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HomeMy WebLinkAboutMiscellaneous - Exception (606)a AUTO HOME LIFE Claims Processing - Arnica Scan Center PO Box 9690 Providence, 8102940-9690 Building Inspector Town of North Andover 120 Main Street North Andover MA 01845 File Number: 60002266349 Date of Loss: 03/16/2015 Owner/ Insured: Theresa M. Melnikas Street: 60 Wentworth Ave Town: North Andover MA Type of Loss: ice / snow To Whom This May Concern: Toll Free: 1-888-70-AMICA (1-888-702-6422) Fax: 1-888-999-4641 September 28, 2015 Please be advised that we insure the above named individual(s). A claim has been made for Damage to Real Property and as the insurer, we are presently in the process of adjusting the loss. We are mandated to comply with Massachusetts General Laws, Chapter 139 and as such, if there are any present liens on the above property, please notify us within 10 days of receipt of this letter. If we do not hear from you, we will be under no obligation to pay you any portion of this claim. Sincerely, Bruno J. Costa AIC Claims Department 888-702-6422 x21117 BCOSTA2@AMICA.COM AMICA MUTUAL INSURANCE COMPANY AMICA LIFE INSURANCE COMPANY AMICA PROPERTY AND CASUALTY INSURANCE COMPANY AMICA LLOYD'S OF TEXAS AMICA GENERAL AGENCY, LLC. WEB SITE: WWW.AMICA.COM .Z£ a o 0 Q� �o Q. a `£ W X �LL Q 0 4� Q) O a ,CE o, a � N N W 'Q M Z Date. . A —Ili. l'.`/...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . ........... has permission for gas installation in the buildings of .. . ..... .................. at ."/o .... North Andover, Mass. Fee.Lic.7,. Check # //4/ 4533 10 I J MASSACHUSETTS UNffDRMAPPUCATON (Type or print) NORTH ANDOVER, MQQAS��SACHUSETTS Building Locations New ©' Renovation j� Replacement ❑ W PERMIT TO DO GAS FTI IMG Date�fl� OZ�� Permit # r is Amount $ , Cat'F0�f 1gvyS�3e� Plans Submitted ❑ (Print or type) /IAN��� ��y rt/'I ��' ( C ec Corp. onCertificate Installing Company Name C7 e4 kt CD2 f) S ElPartner. Address 1 'L., -e- // /�? d4 0 / 5 rZj-Business Telephone f7T fi r, 91/ 2 3 n Firm/Co. Name of Licensed Plumber or Gas Ftter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes ff No ❑ If you have checked yes, please i 'cate 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 or me aetaus ana nuun„ativ„ i ,javc k..- _-_ _-_ ___ ____ ________ -- 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 Massa u etts late Gas9DVnd/�hapter 142 of the General Laws. City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber ® Gas Wer Plumber & ❑ Gas Fitter License um er ❑- Master ❑ Journeyman f eu Date. I TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that -,4 ............ has permission to plumbing in the buildings of.............. P at .. ......... Pp5hhAndover, Mass. FeeC-)/j Lic. No. M,,,(/... ... — .......................... 46 PLUMZIN INSPECTOR Check # 6246 _0 C MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUSETTS Building New Er Renovation APPLICATION FOR PERMIT TO DO PLUMBP AV -e Ownis Name fCy FIXTURES a 3Ate �--- ermtt #� Amount �/l3 4 Plans Submitted Yes No (Print or type)Check one: Certificate Installing Company Name �R N�/y eG� �' IV �C / El Corp. Address _ .0c 40L4 aleoglo .5f ` El Partner. Lotr4/( #KA- 018 F9, Business Te ep one Z 3 0 aFirm/Co. Name of Licensed Plumber: R1 C4p—p G. ! A Aha'q'tl T/L, Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity 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 0 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 M chtdetts Stag Code and Ch Xpter 142 of the General Laws. By: -Signature o icense um er Type of Plumbing License Title D City/Town icenseum e6 r Master Journeyman ❑ APPROVED (OFFICE USE ONLY r DP • Location '`- No. �5� Date NORT1y TOWN OF NORTH ANDOVER Certificate Occupancy $ • ; , of �� s'"�•° Eta' ACNUS Building/Frame Permit Fee $ _ � r —AA Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 17602 `�- `�Building Inspecr" I 1.l Property Address: n womC 1.2 Assessors Map and Parcel dumber. 000, Map Number Parcel Number 1.3 Zoning Information: Zoning Distrid Proposed Use s � 1.4 Property Dimensions: Lot Area Frarna ft 1.6 BUILDING SETBACKS ft Not Applicable C Front Yard Side Yard Rear Yard Required Provide 'red Provided Reqwred Provided r E*ration Date 1.7 waters M.CzLC.40. s4) 1.3. Public Priv.te ❑ Zone Flood Zone hdomntion: 1.E sew ontsido Flood Zone Mvnicipst Disposal system On Site Disposal system ❑ SELMUIN Z - PKUPERTY OWNERSHIY/AUTHORMED AGENT 2.1 Owner of Record (o O co_Q v Name (Print) Address for Service : ,-s 2.2 Owner ecord: " �2u✓ �i d GL��7't. f KJ �', c 7�� /�L�' Name Print Address for Service: 1�;2& 7ee24-1 Or,%_11V1,q J - %_WLI..11AN%"11V1• �7GA ♦il.L'�7 1 3.1 Licensed Construction Supervisor: // I r.. , F11//19A,' f �� e Licennsed Construction Supervisor: f/- CJ's e 11,P,, j-, e e Address / Signature _ Telephone Contractor Company Name Address Not Anolicable G License Number? s � Expiration Date Xp 1,51 Not Applicable C n rl Registration Number r E*ration Date SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 22 Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building it. Signed affidavit Attached Yes.... No ....... C SECTION 5 Description of Pro6osed Work check an. ble New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ application. Alterations(s) 0 Accessory Bldg. ❑ I Demolition ❑ I Other 0 Specify- Brief pecifyBnef Description of Proposed Work: 1 CF.rTION 6 - F.STiMATF.n roNCTRITf TinN rncTc 1 to provide this affidavit will Addition 0 Item Estimated Cost (Dollar) to be Complete by permit applicant OFFICIAL USE ONLY I . Building y DOO 00 (a) Building Permit Fee Multiplier 2 Electrical 000 OQ (b) Estimated Total Cost of Construction f tyro #1S-azso _�— 3 Plumbing D G Building Permit fee (a) x (b)o-o 75� 4 Mechanical HVAC p 5 Fire Protection cr, rs� 6 Total 1+2+3+4+5 _ Check Number it ar.a,lav14 is Vwi'4rVLA►uinVicMA11%JS 1V nr %_UMrL'ZJEL Wtt=f4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relati%e to work authorized by this building permit application. Signature of Owner SECTION 7b OIA AGENT DECLARATION Date I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are tnie and accurate, to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES / SIZE BASEMENT OR SLAB T SIZE OF FLOOR TIMBERS X"2 V.P 2 NU 3RD SPAN / DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS x HEIGHT OF FOUNDATION / // THICKNESS /O SIZE OF FOOTING X MATERIAL OF CHIMNEY '6. IS BUILDING ON SOLID OR FILLED LAND o/ IS BUILDING CONNECTED TO NATURAL GAS LINE 'r b, 1.1 Probity Address: W_, jue-q- 0 G-� (�4 A7,J z 1.2 Assessors Map and Parcel 6., 'Nap Numbs Number: Parcel Number (�- 1.3 Zoning Information: Zoning District Proposed Use a 1.4 Property Dimmsians: Lot Area Fronts R 1.6 BUILDING SETBACKS ft Not Applicable C Front Yard Side Yard Rear Yard Required Provide red ' Provided Reqttired Provided �A .w 2 G Expiration Date 1.7 waters M.G.L.C.40. 54) 1.3. Public Private ❑ Zone Flood Zoe Isformstion: 1.a Outside Flood Zone Municipal Sew Disposal System On Sire Disposal System ❑ bAU-11UPt l - I MUrEMI Y VWP1EKJrilY/AU lriV1ULED AGLrPIT - c,. 2.1 Owner off Record n , t �� � �o O Name (Print) Address for Service jjjttk-td ttz*jl ?7f"- 2.2 Name Telephone /1 /Z �ee-g4-1 6 ® wiz f�)�.rEy Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: en Address /, W / Signature i Telephone Company Name Address Not Applicable ❑ License Number z a Expiration Date % Ic Not Applicable C ao r(' r Registration Number �A .w 2 G Expiration Date SECTION 4 - WORKERS COMPENSATION (XG.L C 152 J 2' Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building it. Signed affidavit Attached Yes _ .... No .... ...0 SECTION 5 Description of Pro6osed Work check applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ application. Alterations(s) ❑ Accessory Bldg. . ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS I to provide this affidavit will Addition 0 Item Estimated Cost (Dollar) to be Compt by permit applicant OFFICIAL USE ONLY I . Building DO 000 (a) Building Permit Fee Multiplier 2 Electrical OO o Q Q (b) Estimated Total Cost of Construction w 3 Plumbing D G Building Permit fee (a) x (b) or -0 1/7 S0 r - 4 Mechanical (HVAC) p 5 Fire Protection Cr -c-- c 6 Total (1+2+3+4+5 Check Number Jr"l.11VIN In VW 1•rrxAUlnVK1GA11VA IV DE I.VMMEIEli WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relati%e to work authorized by this building permit application. SignatureofOwner Date 0 / '7 SECTION 7b OWNEIVAUTHORIZED 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 Si ature of Owner/A ent NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TIMBERS SPAN /.IIi / DMNSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS Date I_ HEIGHT OF FOUNDATION -7 / l // THICKNESS i0 SIZE OF FOOTING // ii X MATERIAL OF CHIMNEY Ale IS BUILDING ON SOLID OR FILLED LAND o/ IS BUILDING CONNECTED TO NATURAL GAS LINE I/, , r fA z d. 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O y � C O Cm I O 'D O �— h O O .ca 0o m o O a G O a- a c O C O .ts y c O •V Z � 0 0.� �..± ca c cv 4 W -cco w cn �?cu chi a w° r�4° v U w ° 1 0 O_ H ' C 7v O • C1 V CL r� d a� c0 O C 4 �L O O ga h EcCc r c o _o _ ts .. o c 0W i Ga r0+ Ts CD �• .cmc E .14 O�y � 3 A C ,y: • �! �tl� �p O Q ccs L m H m c c" c Q c O 1 c= 0o. 0 'C m a. C�;cmZ • ;Coco H O fA C F— CL*- 0O2WS0.212 W OZ m ♦=..r C +r -==t H .N AD ) C� 4!.s Z W �E ca .o c� c, O cm CO2 CL 0,9 O� = ego a_� O E- z SnZm S F W 0 C/) O U C/) 2 M L CD Z o. O y � C O Cm I O 'D O �— h O O .ca 0o m 0 v/ LU ca W W W co O O moCL G O a- a c O C O .ts y c O •V Z � 0 0.� �..± ca c cv 4 0 v/ LU ca W W W co 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 I -1't A C TvrAw-- LOCATION: Assessor's Map Number SUBDIVISION \ 's f STREETi rt PHONES-�_- O Z 1�) PARCEL LOT (S) -ST. NUMBER **************************OFFICIAL USE ONLY ***** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR CO COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS "DRIVEWAY PERMIT_ �� 4'�IRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR RAR I _ DATE So 01zuulf Revised 9197 jm BUILDING DEPT. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City IPhone # 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: `��s �'7 � s e_— Insurance Co. �_OagL �11� -A— llaa Policy # UD Q, -2 i Comoanv 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_penaltieslnlhefam�fa..S ,Op.WORK.OFWER,.and..a.ftne of.(.$10D.0DJ-allay 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. SignatureDate n o Print name s Phone # '( )i() Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina 0 Building Dept ❑Check if immediate response is required El Licensing Board p Selectman's Office Contact person: Phone #: Health Department Other Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax Please print. DATE JOB LOCATION Number HOMEOWNER LICENSE EXEMPTION Street Address Map / lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who awns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC Zip Code a U Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 Data filename: C:\My Documents\Ippolito Design Associates\DOcuments\N4ehiikas_Burke\Energy Audit.rck PROJECT TITLE: Andy Melnikas & Terry Burke Residence CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW / WALL RATIO: 0.15 DATE: 08/30/04 DATE OF PLANS: August 28, 2004 COMPLIANCE: Passes Maximum UA = 703 Your Home UA = 696 1.0% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimete R -Value R Value U- a t r UA Ceiling 1: Flat Ceiling or Scissor Truss 2142 30.0 0.0 75 Ceiling 2: Cathedral Ceiling (no attic) 716 30.0 0.0 24 Wall 1: Wood Frame, 16" o.c. 3274 13.0 0.0 224 Window 1: Vinyl Frame:Double Pane 312 0.490 153 Window 2: Vinyl Frame:Double Pane 89 0.480 43 Door 1: Glass 103 0.330 34 Door 2: Solid 38 0.540 21 Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 2603 19.0 0.0 122 Furnace 1: Forced Hot Air, 90 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MECcheclo and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer I mDate tj lam 14,4Z81*64- /1 �\ �I 100.88, o 0 .o �o J p 6 (q Jaa CIO, Q. LLI o a h Q) Co> n ,LE ►I p QLQ co lL ►L Z co = p UN o coil. cD W 4 a Y x LL] o + v�iU� OE c O O45 N W �a U o a0 + M Cc W ¢ °� � a %-(-z Z 0 '' a O Q O p ,ZS CL Q O �z cc e o Qz 0 W O Z O W"N a , C) LL W ccU Q ,Ce U o vOi o> N o> N SETISj 99'+/- s .r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance wr 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: 4 <3 "r - (Location of Facility) Signatur of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I IV I �Q w� o� oz �o � H 5� a W� z o �A O Iz- Q co = O� 3� � cc � L O d o- a ca c w � � wS _�• �� x� � n`� y c A a Q W � v,bo � a � � iii � � � �. �b � 1 A ��►, o `�� y wcgi w° a°' w ° �.J w°' a°' r� cn cn zCL u Cl a� 0 as • � ea o CO o M rg Ea a o CD :.., 0 CL 2 .�1mc E 3toa A m O IS t y w C � � O O .. m o C Q av Cl t O cm yl c o a 9 ,hof cc ` c CD d C • N m C •O o oA 3 N C** W CLO cW.3 o �� cma•C 0.00 CO3 d • 9 CD O CO s FE A �- Z aa:acon 9 Z O U w f O O co Q co = O� 3� � cc � L O d o- a ca c C cc .Q y O ,�; Z � c V y c cc 4 40RTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ..... .........��..... .;1 ................................................ has permission to perform L .......................................... wiring in the building .!............................................ at. .......... ...........-*� � . ... ....... , North Andover, Mass. Fee. -.2/3 �.... Lic. NoA.....;.... �./ . ................................................. `j ELECTRICAL wspECTOR Check # ?"<? Z 5497 �� L.onmvnorurraat�s a f %/��clsatl(� / For Office use only Now • (Rev. �Nu y Permit Number. srvic:o! BOARD OF FIRE PREVENTION REGU' TIONS Occupancy &Fee APPLICATION FOR PERIVIIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFOX&D Wt'm THE MASSACHUSERS ELECTRICAL CODE 527 CMR/12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION � / Date:_ City or Town of: w -/I/�X�� . y 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) h G l?/e .7 �iv a.�'jly e Owner or Tenant: -- Owner's Address: Is this permit in conjunction with a Building Permit? Yes ❑ (Check Appropriate Box) Purpose of Building- h A— Utility Authorization Existing Service; Amps / Volts Overhead CI New Servicer 2Amply / Z yd Volts. Overhead ❑ Underground. ❑ Underground, M--' Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: No. of Recessed Fixtures i No. Of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No, of Switches No. of Ranges No, of Waste Disposals No. of Dishwashers No. of Dryers No. of Water Heaters .1 # of Hydro Massage Tubs ';� U. a Mk No. of Cell: Susp. (Paddle) Fans No, of Hot Tubs Swimming Pool: Above ground o in Ground ❑ No. of 011 Burners No. of Gas Burners No, of Air Conditioners Heat Pump Totals: Number. TON TOTAL TONS:-I' KW: Space /Area Heating: KW Heating Appliances KW No. of Signs.-_# of Ballasts: No. of Motors Total HP # of Meters # of Meters:_ No, of Transformers Total KVA Generators KVA # of Emergency Lighting Battery Units Fire Alarms # of zones # of Detection & Initiating Devices # of Sounding Devices: # of Self Contained ! O DetecuordSounding Devices Security Systems: No. of Devices or Equivalent Data Wiring, No.. of Devices or Equivalent: Telecommunications Wiring: No of Devices or Equivalent: OTHER; 0 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 eq�uival The undersigned certifies that such coverage is In force, and has exhibited proof of same to the permit Issuing office. CHECK ONE.INSURANCEc--er BOND O OTHER ❑ Please specify: Estimated Value of