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HomeMy WebLinkAboutMiscellaneous - 712 Boston Meadow0 i Location.? ?i 409'NO Mn E4ibOL4) Wo. %-39 Z— Date / d m p 01 "O oT �1hp TOWN OF NORTH ANDOVER L p Certificate of Occupancy $ SL # • t/D Building/Frame Permit Fee $ 444- sACMUs t� Foundation Permit Fee $ S Other Permit Fee $ $ Sewer Connection Fee $ v Water Connection Fee $ TOTAL mow; --t LL n po $ Buildi g nspe6tor Div. 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S JOSEPH AVE PEABODY, MA 01960 _ • -r The Commonwealth of Massachusetts Department of Industrial Accidents tai ,_ /f1IilsUIQS r; 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit city phone I C] I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for mfy employees working on this fob .. insurance co Fob# gatacirld ons Ce necessa Failure to secure coverage as required under Section 25a of NIGL 1a: can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Iovestigations of the DIA for coverage verification. I do hereby cerci nder the pa' and pe jpe1ury that the information provided above is true an correct c Si nature E Date �7`! Mr."M Print name ofricial use only do not write in this area to be completed by city or tows official city or town: C] check if immediate response is required contact person: (revised 3/95 P1A) permi"cense It r -,Building Department OLicensing Board pSelectmen's Office C]Health Department phone #; r JOther y � , z CD O Cr 0 0 o � a� .a � v CCD CL cr CDD O O O O CD CD 0 CO) 10 CD 0 cm im M) C7 CD O O CD CDa y CD CO) 0 CD O CCD 21 0 O H CFO) n= = n • •��� a 3 d �j W O W H O ?m 2 O of <�3 n O H OR •l 0 CO 0 A y m CO co U3 0 CD N �T ■ h O Cr O.� a f0 �--� y i CDca H r., •� ? Cn �n C, � �,� � W m CD vs Vii► ;� 00- co 0 cn ca o c :V 0CD :d CD . Cn CD r' Co.: d . „ . d t� Cj7 : n o :Q cn O o i Cn rt z C 7d z 0 n ypt yJ CO z Q X w O Q y �' T C O G 7 C, C/) O Crnn d v, OT7 O x ; O x E/ rA h-+ GN 4 1y � V� Ottice Use Only uIIf 95z1r41IRft5 Permit No. 0� Occupancy_ oy ME)rT�)�IIYIII IIf �lIblit �3fE� & Fee Checked 319p (leave blank) p� BOARD OF FIRE PREVENTION REGULATIONS 527 VJR 12:00 0 �3 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Eiectricai Code, 527 CMR 1112:00 �q G (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date QM or Town of NORTH ABY •R To the Inspector of wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Numbed Owner or Tenant Ovvner's Address CA Is this permit in conjunction with a buildin permit: Yes V No _ (Check Approonate ?ox) P,,iracse of Suilding C06ritrnyyi� Com. i'On ..LV14TAeAql Utility Authorization No. Existing Service Amps _� NJcits Overhead Unegrnd No. of Meters Nevv Serfice Amos LII a©t Volts Overhead Uncyrna No. of Me!ers Numeer of Feeders ana Amcacay ` fi iA.C. WOae 1c-- Lccaticr, and Nature of Prc•cosed Electrtcei ':ICCX anon . f h No. of L•gming Outlets i No. of Hct . Ss YE' nave suomtred valid proof et same co the CHice. � — — aox. i{ (I11 Cv 0 1,Cc (1 C f— Co (K Tata: NC. of Transformers K.'A No. ��f111 of L:cnnnc Fixtures i Swtmmtnc P_ati Atnover— gfna. 1n - CfnC. Ganefa[Cf5 KVA I O ,� O uc. No. E I No. of Emergency Lighting No. of-ecectacie Outlets C No. of Cil _urners Sus. :al. c. ; Sacery Units Alt. Tel. Address OWNEF S INSURANCE 4VAIVEF: I am aware that the _:censee noes not nave the insurance coverage or its suostanttat eeutva en' e^` waives this regwrement. Owner g outrea av Massacnuseas General Laws. and :nat my signature an :n:s cermtt aopttcatton tP!ease checx one) [ No. or Gas turners I FIRE ALARMS No. of -Ones No. at Swrtcn Outlets No. of Air Cor c. Total No. at Detection anct initiating Oavtces No. gf Ranges tans .No. of Oi5dOS315 Heat ! Na.ct Pu5 rn V Total Tans Total KvV No. of SCunaing Devices No. of Sett Contained SoaceiArea Heating KW Oetec::on)Sounoing ��evtces No. at Oisnwasners - K'w — Muntcioai --Other Local No. of viers J I Heating Cev:ces , _ Connec:;on _ No. of No. of iLow Voltage No. of Water Heaters KVJ i Sicns Sailasts `Nir:nc No. Hvcro Massaqe Tubs i No. of Motcrs Total -P OTriE INSURANCE CCVEFAGE: Pursuant to the recuvements ct aassacnusac:s general Laws — NO 7- Coverage or ;is suos:anetal �cuivaienc. YES — 1 have a current Liaotiity Insurance Policy inciuctng C:.mo:etee Ocerauens 1 NO If','Cu nave cnecxed YES. ptease inoicate the ryoe at coverage Cy YE' nave suomtred valid proof et same co the CHice. � — — aox. i{ (I11 Cv 0 1,Cc (1 C f— Co (K checxtng :ne aoproonate vv 1@� h INSURANCE _ BOND _ OTHER _ (P!ease Scec:!,/) xotratwn Date) Estimated Value of '.ecKncal 'Nor s rC�� g. �`\ Final Rou n Wcrx :a Start \ Insdec::on Date Racues:ac: Signed uncer the Penalties at perjury: 0 i`iG O ,� O uc. No. E FIRM NAM �t" 3 5�0 UC. NO.L:censee1 T •PfSignature Sus. :al. c. Alt. Tel. Address OWNEF S INSURANCE 4VAIVEF: I am aware that the _:censee noes not nave the insurance coverage or its suostanttat eeutva en' e^` waives this regwrement. Owner g outrea av Massacnuseas General Laws. and :nat my signature an :n:s cermtt aopttcatton tP!ease checx one) tSigr.ature of owner or Agenu Tetecnone No. PERMIT r_— Ilk Date ....... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... . CA P. -CA .. ..... 6.:'`.C&.C' . . ............... has permission to perform ........... Vne-1 . ................................................. wiring in the b"ding of .... r'.�.z ..... . ....................... at ...... North Andover, Mass. Fee... Lic. No. .......... 'I'N'*S* P**E* C**T*0—R— ELECTRICAL �/'3/% % � 180. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer