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HomeMy WebLinkAboutMiscellaneous - 97 SAW MILL ROAD 4/30/20189 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that. ... . . ....... .... i ................ has permission to p4form ... ............... plumbing in the buildings of . wwell'-A ............. at. N0 hA n d /Mass. Fee q r ..................... PLUMBING INSPECTOR Check # 8310 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or pmt) NORTH ANDOVER, MASSACHUSETTS Building Location 97 Sfxo Ml Date Amount Owner MAL1,J Vleyto New ❑ Renovation ® Replacement ❑ Plans Submitted Yes No 123 FIXTURES (Print or type) Installing Company Named Wl Q,paJ Address -- 1"7 1 r•�..1na, ��++�t_ Check one: Certificate ❑ Corp. ❑ Partner. 603 -V82.-6733 ❑ Firm/Co. Name of Licensed Plumber: Zakeiz Wn ime.,W Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity El ❑ 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 I Owner ❑ Agent 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 %TjoWof 11 performed under Permit Issued for this application will be in compliance with all pertinent provisions of thStatebing Code and Chapter 142 of the General Laws. By: icens um Plumbing License Title � City/icense um er � Master ❑ Journeyman APPROVED VED to�cE usE orrr,Y The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, 11,L4-02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive (Business/Organization/Individual): T 3tAJ Address; City>State/Zip:Q1�1 ,� j} ��4 5 Phone #: 66-3 -ZFZ —5-7-33 Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no -employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other -.7 "YY-, - ..+ic.:aa UUA w j 1"USi aisv Ull out me seCnon below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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). Failure to secure coverage as required under 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 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. I do hereby rh uO`r the Vns and penalties of perjury that the information provided above is true and correct, Phone *0" - y603 3F2 -2733 Official use only. Do not write in this area, to be completed by city or town officio[ City or Town: Permit/License # N Issuing Authority (circle one): L 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 horse 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 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 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 permittlicense 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 Iicense or permit to bum 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, IIIA 0:21.11. Tel. # 617-7274400 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 vmw.mass.gov/dia Date..... :... l..�...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that... �Ze T V............... ...................................... has permission to perform .......... .E '? './l.T, ....Age ..... �vr'PT wiring in the building of ........ L O Mi?�,.w%}.!.......................................... at ...... .... ....... !...�....................... . North Andover, Mass. Fee. ` ' l.'...... Lic. No .............. .... I ....."...+:... .................. ELECTRICAL INSPECTOR Check # 7370 9 -� Lommonweairn or massamuserrs r �.� �,u; �,� v �y Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ( C), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL I FO ATION) Date: O7 City or Town of: �%a To the Ins ec or of Wiles: By this application the undersigned gives otice of his or her intention to perfoa;m, the electrical work described below. Location (Street S Number) Owner or Tenant MAVU, AyeA= Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building S /1,) S/C- , Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No LI�T (Check Appropriate Box) Utility Authorization No. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters cnnlnletinn nfthe fnllnwi„a rnhlo ,, ,, A, o l h„ VI" LTJ. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KV A No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Lununaires Swimming Pool Above ❑ In -No. o Emergency ig ing rnd. 