Loading...
HomeMy WebLinkAboutMiscellaneous - 1-2 Fernview 6s- C 966 Date....11 ..... .:.�.�.�....... NOFT1{ 4, TOWN TOWN OF NORTH ANDOVER PERMIT FOR WIRING �ss�cNusE� This certifies that ............... � .................. has permission to perform ... S..�/A !7—W ....... wiring in'the building of............. tU � 0.................................... at.. .Vtt-W..... North Andover,Mass. Fee.3 - Lic.No.,�.'3.! f� J LECTRICALINSPECTOR Check # ( � -� L.u►rr►nunwt::a►drr v► r-rss�aa�r►�a��acs ----�q/-- Permit No. /16 ®apartment of Fore Services - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank) �M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9- 13" d010 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) y oZ Fe f n V t-E w e #a Owner or Tenant � f n ES r n/ Telephone No. 9 78-3Q0-7500 Owner's Address 37 ,}n»e R N /7iJ oyer 1Ma Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building re5i din C e Utility Authorization No. Existing Service Amps /a0 a4o Volts Overhead ❑ Undgrd N No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters ` Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: r c_esse 010.✓15 C@ f J;N'/(S kt5 y R Sd 1 t`�h t5 , new �0. r'o0M W;f,Inq 17e 0<tTCt+r-v,1 ouyr�n�•one - Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires y No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergi�i_ncy Lighting rnd. grnd. Battery Units No.of Receptacle Outlets a No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 7 No.of Gas Burners No.of Detection andInitiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: "" .. Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Municipal ❑ Other P g Local❑ Connection No, of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water No.of •No.of Data Wiring: Heaters KW Sim Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNo.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: Q'13_a016 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 ofperjury,that the information on this application is true and complete. FIRM NAME: RICY, JOR-0 aN E LEe 1C LIC.NO.: acWo A Licensee: izidNekrO�W$_VVA Signature 0, .(dMC&&A& LIC.NO.: 36330 E (If applicable, enter "exempt"in the license numbe,rx line.) Bus.Tel.No.:�3- "a750 Address: (o K1 NL-r5TyN {�, " f JI.1415� J N N 0 38tpS Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th6 liability insurance coverage normally required by law y y si atur v,I hereby waive this requirement. I am the(check one)Elowner Elowner's Owner/Agent Signature Telephone No.603-300-0"17 SO PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 °'� ,<• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information //Please Print Lelzibly Name(Business/Organization/Individual): R� CK -,)o HiQ V%- w �I_GC`T i�IC Address: (p K 1 N&STZ)r0 lw 14'p City/State/Zip: PUP k S% W DU/+ 03VD5 Phone#: (003 �300 -- a7 J_0 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.§§J am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y P tY• 9. E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.W Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section 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.Lie.#: 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 cer ' u der t pains and pe alties f perjury that the information provided above is true and correct. Si nature: Date: l — �3 ' oo to Phone#: �94'�— SOO — ;� Sd 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Commerce Insurance- The Commerce Insurance ComuanySM �C Citation Insurance CCMPanySM SM Members of The Commerce Group, Inc.- CLAIMS DEPT. 11 Gore Road,Webster, Massachusetts 01570 (508)949-1500 www.Commerceinsurance.com September 24, 2008 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: KORI KINDYA Property Address: 42 FERNVIEW AVE Policy#: BBTYWP Date of Loss: 09/22/2008 File#: PNC891-MAPN38 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. DEANNA L DAVIS Telephone: (508)949-1500 Ext: 15038 Claim Adjuster Toll Free: 1-800-221-1605, Ext: 15038 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. September 24, 2008 CcmmCrc CIumpanies ....COME GROW WITH US CIC 254 (Rev.4/95) MAIL 560 � �� 1' , �� 1�` ���"�` �� �' if 7 Y/ J Date.... HORTM / of y` TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION o•�� Sy SACHUSES This certifies that ./1?!�. ./ 4. (. !i7w. . has permission for gas installation . . . .KArrf-e. . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . at . . �. .7 .