: Plumber X❑ Gasfitter X❑ Master FlJourneyman 0-,�- -- ES Signature of Licensed Plumber or Gasfitter License Number 3707 } J z O w w U LL LL. O w O LL 0 J w m Z O H U w CL Cl) Z_ w O w a. w m U F - w Y z O H U w a z J Q Z LL w w LL .A C9 z h F w Q C9 O 0 O H O Z w Z a mI-L 0 Q OLL w O m O Z wLL O a O O ~0 ~ w U °8 F= m O w z a Q 0 U Q Z J 0. J 0 N 0 LU F - z C9 Fw- 0 w a O F- U w a U) z Q O .1 7354 Date..U........ "ORTH TOWN OF NORTH ANDOVER : PERMIT FOR GAS INSTALLATION c This certifies that ... �%F.!��J. �,? .. L l' ............ has permission for gas installation ... )L t.L^ { jir, y .:-f......... in the buildings of ...P.0 .�-. .. . Lei.(. ........... at ... ?.. -/of Q . i � c , t............ North Andover, Mass. FeeI4�U.. Lic. No10? �!... ........... ` GAS INSPECTOR Check # 10 FIYTI IRFC W Lu Lu MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town HPA N ribA2 MA. Date: ? - (O - t a Permit# 73) r Building Location:'I-- , Owners Name: 'c,. WKt VyV�`,Cr Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential (� New: V Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIYTI IRFC W Lu Lu N X Z I.- m m N Ir U x ' ` (IQ W v W z 1- O Q w Z J W w ►N- z lX O= m p lz r� O z W X W Z O m O w H a p a l -- W X x x N t- > U V w W w J O z_ w N x W O I- � w_ ❑ W u_ x W O Uj z n Q M H w f- w O m Z -1 0 w O z LL O W E_ W Z Z W W a I.-`L u- O 0 x x -j O IL m >>> 3 O SUB BSMT. ,)BASEMENT ' 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 51H FLOOR 6 FLOOR -i 'FLOOR 8 1H FLOOR /� Installing Company Name: G4. ( Jr1,1;►VL.., `•,/� A Check One Only Certificate # hh' 44814-h�•2.{e3-t 1 Corporation �J l Address: t V_� 1,701 City/Town: LE State: t o -- - - -- - - - ---. . - --- -- - -- ----- - -- - - ----------- - -' . . -E] Partnership ------------.___--- -------- Business Tel: I7�` 3� �( -1 t{� Fax: 17T - 5 2q - L1 3 ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: ST1W G&&L p. - INSURANCE COVERAGE: I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes r�' No ❑ if you have checked Yes, please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's , By checking this box ❑; I hereby details and information I have submitted (or entered) are true and accurate to ine Dest or my nnowmage ana that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. FGIaus of License: BY Fittmber er -� Title Signature of Licensed Plum r Gas Fitter Master Ci mown Journeyman License Number: 1034 APPROVED OFFICE USE ONLY ❑ LP Installer Date. ) /k // o . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .`/... Q'i`. .............. . has permission to perform ....%�...t�� w• ................ plumbing in the buildings of ..OA..k/),. ( 1 4f.-!..... . at ...(?.-.`,'.. j -,;;r Clu.v. A ............ North Andover, Mass. Fee(?Gb Lic. No. U7`/. Y.. ..........i.�. PLUMBING INSPECTOR Check ." 7) 1 7 1` 839z) doe PlYTI IPPA MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: W 4& MA. Date: �- (O - I c7 Permit# 3 Y Building Location IC�tQJOwners Name: _©,Q- E'(' VAIC. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: bj Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ PlYTI IPPA INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes t@ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy in 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's I hereby certify that all of the d I have submitted (or entered) regarding this application are true and accurate to the best of my nnowoeuge anu inat all piumomg worK ana installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: C, Title Plumber Signature of L censed Plumber City/Town Master p 3 Li $ APPROVED OFFICE USE ONLY ❑Journeyman License Number: DEDICATED Z SYSTEMS H W F tn z W UjO . of Y Y Q _j U #.- Uj z Ln ? d H cc Z 4A z W H h- " W Q Q H Ln c C LU of 0 z a X Q in ~ LU Q Q LL 1- Q 3 0 C Q 3 z W = Q 0 W z fA Vf W J J _z U C d LL D: a. = 01! J O L Q 3 W Q Y x UA a a— O vai Q o 0 x F z Q LL > o= 3 o Y Q Fe x a W a W W a, I a Q m m o o LL x x J J o Q D 3 3 3 o u a Cr SUB BSMT. BASEMENT 1' FLOOR 2ND FLOOR Ll FLOOR "4T" FLOOR 5' FLOOR 6' FLOOR 7' FLOOR 8' FLOOR Installing Company Name: Gs I;A6k (V►�►� Check One Only Certificate # V +vl • Q / � � Corporation L 6 Address: 1 '�� ►3 t1�C ��yl City/Town: (��UL�21 1(( state: �1�}. Partnership - Business Tel: % �' 37 t(- l'T X13 Fax: LI Q l ❑ Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes t@ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy in 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's I hereby certify that all of the d I have submitted (or entered) regarding this application are true and accurate to the best of my nnowoeuge anu inat all piumomg worK ana installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: C, Title Plumber Signature of L censed Plumber City/Town Master p 3 Li $ APPROVED OFFICE USE ONLY ❑Journeyman License Number: Date.. .... . . .. ... . .. ....... .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 57 This certifies that ...... ....... has permission to perform ........... e - Z7 wiring in the building of ..' ... ............................... .............................. I I ';�* at A ...... ....... 40(North Andover, Mass. ee ................. �; �e ............. ........ F "�'Lic. Nd.� "*W ; ELECTRICAL INSP� R Check # A Commonwealth Of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1/07j leave blank 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: _ �o �-- (/ City or Town of: NORTH ANDOVER To the Inspector of {fires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) A/-71- Owner or Tenant �� t ="�� etephone No. Owner's Address 1,4 e- O�. 71-, ,a �® Is this permit in conjunction with a build4permit? yes ❑ No (Cheek Appropriate Box) Purpose of Building �,.? / -�� 3/ O _.moi � Utility Authorization No. Existing ServiceAmps / Volts Overhead ❑ Und rd i; ❑ No. of Meters New Service c/ Amps /?tel Zy v Volts Overhead ❑ Undgrd LN o. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion o the o/lowin table ma be waived b the /ns ctor o Wire. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool ove ❑ a- ❑ o. o mergency —Ig Ing nd• rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No, of Gas Burners No. of etection an No. of Ranges No. of Air Cond. ota Initiating Devices Tons No. of Alerting Devices No. of Waste Disposers eat ump um er ons o. o e - ontam Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 0 municipal Connection ❑ Other No. of Dryers Heating Appliances KW Security ystems: No. o ater o. o No. of Devices or E uivalent Heaters KW Signs Ballasts Data Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent e ecommunreahous �nng: OTHER: No. of Devices or E uivalent 1 Attach additional detail if desired, or as required by the Inspector of Wires Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 4� - J'—ICI 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 OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and completes FIRM NAME: /% LIC. NO. 9 y 3 3 Licensee: /�' S�� Signature (1l applicuhle, en r "r.rempt in the /cense number line.) ? LA�IC..y NO.: /,:I-? 9 3 Address: 5 Z Bus. Tel. No.: � � - 2L� *Per M.G.L c. 147, �5-6, security work requires Departm of Public Safety "S" License: Alt. L cl. 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/Agent ) C3 owner 0 owner'~ agent. Signature Telephone No. PERMIT FEE. S