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HomeMy WebLinkAboutMiscellaneous - Matthews Ln-56i v ' (�, Date ...... 690 ORTH 4, TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ...... a ................... has permission to perform ...... �/j ....... ............... CU wiring in the building of .......................... .. at ...... S!"'.) , � X- -.( . ........ . North Andover, Mass. 'M Fee ..... Lic. No. 11��F.74 .............. ....... L*E*C'*T*R'*I*C* A*'L'*I*N'*S* P**E* C"T' 0** R** Ll WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 011E TOMI 011wralt1l of IttgotJUBERB iDepurtmettt of Vublic eafrtU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy ,& Fee Checked �1Lw 3/90 (leave blank) r 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 _— /—/0-171 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform//the electrical �work described below. / Location (Street & Number) Owner or Tenant Owner's Address/ Ar I(� (C1L_��T i �),j LoN.) i Is this permit in conjunction with et building permit: Purpose of Building Existing Service Amps —J Volts New Service ZZ1Z_ Amps f� U / iib Volts Number of Feeders and Ampacity Location and Nature of Proposed I Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrnd ❑ No. of Meters Overhead ❑ Undgrnd ❑ No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- Elgrnd. ❑ grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners v Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ❑ Other ❑ No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO ❑ 1 have submitted valid proof of same to the Office. YES .,ET 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 $ / Work to Start " to 5 -7 Signed under the Penalties of Deriurv: FIRM NE Licensee Inspection Date Requested: Rough L, I C. C C r f I Final LIC. NO. // / 2 '714 Address ; ' kA v All. Tel. No. OWNER'S INSURANCE WA ER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x-6565 It - 3 -2171 Date. /. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that -'211.4 ............... has permission to perform . . &. :� 1�-lq - ................. plumbing in the buildings of ......... at—%. ........... North Andover, Mass. Fee� Lic. No.. A� .. ........... PLUMB G INSPECTOR 03/13/97 13:28 250-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer NP2 Z . 2492 Date. TOWN OF NORTH ANDOVER 16 d PERMIT FOR GAS INSTAL This certifies that /91! .............. has Oermission for gas installation 1� .(41&:':-� . ........ .. in the 'buildings of . . ..................... at ............. North Andover, Mass. Fee. ..... Lic. No.. ........................... GASINSPECTOR WHITE: Applicant CANAY: Building Dept. PINK: Treasurer GOLD: File MASSACIIUSETTS UNIFORM APPLICATION. FUR PERMIT TO UU G�SFIIIING �'i;. (Print or iype) r� . �`^• Mass. Date _ 3 -ll -� 7 19 Permit # -.2 Y� 3, nuilding Location -56 Owner's Name 1. Lou Type of Occupancy SINGLE CAM.[LY G New U Renovation U Replacement O FIXTURES Plans Submitted: Yes d No d Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P.O.BOX 1701 HAVERHILL, F1A 01831 Rusiness Telephone 508-374-1743 Naive of Licensed Plumber or Gas Fitter S•1'EI'IIEN C. GALINSKY Check one: KJ Corporation O Partnership d Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Ves �C No U 11 Inu have checked yes, please indicate the type coverage by checking the appropriate box. A IiA ilily insurance policy Other type of indemnity O Bond U OWNER'S INSURANCE WAIVER! I am aware that the tic ens"- does not have the insurance coverage required by Chapter 142 of the Mass. CenriA I nws, and that my signature on this hermit annlicalinn waives this tenuirement. Check one: Owner 0 Agenl. n �irli,ilure (if Ownet or O%enrl's Agrnl I I,( -I, tetYf) that all of it,, It( jail, and inln,matinn 1 ha.r Suhmiurd In, enirrtvll In tltr ah—r applkaoinn ate Irur and acruraoe to The toast of my knowlydpe and ilio all plumbinp wool and inar'iatinna rrdutmr•d unrir•t Ihr prrmit i�ggvt Int Thi% appllc aGnn.111 M in tnmrl,anre .4th al! prninrnt