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 Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons g No. of Alerting Devices No. of Waste Disposers Heat Pump Number TonsKW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No. of No. of No. of Devices or Equivalent Heaters KW Signs Ballasts Data Wirin No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Ele trical Work: /�I (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COV RAGE: 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 cove ge is in force, and has exhibited proof of s ame the mut issuing off e. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) � 1/G�' %?`/31/7 I certify, under thepgsand pe (ties ofpetjury, zat the information on this application is true and complete. FIRM NAME: v QC 1, LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, enter "exempt -, in the lic ns number line.) / Bus. Tel. No.. Address: 1 /C /r2 l/(�� �-z Alt. Tel. No.: *Security System Contractor License required for this ork; if applicable, enter the license number here: 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 Signature Telephone No._ PERMIT FEE: $ !,..) Air Conditioners: $40.00 each Alarm Systems Security: (for fire systems see smoke/heat detectors) Residential: $40.00 Commercial: up to 10 Devices $60.00 additional devices over 10- $1.00 each Carnival Equipment: $50.00 each Ceiling Fans: $1.00 each Commercial New Construction or Alterations: $100.00 per 1,000 Sq. Ft. of Construction Space Commercial Service Change/ Repair: 14 im have Utility Authorization Number $100 (first 100 amperes or fraction, one meter) a) each additional 100 amperes capacity or fraction. $30.00 b) each additional meter $25.00 Commercial Temporary Service: $100.00 1'Iust have Utility Authorization N u tuber Commercial Repair and/or Maintenance Permit: (Blanket Permit) up to 2 Electricians $150.00 per pair of Electricians over 2 $50.00 Data/Telecommunication: Residential: $1.00 per port Commercial: $30.00 up to 10 devices over 10 - $1.00 each Dishwashers & Disposals: $5.00 Each Dryers: $15.00 Each Emergency Lighting (Battery Units) $ 1.00 each unit Feeders or Sub -feeders: each 100 amp capacity of fraction thereof Residential: $5.00 each Commercial: $15.00 each Gas/Oil Burners: Residential: $20.00 each Commercial $20.00 each l C:IAG141V1J IWOAUGHUM M Commercial: a) including photovoltaic & generating Equip Per KVA $1.00 b) un -interruptible power systems, per KVA $1.00 c) batteries over 100 amp. hours, per cell $1.00 Heat Devices: $1.00 each Heat Pumps: $40.00 each Hydro -Massage Bathtubs/ Hot Tubs: $20.00 each Lighting Fixtures $1.00 each Lighting Outlets: $1.00 each Major Appliances: (not listed) $20 each Motors: (per hp or fractional part thereof) $2.00 Oil /Gas Burners: Residential $20.00 each Commercial $20.00 each Office Furnishings: per circuit $10 (Relocatable Partitions/Cubicles) Outlets & Fixture: $1.00 each Ovens Built in/Counter Top Units: $10.00 each Panel Change/Circuit Breaker: Residential: $20.00 Commercial: $25.00 Phone Jacks: See data/telecommunications Ranges $15.00 each Receptacle Outlets: $1.00 each Recessed Fixtures: $1.00 each Re -inspection Fee: $25.00 Repair to Service Residential: $20.00 Residential New Construction (Dwelling): $220.00 (with service up to 200 amps) Must have Utility Authorization number for services over 200 amps see below a) for each 100 amps capacity or fraction add $20.00 b) each additional meter $10.00 c) each additional panel/sub panel $25.00 Residential Additions/Alterations: $220.00 maximum Residential Service Change or Underground Service: $40.00 Wfust have Utility Authorization Nuniber a) one meter, up to 100 amp capacity $40.00 b) each additional 100 amp capacity or fraction $20.00 I %.r Valhi 0.11U1L1V11C11 1116.N t ...p1 V. V V Sewer Ejection Pump: $25.00 Signs: $25.00 each ballast Smoke & Heat Detectors & Initiating Devices: Residential: $1.00 each Commercial: $60.00 up to 10 devices over 10 - $1.00 each Space Heaters: area, heating $1.00 each Sub -Panel: $25.00 Swimming Pools: Residential: Above Ground: $25.00 Inground: $50.00 Commercial Pool: $100.00 Switches: $1.00 each Temporary Service: Lt:ust have Utility Authorization Nunsber Residential $25.00 Commercial $100.00 Transformers: a) capacitors, Per KVA $1.00 b) ducts, conduit & conductors (Associated w/ Padmount Transformers) $25 c) each manhole $10.00 d) each handhold $5.00 e) per KVA, $1.00 f) primary feeders, $25.00 each (over 600 volts, non-utility owned) vaults and equip. $25.00 each Washers: $15.00 each Waste Disposals: $5.00 each Water Heaters: $30.00 each *Foil- Multi -Family & Large Commercial Project see Wiring .Inspector for pricing: Paul Kennedy (378) 623-8306 (Office Hours 8 am to 1.0 ani) . 'Inspection Schedule: I ROUGH I FINAL 1 TRENCH (if applicable) ADDITIONAL INSPECTIONS *S25.00 (if applicable) (revised 07/05) t N Date,/.6-..07("` 3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....�/".�f.�./..�?f..� has permission to perform ... jar. t ............................ plumbing in the buildings of. t/`1.A:f.9.�!...................... at .. �� ?... ?� . ! .�. �...l.L, r........ , North Andover, Mass. Fee. ? 1...... Lic. No.. ? ....... .........`. .......... ._-... . PLUMBING INSPECTOR Check # � r 576) I 11 l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) cj /� `� / J1'1jQ_, Mass. Date )`7_!Q3 Permit # 1 Building Location --9-:z 9 �!�at,o / � al /� � Owner's Name /7-o joa n Type of Occupancy Residential i4 r 1 New ❑ Renovation ❑ Replacement QQ Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg. &Plg. CO. Inc. Check one: Certificate Address 35 Pleasant Street CX Corporation 714 Stoneham, Ma 02180 E- ] Partnership Business Telephone 781 —43a-7776 F1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked rtes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 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 ❑ 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 the permit issued for this application will be in compliance with all • pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By SUS .- LA -).e QJ Signature of I icArse lu�m er Title Type of License: Master [X Journeyman Ej City/Town 8 3 2 2 APP Ucense Number cn _ rt 0 tn (no Z Z z W K J cn Y d U a ~ N _ O N n o J Z N - w - N .4 H N Cr w I: N MW !- U Q W N Y 2 Z d In a G W O d Z d - Q 4 t .1-� .F•, r(i F U Z z o ¢ d w ¢ a w- o d w z cc a W W w F- z F w 3 3 N 0 O z T' J N a F- Q Y O `t O w LL LL r Q v � x ►- o x °' z � � � z Z o 0 O of z z w � o r) Q Q N Q Q z N N Q d O Q J J Q 2 CL M d O Q 1r P VJ SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOG STH FLOOR Installing Company Name Heritage Htg. &Plg. CO. Inc. Check one: Certificate Address 35 Pleasant Street CX Corporation 714 Stoneham, Ma 02180 E- ] Partnership Business Telephone 781 —43a-7776 F1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked rtes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 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 ❑ 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 the permit issued for this application will be in compliance with all • pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By SUS .- LA -).e QJ Signature of I icArse lu�m er Title Type of License: Master [X Journeyman Ej City/Town 8 3 2 2 APP Ucense Number J z O W N w v LL LL O m O LL 3 O J W m 0 z_ m J a O O O r r cc O W Z a a 0 LL z 0 r d V 3 as w LL < N W V Y � N Date.',: -/?-,-v/ NU 4. / (-` �'.��•:'� TOWN OF NORTH ANDOVER .�� - �• hoc PERMIT FOR PLUMBING This certifies that .. ���/ �1,`l......A . .............. . has permission to perform ... f ....................... plumbing in the buildings of ...f . ........................... at. ` �..' ...: �.. �c tri l , , , , , , , , North Andover, Mass. Fee 4 !..... Lic. No .......... ..........r. .... ......... