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HomeMy WebLinkAboutBuilding Permit #064-2016 - 655 MIDDLETON STREET 7/14/2015 I NoRTy BUILDING PERMIT0� (LED ,6'14•� ,.1h 6 = � TOWN OF NORTH ANDOVER - o y APPLICATION FOR PLAN EXAMINATION coc Permit No#: Date Received 7RpDRATED —7 � gSSACHU5E4 Date Issued: I IMPORTANT:Applicant must complete all items on this page LOCATION 6� / �t -�°^ r— print 1 PROPERTY OWNER 00/�Y`k`'^ Print 10p Year structure yes no MAP l PARCEL. bdo a ZONING DISTRICT: Historic`District Y a no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ` ❑Addition ❑ Two or more family ❑ ustrial ❑Alteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑p c `� Welly �� ���oodplain�� +O�Weflards� -' ®� UVaters�.ed ®�istrict� DES RIPTION OF WORK TO BE PERFORMED: AD Identification- Please Type or Pri t Clearly OWNER: Name: O�� S vr--yy � Phone: 7�1 9 0� S" Address: r Contractor Name: °'��W�'\3 `r e- Phone: 1-7t T-) b Email �►,�.,.,,,� tjr,ak.5 k�c Address: o '7,0' y- � \�r� I Supervisor's Construction License: Q5 09 rG5 3 Exp. Date: Z b E Home Improvement License: 1 S 0 5 Exp. Date: j � ARCHITECT/ENGINEER Phone: i Address: Reg. No. FEE SCHEDULE.BOLDING PE MIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ r FEE: $ Check No.: c,e1 1�-O Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund lam` { yy� — — _ !! t (�W V .. - I �. S _. ....... _ �<a_.3-— .t N 1T;F'R ti r If-_.meso-. , __. �. ... __... .._ :. NORTH Town o E . Ip Andover 0 1� 2 b I h ver, Mass,�7. w��j O CDC HIC"&WICK �d A�RATEO S U BOARD OF HEALTH PERMIT . T LD Food/Kitchen Septic System THIS CERTIFIES THAT .......... �..... `\a") S C1� BUILDING INSPECTOR .... . .... ..... ....`....... .. ....... ...... .................... ... . . ... .... ...... . n1^� tl.c. �� Foundation has permission to erect ................... ...... buildings on ..til/..-.j.'...>...... . .................................................... �1 ( .e k o .� Rough tobe occupied as ............. ..... .........1.......... ................................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S A TS Rough r Service ............... ... ...... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. r �M Roo as gm(ZO PO, Box 185, Norih Billerica, MA 01862 978r 423-71$9. Fax (9 8) 663-2987 PROPOSAL SUBMITTED TO: Brad Reichter ADDRESS: 655 Middleton rd N Andover, MA DATE: July 69 2015 JOB SITE: Andover Sportsman Club WE HEREBY submit our proposal for the following scope of work: 1. Rip and remove existing metal&shingle roofs and dispose. 2. Install GAF Weather Watch ice&water shield to entire roof. 3. Install F8 aluminum drip edge metal to perimeter of roof. 4. Install GAF Pro Start starter shingles on rakes and eaves. 5. Install GAF Timberline HD Lifetime architectural shingles to roof. 6. Install new pipe flanges to all pipe penetrations. 7. Install new lead flashing to all chimneys. S. Install GAF Cobra ridge vent to vented ridges. 9. Install GAF Timber Tex cap to ridges. 10. Install white 6"seamless gutters to 2 trap buildings. 11. Issue GAF Weather Stopper System Plus Limited Warranty. 12. Clean site of all roofing debris. NOTES: 1)Any damaged roof decking will be replaced at$2.50 per s.f. (64 s.f. included) 2)If entire roof needs plywood,$8,900.00 will be added to total cost. 3)Rain diverters will be added above doors as requested. 4)Trap storage shed&wood shed included. 5)10% holding up to 2 rain storms,or 30 days,whichever comes first. WE PROPOSE to hereby furnish material and labor,complete in accordance with the above specifications for the sum of. Nineteen Thousand Five Hundred dollars. ($1 , .00 AUTHORIZED SIGNATURE: Jus ' .Morgan. E ojeet Manager ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will be made as outlined in TM hoofs Inc terms agreement. Authorized Buyer Signature: Date:�� tmroofsinc.com Thank you for choosing TM Roofs Inc. facebook.com/imroofsinc The Commonwealth of Massachusetts Department oflndustrialAccidents X Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia 'yJ� Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTEIORITY- Applicant Information Please Print Legibly NaMe(Business/Organization/Individual): (� 1(..r�a 1 A Address: v Ay gilt w J r\ff Phone#: 1-7 3 3 161 City/State/Zip: ,(J . Are y a an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition I Q I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workerscomp.insurance.