p,n.;sions of The Massachutetu state USS Code and Chattfet 142 0(0* Grrteral l J— ,str nr 11trntr 1 klaurt S'[Inahne of titAxd Plurnl r of Gat 1Met J -- -- [- Inutnryno, lit enrr Nun• �• _. _. _ _ egsaii'� IlImaN9NaNNNNNN�� �I g� tioiie9e�ee�il�:E� Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P.O.BOX 1701 HAVERHILL, F1A 01831 Rusiness Telephone 508-374-1743 Naive of Licensed Plumber or Gas Fitter S•1'EI'IIEN C. GALINSKY Check one: KJ Corporation O Partnership d Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Ves �C No U 11 Inu have checked yes, please indicate the type coverage by checking the appropriate box. A IiA ilily insurance policy Other type of indemnity O Bond U OWNER'S INSURANCE WAIVER! I am aware that the tic ens"- does not have the insurance coverage required by Chapter 142 of the Mass. CenriA I nws, and that my signature on this hermit annlicalinn waives this tenuirement. Check one: Owner 0 Agenl. n �irli,ilure (if Ownet or O%enrl's Agrnl I I,( -I, tetYf) that all of it,, It( jail, and inln,matinn 1 ha.r Suhmiurd In, enirrtvll In tltr ah—r applkaoinn ate Irur and acruraoe to The toast of my knowlydpe and ilio all plumbinp wool and inar'iatinna rrdutmr•d unrir•t Ihr prrmit i�ggvt Int Thi% appllc aGnn.111 M in tnmrl,anre .4th al! prninrnt p,n.;sions of The Massachutetu state USS Code and Chattfet 142 0(0* Grrteral l J— ,str nr 11trntr 1 klaurt S'[Inahne of titAxd Plurnl r of Gat 1Met J -- -- [- Inutnryno, lit enrr Nun• �• _. _. _ _ r - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date 19 Permit # J 2-% Building Location Owner's Name m -L pw(tnj. Type of Occupancy SINGLE FAMILY Nev/ Renovation ❑ Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No ❑ Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P.0.BOX 1701 HAVERHILL, MA 01831 Business Telephone 508-374-1743. Name of Licensed Plumber _STEPHEN C. GALINSKY Check one: Certificate IX Corporation 1906 ❑ Partnership INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes>,P No O If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy>-�l 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 Ivlacc. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent 0 Signature of Owner or Owner's Agent , I hereby certify that all of the details and information I have submitted for entered) in the above application are It and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issue A for this application will be in compli ce with al ninent proviVons of Ih ache s Sta tumbing Code and Chapter 142 of the General Laws, By Signature of license PI u her Title Type of License: Master Journeyman O l:itv/Town License Number _—W-348___ nPPRn\,TD'OFFICE U SE ON[y1 ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■�]■■■■■■■■■0■■■■■ •• ■■ ■ ■■■■■■■■■■■■■■■■■■■■ 6th FLOOR Installing Company Name GALINSKY PLUMBING & HEATING INC. Address P.0.BOX 1701 HAVERHILL, MA 01831 Business Telephone 508-374-1743. Name of Licensed Plumber _STEPHEN C. GALINSKY Check one: Certificate IX Corporation 1906 ❑ Partnership INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes>,P No O If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy>-�l 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 Ivlacc. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent 0 Signature of Owner or Owner's Agent , I hereby certify that all of the details and information I have submitted for entered) in the above application are It and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issue A for this application will be in compli ce with al ninent proviVons of Ih ache s Sta tumbing Code and Chapter 142 of the General Laws, By Signature of license PI u her Title Type of License: Master Journeyman O l:itv/Town License Number _—W-348___ nPPRn\,TD'OFFICE U SE ON[y1 Z I& Location',, No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 7 7 S rep Foundation Permit Fee $ C Other Permit Fee $ Sewer Connection Fee $ (997 Water Connection Fee TOTAL 1161d' Mi DIv..P 8 Works Location No. Date TOWN OF NORTH ANDOVER S Certificate of Occupancy $ �5,v Building/Frame Permit Fee $ -34A MU Foundation Permit Fee $ ezo Other Permit Fee $ Sewer Connection Fee' $ Water Connection Fee $ TOTAL H2 6 5 1 01/24/97 11:36 Build 150. 00 A�Vnspector Div. Public Works Location No., Date TPI TOWN OF NORTH ANDOVER So- Certificate of Occupancy $ Building/Frame Permit Fee $ SS U Foundation Permit Fee $ Other Permit Fee $ tewer Connection Fee $ Water Connection Fee $ TOTAL $ ng Indpector j, 2 C,21400 M11 984.00 PAID Div. Public Works 3. PER'.%'"C NO. - D APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP +40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONA E ` SUB DIV. LOT NO. LOCATIONI P �I iJ a 7-T �� S 0 _�� PURPOSE OF BUILDING S� f yy� - ( sj OWNER'S NAME t V1 OWNER'S ADDRESS 973 OC `'! � Q 0 cl 4 Cor NO. OF STORIES SIZE BASEMENT OR SLAB V ARCHITECT'S NAME �j © G_ SIZE OF FLOOR TIMBERS IST V.��/�{-� 2ND V ���a 3RD BUILDER'S NAME _J j1� L)` CD y- )202 SPAN f DISTANCE TO NEAREST BUILDING i•I en 1 DIMENSIONS OF SILLS LL X Z� DISTANCE FROM STREET � n a0�1 POSTS DISTANCE FROM LOT LINES - SIDES . 2 REAR 1 ,. ,GIRDERS AREA OF LOT E D E & FRONTAGE / � [ HEIGHT OF FOUNDATION O [ THICKNESS j� f �j IS BUILDING NEW1` 4s SIZE OF FOOTING /d'�� X G IS BUILDING ADDITION 1 © / �/j� MA MATERIAL OF CHIMNEY r IS BUILDING ALTERATION 1 0 V IS BUILDING ON SOLID OR FILLED LAND 5 441 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ,eS IS BUILDING CONNECTED TO TOWN WATER ] z s jl/,e BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER S 7 IS BUILDING CONNECTED TO NATURAL GAS LINE /-,-s 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 ATYACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED / I��A b SIGNATURE OF OWNER OB AUTHORIZED FEE PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST r V EST. BLDG. COST EST. BLDG. COST PER . FT EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. J 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # CONTR. TEL. # CG c(- 36'>y CONTR. LIC. k 16 90 H.I.C. N BUILDING RECORD OCCUPANCY 12 SINGLE FAMILYEok! �_ _717 MULTI.'k FAMILY . OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 i 2 13 PINE CONCRETE - CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL 17NFIN 3 BASEMENT', AREA FULL 1/1 1/2 1/1 FIN. B'MT AREA. FIN. ATTIC AREA' NO 8 M'T FIRE -PLACES T HEAD ROOM -MODERN KITCHEN 4- WALLS I 9 FLOORS CLAPBOARDS B Hl� 1 2 3 DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING CONCRETE EARTH HARDW'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR _.ADEQUATE POOR NONE 5 ROOF 10 PLUMBING GABLE I I BATH Q FIX.) GAMBRELJJ _HIp MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR X .TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL EMS. & COLS.. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING - RADIANT H'T G IT HEATERS 7 NO. OF ROOMS GAS OIL 2nd B'M'T__O J%Z_f J.t _3' d I ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OFAWILDiNGS.: WITH, PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS.REPLACES PLOT'PLAN.,- L 7 -l%VAj=WC"CorX""WvJ m Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Naof Applicant on Building Permit (below) Address of Property for Permit (below) 172 /41010 a/ 'at), rd Y%O — 60 /Wo /_7A Lv��s L3 1,1 Map and Parcel : Purpose f��Application (check below) Phone Number of Applicant: ' D� Single Family _ Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. ZThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy allowed an EXEMPTION as cited above inaccurate information, or the checking knowled94q or not, is grounds for refusal of the information provided and that the attached building permit Further I understand that the submittal of misleading and or off of an above item which does not comply, whether done to my by the Building Department to issue a Building Permit. mire or uwner or Nuinonzea Ngent wno sioned the Attached Buildina Permit Date form must be attached to the Building JJ �� upon application for such permit. FORM U - VERIFICATION 