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer V V MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date d Permit # R Renovation L7 �- A ©, ner's (Name_ H0n0/`? _ Type of Occupancy Residential Replacement IN Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &Pig . Co. Inc. Address 35 1 eaaant Street Stoneham, Ma 02180 Business Telephone __781 — 4 3 8 —Z7j_6_ Name of Licensed Plumber Gordon Switzer Check one: LX Corporation [] Partnership 11 Firm/ Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ It you have checked Yes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Slonalnrw of (iwnor e.....0 Owner ❑ Agent ❑ i nereoy 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Plumbing and Chapter 142 of the General Laws. 6y �a A1 Signature of Licensod Plum er City/Town Type of License: Master iX Journeyman ❑ 8 3 2 2 APPFiOVE�OTFICE SE ONLY) License Number Z N r -i iron Z 0a Y a r- •rI O r9 r --t W '- w n V Y Z u� a n r z w a N O — w N w N CC H z~ U a N — r� o w Z z _. .. �� ,�.) Q� .1-r •1-� 34 i� U Z ¢ o m N N ¢ } N x a O a C i rii Ri i t w z ~ ? w s O O j J N 2 J .� p 7 r_ 0 a z 3= a x x r x a o r _ .t w LL u S4 a r- Q o z N N _ Q �' Q 0 z a o o J v' Q —- rr CC w~ a s a Q��1 4 r q +� Y J m Up J 3 z H uJ w O A Z LC at SUB—BSMT, BASEMENT _ IST FLOOR _. 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg . &Pig . Co. Inc. Address 35 1 eaaant Street Stoneham, Ma 02180 Business Telephone __781 — 4 3 8 —Z7j_6_ Name of Licensed Plumber Gordon Switzer Check one: LX Corporation [] Partnership 11 Firm/ Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ It you have checked Yes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Slonalnrw of (iwnor e.....0 Owner ❑ Agent ❑ i nereoy 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Plumbing and Chapter 142 of the General Laws. 6y �a A1 Signature of Licensod Plum er City/Town Type of License: Master iX Journeyman ❑ 8 3 2 2 APPFiOVE�OTFICE SE ONLY) License Number } J z 0 w N w U LL LL O 0 LL. 3 0 J w m N z O U W CL N z N N W C U OI al N z O F U w a N z J a z LL w w LL 0 z O z m i J a 0 A O r r W a 0 LL z O F 4 V J M m a J a 0 2 5 1 6 Date ...... ...l�.� U TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that......... —4.k Sr C 5r J has permission to perform ......... G ..... c �......................... wiring in the building of ............................... ........................ .......... at ............. Andov MC17 SU................... ......................ZorthFee.3��4.... Lic. No. `. .........<a.............. .......... LECTRICAL INSPECTOR Check # Ul VM, �y WHITE: Applicant CANARY: Building Dept. PINK: Treasurer V' Commonwealth of Massachusetts -f Department of Fire Services - BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 11/99] (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: 14 tJ & U S -r P, �1 0 0 a City or Town of: VOP -7-9 410,boUP/� 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) 97 5,L) Ali / J E Owner or Tenant 199 ATT �C vim) fiord i Telephone No. ?479qlll Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® • (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: urs � el -r " fry Completion o%the following table may be waived by the Ins eetor of fFires. No. of Recessed Fixtures No. of Cet1-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ n- ❑ g rnd. grnd. a o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Bulrners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices b No. of Waste Disposers Heat Pump I Number I Tons JKW INo. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local Municipal ❑ Other ction No. of Driers Heating Appliances KW stems: a of Devices or Equivalent j,3 No. of Water KW o. o o. of Data Wiring: Heaters Signs Ballasts Na of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER Attach additional detail if desired or as required b l the Inspector of Wires. 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:) Estimated Value of El ctrical Work: '/,55- 1-1 (Expiration Date) �j (When required by municipal polity.) Work to Start: S d� Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and penalties ojperjury, that the information on this application is true and complete. FIRM NAME: ADT Security Services 111 Morse Street, Non4o(L MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Signatur (If applicable, enter "exempt " in the license number line.) Address: OWNER'S INSURANCE WAIVER: 1 "am aium that the Li enset does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: 1533C Bus. Tel. No.: -1 Alt. Tel. No.: 603-.594-.59 resi not have lite liability insurance coverage normally ONLY Iain the (check one) ❑ owner ❑w oner's agent. PERAII T FEE: SOS, N No 2 5 13 6 Date...... i?