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04t Lfamn Dnwailth of �$cZL}�lI5P 5 Permit No.
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-_ lepazttment of Public —Aafrtq Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICALWORK
All work to be performed in accordance with the Massachusetts Electrical Code, 5
27 CMR (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(X)Q or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Numb ) ���GieG'�l917
Owner or Tenant
Owner's Address��-
Is this permit in conjunction with a building permit: Yes _ No C (Check Appropriate Box)
wi
Purpose of Buildina 1 ' �'�'r'� 14 Utility Authorization No. ✓ V
Existing ServiceAmos /—J Volts Overhead !—i Undgrnd No. of Meters
New Service A y Amps Vaits Overhead Uncgrnd No. of Meters
Number of Feeders and AmpacityL D x
Location and Nature of Proposed Elecmcai Work ��v` /
V
No. of Lignttng Outlets
i No. of Hct ubs
(
Total
No. of Transformers KVA
No. of UghFixtures
I
Swimming Pool A e—
g•ting
crnc. —
! Generators KVA
No. of Emergency Lighting
No. of Recectave Cutlets
i No. of Cil Burners
Barery Units
No. of Switch Outlets
I No. of Gas Burners
FiP.E ALARMS No. of Zones
Total
No. of Detection and
No. of Ranges
I No. of Air Core_ tons
Initiating Devices
Heat Total
Totat
No. of Disposals
No.of?ur^cs cons
KW
No. of Souneing Devices
No. of Seit Contained
No. of Dishwashers
i SoaceiArea Hearing
KW
Oetect:oniSouneing Devices
No. of Dryers
Heating Devices
KW
— Muntcicai '—Other
Local _ Conne'ct:on
No. of No. of
Low Voltage
No. of Water Heaters KW
! Signs Satiasts
Wirinc _
No. Hyaro Massage Tubs
I No. of Motors Total HP
OTHER:
1
4L
INSURANCE COVERAGE: Pursuant to the reautrements of Massae -users ;eneral Laws _
I have a current Liaetiity Insurance Policy inc!ucmg Comc!eted Ocerations Coverage or its sucstanual eauivaient. YES NO — !
have suornineo valid proof of same to the Office. YES ;' NO _ If you have checkea YES. -lease maicate the type of coverage cy
checking the aoproortate oox.
INSURANCE 4D BONO = OTHER = (Please Scec:fy) (Exotration Date)
Estimated Value of E!ec:ncal Work S
Inspection Cats Raguest2a: Rough
F�nai
Work to Start
Signea unser the enaities of er ury:
LIC. NO. __---„
FIRM NAME LIC. NO.
Ucensee Signature 8.
Bus. Tel. No.
- Alt. Tel. No.
Address as
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee toes not nave the insurance coverage or its suostanttal eauivale t o
auireo by Massachusetts General Laws. ana that my signature on :his permit aopitcation waives this reouirement. Owner Agent
(P!ease check one)
Teteonone No. PERMIT FEE S
(Signature of Owner or Agents %'65 65
ae,;,..>»� �=�tiv;�.55w.x._.�y-._.,. .:-� N.---�:���".ey'31'"'"s."""e'a%.N,1P:..�� .�- ....,.>....,._•."�+:�
L
Date ... 1. .
2663
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NORTH TOWN OF -NORTH ANDOVER r,
_ 0 ..... , ,qhs
j '�. ��, PERMIT FOR kL "ATION
a
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�4SS4C,HUSES M
8 �+
This certifies that t,>...:.:...,:
has permission for gats st Nation ........ .Al
(�
in the. buildi s _of :.
RA.� .{p North Andover, Mass
Fee. /. Lic. N <d I s ............. .......... .. ��
t _ GAS INSPECTOR
y} -*50
WHITE: Applicant CATRR4iY Building Dept PINK: Treasurer GOLD: Fil
^ = The Commonwealth of Massachusetts Office Use Only
4
Permit No.
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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 �17(11
City or Town of /- , f}tia® UES To the Inspector of Wires:
The undersigned applies for a permittoperform the electrical work described below.
Location (Street & Number) / / .5-u G R /Z 6 /q fu F Lli`yo
I
Owner or Tenant rs U t Q I t l ot ��' lak
Owner's Address
Is this permit in conjunction with a building permit yes L'O no ❑ (Ch�,;k Appropriate Box)
Purpose of Building R -es, `
/ G��y7 -),/ -, / 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 Nat*.,,a of Proposed Electrical Work l'Gr,'-& A9' (_A 17 %`
OTHER:
S�&U" —f'7 /�-I_A !Z A4,
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy I cluding Completed Operations Coverage or its substantial equivalent.
valid proof of same to this office. YES fl N' O ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ 41, G a a
Work to Start i Inspection Date Requested
Signed under the penalties of perjury:
FIRM NAME 5 2 ✓ 2 /VII It-' (
Licensee & der-/ 0 J[/ L-14"� Signature
YES e< ❑ I haave submitted
Rough Final
Bus. tel.
