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HomeMy WebLinkAboutBuilding Permit #368 - 21 DUDLEY STREET 12/1/2008 BUILDING PERMIT Of OORTH q TOWN OF NORTH ANDOVER o? o� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 7 ADAATED (y �SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Prim PROPERTY OWNER ' Q Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: I entification Please Type or Print Clearly) OWNER: Name: Phone: �✓ Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �J� f FEE: $ Check No.: �f2 � Receipt No.: NOTE: Persons contracting w'h unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner_ Signature of contractor -- Location `6— 1 1 1 'S T— No. / Date a NORTH TOWN OF NORTH ANDOVER O Certificate of Occupancy $ Building/Frame Permit Fee $ t� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector 03!26/02 09:59 FAM 978 682 1646 LANDERS ELECTRIC Q03 Ne 3525 Uate_...� ........�...... TOWN OF NORTH ANDOVER ° PERMIT FOR WIRING w Acius Thi Certifiesthat -... 0.�•'^� ............. ..__ ......................... has permission to perform tL.e0�`V2 .. wiring in the building of.-._..... vt,-l... .. ..... at...................... V��G�,��. ......Sr........ .No Andov Fee....h7.'dU.. Lic.No.. 's'L?� ......... ._ .�,- •..... ' - ? cwt b Check 9 WHITE:Applitanl CANARY:Bulldinp Dept PINK Treasurer i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature If COMMENTS a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signaturefdate COMMENTS L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use i I i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Application Revised 2.2008 NORTH TO" Of - Andover 0ti=y•t�. (1 o dover, Mass., Q _ — LAKE 1. CoCHICHEWICK V 7 ADRATED "♦� BOARD OF HEALTH !V1 I Food/Kitchen Septic System BUILDING INSPECTOR PE11 T T� THIS CERTIFIES THAT.......................... .. .W.................. ........ .. .. -.... ........................ .............. Foundation buildin s on .........�.. .....!�.�....... :.�. has permission to eli.­­ ...p............ g � ..... ............ ............................. _;; Rough to be occupied as.... .. 1 ...' ....1....1.�.Q. ...... ............... • Chimney provided that the person ac8epting 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 Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 3b PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N START Rough :.............. x Service BUILDING INSPE R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall 7o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ,AORTM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT • 1600 Osgood Street Building 20, Suite 2-36 �,swctt� North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION lease V&t DATE: O I JOB LOCATION: q OZ ( Number Street Addre Map/Lot HOMEOWNERQW(f, I�Q YI N Home Phone Work phos PRESENT MAIIING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to en an individual for hire who does n engage ofP a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements- HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowam Exemption 110AR.DOF \PPFAJ.S6R89541 CONSER\".vrioNf88-9530 ITE.\L;FI1688-9540 PL.LNNENG 688-9535 - The Commonwealth of Massachusetts >" dl Department of Industrial Accidents Office` t ff of Investi;ations 600 Washington Street Boston, M4 02111 www_mass.gov/dia Workers' Compensation Insurance.A€ davit. guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.❑ I an. a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet �• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers, comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9• ❑ Building addition required.] officers have exercised.their 10:❑Electrical repairs or additions 3 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions yself. [No.workers' comp. c. 152, §1.(4),and we have no insurance required.] t employees. [No workers' 12.❑ Roof repairs comp. insurance required_] 13 Other *Any appficant,that checks box#1.must also fill out the section below showing their workers'compensation policy information. t Womeowoers who submil.iltis a devil indicating Esey art uuit:9 �ttd ihen hi,outside runtriLc tuts muni submit a new —davit indicating such, xContractors that check this box must attached an additional sheet showine the nAme of the sub contractors and their workers'comp,Policy information. I fo an.employer that is providing workers'compensation insurance or l employees. Below is the policy andjob site information. 