�Q.... °.,``° TOWN OF NORTH ANDOVER •_R _..a,_ a QL p PERMIT FOR WIRING This certifies that........4 �.o ......................................................................... , has permission to perform ....... f ..4....:.........��........................... wiring in the building of ......1.�.�.�. P�/ .. t�............................................... �' ``� ... ,1�iorth Andover., ass. at ...........%.. �...... 5 ............. .2:..(..... �... ..... Fee ...... l 5....: �(J Lic. No. �� ../.?� /. � � ............ r .�� % �....................... / � 3K / LECTR(CAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 01 4t (fammunwalo of 149mar4uliet f9epartment of Public =%afetg BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 Office Use Only/� Permit No. v Occupancy & Fee Checked 3/90 (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 .1 / x -V City or Town of _& Ate/ To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) `f 7 y�-1w /r4it e .C6 Owner or Tenant Owner's Address 15,97W1_1 Is this permit in conjun tion with a building permit: Yes ❑ No D(Check Appropriate Box) Purpose of Building lkle_zt_ r ylic/ 49�e Utility Authorization No. Existing Service/�v Amps�� /��y Volts Overhead E�Undgrnd ❑ No. of Meters _L — New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity e,4 Location and Nature of Proposed Electrical Work .�/7,!5Z/ No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ grnd. grnd. GeneratorsA 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. f Zones No. of Detection an No. of Ranges No. of Air Cond. Tot t ns Initiating Devices No. of Disposals No.of Heat Tot Total Pumps T s KW No. of Soundi g Devices No. of Self ontained No. of Dishwa ers Space/Area H ting KW Detectio Sounding Devices Local Municipal E] Other ❑ No. of Drye Heating D vices KW Connection No. 0!/No. of LoW Voltage No. of ater Heaters KW Signs Ballasts iring Not Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Compjl Wd Operations Coverage or its substantial equivalent. YES -'-N'O G I have submitted valid proof of same to the Office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appro fate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ Work to Start iyi&�! Inspection Date Requested: Signed under the P nalties of perjury: FIRM NAME tT� �+ / ,L Licensee A457zCL Sinnaturw Address Rough& Final Bus. Tel. No. Alt. Tel. No. (Expiration Date) LIC. NO.l�–�� LIC. NO.-c=�3/2"> OWNER'S INSURANCE WAIVER: 1 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. Ow , Ageftt (Please check one) Telephone No. PERMIT FEE $ V (Signature of Owner or Agent) x-6565 Location / '% �-�t<�--} .2 • {" ��' �No. o- Date A N NORTH TOWN OF NORTH ANDOVER Oi•t.•o ,1h•G pp p Certificate of Occupancy $ Building/Frame Permit Fee $ 4sFoundation Permit Fee $ Other Permit Fee $ 0 Sewer Connection Fee $ Water Connection Fee $ __C TOTAL $ ti y Building Inspe 4or 22 Div. Public Works Location to CkAU►cIc s+ i No. Date f NORT#1 TOWN OF NORTH ANDOVER n Certificate of Occupancy $ ° ;•� Building/Frame Permit Fee $ Eco Foundation P chit Fee $ Jaws A Wee thT ee $ Sewer Connection Fee $ Water Connnep4'on Fee $ Building Inspector i J 0004/2 Div. 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CDo ' TJ CD Z c, �• C) 0r 8* CD 7 a� CCD O: rL.v C O_ 1 U CD_ � C', 1 C O O /r 0 cnCn r 0 O o w rD an -n w � 00_ x y 0 �A w 0 (7 O C � O x O a aITI Cy r 0 � p a 7C G7 9r y IJ omq 0 9 0 c 11 %MAY -10-99 MON 12:00 PM P. 1 F.I.D. No. 17.2320449�€ � MB LIC. No, DD1893 Job N 3.5 bb NHL No, M�M MA ltok. Ne. t 20466 SALIES1 FOR ALL HVl l l�lr New York Deo. of Consumer HV'�tl' 1'�YI� Al1eNa Lk. No. 0730866 New York: SERVICEIREPAIRS til l a Nassau Ltd, No. M27041MOOD 800-942.6111 PLEASE CALL The Service Side of Sears Suffolk Lk. No. 21 194H 80310�t: 81iB.