�!1'`�b�� . . ��-. . . . . . . ., North Andover, Mass. Fee. , Sr. Lic. No.. ,�s 32. . . . . . . . . . . . . . . . . . . . . . . � c GAS INSPECTOR Check# Ow t MASSAM SETTS UNIFORMAPPLICATONFOR PERN-HrTO DO GAS MTHNG (Type or print) Date NORTH ANDOVERY MASSACHUSETTS Building Locations 47- E—T 6,VIEZo Permit# Amount$ f! �O Owner's Name New❑ Renovation Replacement ❑ Plans Submitted U vi w x o M 0 c� N ? x z 0 zF a O W O � -7 H p W H O y, 0 a x U z I - O A > W W W r Ri O W O A C7 .a U x A R H C SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR 4T II . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8T H . F L G O R (Print or type) Check one: Certificate Installing Company Name_ n��I�E /I/l�c4G/A,2o /�Luyr�ANG Corp. Address �Ze7 AAPA 2 loJ)i DS .9Vlj partner.. •SQ+�?200% ,N 1-I 0-?,?7+ Business e ephone 4nd -3 d SZ Firm/Co.- Name irm/Co:Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No If you have checked M,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 1.12 of the :Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Uw%er 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, beat of m} knowledge and that all plumbing work and installations performeii unrler Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas C I a d Chapter 142 o' he General Laws. By: Signature of Licensed Plumber 0 as Fitter Title Plunnber �Z�i Z Cityr•T�wn Gas Fitter Gtccnse um ©'ifaster :APPROVED(OFFICE USE ONLY) [3 Journeyman Date 9.' v. TOWN OF NORTH ANDOVER ° p PERMIT FOR PLU GING ♦ s �,SSACNUSE� { This certifies that t� . . , �#' . . . . . . . . . . . . . . . . . . has permission to perform ./1!x"?. •f.�� .:• . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . at . . . . �. 1/t!1 . . . . . . ., North Andover, Mass. Fee-7& . . . .Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .` ' PLUMBING INSPECTOR Check # ! 4� 8666 r ' IV A.SSA.CRUSETTS U1 HORm APPLICATION FOR PERMIT TO DO PLUMING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date w 2 Owners Name %1j��E �1 ______ Permit# " Building Location '4,Z 1E Amount T eofOccupancy CO�o Replacement Ej Plans Submitted Yes No Renovation E2/ New � FIXTURES ° �, H W U) � - NMP-54- i �W' A tY H p, C ° a a a as s�B-Bs� M MDR 3RDL FLOCK 5MFtOCR 6IB[FI� 7ISFLOOR 9IRFLOOIZ ' Check one: Certificate (Print-or type) n Installing Company Name Ml�1:p2O P.$ — !_.1 Corp. Address 70 'ti3dZj-�Z ❑ Partner. S'�'�Ctr�2Gr /1/Ij a gel Firm/Co. ' Business Telephone Name ofLicensedPlumber: M i(Q& M AAC r 0 Insurance Coverage: Judicate the type of insurance coverage by checking the appropriate box. Bond Liability insurance policy Other type of indemnity ❑ ' e o£the above of have an on ;Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does n y�I three insurance r Signature ' ; Owner II Agent 0 Z I hereby certify that all of the details and information I have submitted(or enfered)in above application are.true and accurate to the best of mylamwledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat ing ode an a er of the General Laws. By: NignalurLokllcenseffllumDer Type ofPlumbing License Title /ZCj Z / ❑ - City/Town - License um er Master E]"' Journeyman MPROVED(OMCE USE MY - - E The ComRzonvealth ofAfassachusetts Department ofIradush ia1_4ccidents Office of bivesiigations 60.0 Washineon,Street $ostorz, _W 02-111 N'O'N'-mass-govldia Workers' Compensation lnsurance AffidR'Vit:gnjders/ContracforgXlectri,-- -,kin ns/Plumbers ficant-Informal on .. � Please Prim Legibly Name(Business/Oro aizatio&lndividual): A L I NZo pWAirgN Address: ' cj " '7/l In71j S A�lE City/State/Zip: ACM-bplC Phone .Are y, u an employer?Check the appropriate box: 1•Lv1 1 asn a employer ivifh 2 4. ❑ I am a Type of project(required): bezteral contractor and I employees(fall and/or part-time).* have hired the sub-contractors 6' ❑Na-w construction 2.❑*I am a sole proprietor or partner_ •listed on the attached sheet.# 7• remodeling ship and have no employees These sub—contractors have working for me in any capaci4r, workers' comp,insurance. El Demolition [No workers'comp, inctaranCe 5. ❑ We are a corporation and its 9. Building addition 3•EJrequired.] ofncers have exercised their 10 0 Electrical repairs or additions I am a homeowner doing all work riQ t of ex: ' Myself empti�n.per MGL 1 L❑Plumbing repairs or additions y [No workers comp, c. 152,§I(4),and we have no insurance required.] t employees. (No workers' 17'0 Roof repairs OMP.i suranct,-required.] 13.