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HomeMy WebLinkAboutMiscellaneous - Exception (99)rs rm 1 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and may be.deemed-by the -Inspector-of_Wires abandoned-and-invalidlfhe—_. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written W request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. !1. 8—Permit/Date Closed: IJ Note: Reapply for new permij)ff-I 0 Permit Extension Act — Permit/Date Closed: 9 66r Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... 19.q' ... 17..q..e . .............`f...!..e�� /,' /r '�: .... . .............. . ........... has permission to perform ..... ......... ......�. wiring in the building of ..... ............ 7 ....... at ........ .9 .— ................... ... .. North Andover, Mass. Fee ..5?? .... Lic. No. /?'.�;zpw ....... Z k� Ei ICAL INSPECTOR Check # 1-0.. -C-\ Commonwealth of Massachusetts Official Use Only MIEW Department of Fire Services Permit No.� S 9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code i(MSCMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2 /'710 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intentio to perform the electrical work described below. Location (Street & Number) /d b %2 E�6 ccs Owner or Tenant i A 0 f— 11 i A G Owner's Address /© Ea 5f We , Is this permit in conjunction with a building permit? Yes Purpose of Building 2 ✓� / .� (�� y r a'o r� Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity L a c h Telephone No. 9 7Li75 —O gy `71 No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ 4 - Location and Nature of Proposed Electrical Work: l r, he„U a c1d i f i U,, S No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Z No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- -1o. rnd. rnd. o Emergency Lighting Bette Units No. of Receptacle Outlets /3 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I.NR Tons KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ElOther Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of WaterKW Heaters No. of No. of Signs Ballasts Data Wiring: 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 Electrical Work: (When required by municipal policy.) Work to Start: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties of per'ury, that the information on this application is true and complete: FIRM NAME: LIC. NO.: 12'7�YF� t12 Licensee: Ley, r 1i r2 1%C .e Signature 1.ci LIC. NO.: 1 2 12— (If applicable, enter "ex t" in the license gber line. ifff B s. Tel. No. -/,2n3— " Address: �� �/5 % Alt Tel. No.:lckoZ-097 *Per M.G.LC 147, s. 57-61, security work requ' es Department of Public Safety "S" License: Lic. No. OWNER'S I %4N. WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. signature below, khereby waive this requirement. I am the (check one) ZLowner ❑ owner's agent. Owner/ t j ��� P ���_� �� O�t( PERMIT FEE: $ �U O Signa �� a Telephone No. www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name (Business/Organization/Individual):_ C/ 1 C_ Address: /0 E, Q)a TCS S 4 k City/State/Zip: Ai(A0 dd\Jt � � M9 d) 0hone #: 9 % 9 7 5 6 i 4 y Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts ^, Department of Industrial Accidents ;;. office of Investigations 1 at L 600 Washington Street "J Boston, MA 42111 workers' comp. insurance. [No workers' comp. insurance www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name (Business/Organization/Individual):_ C/ 1 C_ Address: /0 E, Q)a TCS S 4 k City/State/Zip: Ai(A0 dd\Jt � � M9 d) 0hone #: 9 % 9 7 5 6 i 4 y Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 art► a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub -contractors have working for mein any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ElWe are a corporation and its required.] officers have exercised their 3.5 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. [❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ® Electrical repairs or additions 11. Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks bog # I must also fill out the section below showing their workers' compensation policy information. t 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. 1 am ann 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 cert fy unde its andyenalties of perjury that the information provided apove is true and correct O -i Phone #: ��% 9'7 5� O y ((_-01 BD� K�Q�7 97?'L,1%9 �3> Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm. or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing constmction activity, and may be.deemed.by. the7nspector_of_Wires abandoned-and.invalid-if he— .. _ ' or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long -terra economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extendingthrough August 15, 2012. 9-RUle 8 — Permit/Date Closed: - Z / * Note: Reapply for neff permit )4ermit Extension Act—Permit/Date Closed: ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shalLbe limited as to the time of -ongoing construction activity, and may be.deemed.by the lnspector_of_Wires abandoned.and.invalid-if_he—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ 0 Permit Extension Act—Permit/Date Closed: I 4 I /- 416 - 10 (0 nate.... .............................. TOWN OF NORTH ANDOVER 0, PERMIT FOR WIRING This certifies that ................ A C C- .................. .............................. bas permission to perform ............... wiring in the building of ........ ............................ f f-t�� 'at .... /!0 614377- .-; N6fith Andover, Mass. ........................................................... Fee. g"":4. Lic. No. ............ ....... A -A K, -, LECrRICAL-INSPECfOR' Check 7 0 illk 0 01 OW Commonwealth of Massachusetts Official _Use Only Department of Fire Services Permit No. FlJ Occupancy and Fee Checked a 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 (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11-5--o(--> City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)_ Owner or Tenant bi C, .n Owner's Address /2) 1 _,,-5+ Lua-ver- W 0d Telephone No. 9 7,5-0'3 q Is this permit in conjunction with\ia building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building f -e 5 i &fX 6-p— Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: c (��t11►1,Ct r-06ty1, I i V 1t�i /'Q4 Mti� "root)-) Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires �— No. of Ceil.-Susp. (Paddle) Fans Tr o Total Transformers KVA No. of Luminaire Outlets -- No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool ❑ El No. o. o Emergency Lighting rnd. rnd. Units No. of Receptacle Outlets( No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detectuon and Initiating Devices No. of Ranges — No. of Air Cond. TotaTonal No. of Alerting Devices 14 No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water _ KW No. of No. of Data Wiring: Heaters Signs Ballasts 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 N%ires. Estimated Value of Electrical Work: ` 70D (When required by municipal policy.) Work to Start: I D Z 5-0<= 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 ❑ BOND ❑ OTHER ❑ (Specify:) / certify, under th a/ns mid pent�{ties of pgrjury, that the information on this application is true and complete. FIRM NAME: J L� �--1 z�-- G" P 19 LIC. NO.: l Licensee: L ,,,y e ycltr Signaturep +- ,LIC. NO.: t 3 ill (If applicable, nter " xempt" in the lice e number line.) v Bus. Tel. No.: (v6 3"- `1Z6— -S I Address: r6 �nk 12 � E r4r�r�/J i�v� 4115 %1) 39 Alt. Tel. No.: 4�,517 *Security System Contractor License required for this work; 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. y m signature below t hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent - Signature _�/° Telephone No. PERMIT FEE. $ 25 ,00 Date. .-�U-c.`<...... Aoi ,° ,,+e OL TOWN OF NORTH ANDOVER FO 9 • - PERMIT FOR GAS INSTALLATION iW �SSACMUSEtS This certifies that ...1 '..� ... .:-r ................. has permission for gasinstallation... 1'5d` ............... in the buildings of ..(r. �.`^..`............................ . at .../. 2 J4..�. (` .... . , North Andover, Mass. Fee.. ... Lic. No.,.�.4 ?.� .... .... .� o:�� ........ . i GAS INSPECTOR Check # 4 69 8 MASSACHUSEIIS (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations New 0 Renovation ❑ Replacement [a FOR PERNIlT TO DO GAS FTITNG Date jlovl Permit # 4/�./9l Amount $ i,, e- ame "kA K11" X -P l✓1 N iPvi/ Plans Submitted ❑ (Print or type)I �r Check one: Certificate Installing Company Name td //� /0 aft_ �� J ❑ Corp. Address +� , k ` K.� d ❑ Partner. Business Telephone y- _ irm/Co. Name of Licensed Plumber or Gas Fitter 21j vi L 114-11'- 41111-1- 4E!— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ©' No ❑ If you have checkedrtes, 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. General 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 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 Mas chin State Was C andC apter 14 3pf the General Laws. 10- or- City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter [3 -Plumber n) 3 b ❑ Gas Fitter License um er Master 0 Journeyman x U w v� WW W a m W O U F Z L w W W v� .Z.. U a w a W F W U vn C7 F z z F �a} E O z w F (a WWF Cn O a A a t� O x wU D A C7 a U F O SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4 T H. FLOOR 5TH. F L O O R 6TH. FLOOR 7TH. F L O O R STH. FLOOR (Print or type)I �r Check one: Certificate Installing Company Name td //� /0 aft_ �� J ❑ Corp. Address +� , k ` K.� d ❑ Partner. Business Telephone y- _ irm/Co. Name of Licensed Plumber or Gas Fitter 21j vi L 114-11'- 41111-1- 4E!— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ©' No ❑ If you have checkedrtes, 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. General 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 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 Mas chin State Was C andC apter 14 3pf the General Laws. 10- or- City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter [3 -Plumber n) 3 b ❑ Gas Fitter License um er Master 0 Journeyman Date. ` . �Z/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This -certifies that has permission to perform plumbing in the build2.... s of�.%�.�. ;.�%,L1[ ........ at% ............... :.............. ,North Andover, Mass. Fee.. ........ Lic. No.. �. ............................. . PLUMBING INSPECTOR Check # 6228 MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUSETTS Building 1/ C4 I/ R APPLICATION FOR PERMIT TO DO PLUMBI? /n ` Date A 'L� Name 61 Cc� Permit # Amount New 1:1 Renovation 1:1 Replacement 19-- FIXTURES 9' FIXTURES Plans Submitted Yes No ❑ (Print or type)Check Certificate Installing Company Name �� 1 �'� c.c�_ vi.�P �i `� ❑ one: Corp. Address J U 0 Partner. Business Telephone 0-pirm/Co. Name of Licensed Plumber: l,¢ P mac. 