�Z•��iT Yonkers 1397 800SEd Area: SIDING WeetchnrerWC0613•H67 Hertford Area: Now Jolley Lit. No. Lo11064 CONTRACT 000•SEARS-99 Connocticut Caere, of censutnar Providen�1ce Area: Affairs Llc. No. 00532774 88111 -SEARS -5i VT LIC. No. Rhode bland Uo, o. I Z` SOLO TO .i !p ADDRESS PHONE (Home) ON % ZC07 7 CITY �r STAT ZIP (APHONE (Work) ()%F"?,%/0 JOB SITE ADDRESS (if diHerenl) APPLIED VINYL & ALUMINUM SIDING CL"Wrek nN ct1Ua� Sold, Furnished 6 Inatelled by ad•Rey Numinum Skiing Corp. of 0 no, Inc. lata 311 a? 19 Lyman at., gulls M1 A Sears Autho ixeP Contractor �y . l �� r— f f ra"'T isle Westborough, MA 01561 44 Elmore Rd. Elmoni, NY tibd3-fahr•P CQ�C [if cP O t! /)Qrcrltr f tJrl CapTav General DfAcripiion of Work at Above Address; Approx. Start Dale: Typo of House: b4ame 11 Masonry Approx. Completion Date: b .�/ � _ �5lL^ItK'4 SPECIFICATIONS ht r! Sears approved malerleLn will be "shed end Installed to these epeelAeelbrrs: III/��� �YE�S,� PLEASE READ CAMEFULLY. ONLY THE ITEMS CHECKEO'YES` ARE INCLUDED IN YOUR ORDER. i/ C� 0 SOLID VINYLSIDING•cover my at raedsslgnabdloreid g etpl(Feselreas natedbelow. 3ge-------- Z Color Palkrn Packape 117L Custom canter poatscNor IA�51DING wdlytepplled to the Ilow p a only 1 c.F�F 1 Elevation -a III %411on 0 Engrg oelailt:.�_ h '~ aeElevation Met Elevation 0Partial pYtpp.,ts1 ❑ OIMr 0 (eta rxultR .1 2..E1'� INSULATION • Cover only Ilalwall Veli designated for slake With Inch Insulation. � O U 16ara approved CALVM19ED 67EEL STARTER STRIP where cal aclorY Deems nectssary (Not awReEla wlln Nan le.) 4. O 10110 to be applied over existing foundation. p5.�� G use Stara approved PERMA TABS AND FINISH STRIP where contractor deems necessary In same Wil r u 91TIAO. (Not avaaabla with Nalnto.) :� O WINDO OPENINGS a{}e(alaIn wrap Willi Sears approved vinyl clad aluminum tit � Color a d Jump Over Castings with siding and 'J' channel Color 13 Channel exlslIng window only (00. Angolan "or proviousty wrapped) III Color / Details 7KI HULK, all sills with rubberized color co-ordinated caulking syr p0 p n5 - custom wrap With SEARS approvad VINYL CLAD ALUMINUM. er of Doors Cola 9. Ej J;1, AMGEDOOAFRAMES•cuslamwrnowLNSEARSepprwadVINYL CLADALUMINUM.Color �Jingle E] Double With Mull a Double No Mull D. •cuslomwrap with SEARSapprovedVINYL CLAD ALUMINUM. Color I • (eavaVoverhangs) Cover With SEARS approved SOLID VINYL SOFFIT SYSTEM. Except Val noted below. 'AVenled. Color iENWOOD•WillonlyInrcpaindorreplacedwherespaiaedonlineitem,y27Eshsdbelow.Anyadditionalareasneedkparepel,l iljbeealimelodUpon "' Uislr discovery and priced accordingly. (Does not Include wood studs, or exlerlor sheaUxnp). 13,w U Remove existing malergl On eRldrlat of house• Cl Vinyl 0 Aluminum 0 Wood Shingle CJ Wood Siding Q4or DW not Include any asboftos removal. 11.0 ORCH CEILINGS - cover Win SEARS approved SOLID VINYL CEILING MATERIAL in the folowing arias Is.O le, 11" wrap wilhSEARS opliVNInCLAD ALUMINUM (No circular orround columns).Color 15.0 le ERsn.EACER3-remove exlating and replace with new Colem Stainless outlets and leaders, While Broom 17. U HU TIERS• provide and install,SEAR6app<ovedpplysiyranaBlutters.Color _ 19 ASTEllMOUNTS-provideanOmslansor _ exterJafight fixtures only.Cob1 1g. C] GABLE VENTS - provide and Install vols. Color r No circular or tdingle vents. 20CLEAN UP oroperi it wmpk(lo t of work, / , — 21. INSURANCE • all requhtd WAXIVANS COMP. and LIABILITY to be maintalnad. I(� mletdve0 ,on Appnod 22.6�lff WARRANTY - mill b CV3101Tter /her completion and full poymtnl Is received. 