(Expiration Date)
. NO. 47 y -5 -C-
LIC. NO. _V q-1 0
No�0 9_6e2-t.Vil
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent • (Please check one r
Telephone No. PERMIT FEE $ S
G�? '/ (Signature of Owner or Agent)
TOTAL
No. of lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
No. of Lighting Fixtures
Above In
Swimming Pool grnd. ❑ rnd ❑
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. of Detection and
TOTAL
No. of Ranges
No. of Air Conditioners TONS
Initiating Devices
No. of Sounding Devices
HEAT TOTAL TOTAL
No. of Disposals
No. of Pumps TONS KW
No. of Self Contained
Detection/Sounding Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
❑ ❑
No. of Dryers
Heating Devices KW
Local Connection Other
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. of Hydro Massae Tubs
No. of Motors Total HP
OTHER:
S�&U" —f'7 /�-I_A !Z A4,
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy I cluding Completed Operations Coverage or its substantial equivalent.
valid proof of same to this office. YES fl N' O ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ 41, G a a
Work to Start i Inspection Date Requested
Signed under the penalties of perjury:
FIRM NAME 5 2 ✓ 2 /VII It-' (
Licensee & der-/ 0 J[/ L-14"� Signature
YES e< ❑ I haave submitted
Rough Final
Bus. tel.
(Expiration Date)
. NO. 47 y -5 -C-
LIC. NO. _V q-1 0
No�0 9_6e2-t.Vil
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by
Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent • (Please check one r
Telephone No. PERMIT FEE $ S
G�? '/ (Signature of Owner or Agent)
7y } f
DI
'�-
26ate....
x
AORTH - TOWN OF NORTH ANDOVER -A.2
p PERMIT FOR GX& INSTALLATION
�9SSAC HUSEt
This certifies that ........✓T!1 / �,!'.,"�!,' ."
has permission for 'installation .. �:lq
in the buildings of `ca: � . U�As......
at ...: : e'• . J vc. ei k P..'... . ,. North Andover, Mass.
Fee 3S,,. C%! Lic. No.
..
((5.w*�33IOR%ttWqqkpb"4.nt CZARY::Buildi.Detp.PINK:Treasurer:
GOLD: File- '
--b.-....ri-�;..--�..'�a+w+:..,.•�,-�..+-°'�-^��``�iir'^'`a.�✓°°7i,.��--a..s+Lis'wi,,:.hw....r �- �.�..
L j d
Location-
No.
ocation No, Date
NaRT� TOWN OP NORTH ANDOVER
A Certificate of Occupancy
$
# Building/Frame Permit Fee
$
ss�cwust Foundation Permit Fee
$
Other Permit Fee
$
F, Sewer Connection Fee
$
Water Connection -Fee
$
TOTAL
.l
ilding Inspector
—I`84fGi1`r.�1( PAID
9.654 Div. Public Works
•
Z -a
l0 5
o9at,ion. ;fe
Date
No.,
NORTH '
"TOWN OF NORTH ANDOVER
.0
0 Certificate of Occupancy $
4L Building/Frame Permit Fee
CMusEt .Foundation Peimit Fee $
.-..-'Ot.her Permit Fee
S4'wer Connection Fee
2'
5-73 Water Conn tion,Fee Zoz -7, /ZQ
TOTAL
ild', I ect.
Div Alic Works,
� �f
Location [ /f r'�4
No. d % Date
. ,
f NpRTij 1
TOWN OF NORTH ANDOVER$
4a. t
0*��0 '• 'y0 s a
owrZANSiMMIL Certificate of Occupancy $
_ F A ` �1
` Building/Frame Permit Fee $ u 3
Foundation Permit Fee $
t
SSACH
Other Permit, Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ . C�
' t (� _ Building Inspector.
` 9 6,5 5 Div. Public Works
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 6 Loy. ,4 L"I .— oZ . (U�e Phone d rZ -21.2.)
LOCATION: Assessor's Map Number 16,ir,9 Parcel _IV
Subdivision i 019.�S Lot(s)
Street 99 S^,*%gz e 4Aa,.e_ St. Number 22
************************Official Use Only************************
RECOMMENDATIONS OF TO AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments ` & 4,5 iN100 e , eV,)5iJ,) OL
Town Planner
Comments
Food Inspector -Health
Sep is Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- drive ay perm' t Z- (S -
Fire Departmentc1-
Received by Building Inspector pate
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