'f � P c1' J insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: .lob 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 5250.00 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. Ido hereby ce under the pains and penalties of perjury t-hat the information provided above is true and correct S i grtature: Date: Phone#: Official use only. Do not write in this area, to be.completed by city or town offcciaL City or Town: Permit/License# issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector $. Plumbing inspector 6.Other Contact Person: Phone#: Information a.nd Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. I Pursuant to this statute,an employee is defined.as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and includirn.g the legal representatives of a deceased employer,or the I receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house I or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state o r local licensing agency shall withhold the issuance or renewal of a license or permit:to operate n business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill out the workers'compensation affidavit compl-etely,by checking the boxes that apply to your situation.and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an,.LLC or LLP does have _ employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the Iaw or if you are req uimd to obtain a workers' compensation policy,please call the Department at the nurnber.listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/hcense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog iicense or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations e frons 600 'Washington Street Boston, 14A 02111 Tel. # 617-727-4900 ex`t 406 or 1-877-MASSAFE Revised 5-26=05 Fax#617-727-7749 vAm,.mass.c ov/dia Date.. . 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACMUSEt This certifies that . . . . . . . . . . . . . has permission for gas installation . . . . . . . . in the buildings of at . .�9. . . . . . . . . . . . . . ed?�" North Andover, Mass. Lic. .. . . . . . . . . GAS INSPESY6 Check# 5570 t� n 2 �q• • � 4 5 w h • i. .yf s A s oZ r. >Cy�� >o' o xlo z� "d o rn Q l� ZC '1 A 1, r1 AFM J: Yri fir,.. :•'�. •a. �M tt fAtIll 'RA469 Am .r �" ,WV as" On x 4+: a� i a •�' •4 •7 I �1• 1. •a ,a I •r Y y ^�r t '`Iri•w y .•.:M:,i,i ) ..fist •.� f •1 'r A} ♦:`v; i. N. 1� r •V: aF 4 'C'I .t:t•4rn'. q• 1 i. .iF4• _ ��'v 1 4'i' .io f: ,4 '+1 , : , , „ 1• n t, iry I: a�+• I j +r11 , a :Cyj' •'�5.:'t•:. jA�sr l O. Lij ell Pr .'r`• aN''%EI '•R : i : r.. , N :•r !tr f�' ,f a I{, , YL• e :•t. a + 2ty��a i'iCt Vit'' •M y 7 � F , sa 1. ro Y� A� ..ti C3 R , YHL •,'yY • : si`• l'f 1". Y. is ;.1 bi ,4•i" © r i' 1t m h' / i ro ,:r•' a' FO: C' �� i . .. 1' .... _ .. _. :. i .. 4 .. � ; , . + .. �. i� ti .. _ �_. .. _. ,P .. t � � . .i,._ �. -.. .... .. ,. - _ .... ... � .. ,... .. ..,.. .. _ _.4 1 1 � , �. � 1� i ,., ... _ .... . ., _. .,...,. .: .. .... ... .. _. i i _ x .'�f r ... .. ., .. , . j i ' .. � � r � � .. • � �r � �. I -_ _.., 357 -r Date..!?./.�. .1`��.•••••• NORTH TOWN OF NORTH ANDOVER 0 `p PERMIT FOR GAS INSTALLATION SACMUSES4 This certifies that . .I. . .v�. . . . J�:". . . . . . . .� . . . . . . . . . . . . . . has permission for gas installation-.e. . ~' in the buildings of . . . . . :., r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at l . .��. ,'1-r l� . . . . . . . . . . . . North Andover, Mass. Fee. .,�.�. .'. . Lic.�No.�f .r�. . . ..-�: .�,� . . . . . . . . . . GAS INSPE&OR / WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,�I N�n�/E� , Mass. Date — <=ZDO Permit # _7 Building Location � ��n - y Owners Na e ,rJ1E "" .. Ty of Occupancy reS%d'P�( r� New` Renovation ❑ Re acem ❑ Plans Submitted: Yesp No p cc N W N Ny U Z OC CCcc Q) XN 0 = W W OC O U = t ~ m s n z a CrU, I' a � r w Q ¢ O m t!f H y W O a C tt F- N N tl W W S y of O > W W 2 N W < a h O F� 2 tl F- Z J !