23 PAYMENTS on NON•FINANCED Orden Instiller b 1uNorked to coltct proprl4sive paLnnPnis. Oelorrcd Payment, Inleroq will ACCnm 21. �'ALL DISCOUNTS APPLIED. /�44 25(57/❑ Ab tTl HAL WORK - not s pilled a Otis F ��TR IP e5 I C SIF 3 f .P.,.0... _ q!R!6 .g _ a Cash Sale Total 11!y7les de it 33% $� Cash Balance $ 22 Olher Payment (if arty) $ r_I CASH t2rFINANCI! SU 7�F I does not include Interest Bit an Substantial Complellon $ 11 flnfrall, belenee payable M t t LA _ monthly Inatiamenls W approxlmafab S oar month. payable by 'owns- so uu6ador but d 11nonte4 by Owner then owner will ply Sal amouni 10 drt kndinp Indtilution plus such f Merest and credit service charge of said lending institution payable dlreclfv to the lending Incltuuon loaning tum monies to 'Owner' and will assault a Retail Installment obligation and any documents roauirod by such lending institution in connecli"h such Wan, 26tcYo WORKNOTtobodono._al d1¢rot, N1 uF 27 0 RepNfol,cothe �following woodss At I a �r1 NOTICE, II Mumad, NY 114W M eW Cenfuror Cntol Conne a bot re au01001 % to M16nm 11616.105 which nM 11veM said 55x11 paul eu neer el mob or rtnkn ON" pvau6,e no,uo 6r V61A eau procoaN rlereol. Fewveey by an debtor linea col biretta -Y,45 pew by list debla ho,ou.11 ,. "OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLICATE ORIGINAL OF THIS AGREEMENT AND TO BE THE AUTHORIZED AGENT OF ALL "OWNERS" OF THIS PROPERTY UPON WHICH THE WORK OR THE MATERIALS ARE TO BE SUPPLIED. NOTICE TO THE HOME OWNER(S), GUARANTOR(S), LE$SEE(S), CO-SIGNER(S). Contractor, ed theexpento of ow"r, shall procure all permflo required by lata as lollawe: 1, Owners Who secure their awn permits *of be secluded from the yeprenly fund provlsrons of MSL Chapter 1421- 2, Any porion who whoa havo co-signed, guavntwed or signed any credit application or note rotating to this agreement hereby acceplo to be bound by this Parliament, 3, OWtiorM represents that the contents on the bock of No Paret- ` man► is a true pert hereof and hu been read and accepted by Owner. 4. ALL INSTALLAT N G RAN E I (ONE) YEAR, Delhi 6 5005man s NomSipnehere Salesman's License No. Signature SEE REVERSE SIDE FOR ADDITIONAL SALESMAN NAS NO AUTHORITY TO CHANGE ANY TERMS OR MAKE ANY REPRESENTATIONS OTHER THAN CON- TAINEb IN THIS AGREEMENT AND"OWNER" REPRESEN FS THAT NONE HAVE BEEN MADE TO OR RELIED UPON BY "OWNER". YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE ORIGINAL OF THIS AGREEMENT. "YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT, ON ALL ORDERS CANCEL- LED AFTER THE RECISION PERIOD, CUSTOMERS WILL BE RESPANSIBLE FOR A 20% ADMINIO rHATIVE AND AE. STOCKING FEE. THE COMPANY WILL DEPOSIT ALL MONIES RECEIVED #105-1-062069, WI RECEIPT, Date Do not sign this it chains any b or S Here) TERMS AND CONDITIONS DAYS OF ITS :tore you read It or If II It does not contain r (� d, ~ HOME IMPROVEMENT CONTRACTORS REGISTRATION i Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR - Registration 120456 Expiration 01/01/00 Type - PRIVATE CORPORATION BIL -RAY ALUM, SIDING CORP JOHN O'NEIL 4.0 ELMONT RD ELMONT NY 11003 ACORD,. CERTIFICATE OF LIABILITY INSURANCEDA7EaUaA=nM 08/OS 98 rRooucER T�l1S CERTIFICILTE IS ISSUED AS A MATTER OF iNFOR,MATION COUNTRY INN INSURANCE AGENCY, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 217 MERRICX ROAD ALTER THE CCiVERAGE AFFORDED BY THE POLICIES BELOW. SUITE 212 AXITYVILLE , NY 117 C NSURERS AFFORDING COVERAGE. BIL—RAY ALUMINUM SIDING CORP. INSURER AlliiLL.i' LISURANCE CORPORATION OF NY 134-10 ATLANTIC AVENUE INsupma.-CIGNA 'INSURANCE COMPANY RICMIOND HILL, NEW YORK 11419 INw-vwx cREALM INSURANCE COMPANY c-llvFuer.F-q THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFO ABOVE "OR THE POLICY PERIOD INDICATED. NOT11bTfHSTANDWG ANY RECLOMEMefC, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ROPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR W. Y PEI? TA1N. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUMCT TO ALL THE TERMBs£(CLVSJ01l AND CONDITIONS OF SUCH POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS- INSR 1 TYPE OF INiiliiANCE POLICY NU1dRt3t �'OUCY �Tr*'E mu' Y EXPSRAw uMrm GENERAL UAXUrrY EAC.4 OCCURRENCE 21 000,000 X COMMERCAL GENERA- LL4BILTTY ARE DAMAGE (Arm wo A -al s 50,000 CLAIMS MADE 7 OCCUR MED M Wry OM OW2&Q s 5 000 A IGL006886 05/14/99; .05/14/00 PERSONAL IAAOVINJURY 61,A00, 000 GENERAL AGGRECATE *2,000 000 GIN'L AGGREOJATE LIMIT APPLIES PERI PRODUCTS - COMPIOP AGC F-1 �a POLICY Loc AITroMo611E UABa TY COMBINED SINGLE LIMIT APPY AUTO (Ea �ceidanq � 400u.Y INJURY ALL OWNM ALTOS SCHE:)L"—OD AUTOS rw pO7or4 s HIRED AUTOS NON•OWNED AUTOS « BODILY