❑Other ~n3'app?icr t tcheab box, ,ss Qso a'ot:•f-secti he ow EL-o Lig homeowners who submirt7iis affidavit indicating h ,. d him lou tmo t_CS a..,doing all —it and- +Contra h-- he "`"' :nen hire outside eons*_ctora�ri,^t 9a uit a new affidavit indicating such. curs t....t G....c};this box m•.:st atiach�'an addirioaai sheet showing the came of the sub-contractors and theirwerkers'comp.policy informatim dam an employer that is providing workers'cornpensarion irz szirance for my employees Beloitr is the policy and job site. LPLfol7TlatZpn. . Insurance Compiny Name: Policy#or Self-ins.Lic.M. Fxcpiration.Date: ��� Job Site Address: 2 City/-State/Zip: AL Attach a copy-of the workers'compensation policy declaration page Failure to secure coverage as required u (showYrritig the policy number•and expiration date). • nder Section 2SA of MGrL c. 152 can lead to the im osition of c ' one 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 ffiis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I ria here/iy certify under the pat and peisalties o 'erjury thrzr flw information provided above'is true and corre ct Siffiatur 00, 61� • __ .Date,• Phone,#: Of- chd use only. Do not write in this area, to be completed hJr citJ,or town official t City or Town: P'ermit/License# ' Issuing Authority(circle one): I.Board of Health 2.Buildinb Department 3. City1Tawn Clerk 4.Electrical Inspector 5.Plunibiii,;inspector 6.Other Contact Persux Phone'#': Location No. 3Z3 Date 1-02P-CA� NORTq TOWN OF NORTH ANDOVER O F � .. 9 4ry • AOL Certificate of Occupancy $ MusE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 0 B `i 27 9 f Building Inspector f' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: m ob, ) —C;?Z_,=�) o� SIGNATURE: Building Cornmissioner/12ECEtor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: W Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSI3IP/AUTHORIZED AGENT rnl 2.1 Owner of Record Ar —Z �� f.1�11� ill li�F' QCs Name(Print) Address for Service x`18 g co — Z Z c)Z. Signature Telephone 2.2 Owner of Record: OName Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constructidn Supervisor: to O License Number mn Address 1 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v I o�c,1tiS QNB �v 1� 55 Company Name �P� �S3 M aqRegistration Number '.■. Address Expiration Date —Signature Telephone d♦ { U 9 SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) 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. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Fddition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be "� p ° � >; OFFjIO�jf , > 3 s , Completed b permit a licant � � $ 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 6�5 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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, 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 Print Name r Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIN EN'SIONS OF SILLS DIMENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHFVNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts LT Department of Industrial Accidents s,• Office of Investigations Boston, Mass. 02111 Workers`Compensation Insurance Affidavit Please Print Name: 4 c on all. Location: (Sck City u , Ith�nC.A w):n Phone Q 1 6,.S7 am a homeowneMperforming all work myself. F 7-11 am a sole proprietor and have no one working in any capacity aI am an employer providing workers'compensation for my employees working on this job. Company name: Address e City: Phone# Insurance Co. Policy# Company name: .Address City: Phone#• Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties.of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penareies of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' Ej Building Dept ❑Check if immediate response is required Building Dept [] Licensing Board p Selectman's Office I Contact person: Phone#: r-� Wealth Department [] Other FORM WORKMAN'S COMPENSATION 4, t North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid.waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: C (Location of Facility) gnatur ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ' ✓!�T�am�nzo7uuP,a�! °�✓Z�aaaac/ucaeba s BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 058410 Birthdate: 02/08/1964 Expires:02/08/2002 Tr.no: 16694 ' I Restricted To:.-00 LELAND H JACKSON JR 69 WILDWOOD ST WILMINGTON, MA 01887 Administrator { �, - �e�Oom�nanur«alG6 o�..iti!iseaae�ivaefld HOME IMPROVEMENT:CONTRACTOR Regi'3t�alion. �1�Ub53 � ' E>tp�ratEon.. 8/2O�D� Type DBp . UACXSON BUILDERS lel od Jacksen, Jr: .. . 