- Z r, W W tl ul 0 > W t•- W J �y. W Y Q W Q C h Y• N M Z O Z Q O N X ¢ 'x O tl � U.3 G(1 v ¢ Y Q a O SUB—BSMT. BASEMENT e 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR FIE Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET �C] Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Buskiess Telephone -687--11105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 1 hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accv�te to the best of my knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (j i T of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 8697 9City/Town Journeyman APPROVED(OFFICE S _ONLY ov BELOW FOR OFFICE USE` ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO:DO GASFITTING 5.. NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE -19 GAS INSPECTOR 3 �e3 � Date.. . :.. ..... ........ • NpR*p TOWN OF NORTH ANDOVER 3?py`��ao ,a 1�ypL PERMIT FOR GAS INSTALLATION F 9 ,SSACMUSES This certifies that . . .'. .f. . . . . . . L has permission for gas installation in the buildings of . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . :�f . . .North Andover, Mass. Fee! : . . . . . . Lic. No.. . . . � = . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Ty�pe�) L&/L , Mass. Date 00 Permit # 3513 Building Location__ /9 ��/D '/ o C/ Owner's Nam 'F; 7 Typ fOccupancy d'Pslyet'b -( New Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ W W cc Y W N WW V X cc CC W rt W = � N O W = M F- tl U nI LJ Uj cc m W t' y4j W occ O d Kf H W tl W Q x z �. W W W W W J z Q x a D: W a W t- m r x z 4 W J Q C F' H �W. W O z W H V J yH. W m z o z a o <ll x a W w z. Q ¢ Q 41 '.x O tl 3: U. a 3 G tl J V ¢ Y a a F- O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 380 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership BUIliness Telephone .687-:1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or lits substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked Yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity❑ god ❑ 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 Owners/gent Owner❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted(or entered)in abo plication are true and accuTte to the best of my knowledge and that all plumbing work and Installations performed under the permit Iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. i T of License: . Title !�— Plumber Signature of Vcensed Plumber or Gas Gasfitter City/Town Master License Number 8697 mwgO IC S ONL Journeyman BELOW FOR OFFICE USE'ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO,D0 GASFITTING NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE X19 GASINSPECTOR Location / Do C/A, No. Date k�/ TOWN OF NORTH ANDOVER f �1, A Certificate of Occupancy $ i 1 �. Building/Frame Permit Fee $ tea, �'�b'•••° '<�' Foundation Permit Fee $ Y Ss•►cNusE • Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ AI/1M C vl# .30S 0 Building Inspector 02/23/99 10:35 52.00 PAID 12 �' 7 8 Div. Public Works F PERMIT 3 ILI)********NORTH ANDOVER MA III-'RM 1T NO. APPLICATION 1'OIZ I CRMIT TO I U , Al(I'NO. 0 I.M.NO. � / 2. HECORD OV OWNLHSIIIP DATE BOOK PAGE ZONE CJ SUB DIV. 1.0FNo . 4 LOCA I ION r>` 7-( , � PURPOSE OF BUII DING V i OWNER'S NAME Pvt,vLF—r, NO.01:S'TORIES SIZE. r OWNER'S ADDRESS i ( / S�" BASENIENr OR SLAB ND RD AR(IIITE(-1'S NAME C �( ' SIZE OF I'l O()R 1IMBERS 1 2 3 BI III DER'S NAME i SPAN DISTANCE TONEARES'r BUILDING DIMENSIONS OF SILLS DIS FANCE I:ROM S MEET DIMENSIONS Of:POS IS I)IS I'ANCE FROt.1 I..OT LINES-SIDES REAR DIMENSIONS OF GIRDERS ARTA OF LOT FRONTAGE I IEIGI IT(N=FOUNDATION THICKNESS IS BOILDING NEW -SIZE OF_I((JUNG a X IS BUILDING ADDIII(NJ MAl ERIAL OF Cl II I-INEY IS BUILDING ALTERATION IS BUILDING ON SOLID CYiT1l LED LAND WILL BUILDING CONFORM TO RFCxIIREMENI S OF CODE IS BUILDING CCNJNECI EDT O TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CCNJNECI"ED TO TOWN SEWER j' ( n ^��r�(,� �/✓(W //C�k/� IS BUILDING CONNECI ED TO NAI URAL GAS LINE INS N-TIONS 3. PROPER-rl'INFORMATION LAND COST EST.B(T)G.COST U I`� PAGE I Fll.l.CN1T SECTI(N s 1-3 EST..BLDG.COAT PER 50.FT. EST. BI.IXi.COAT PPR HO(*1 EI E(TRIC METERS mus-r BE ON CNi-i-siE OF BUILDING SEPTIC PERMrI NO. Al-1 ACI IED CAR AGE SMUST CON FOR MTOSTATE FIREREGI H.AIIONS a. APPROVED BY: ` < f MANS MUST BE FILED AND APPROVED BY BUILDING INSPECroR BUILDING INSPECTOR UDA'1'f:I II.Fl) / / OWNERS I ETA- CON FRA 1:1.11 TA CONFRA1:1.11 G SICNA II IRF(N OWNIAZ ORAl 11110RIZ14)AGENT Ll li. .d I'I Rt.I1TGRANI1 I) r G t4OR Town of V Andover No. 0 34" C1_ dower, Mass.,— —19 0 _ LAKE �C0CH[CHEW JCX 0,9-TE- -p D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ..!5 '0 S W /10 BUILDING INSPECTOR ....... ............ ........ THIS CERTIFIES THAT................ ....... ............................... Foundation 41 has permission to erect...../...... .,buildings on .......(:9.. ........ ....AW.4, ........ Rough to be occupied as...j %..................................... .......... ................ Chimney provided that the person ficepting 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 Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Poe PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUWCjPN S ELECTRICAL INSPECTOR Rough .. .... ... .. .................... ................................................................ Service BUILDING INSPECTOR Final Permit Required to Occupy Building Occupancy PL GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. a, Page No: 1 of P gea P �� •:e4i RICHARD FLU ET CONT RACTING INC.,', 102 Bridle;Path Ln., METHU EN, MASSACHUSETTS 01844 (508) 685-7010 "PHONE DATE TO SusatfiHen] e r 9?5-21 8ti 1; 28/99 '.Du d l e y s s. ''JOB NAME G LOCATION N Art dov e r . 11ass. 01844 J. JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: INSTALL 32 HARVEY CLASSIC DOUBLE HUNG WHITE TILT—IN VINYL- REPLACEMENT WINDOWS WITH 1/2 SCREENS,LOW "E" GLASS, WITH GRIDS IN UPPER SASH ONLY . -x220 .00 EACH TOTAL $7040 .00 � INSTALL SAME AS ABOVE EXCEPT ORIEL IN FOUR LARGER WINDOWS. X310:�tO--Efd�H T�AL' 1240 .00~~� __ WORK TO INCLUDE REMOVAL OF EXISTING SASHES, INSTALLING. INSULATING,CAULKING, PER111T AND TRASH REMOVAL. Extras or changes to be completed at a rate of j per hour, per man. Unpaid balances subject to llh% finance charge per month. WE PROPOSE hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: dollars($ 0 .00 ). Payment to be made as follows: J/2 WITH ACCEPTANCE, BALANCE UPON COMPLETION. All material Is guaranteed to be as specified. All work to be completed In a professional manner according to standard practices. Any alteration or deviation from above specifics- Authorized tIons Involving extra costs will be executed only upon written orders,and will become an Signature ..""��� extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tomado,and other necessary Insurance. Note:This proposal may be -� Our workers are fully covered by Worker's Compensation Insurance. J 0 withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL—The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: Town ofNorth Andover ! AORTol OFFICE OF ?Otti�ao <e1ti�0 COMMUNITY DEVELOPMENT AND SERVICES - p 27 Charles Street `. North Andover,Massachusetts 01845 �9' •'nth WILLIAM J.SCOTT SSACHUS� Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number 63 S is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) l Signature of-Permit-Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through-#he-Office-of the-SuAding 4nspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Location 1,�1v Qj i No. 6 Date 91 � MORTIy TOWN OF NORTH ANDOVER f w A � s Certificate of Occupancy $ sACHUSEt� Building/Frame Permit Fee $ J Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ v U Check # � Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING mus. for fl �> �I ,. . . � rn BUILDING PERMIT NUMBER. / / DATE ISSUED. SIGNATURE: hf V Building Commissioner/1215ector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Y A Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ;2Li A>y:�r 77 ,8' 79 Zoning District Proposed Use LA Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Su�p1y M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sew a Disposal System: Public iB/ Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes—Nojd-- rn 2.1 Owner of Record �, o S'c,c►s�' la.�,�cry /9�7-, ��o �rz st. � Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 Z M Signature Telephone 9 SECTION 3-CONSTRUCTION SERVICES 3�1 Licensed Construction Supervisor: Not Applicable ❑ /l rr V srf&I Licensed Construction Supervisor: G S 07.7- / !/P7 O 7" License Number Address / Vu �/o X 23 '`zr Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v a Company Name M t Registration Number r Address r Expiration Date z^ Signature Telephone Y t SECTION 4-WORKERS COMPENSATION(M.G.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. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition X Other ❑ Specify Brief Description of Proposed Work: �1 tri•�ovdt O� 3� X 4/0 jJ lGk SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 01MCIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Lf�ok -ria / Z,3'DO, Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) (�_� 4 Mechanical HVAC 6 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 7 I, ,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 Y Print Name Signature of Own er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TEVIBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS ItEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X r MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL•GAS LINE NORTH Town of 4Andover nTO Fjj 0 = LA o dover, Mass., COCMICMEWICK ORATED O'? C7 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System e+ BUILDING INSPECTOR �� THIS CERTIFIES THAT.............. N.a ............ ...... ................. ........................... ...... Foundation ...................................... ... has permission to erect..... ....M.NIr+................ buildings on...................................... ..... /� Rough to be occupied as...... ��` y a�� / a 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-L a relating relating to the Ins pec on, Alteration and Construction of Buildings in the Town of North Andover. / � / a D PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough ...... ............................................................. ... Service 4 BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 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 properly licensed solid waste disposal facility as defined by MGL Chapter 11.1, S 150 A. The debris will be disposed of in: S0,4,4 d✓f �/d jL dG J6A16 (Location of Facility) 917gn4ure of Permit Applicant —z Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector t F R t ' BOARD OF BUILDING REGULATIONS i! License: CONSTRUCTION SUPERVISOR a ' t Number: CS =-072487. I' Birthdate: 03/22/1960 ` Expires:03/22/2004 Tr,n0; 1067 ; Restricted: 06`" ` MATTHEW F DESMOND !' 31 UPLAND ST N ANDOVER, MA '018454 Administrator r w The Commonwealth of Massachusetts qz �. Department of Industrial Accidents r Office of Investigations 9�F Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: 1*'V',4l' Ze r mrclA!' Location: X r- City"ele, Phone # I am a7 homeowner performing all work myself. T 1 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: Address City: Phone#: Insurance:Co. Policv# Company name: Address city: r #: Insurance Co. Policy# Failureto segue coverage as required under Section 25A or MGL 152 can lead to the anpesition of crWhat penalties or.miihe and/or one years'imprisonments mas eWL _cbA peaaKies-os .ahelmn- STQPWORK9RQER.and afmsf_(,SIMW)-atlay�ai�m—j understand that a copy of this statement may be forwarded to the office of Investigations of the DIA far coverage verification. o /do hereby certify under Me and penalties of perjury that the kdbm)adw provided above its true and correct Signatur Date eF' ®�. Print name Phone#�cP,r � official use only do not write in this area to be completed by city or town official' City or Town Perm17/t iCe/1Slrk7. ❑Check I immediate0' Bftitt/ing. Dept response i reguirer! ❑ Licensing Beam ❑ Selectman's t Contact person: Phone# rl Health Uepartm, ❑ Other J LANDERS eLECTRICAL CO.,1 December 26,2001 Mr. Scott Hanley 12 Richardson Ave. North Andover,MA 01845 _ RE:21 Dudley St. Dear Scott As we discussed I am sending you the service report for your property at 21 Dudley Street.I have been in contact with the North Andover Wiring Inspector,James DeCola and will be sending a copy of this letter and the service report to him. The following items need to be addressed 1. The ground connection should be cleaned and reconnected 2. The fixture and ceiling plate removed from the bedroom must be replaced or blanked up properly. In addition I would recommend that a ground fault circuit interrupting type circuit breaker be installed for the bedroom circuit. This circuit breaker would trip if someone were to receive a shock from this circuit. The circuit breaker would require monthly testing to insure proper operation. I have enclosed a cost estimate to make these repairs. I wait your direction. Sicerely -177-26-1 J Terry Landers Vice President Landers Electrical Co.,Inc. cc. James DeCola 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL(978)686-3828 FAX(978)682-1646 ENDERS ELECTRICAL CO. INC SERVICE REPORT 1000 OSGOOD ST. P.O. BOX 783 NORTH ANDOVER MA. 01845 978/686-3828 FAX 978/682-1646 Cumamw Scott Hanley Tenant gets shock when she touches faucet in bathtub 12 Richardson Avenue 21 Dudley Street North Andover C#Y r*,ZD --7 bled North Andover MA, 01845 978/975-2186 12/20/2001 12/21/2001 Met with Mr Hanley at 21 Dudley Street 21 Dudley Street is a two family"Philadelphia Dutch'. The first floor is tenant A The third floor is tenant B and the second floor is split by both. Tenant B was leaving for work and described she and her daughter felt a shock when they would touch the faucet in the tub located on the third floor. She explained she now wears latex gloves when she showers. In the tub I found a 5 volt potential between the drain and the faucet This 5 volt potential was also present between the drain and the steam radiator in the bathroom I went to the basement and-measured for a potential between the copper water pipe P and the cast iron drain pipe which appeared to be going to the third floor bath. I did not find any voltage. I checked the ground connection on the main water service. The connection was tight but was corroded and should be cleaned. With the help of Mr Hanley,we shut off circuits one at a time until we lost the 5 volt potential. The circuit which seemed to be causing the problem was a second floor bedroom circuit. These bedrooms belong to tenant A In one of the bedrooms the ceiling had water stains and the ceiling fixture was not working. Upon removing the globe for the fixture we discovered the globe was full of water and bothe lamps were broken at the bases. I disconnected the fixture and removed the ceiling plate. The wires are knob and tube. I told Mr Hanley we should let the wires dry out for a few days. We turned the power back on for all the circuits and measured the voltage at the tub. The voltage was now 300 millivolts. This voltage was present with the power on or off to the building FOR OFFICE USE ONLY The Commonwealth of Massachusetts Permit No. e Department o f Public Sa f Ulf Occupancy d:Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All workµ•i11 be performed in accordance with the Massachusetts General Code.527 CMR 12:00 (PLEASE PRINT IN D;K/ OR TYPE ALL INFORMATION) ' Date �a' 0 City or Torn of /(/a - To the inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: _ LMap: Lot: Location (Street and Number) y ey 5 Owner or Tenant CO Q 1�/ / _ Zone Owner's Address L7 r-ds 6Y7 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) utility Authorization No. Purpose of Building Existing Service _ Amps / �'o is Overhead ❑ Underground Li No. of Meters New Service Amps _ L %"Olts Overhead ❑ underground ❑ No'of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical�ti'ork Am0 U� 7TnQ177Z 62 C Lal 1/ acl i.�i ,eLf oU� No. of Lighting Outlets I No.of Hot Tubs No.of Transformers Total ICVA No. of Lighting Fixtures I Swimming Pool Above gmd. In-grnd.ElI Generators KVA No. of Receptacle Outlets No.of Oil Burners No.of Emerg.Lighting Battery Units No. of Switch Outlets I No.of Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total Tons No.of Detection-and No.of Total Total Initiating Devices No.of Disposals Heat Pumps Tons KEN No.of Sounding Devices No.of Dishwashers Space/Area Heating KW No.of Self-Contained No.of Dryers Heating Devices KW Detection/Sounding Devices No.of Water Heaters KW Into.of Signs No.of Ballasts I Local❑ Muncipal Connection ❑ Other No.of Hydro Massage Tubs No.of Motors Total HP I Low Voltage Wiring OTHER: I INSLRatiCE COVERAGE:Pursuant to the requirements of Massachusetts Genoal Laws I have a current Liability Insurance Policy --tcluding C2Xpleted Operations Coverage or its substantial equivalent.YES 19 NO❑ 1 have submitted valid proof of same to this office.YES L-J No If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE E BOND 0 OTHER t](Please Specify) (gy-p irotion Date) Estimated Value of Electrical Work$ Inspection Date Requested:Rough Final Work to Start Signed under the penalties of perjury: S 9l FIRM NAME (2 Z �� x-4/0. LIC.NO. 14 Licensee///,( ti�g 'yD£�S Signatur LIC NO. ,/¢ s9i 'z- Address � ' �s a o-t� s`'` /11 'o ey-e_1e_ "24-AS`Bus.T e L No. 97 8' 691L:3 8 '7- Alt.TeL No. OWNER'S INSURANCE WAIVER I am aware that the Licensee 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. - r `LAN D E RS ELECTRICAL