INJURY i IAr oodAw tl PROPSgTY DAMAGE s i I (PQ ,me",a i dAP=Z LL&anTY AUTO ONLY . EA ACCIOENT s OTHM THAN EA ACC t ANY AUTO I AUTO ONLY: AGG t EXCE= UACnXry EACH OCCURRENCE 1= 3 0 0 0 0 0 0 OCCUR `• ' CLAIMS MADE AGGREGATE S 3 0 0 0 0 0 0 B BINDER # 05/14/991 105/14/00 s DEDUCTIBLE CII 514 9 7 s< a RETENTION s WOFIX13M COME-INWAT10Y ANDLrrY g I WC STATUE OTH C H`"«"`MFW u''� BINDER # 05/14/99 05/14/00 E.L. EACHACCIDExT $500,000 CII 514 9 8 E.L. OISEASE - EA EMPLOYEE 0500,000 E.L. DIswe - POLICY UMIT 9500, 0 00 OTHER D DISABILITY BINDER # 06/01/98 UNIrIL C1151499 I CA3C=D OE3CRIP }ON OF OP9tATVN=CAM0NSNMC3FSlFJ UXllONS AD= BY 2=<MlMWfflXFEClA -"=l L90N3 CERTIFICATE K scat CANCE_.LAT10N r,KM D A. -TY OF THE•160VE DESCICBED POUCIE3 6E CAM_-tFD BFFDRE TM EXIIRAT)0N MATS Tl- t F. TM IStI M INSURER WILL 6NDFAVOR TO M.LL 30 DAYS wmT'Tm NDT=r; TD THE COM:ICATE HOLD@t HAm= To TME LENT, sur ^; =wM TO 00 30 StMiL Ur'O" NO OBUCAnn* OR UAM TTY OF Alit IQNO UPON THE INSURER. TTS ACEIiTS Oft P81tS3 WrA '--1 NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542. BUSMESS FORM FOR TOWN CLERK DATE: (0&4 NAME: A I.JGN ADDRESS: `� �Mvd�— ZONING DISTRICT:/ TYPE OF BUSINESS: (D)AS BUILDING LAYOUT PROVIDED: AVAILABLE PARKING SPACES: N /A ZONING BY LAW USAGE:NO BUILDING INSPECTOR SIGNATURE Revived 11.5. 04 �J BUSINESS FORM FOP. MWN CLERK j 'SSyItJ ��i w'(� bL4Sl�R*sS ldV1 lLL:� itil`�� iil°v �S VIA a I Date .... f Z. -.L-7`119..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... '--Z4 has permission to perform A zz wiring in the building of .................t` p&f!&� .... ...................................... '!��J( .... jah ............................ North Andover, Mass. at .....7.......S...........o . Fee (Pp .......... Lic. No::. 3x............. ........... EL RI*C*ALNS i ** P**E* R Check # 9170 Commonwealth of Massachusetts kVDepartment of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 0 70 Occupancy and Fee Checked ,ev. 1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 5 7 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: � f City or Town of: NORTH ANDOVER To the In of Wires: By this application the undersigned gives notice of his or h_ intention to perform the electrical work described below. Location (Street & Number) 7 3,4 It j M r % / /J1 Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building ermit? Yes Purpose of Building/ NO ❑ (Check Appropriate Box) � M ` ` Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: �,,,. _ d A,� 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 Completion of the No. of Ceil: Susp. (Paddle) Fans of Hot Tubs Swimming Pool `tet gr No. of Oil Burners No. of Gas Burners No. of Air Cond. Totals: u Fol No. of Meters No. of Meters Je4IT K !able may be waived by the Inspector of Wires No. of Total Transformers KVA Generators KVA IFILRE ALARMS No. of Zones No. of Detection and Tnitiatin Devices Total Tons No. of Alerting Devices ons KW Nn of Coif_h,.-.a_s__� Space/Area Heating KW No. of Dryers Heating Appliances KW No. of Water No. of Heaters KW No. of Signs Ballasts No. Hydromassage Bathtubs OTHER: 1, low No. of Motors Total HP C 11 u. ul Levices or ! Data Wiring: No. of Devices or F Telecommunications 1 No. of Devices or E ❑ Other Estimated Value of Eectrical Work: _!�, Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE O GE: 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 cove ge is in force, and has exhibited proof of IiZ"i permit issuing o ce. CHECK ONE: INSURANCE BOND ❑ OTHER %Z %I certi ❑ (Spectfy:) vfy, under the ai nd ez�rgsg%erjury, th the intton on thts appon is tr a compl�C/ p p FIRM NAME: �� Licensee '�� LIC. NO.: U Signatur LIC. NO.: (If applicable, en empt " 'n he li nse number li .) Address: Bus. Tel. No.: *Per M.G.L c. 147, s. 57- 1, security won equines Dic ty AIL Tel. No.: , OWNER'S INSURANCE WAIVER: I am aware that Department Licensee a does not have,the liability Lic. No. required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ownercoowner's gent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Ah "' S I Qin I Z- �� o � ''