69`Yildraod St ADMINISTRATOR" "'" N2IrlRgt08 MA OI887 NVr. � M Town of . 4Andover No. 3�, - LA o I h dover, Mass.., ��a a D °Z COCMICMEWICK V ADRATE D AP�,�,�5 ' S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.../► .1.. 1.. .. ....... ...........�.��.......................................................................................... Foundation has permission to erect...R%em o �L�.... buildings on s F��N V t toW A&#.& ... ( Rough .............. ................................................................................... to be occupied as............... A,`.�..r k r O •► Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspect io Alteration and Construction of Buildings in the Town of North Andover. 444 / 4a G S O dWWW PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION T S ELECTRICAL INSPECTOR � Rough ........................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer Street No. SEE REVERSE SIDE smoke Det. Date. ./-�""����0 oZ to:rho TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSAC04US� This certifies that r.r. . . . ./�. . . . . . . . . . . . . . . . . . . has permission to perform . . . .X14.?�? . . ��. . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . /!�.1. ?. . . . P—#.°:t/.. . . . . . . . . . . /�frNvI.Qtu �} Ue „lv, North Andover, Mass. Fee. . . .. .1. .Lic. No.. . J.0.� 98. . . . . . . . .7D/!?��. 1./�!M��.. PLU" ING INSPECTOR Check # 5 12 7 /S MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING r (Type or print) NORTH ANDOVER,MASSACHUSETTS , Date / Q Building Location Fern k1 f�f/�l/C/ Owners Name m�,�p d 7 7`� Permit Type of Occupancy Amount New 0 Renovation Replacement ❑ Plans Submitted Yes ❑ No ❑ FIXTURES H � � Cn co w w a w � a ca U 3 w� SLR> BASEVENr JAILOCR am H� 3MMOM 4MEKM 5M HBM 6M HIM 7M11" 9M HDM (Print or type) Check one: Certificate Installing Company Name El Corp. Address t Y ❑ Partner. S4!� Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate t e type of insurance coverage by checking theappropriate box: Liability insurance policy 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 incurance ignature 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 ins Mations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa etts State P i de Chapter 142 of the General Laws. By: gna ure o icense um r Type of Plumbing License Title /Q �;-- City/Town incense um0 er Master Journeyman 11 APPROVED(OFFICE USE ONLY ❑ Official Use Only •+ Permit No. w� De�at oa�u8lle Sa�ety Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 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 To the Inspector of Wires: i Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number �1 G Owner or Tenant �✓�I UAL �"[ Owner's Address Srt � Is this permit in conjunction with a building permit Yes v No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity j Location and Nature of Proposed Electrical Work _41 n n c•/ti c n Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures v2- Swimming Pool gmd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets 1 No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = 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 appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ 0-6 > Work to Start 117 -30 Inspection Date Resquested l ! 3 7 Rough 3 Final Signed under the ena les of perjury: J /� FIRM NAME A/' �/' L� LIC.NO. i Lkensee r 1-ex-1 co/" Signature LIC.NO. /� ��RI Bus.Tel No. ©A R— Address SaOL ,� .�. Lf" Alt Tel.No, OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITIFEE $ (Signature of Owner or Agent) 3574-- Date...... . .. .o� NORTH °f� °;•'"° TOWN OF NORTH ANDOVER sj •` °JL p PERMIT FOR WIRING 4 i Y 'O��r�°�f'•`'h SSACMUS� Thiscertifies that ............................................................................................. has permission to perform k �2 V WL Oct .............................................. S2v� ....��c� �1Ati� �rV F lr� wiring YR building of........................." ..................... ......................... er •ewt�at....... .......... .................................... ......... .North Andover,Mass. Fee....... . ... Lic.No. fl. P...........A ' '``*`....................... ELECTRICAL INSPECTOR Check # A S 4 OMME?vWEALFH-F MASSACHUSS� Ste` OF ELECTRICIANS REGISTERED MASTER ELECTRICIAN I ISSUES THIS LICENSE TO I RICHARDS HANEGAN i PO BOX 918 PELHAM MA 03076-0918 i 11322 A 07/31/04 33339200 • • - • • S Fold,Then Detach Along All Perforations