CO.,INC. December 26,2001 Mr. Scott Hanley 12 Richardson Ave. North Andover,MA 01845 RE: 21 Dudley St. Dear Scott As we discussed I am sending you the service report for your property at 21 Dudley Street. I have been in contact with the North Andover Wiring Inspector,James DeCola and will be sending a copy of this letter and the service report to him. The folloning items need to-be addressed 1. The ground connection should be cleaned and reconnected 2. The fixture and ceiling plate removed from the bedroom must be replaced or blanked up properly. In addition I would recommend that a ground fault circuit interrupting type circuit breaker be installed for the bedroom circuit. This circuit breaker would trip if someone were to receive a shock from this circuit. The circuit breaker would require monthly testing to insure proper operation. I have enclosed a cost estimate to make these repairs. I wait your direction. Sincerely Terry Landers Vice President Landers Electrical Co.,Inc. cc.James DeCola 1000 OSGOOD STREET PO BOX 783 NORTH ANDOVER, MA 01845 TEL(978)6863828 FAX(978)682-1646 LANDERS ELECTRICAL CO. INC SERVICE REPORT 1000 OSGOOD ST. ' P.O. BOX 783 NORTH ANDOVER MA. 01845 978/686-3828 FAX 978/682-1646 Qutomw Dftmow of Problem Scott Hanley Tenant gets shock when she touches faucet in bathtub 12 Richardson Avenue 21 Dudley Street North Andover Qh re,LP Phone Date Caled North Andover MA, 01845 978/975-2186 12!20/2001 12/21/2001 Met with Mr Hanley at 21 Dudley Street 21 Dudley Street is a two family"Philadelphia Dutch'. The first floor is tenant A The third floor is tenant B and the second floor is split by both. Tenant B was leaving for work and described she and her daughter felt a shock when they would touch the faucet in the tub located on the third floor. She explained she now wears latex gloves when she showers. In the tub I found a 5 volt potential between the drain and the faucet This 5 volt potential was also present between the drain and the steam radiator in the bathroom I went to the basement and measured for a potential between the copper water pipe and the cast iron drain pipe which appeared to be going to the third floor bath. I did not find any voltage. I checked the ground connection on the main water service. The connection was tight but was corroded and should be cleaned. With the help of Mr Hanley,we shut off circuits one at a time until we lost the 5 volt potential. The circuit which seemed to be causing the problem was a second floor bedroom circuit. These bedrooms belong to tenant A In one of the bedrooms the ceiling had water stains and the ceiling fixture was not working. Upon removing the globe for the fixture we discovered the globe was full of water and bothe lamps were broken at the bases. I disconnected the fixture and removed the ceiling plate. The wires are knob and tube. I told Mr Hanley we should let the wires dry out for a few days. We turned the power back on for all the circuits and measured the voltage at the tub. The voltage was now 300 millivolts. This voltage was present with the power on or off to the building N° 35 5 Date....e ..�. NORTH °. '•«` 6., TOWN OF NORTH ANDOVER .. ,.e OL p PERMIT FOR WIRING �SSAcHusE� This certifies that U`�` ....................k-e in. ............. .. -e C. ......................... has permission to perform ................. ...p.. a.`..'.�.5.................................. wiring in the building of...................................U`r .� l . .................. vZ u I S ,NortlT'Andover s,� at e....�S .�U..... o. LL..f--? .................. ,:A . .. . ... �l Fee..........:.......... Lic.No. .�.!l.... .. .. .. � ( lL ICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts FOR OFFICE USE O Permit No. Department of Public Safety Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TY/P�E,ALL INFORMATION) Date �07 � City or Town of lo serii7��'�� To the inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location (Street and Number) U 6 LFV 57" Map: Lot: Owner or Tenant Zone: Owner's Address k1 d,7 143 6Y7 ©> � Is this permit in conjunction with a building permit? Yes ❑ No D (Check Appropriate Box) Purpose of Building Utility Authorization No. Exiting Service Amps / Volts Overhead ❑ Underground ❑ No.of Meters New Service Amps /_ Volts Overhead ❑ Underground ❑ No.of Meters t ` Number of Feeders and Ampacity / / Location and Nature of Proposed Electrical Work �Q/n0 UPJ n2A'ojL /� 7`� � i �G 7`� / �. �h417 7Z- 162C''e1'11 ,'19' '366ck I'd/ q a DUB No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above gmd. ❑ In-grnd.