't -c -e Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Or Other type of indemnity E Bond ❑ 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 Agent El 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 i llations performed under Pe t Issued for this application will be in compliance with all pertinent provisions of the Mass setts Sta umbi Code an hapter Wof the General Laws. BY Signature of Licenseau er Type f Plumbing License Title 3 1 City/Town icense Mumrer Master Journeyman ❑ E APPROVED (OFFICE USE orn..Y Date ...... 7..e( . ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ;...r .......... . .. ......... .......................... has permission to perform ..... A-*.A.� .................................................. wiring in the building of ....... ........................................ f . .......... �'r at./4�.-J.2 ...... North Andover, Mass. Fee ....... ........ Lic. No 3/2 ELECTRICAL INSPECTOR' Check # 7 6 7 "'.' -3 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. &X123 Occupancy and Fee Checked [Rev. 11/991 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: May 4, 2006 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 10-12 East Water Street Owner or Tenant :Dianne Hin Owner's Address Same Is this permit in conjunction with a building permit? Yes X Purpose of Building Telephone No. 975-0844 No ❑ (Check Appropriate Box) 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: wire above ground pool Completion of the following, table may he waived by the Incnertar nfWiree No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. R rnd. ❑ No. of Emerge—n-c—y-Eighting Battery Units No. of Receptacle Outlets No. of Oil Burners 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 g No. of Waste Disposers Heat Pum Totals Number 1*'**** ... Tons ........................ KW ......'" ..._....... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal F-1OtherConnection No. of Dryers Heating Appliances Kms, Security Systems: No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs ` Ballasts Data Wiring: 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. 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 X BOND ❑ OTHER ❑ (Specify:) On File Estimated Value of Electrical Work: (When required by municipal policy.) Feb/2007 (Expiration Date) Work to Start: 5/2006 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Kelly M. Casey Signature u LIC. NO.: 37200 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 978-697-445 Address: 700 Robbins Ave Unit 3 Dracut Mass 01826 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law y my sig lure Vow, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent t 9/ j'fS // Signature r,: �/,��Zz4tIJIU&1Telephone No Ob PERMIT FEE: $ 35.00 5 975 Jo,?Uy 0 Location/-,) /-, keel No. 1 Date TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ sS�cNu••CHU Building/Frame Permit Fee $ s Foundation Permit Fee $ Other Permit Fee $ TOTAL a Check # �� �_ :c Building InsP46*tor C/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED:! S, SIGNATURE: Uva Building Commissioner/12yector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: F--c- 5-t 27 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Z 75 23 Zoning District Proposed.Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 2-13 3 Q &Dpfu 10` 1.7 Water Supply M.G.L.C.40. 54) I.S. Flood Zone Information: Zone Outside Flood Zone 1.8 Sewerage Disposal Sys Public J, Private 0 Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) 1 dr ` Address for Service: -6� 97f 2zj- Signature Telephone 12.2 Owner of Record: t Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable %L Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable J( �ompany Name Registration Number Address Expiration Date Signature Telephone T M X ic Z O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other fel Specify :IG Brief Description of Proposed Work: V SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit applicant t bFFICIATr USE ONLY ;; 1. Building c (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee X (b) - 4 Mechanical (HVAC)—` 5 Fire Protection 6 Total (1+2+3+4+5) 190e'. o v Check Dumber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �) (Gi. n r) c 1< lif i ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief r� n n cr Print Nam f -------- Si n iue of Owne;/A ent Date 111 1 11,111 NO. OF STORIES SIZE BASEMENT OR SLAB. SIZE OF FLOOR TINMERS Isr2ND 3kw SPAN DD,4ENSIONS OF SILLS DIlVIENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE +Izt�� -. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT D A r.. n �1 K 1 -moi PHONE LOCATION: Assessor's Map Number PARCEL 2- % SUBDIVISION LOT (3) STREET IE�—> E • �`-�� ` 5� ST. NUMBER 12- ------- OFFICIAL USE ONL REC M OF TO AGENTS: CO ERVATION ADMINISTRATOR DATE APPROVED " DATE REJECTED. COMMENTS jkf /,h1 S TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RavloW WN )m M! MORTGAGE INSPECTION PLAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY, LAWRENCE MA. 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR:.DIANE HINCKLEY LOCATION: 10- 1 2 E WATER STREET CITY,5TATE: N. ANDOVER, MA DATE: 7/15/04 UNABLE TO DETERMINEAGE. IJ THAN TEN YEARS OLD. 4 ZONIN V 10"T/ONMAY LAIST /1-15. E. WATER STREET CERTIFIED TO:. 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