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HomeMy WebLinkAboutMiscellaneous - Exception (84)I 10 Date .............cl—.......(2— .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... AqIe-.S ...... ......................... has permission to perform ...... wiring in the building of ......pog P , .F .......................................................... at ..... ......5-7— ......................... North Andover, Mass. .. ........ L E5� Tic. No. 3: .............. Check # 110837 14 q Commonwea& of /i"ladjach "ef Official Use Only 7 FPermit No. JQ �`7 �eparfinetzt ofQ ,.J�ire �ervirT— BOARD OF FIRE PREVENTION REGULATIONS Rev. i hancy and Fee inecxe: :r i J (leave blanx) 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 %v ata 200 City or Town of: ff( &-Z>,0 vei2 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location (Street & Number) :5—¢ Owner or Tenant �!,p? y� �;�,t�ajl t' Telephone No. 97,6 Owner's Address SA 1-4 Lf_ Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boxl Purpose of Building ± FA M 1 LY Utility Authorization Nu. Existing Service Amps 1 Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Amnacity Location and Nature of Proposed Electrical Work: -g(fss 14fl? 144&)bL , Undgrd ❑ No. of Meters _ Undgrd ❑ No. of Meters Transformers KV�4 No. of Luminaire Outlets No. of Hot Tubs Com letion o th 11 No. of Recessed Luminaires 8 owrnR No. of Ceil: Susp. (Paddle) Fang a c ,,,uy ue wui veu ay the inspector of Tota? Transformers KV�4 No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o mergeney ig ing 1 rnd. rnd. Battery Unit . No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS iNo, of Zones I No. of Switches No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No, of Se f-Containeu Totals: Detection/ ertinR Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Mgnicipal 11 Other Connectic" No, of Dryers Heating Appliances Katt Security Systems:* No. of Devices E No. of Water KW Heaters No. of No. of or uivalent Data Wirin: Signs Baliascs 1 No. of Devices or Enuivalen=. No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Vvirtn No. of Devices or E uivaienf OTHER: i a v Attach additional detail if desired, or as required by the Inspector of Wires Estimated Value of Electrical Work: Sb (When required by municipal poic Work to Start:1 �Q dja Inspections to be requested in accordance with MEC Rule 10, and upon comnieriu_. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue uniess 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 0 BOND ® OTHER ❑ (Specif,­�` I certify, under the pains and p�Ralties of perjury, that the information on this application is true and corm?ct FIRM NAME: Aries Electrical Service and Controls LLC LIC. NO1 565r,. Licensee: Nor and Michaud Signatu,- -~ _ ___ _ _ AC. NO.: 9 594e — icable, enter "exempt" in the license Address: number line.) Bus. Tel. No.• 978 687 054a Address: 290 Broadway suite 117 Methuen ma 01844 Alt. T,-!, ; *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Salety "S" License: Lit:, OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the iiabiiny insurance coveraee na:.-;.-.. required by law. by my signature below, I hereby waive this requirement. 1 am the (cheeic one) Li owner L_I ownerc s ai~_ Owner/Agent Signature Telephone No. _ PERMIT FEE: $ "i`J� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations V 600 Washington Street Boston, Mass. 