Electrical Work $ (When required by municipal policy) Work to Start:_% Z" Z Z — ma yIns' 1 certify, under the pains and penalties of er'u that the Information on thisections to be requested application its truein accordance nd complefeMEC Rule �0, and upon completion. P 1 r5'. ppcomp lets. Name: LIC. #_1 Licensee: p �✓ / %� H�I �' Signatu3"a (if appllcable,antt"inthe license n erline) Address: Bus. Tel. # �--2/G Alt. Tel. # OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this mquirement. I am the (check one) Owner ❑ OR Agent o Signature of Owner/Agent: Telephone # i PERMIT FEE: Ste% —� (Ommonwda&t o` 7%r1aAS iTERFORM' For Office Use Only rf PerrmitNum)ber. 1Jspaimsaf o�..tira Occupancy & Fee I BOARD OF FIRE PREVENTION RNS APPLICATION FOR EELECTRICAL WORK (AU WORK TO EE PERFO 'nM MASSACIi MTS ELECnUCAL CODE 327 CMR 12.00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date:-/, City or Town 'of:' /lam /- �iP/�1,< <-g To the Inspector .of Wires: By this application the undersigned gives notice m the electrical w of his or her intention to perform descntied below.:. Location: Street & Number Owner or Tenant:��`� Owner's Address: /" Is this permit in conjunctlon with a Building Permit? Yes c3 x--90 o (Check Appropriate Box) Purpose of Bullding , Utility Authorization Existing Service: Amps / Volts Overread 13Underground.D # of Meters New Servicer 2-1/ Amp4J2 olts Overhead D Underground.6----_ # of Meters:_ er of Feeders and Ampacity: ion and Nature of Proposed Electrical Work: Recessed Fixtures (J No. of Cell: Susp. (Paddle) Fans No. of Transformers Total KVA Of Lighting CmUsts No, of Hot Tubs Generators KVA of Lighting Fixtures Swimming Pool: Above ground o In Ground o # of Emergency Lighting Battery Units of Receptacle Outlets No. of Oli Burners Fire Alarms +.. ' . # of Zones # of Detection & Inhlabng' Devices of Switches c ev No. of Gas Burners Sounding ding Devices: # of So ! U Devices of Ranges No. No, of Air Conditioners TOTAL TONS: r/ d Local ❑ Municipal Connection o Other ❑ of Waste Disposals Heat Pump Totals: Security Systems: Number. TONS:T_ KW: No. of Devices or Equivalent of Dishwashers Space /Area Heating: KW Data Wiring, No.. of Devices or Equivalent: of Dryers _ Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent: of Water Heaters KW No. of Signs: # of Ballasts: OTHER; Hydro Massage Tubs No. of Motors Total HP IRANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may Issue unless the licensee provides proof of liability insurance Ing 'completed operation' coverage or Its substantial eq�uival �. The undersigned certifies that such coverage Is In force, and has exhibited proof of same to the permit g office. CHECK ONE INSURANCEe— BOND O OTHER a Please specify: Estimated Value of Electrical Work $ (When required by municipal policy) Work to Start: /Z L Z - o y Inspections to be requested In accordance with MEC Rule 10, and upon completion. " 1 certify, under the pains and penalties of perjury, that the Information on this application is true and complete. Finn Name: LIC. Licensee: w+t y Signature: LIC. # 4t' 2 _ (If applicable, enter " t" 1n the II anse ninf6er line) Address: Bus. Tel. # , % — /G� AIL Tel. # i OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) Owner o OR Agent o Signature of Owner/Agent: Telephone # \ PERI4II7' FEE: S ' 5ER 0 tc �7 S c l 68(E'• -c �•f C � K a- a 3 0� QTM 0 0 Town of North Andover NORTH Building Department q 400 Osgood Street North Andover Ma 01845 (978) 688-9545 Fax (978) 688-9542 nO 'QA cx.ncwew.c«`y7' 7SSACHUSE APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER DATE REQUEST FILED _ I DATE READY FOR INSPECTION C.. TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING D.P.W. — WATER METER OFFICIAL USE ONLY DATE P &L&;— D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. *WWA SIGNATURE / DPW AUTHORIZATION usec t 'Ve 0,CtnVA4 <,w)i,ce