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ell (12o d ✓, Cr Phone 6 7 4/ LOCATION: Assessor's Map'Number. Parcel Subdivision //-/ �i �(,�r�0D1 Lot (s) �— Street ���c�.e 1 St. Number I *********************** Official;LTse Only************************ RECOMMENDATI NS F T AGENTS: Date Approved Conservation Administrator Date Rejected Comments I �- r QQ Date Approved ( D Town Planner Date Rejected Comments a Food Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date -Approved Date Rejected Public Works - sewer/water connections driveway permit FAirirVe✓ De artme , Receiv d by Buildi • JAN 1 5 1 r-1 W W cd o a O c CD c �r +i CD cm o d y E� Z y o .� m �s O z °° cc o as co U 110 Oman c ® a (n cm O •oo �: c o v m O nnom : 0. -0ti 1� .0ti 0. Em ,c C • m o cm .�.. CLC-3CD C O i t .mo C w .CL O may+ I cos Q w Z3 y z .G7 moi m a §F. N Iz c•ao c !o !- o ' S m ® r o Y/ W CO +• "O t o® • 3 'o at _ Z .� m •N O v ® � E CL0,0g p y S A � O " �- w � w 0 > w C) a°' . w a w a°' w a a a°' w E� z w a � rA O U L o a O c CD c �r +i CD cm o d y E� Z y o .� m �s O z °° cc o as co U 110 Oman c ® a (n cm O •oo �: c o v m O nnom : 0. -0ti 1� .0ti 0. Em ,c C • m o cm .�.. CLC-3CD C O i t .mo C w .CL O may+ I cos Q w Z3 y z .G7 moi m a §F. N Iz c•ao c !o !- o ' S m ® r o Y/ W CO +• "O t o® • 3 'o at _ Z .� m •N O v ® � E CL0,0g p y S A � O " �- w � w 906 ,AORTil Date ....... ; I TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... &(W.444 ...... Ele ..... a., .................... ....................... has permission to perform ...... wiring in the building of... 7f ... y ... TJ.. .... . ............... i ........ ..... e orth Andover, Mass. a4& ..... .... . . ................. . Fee2:50-9. Lic.NoM�-.7/14/ ................. ........ I ELECTRICAL INSPECTOR ($04 15,S15V2197 08 :50 2M.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1� Office Use Only Ile &IR111vowealf l of MUDDUCIJUDWD Permit No. O iDepurttnent of Vublic 0�ufetU Occupancy A Fee Checked .,7 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank) 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 ` - 1-17 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described/below. Location (Street & Number) __ 1 C6 yt- :57� ^�'e 57,/ Owner or TenantUc� nn cZ L) 0 fr , Owner's Address �UZ� Paxk, — /I..) , f %ti F,Q o/jiuA Is this permit in conjunction with et building permit: Yes .0 No ❑ (Check Appropriate Box) Purpose of Building S`,',� l o ltir i i tJ o� Utility Authorization No. _7 U 3 .R 7 3 Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service 'ZOO Amps /2�4 I V 0 Volts Overhead ❑ Undgrnd * No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work AJ P,�f' iU tom. No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ElOther❑ No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Com eted Operations Coverage or Its substantial equivalent. YES NO ❑ 1 have submitted valid proof of same to the Office. YES NO ❑ If you have checked YES, please indicate the ty f coverage by checking the appropriate box. INSURANCE� BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ , Work to Start ,�— Z— 9 -7 Inspection Date Requested: Rough _(.0 l i Final Signed under the Penalties of perjury: FIRM NAME / w - LIC. NO. Lice nsedc,4i'7�S— Signature LIC. NO. s�/� /� Bus. Tel. No. 1 — 6-9 q� Address —y t�!/J�Gf C It j a e �/ //i e A All. Tel. No. OWNER'S INSURANCE WAIV R�I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) W.Ag;rag; s� 4 A CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building permit Number 0-30 Date 6'aG /9q THIS CERTIFIES THAT THE BUILDING LOCATED ON S MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE SSACHUSETTS ST TE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED T -� ADDRESS Building Inspector qp O FM4 01-1\ ON ►i •am c E-+ EU o CL •00 :Q dcc !a; mry C `'� 9r •' CD .41 0 Go 0 c.= E t \J co 3 ti -1 jwG+ •0 5 m o 'Y.� Z = N �, ✓- + E a 75 O O--4 ac. o N .L= o co CMIS C.i ti Z O ' 4 C O! 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