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):__ARIES_rELECTRICAL SERVICE AND CONTROLS LLC Address: 290 RgoAnwAy STTTTF. -A11_17 City/State/Zip:. Mr=t_h„pn Ma n1844 Phone#: 978 687 0544 Are you an employer? Check the appropriate box: 1.l I am an employer with f!!n 4. ❑ I am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2 's am a sole proprietor or partner- listed on the attached sheet. ship and have no eta r_•l+ yees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ required] 5.0 We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t 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 10f(lectrical repairs or additions UR 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #t must also fill out the section below showing their workers' compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: %;4�j j '' S%�� 4 �yJ �t 4, 4,6e Policy # or Self -ins. Lic. #: /�C Expiration Date:_ 1 -DL-(-/ Job Site Address: -.54- 1p gids S--1— City/State/Zip: ,/�/tT�/Hi✓�I 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: -�� Date f f j .4'y �.Q /z,. Print Name: Normand Michaud Phone#. 978 687 0544 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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: 11n f Phone rV' PERJIIT NO. -4W 91 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP NO. LOT NO. I 1 2 RECORD OF OWNERSHIP iDATE BOOK PAGE l ZONE SUB DIV. LOT NO. I I LOCATION �� PURPOSE OF BUILDING a"4' -4k yam_e_` OWNER'S NAME - s NO. OF STORIES SIZE v OWNER'S ADDRESS[/ A P BASEMENT OR SLAB ARCHITECT'S NAME7 SIZE OF FLOOR TIMBERS 1ST �\/C 2ND 3RD /1'•✓� BUILDER'S NAME �A ' _ _ _ ,L� SPANa- DISTANCE TO NEAREST BUILDING C�/ DIMENSIONS OF SILLS DISTANCE FROM STREET No_ /I " POSTS DISTANCE FROM LOT LINES - SIDES (� �� REAR ."A" l GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION Ll THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION p MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND •_ _ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Dw- IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY r IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR FEE r4l dm PERMIT GRANTED �9 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR * NV-ld 'NV-ld 101d S3Jb'1d3U SIHl 'c33SOdwim3dns *::)13 'S30VM -VE) 'S3H3?!Od H11M 'SJNId1If19 d0 SNOISN3W14 1:)VX3 (3NV S3NI-I 10-1 WOMA 3::)NVISIO 4NV 101dOSNOISN3Wl4 lZ)VX3 MOHS1Sf1W N01103S SIHl ZL (1110:)3b ONlaiins —I 40013 '8 'SSIS OI11V alll .1v £ ONIIV3H ON _ I Pic I M P"L 1.W.9 31340400 JINIJ313 S110011 6 110 SV0 S431V3H 11Nn SWOON 40 N3HDIDI N4300W O.1.H INVIOV8 V34V OIIIV 'NI1 ONINOIIIONOJ 41V 4OdVA 40 4.1.M IOH WV31S N4n1 41V IOH 03DdO1 _ S8311V4 DOOM 'S10D g 'SW9 1331S 'SIO:) I 'SW9 d39W11 3JVN8n1 SS313dId lslor OOOM ONIIV3H L L I) ONIWVBd 9 NI1Nn OOVO 3111 I1VPA A40 NO011 3111 s3dn1X13 N8300W F— 9N130Od 1104 _ d3MOHS 11V1S 13AVdO B NVl JN19Wnld ON 31VIS FINIS N3HDIDI S30NIHS DOOM A4O1VAVl S310NIHS 1lVHdSV 13SO17 431VM IHS 04VSNVW 1V11 1349WVJ I'm Z) 'W4 131101 'Xld £1 H1V9 dIH 319V0 ONI weld OL BOON 5 3 good C—J ogd3dns —_ ONIHIM 3WVg1 NO 3NO1S A4NOSVW NO 3NO1S * NV-ld 'NV-ld 101d S3Jb'1d3U SIHl 'c33SOdwim3dns *::)13 'S30VM -VE) 'S3H3?!Od H11M 'SJNId1If19 d0 SNOISN3W14 1:)VX3 (3NV S3NI-I 10-1 WOMA 3::)NVISIO 4NV 101dOSNOISN3Wl4 lZ)VX3 MOHS1Sf1W N01103S SIHl ZL (1110:)3b ONlaiins —I 40013 '8 'SSIS OI11V alll .1v £ �S-- 31340400 S110011 6 N3HDIDI N4300W S3DVld 3411 V34V OIIIV 'NI1 V34V .1.W.9 'NH NI1Nn I1VPA A40 431SV1d F— X19 g30NIO 40 'ONOO 3WV81 NO )10149 7NNOSVW NO XJIg9 3WVg1 NO omnis A4NOSVW NO 0:)On1S ONIOIS 'MA ONIOIS SOIS39SV ONIOIS 1lVHdW S310NIHS DOOM ONIOIS dOdG SOgV09dVlD 511VM ti W008 OV3H 1.W.9 ON IA 1A %i llnl V3Ny IN3W9SV9 E ]1]OJIVVJ HSINId S01IJ31NI 8 NOI1VONnod Z NOi.Lon ISNOT S1N3W14VdV S3DIllO AIIWVl Illnw S31g0!S A11WV1 31ONIS AON `dd f1000 L Location No. r. , Date 75/2 CA/ TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $ ^°''<�' cMust Foundation Permit Fee $ s� "Other Permit Fee $ ,? D $e gr Connection Fee $ p.� Water Connection Fee $ -TOTAL Building Inspector Div. Public Works PERMIT NO. 0 O APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. L PAGE 1 MAP d-40. LOT NO. 2 RECORD OF OWNERSHIP PATE BOOK 'PAGE ZONE SUB DIV. LOT NO. �- LOCATION (//I� PURPOSE OF BUILDING OWNER'S NAME ` I'K NO. OF STORIES OWNER'S ADDRESS`c Lj BASEMENT OR SLAB 91 6f ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 0 SPAN /i DISTANCE TO NEAREST BUILDING DIMENSIO IL ��r DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS ry AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION SIZE OF FOOTING X -'i IS BUILDING NEW IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR GATE. -FILED n 3 /A & / ( / ATURE OF OWNRR OR AUTHORIZED'AGENT FEE PERMIT GRANTED /> o4ia4 A4 I9 91 OWNER TEL. # �?��7 CONTR. TEL # CONTR. LIC. # Z Z DC7 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER Be FT. v EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR 'NV -1d 101d S30V1d3M SIHl 'a350dWIM3df1S '013 'S39VM 'V9 'S3H0MOd H11M 'S9Nia11f19 d0 SNOISN3WIa 10VX3 aNV S3NI1 101 WOMB 30NV1SIa aNV 101 JOSNOISN3Wla 10VX3 MOHS1Sf1W N01103S SIHl Zt I AONVdf1000 l - abc�aa �Niaiina 0NIIV3H ON _I PSE I ", .y P"L 1. W.9 DIW1D313 110 SWOOV dO 'ON L SVO S431V3H 11Nn O.1.H 1NVIOVM ONINOUICIN05 MIV _ SM3iAyd DOOM MOdVA 210 d.1.M 1OH WV31S 'S10D V 'SW9 1331S SIO R 'Sw9 M39W11 'NMnj MIV lOH 03JMOA 3JVNMnj SS313dId 1SIOf OOOM ONIMN it I ONIWV4d 9 OOVO 3111 dooli 3111 S3Mn1Xlj NM340W ONIA00d 1104 _ M3MOHS 11VIS 13AVWO '8 MVI ONI9Wnld ON XNIS N3HDIDI 31V1s S90NIHS DOOM AWO1VAV1 S310NIHS 1lVHdN 13SOID M31VM 03HS I 1Vld 113bMV0 ('XI4 L) 'W4 131101 OWVSNVW 'XIJ EI H1V9 dIH 319VO SN19Wflld Ol dOO4 5 WOOd �I 3OIa3do Ws WHIM 3WVMj NO 3NO1S AWNOSVW NO 3NO1S X19 M30NIO 40 'JNOJ _I 800I1 8 'SM1S :)111V 3WVMj NO XDIM9 AMNOSVW NO XDId9 —� e I 9 3111 'HdSV N'JlNWOD 3WV4j NO n1S AMNOSVW NO omnis ONIOIS '1W3A ONIOIS SOLS39S7V O,h\OWVH ONMIS 11VHdSV S310NIHS DOOM H1WV3 313MDN07 ONICIISo4a sloold 6 I S77VM y N3HDMI NM300W S3DVId 3WIj V3WV JI11V V3dV .1.W.9 :NFNlI OOM OV3H 1.W 9 ON % °/l FT , Ilnj V3MV 1NIW3SV9 £ E L _ 1 _ E NIJNn 11VM AWO W31SVld Sd31d O.MOWVH 3NO1S 4O 11DIa 3NId X,19 313WDNOJ 313MDNOD HSINId 1101431NI 8 NOILVONnoj Z NOI1onHISN00 S1N3WIdVdV _— S3JIjj0 —_ AIIWVj I1lnW S31WO!S AIIWVj 310NIS Zt I AONVdf1000 l - abc�aa �Niaiina .i fc.770 !MM txca� = O 0 o m 0 W H Z Z m L 3, C E c 0 u W %A Z u ? J °' L �' S 0 u W IA ? V Lai -AL W � c U c 0W u W CL N ? L �° C6 W p W �. Y o �. Q U LL a: U. cc (niL cc LL m N 4 Ln 2 z V a► a\L/c �\ r z u — > W O� �X W ce c G go w �.. CL O 00 c C O N 0 0 Q 0 uo W J ZD 0 z N cu �. .y E a L c 0 w O d u E c �. 0 y O c r V z •� CL o c V 0 z Location No. Date �RTh TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ +O��ne ♦I ,s.7 CMtIStA Foundation Permit Fee $ i, rC "9�=5f>L $ Other 4rmit Fee .� Sewer Connection Fee $ Water Connection Fee $ iJl�►�, 2 i J Building Inspector Div. Public Works PERMIT NO. ®� APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. `_ PAGE 1 MAP 4J0. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE + j SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES V OWNER'S ADDRESSBASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR ERS IST 2ND 3RD SPAN DIMENSI N F SILLS POSTS BUILDER'S NAME at DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GI U AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THI ESS SIZE OF FOOTING X IS BUILDING NEW IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED l to SIGNA= m=, FEE P - s- 01 - PERMIT GRANTED OWNER TEL. # y� CONTR. TEL. # CONTR. LIC. # Z 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST y0ig _ v A EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR or , ONIIV3H ON _I Pic JIb1J313 P"Z 1. W.9 110 SWOON d0 'ON L _. SVJ S831V3H IIN11 0.1.H 1NVIOVd _ ONINO11IONOJ SIV Sd31dVd DOOM mOdVA 210 d.1.M IOH _ S10Jy 'Sw8 1331S WV31S 'S10J T 'SW9 m39w11 Ndnj dlV IOH 03J2101 3JVNMnj SS313dId 10IOf DOOM ONIMH L L I ONIWVmd 9 00V0 3111 _ dooli 3111 _ SMn1X1j NM30OW ONIJOON 11021 83MOHS 11VIS 13AVMO B MVI _ `JN19Wnld ON 31V1S XNIS N3HJ11)1 S30NIHS DOOM AMOIVAVI S310NIHS llVHdSV 19SO1J 831VM 03HS ly A ('Xlj L) WM 131101 OMVSNVW 13M9WVb 'Xlj V H1V9 d1H 1 1 319VO Mawnld 01 doom 9 LNoN3 MOOd �I MOIM3daS 3WVMj NO 3NO1S ONIUM AMNOSVW NO 3NO1S _ X19 M30NIJ MO 'JNOJ _I 3WVMd NO XJIm9 8001A $ SdIS J111V kMNOSVW NO )IJI89 — �NO OJJn1S AMNOSVOSVW NO OJJn1S _ 3111'HdSV ON101S '1M3A FOWWOJ ONI01S SOIS313SV O.P+\OMVH ON101S 11VHdSV _I HldV3 S310NIHS DOOM C I 8 313yJNOJ S0MV109dO10 jjj zzz SMOOId 6 S71VM v N3HJ11X N8300W WOOM OV3H S3JVld 3N13 1.W 9 ON VRV JI11V 'Nlj% °/� IA V3MV .1.W.9 'NH ltnj V3MV 11, 1N3MM $ NIJNn 11VtAAMO O.MOMVH 3NO1S MO XJIM9 3NId 'X.19 3138JNOJ Z I 9 313MJNOJ HSINId mOIm31Nl 8 NOI1VQNnoj Z NOi-L:Dn dlSN0a NV1d 101d S30V"1d321 SIHl 'a3SOdWIM3dns 013 'S3JVLI SlN3W1MVdV -VE) 'S3HOU0d H11M 'S°9N1a11f19 d0 SNOMN3W1a 10VX3 aNV S3NM 101 — 03JIjj0 = A1lwvd Illnw WOUA 30NV1SIa aNV 10'1d0SN01SN3Wla 1.0VX3 MOHSiSf1W N01103S SIHl s3IMo s Allwyj 31ONIS Z L AON Vdf10J0 L GUOD38 ONiaiins 11 P -J, .;amara. a. ecP' T i O 0 Q ' an v Z u Z T m L °i O C E L ro C O � Z u Z m J a. L rn O C O Z V J W t a O U 0 W H ? u t 0S W 0 c. L6 c � o Y O Q0 ii Q U. ¢ � .5 LL m U. m co c W ZD S H E L .0 *00 v O L CL Z� 00 C tv C W, ao C O Z )FFICES OF: � ... Town of WIPEALS :: NORTH ANDO` EIt wiLDING ;ONSERVATiON I)IVISI()N ()I JEALTH 'CANNING PLANNING & CUI11t11UNt't'ti' 1)I;�'I;I,OI'1\It:N'1' KAREN 11.1. NELSt )N• I )II tl -('I OI t (1; I T ) G85,177', In accordance with the provisions of h1GL c dll, S 54, :r rnn(liliun Of Ilnil(I'Inl, I'cr111i1 Number is that the debris m"1111inr hom this «vrl; s11:111 be disposed of ill a ptopetly licensed solid waste disposal lacilily as delincd by MUL c I H, S 15UA. The debris will be disposed of ill: (Lt)c3liurt ul I acilil) ) Si6natur ul I'crnlit i�l►I Ic;)nt hate NOTE: Demolition permit from the Town of II(,I-th Alld"Vor nnr:t I)e obt n l ned for this project through the Office of the Merl ldlnl; ln!,I>e(•t0 v- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBINGq (Print orr Type) T � ��`�XJ��i/� , Mass. Date 19 0.7 Permit # Building Location Owner's Name Type of Occu ncy �L✓G G New O Renovation ❑ Replacement -Er"' Plans Submitted: Yes O No O B . P . # SEWER#' FIXTURES SF,PTTC# Installing Company Name 1) p m n n Inc. Cheone: Certificate # Address_ P'0.- Q vx 88 t"I Coorrporation 21440 Methuen, M a 0/844 ❑ Partnership Business Telephone (5o8) 683-9755 ❑ Firm/Co. Name of Licensed Plumber Dona.Ld INSURANCE COVERAGE: I have a currenttliability insurance policy or its substantial equivalent which meets the requirements of MGt Ch. 142. Yes No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy LIf7 Other type of indemnity O 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: Slanatura of Ckunor .,. n.,.,e.� e..,,..• Owner ❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and a knowiedge and that all plumbing work and installations performed under the ermit issued for this application will be pertinent provisions of the Massachusetts State Plu i Code and C pte a General Laws. CR 44 Title SignaMr of 'censed Plumber City/Town Type of License: Master Journeyman ❑ ' APPROVED O -U FIC SE ONLY) License Number 9 --'AT u14SWI aiu v �- Jul � �2 L111 SUILDING_DEPARTMEF z X Y W O Q Z Q V) C7 > W W N �4 O N OJ Z N W Q !- rt W y C X ~ S Y Z Q O W Z X N Z a -W 4J N F.cc y a O OQ ¢ Q W _Z a .� .0 W >Yi~ F- O Vl N = Z fW- t }~ Q' Q x �' N a a o a° a Q ot a �. ]C J Ci U)( D D J 3 -• N LL G7 D Q 3 ¢ m Q . 0 sus—SSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name 1) p m n n Inc. Cheone: Certificate # Address_ P'0.- Q vx 88 t"I Coorrporation 21440 Methuen, M a 0/844 ❑ Partnership Business Telephone (5o8) 683-9755 ❑ Firm/Co. Name of Licensed Plumber Dona.Ld INSURANCE COVERAGE: I have a currenttliability insurance policy or its substantial equivalent which meets the requirements of MGt Ch. 142. Yes No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy LIf7 Other type of indemnity O 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: Slanatura of Ckunor .,. n.,.,e.� e..,,..• Owner ❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and a knowiedge and that all plumbing work and installations performed under the ermit issued for this application will be pertinent provisions of the Massachusetts State Plu i Code and C pte a General Laws. CR 44 Title SignaMr of 'censed Plumber City/Town Type of License: Master Journeyman ❑ ' APPROVED O -U FIC SE ONLY) License Number 9 --'AT u14SWI aiu v �- Jul � �2 L111 SUILDING_DEPARTMEF Date. HORTI ��.• � '•��c TOWN OF NORTH ANDOVER .- PERMIT FOR PLUMBING This certifies that .. P�!j'1/�. ,S ... o�„�T: ............ $` has permission to perform .... LL'.. g plumbing in the buildings of .. Pi1 ......' at Z�4 .V../. S.... ��C........ , No Andover, Mass. Fee � s,.'” .. Lic. No..(? 41: L ........ . .... p, u �BING INSPECTOR ro h. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer K7 /0 - /,) :"> Date ...... .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ................... '"has permission to perform ....... ......................................... 'wiring in the building of .... ............................................................. at ........... I/........... . ........ ............................ .North Andover, Mass. Fee....� ............. Lic. No: . ............. .. ................ ELECTRICAL R Check # 4.630 Official Use Only Permit No. '7"G3o �1♦ %Jf� (��2712d7Zk5,4z� 09 5.5,4e2WS5-7Is d, Z)0 -6--c 4 P -I` S-04 Occupancy & Fee Checked - 6z -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 12:0 (Please Print in ink or type all information) Date T— _ To the Ins ector 1bf Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location ( Owner or Owner's Address 's- H V � S S Is this permit in conjunction with a building permit Yes ❑ Purpose of G6-1 Existing Service I On Amps ;2 �— 1 O Voits New Service �?.© C) Amps a� O Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical No Ji�­ (Check Appropriate Box) Overhead R Overhead Authorization No. % 6 lo IS Undgmd ❑ No. of Meters _ I Undgmd ❑ No. of Meters t OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includiQg.GQmpleted Operations Coverage or its substantial equivaler t i;; NO = su valid proof of same to the OffiYE NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURA = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Valueof EI ctrica Work; %JVorktoStart /_ In pectionDateResquested Rough Final Signed under th t Penalties of perjury (( / f �"'� T� --- FIRM NAME "0%, 1^�i o ree n 'i; ^-.o �eG^E r� c— o_i a ,� LIC. NO. 4 J � J J NO. 4 // LL N 4"_' � r' Bus. Tel No. 7o f Address �� �.:``��' � d-- -1 � o wid- 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) .- `moi No. PERMITTEE $ `:6 , (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units 4o. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices i Heat Total Total No. of Di sal 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 NoHydro 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 includiQg.GQmpleted Operations Coverage or its substantial equivaler t i;; NO = su valid proof of same to the OffiYE NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURA = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Valueof EI ctrica Work; %JVorktoStart /_ In pectionDateResquested Rough Final Signed under th t Penalties of perjury (( / f �"'� T� --- FIRM NAME "0%, 1^�i o ree n 'i; ^-.o �eG^E r� c— o_i a ,� LIC. NO. 4 J � J J NO. 4 // LL N 4"_' � r' Bus. Tel No. 7o f Address �� �.:``��' � d-- -1 � o wid- 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) .- `moi No. PERMITTEE $ `:6 , (Signature of Owner or Agent) Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02 911 Workers' Compensation Insurance Affidavit Please Print City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone # Insurance. Co. Policy # Company name - Address CiMr. Phone # - r1. Inc��ranrp C'.n Dnlir•,• � 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 $1,5oo.00 andfor one years' hVrrorrnent_as v elLas_cbaij enaltm-m-thei>xniofa.STS?P]I RK-ORDERand_afine-cfJ,$lOD-00)-ajiaYAgainst.me 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the fnfonnabw provided above is Eve and correct Signature Date Print name Pie Official use only do not write in this area to be completed by city or town official' City or Town -- PermitA icensinq Building Dept r OChecic if immediate response is required Licensing Board '} p Selectman's Officb Contact person. Phone A E] Health Department Ei Other