❑ Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emerg. Lighting Battery Units XTo.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total Tons No.of Detection and Initiating Devices :V a• No.of Total Total g o.of Disposals Heat Pumps Tons KW No.of Sounding Devices No.of Dishwashers Space/Area Heating KW No.of Self-Contained No. of Dryers Heating Devices KW Detection/Sounding Devices No. of Water Heaters KW No.of Signs No.of Ballasts Local❑ Muncipal Connection ❑ Other No.of Hydro Massage Tubs No. of Motors Total HP Low Voltage Wiring OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts Gen0al Laws I have a current Liability Insurance Policy including C2p?(pleted Operations Coverage or its substantial equivalent.YES NO❑ I have submitted valid proof of same to this office.YES MNOP 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 Inspection Date Requested:Rough Final Signed under the penalties of perjury: FIRM NAME D F Chi e L =�'v�' LIC.NO. �q $ 9l _ Licensee��i�int,vr g L�4�o Signatur g -r• LIC NO. -5-91/o -Z— Address Address � ' Os S a-o �Q S /( . ,0 cy- �lr� � SBus.Tel.No. 97 649e-8- 6 3 g Alt.Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee 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. PERMIT FEE$ (Signature of Owner or Agent) 03/26/02 09:59 FAX 978 682 1646 LANDERS ELECTRIC 901 LUDERS ELECTRICAL ON. INC. 1000 OSGOOD STREET-P_O.BOX 783-NORTH ANDOVER,MA 01845 Phone 97886-3828—Fax 978-682-1848 FAX COVER SHEET TO: A114 �Q t2 FROM: DATE: SUBJECT: TOTAL PAGES (Including Cover Sheet) 03/26/02 09:59 FAX 978 682 1646 LANDERS ELECTRIC 002 The Commonwealth of Massachusetts No OFFICE USE ONLY Pesm;t s_ DepaTtment of Public Safety Occupancy&Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12 00 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AU work wQl be performed in accordance with rhe Massachusetts General Code.527 C%%11-M (PLF-ASE PRINT IN INK OR TYPE ALL INFORMATION) Date /oZ- e Cit•or Town of �d A"n1/"�'' To the inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location(Street and Number) 57-57- Map: Lot: Owner or Tenant T/0 t7�� — Zane o r C�S 6,7 / Owner's Address D v1� � e Sr Is this permit in conjunction with a building permit? Yes Q No LK (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps X'0-1:5 Overhead❑ underground❑ No.of Meters New Service Amps I- VO4s Overhead❑ underground❑ No.of Meters Number of Feeders and Arnpacity Loca:ion and Nature of Proposed Electrical Work and 'PA 2,4111 rJQiIA ,eQC'PiUifl g iY7 IZgo ' No.of Lighting Outlets No-of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above grnd-0 In-grnd.Q Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emerg.Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No.of Ranges No.of Air Cond. Total Tons No.of Detection-and NO.of Total Total Initiating Devices No.of Disposals Heat Pumps Tons ICM/ No.of Sounding Devices No.of Dishwashers Space/Area Heating KW No.of Self-Contained No.of Dryers Heating Deices KW Detection/Sounding Devices No.of Water Heaters KW No.of Signs No.of Ballasts Local❑ Muncipal Connection❑ Other No.of Hydro Massage Tubs No.of Motors Total HP Low Voltage wiring OTHER: INSL-RA.NCE COVERAGE:Pursuant to the requirements of Massachusetts Gentfal Laws I have a current Liability Insurance Policy including Cerations Coverage or its substantial equivalent.YES NO El have submitted valid proof of same to this office_YES Al[C+'�� l 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box. I`SL-RANCE BOND Q OTHER❑(Please Specify) fEryirafWn Date} Estimated Value of Electrical Work 5 Work to Start Inspection Date Requested:Rough - -Final Signed under the penalties of perjury: n F1Rut NtAAME C''7'fP�C' L .vC'. LIC.NO. - Ucensee44%/� g L yD'� 5 Signator 8 S• LIC NO. �-- Address ' OS a-s -f: /l'l8. t�i�ev.�,t A�.4 id'YSBus.TeL No. 929- 604,3?-7-8 Alt.TeL No. OWNER'S INSURANCE WAIVER I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required byy Massachusetts General Laws,and that my signature on this permit application waives this requirement. (.}weer❑ Agent Q{l�l�� a inrc 8!11!) . Telephone No. I'ERMTI FEE 5 ls--- �c:�..... a—s fNe m ow Ae"O