$ 14. Other 6.F1 We are a corporation and its officers have exercised their right of'exemptioa per MGL c. �] 152,§1(4),and we have nn employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,4kiey must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. ss Insurance Company Name: Policy#or Self-ins.Lic.#: tV C o6-1 l Expiration Date: / 16 Job Site Address. b�5 1 \ekA\.`o, tU City/State/Zip: / A+1JeJ2-` r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forme of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Y do hereby certify under tlae p 'ns and penalties of perjury that the information provided above is t ue and correct. Signature: Date: Phone#: CC) 370 Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6.Other i Contact Person: Phone#: TMROO-1 OP ID: LO CERTIFICATE OF LIABILITY INSURANCE DAT07/06/1155 07/06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies.may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ONACT PRODUCER Phone.•781-935-8480 NAME: DeSanctis Insurance Agcy,Inc. ---F -- ____. Fax.781-933-5645 ALC No Ext) 100 Unicom Park Drive ---- E-MAIL. Woburn,MA 01801 ADDRESS: — INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A.Maxum indemnity Company - 26743 INSURED TM Roofs,Inc. INSURER B_:Plymouth Rock Assurance Group -� TY 14737_ �- Tim Morgan PO Box 185 INSURER C;Hanover Insurance Company — 22292 North Billerica,MA 01862 INSURER D:Star Insurance Company '^- 012243 INSURER E:Evanston Insurance Co. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER.DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.ADDL { IL7R TYPE OF INSURANCE Po I INSR I wvD POLICY NUMBER (MMIDDM EFF MM/DDY EXP C LIMITS ----- GENERAL LIABILITY i I EACH OCCURRENCE $` 1'000,000 GLP6022466-03 GE�O RENTED A X !COMMERCIAL GENERAL LIABILITY 07/0111ar 07/01/16 PREMISES(Ea occurrence) 100,000 CLAIMS-MADE X I OCCUR Ij MED EXP(Any one person) $_ 6900 1 I PERSONAL&ADV INJURY $ 1,000,000 _ i I GENERAL AGGREGATE $ 2,000,000 _ I GEN'LAGGREGATE LIMIT APPLIES PER- j PRODUCTS-C_OMPIOPAGG $ 2,000,000 J POLICY X ECT I 1 LOC { 1 $BINE -- AUTOMOBILE LIABILITY I ! EaaccideDS1NGLELIMITnt) $ 1,000,00 B ANY AUTO PRC00001004279 06/28115. 0612811$ 1 BODILY INJURY(Perperson) $ ALL OWNED —I SCHEDULED { I BODILY INJURY(Per accident) $ _ AUTOS I X I AUTOS NON-OWNED X .PERAMAGE $ HIRED AUTOS AUTOS dY _ I I i $ � X UMBRELLA LIAR IOCCUR i I EACH OCCURRENCE S 5'000,00 — I KLV10LE10235i 000,000 B ;I EXCESSLIA'B� I CLAIMS-MADEI M / # 07101/15 I 07/Oi116 AGGREGATE $ 5_+__-_ _ I {DED I X I"(RETENTION$ f I $ WORKERS COMPENSATION 4 WCSTATU- OTH- {AND EMPLOYERS'LIABILITY YIN I i TORY LIMITS ER D ANY PROPRIETORIPARTNERIEXECUTIVE❑ N/A C0679514 07101115 07101/16 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIM EMBER EXCLUDEp7 Mandato in NH N i j I E.L DISEASE-EA EMPLOYE $ 1'000,000 (Mandatory I --- If Dyes,DESCRIPTION i I i 1 000,000 DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ , A Equipment Floater I iIHNA61062200 04/15/15 04/15/18 A Property Section IHNA61062200 04115/15 j 04115118 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION REGIS-4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE L .1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD _ - -.._� — _._... ------------- ----------- ... -A %1rr, ar�r�;r.c�rue�al�/r.nC>/Ji��lac�u el(J _ Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTR,4CTOR 1tegistration 175609 Type Expiration 5/24(2017 d6ir Cation TM RQOFDANC r� TIMOTHY 56 ROGER ST. BILLERICA,MA 01827 Undersecretary Massachusetts-DepartMent of public Safety Board of 3u;lu„ig-egulaticrs and Stan'a„ds Construction SuP"vi.5or License:G5-095653 TIIVIOTSY R MOAN 56 ROGERS STREET RMLRRICAMA.'01942 ExpiF.atic6 Q9C28f2Q16 I � Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. l� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.i/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: /�✓ /�' City or Town of: NORTH ANDOVER To the I spec or of Wires: By this application the undersignq gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant `� q 61V e5 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [ NQ, ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters � I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No,of Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators J KVA 20� No.of Luminaires Swimming Pool Above ❑ In- E] No.o Emergency ig tmg i rnd. rnd. Baftery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: " ..'""'.... ............................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* "a No.of Water No.of No.of No.of Devices or Equivalent KW Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: h Atfach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: f('/d `���� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O RAGE: 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 equivalent. The ' undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE R BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. �\ FIRM NAME: . r/ZI-e GVrC�Gf-, �,�// ale 47w�l G LIC.NO.: 01W- 9� Licensee: 41P C2�/ IZ44- Signature LTC.NO.:/7,0'4111;00, (If applicable,enter "exempt"in the license number lije.) Bus.Tel.No.• Address:f/,, ,0ah '4,7- Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. • 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 ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. 3L,the 2012 Massachusetts Electrical Code Amendments 5 of w27 iring shall be niform throughule 8: In out accordance-with th w alth nand apps of l cations shall be filed permit application form to provide notice application 32,an r el the prescribed form.After t ntheit a erson,firm orbeen corporation stated on theinspector permit application. Such entity shall responsible for the electrical permit shall be issuedp notification of completion of the work as required in M.G.L.c.143,n activt 3L. abandoned and Permits shall.be limited as to the time of ongoin work has if he not commenced o has not progrey,and may be ssed during ed by the lthe preceding 1125month per od.Uponlwritten or she has determined that the author ized application,an extension of time for completion of work shall be permitted application.for easonable cause.A permit shall be terminated upon the written ed on the permit request of either the owner or the installing entity stat p d extended by Sections 74 d 75 of Chapter 238 of The Permit Extension Act was created t i Section promote job growth and long-term economicnrec very and the Permit Extension ion Act furthers this the Acts of 2012.The purpose of this act is to p J the use or th purpose by establishing an automatfour extendstforrfouryearon to s beyo d r s otherwisin permits and e appl cabler expiration date,Vany permit or appro al that was limited exceptions,the Act automatically "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ **Note:Reapply for new permit❑ Rule 8—Permit/Date Closed: ❑Permit Extension Act—Permit/Date Closed: I nch Inspection Failed ss � Re-Inspection Required($.)❑ )ectors Com nts: 1 d'—� Date: spectors Signature: ?,VICE INSPECTION: Failed® Re-Inspection Required($.)❑ rss 0 � pectors Comments: Date: lspectors Signature: .RT][AL ROUGH INSPECTION: Failed Re-Inspection Required ass M ($.)❑ spectors Commentg: Date: nspectors Signature: DUGH INSPECTION: 0 Failed Re-Inspection Required($.)❑ )ass lspectors Comments: Date: Inspectors Signature: INAL INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ nspectors Comments: Date: Inspectors Signature: ------ nnn riIn/ainhnicia7townofinerrimac.com Commonwealth of Massachusetts Official Use Only • Permit No. TZ Department ®f Fire Services kip Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed m ' accordan ce with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date. V//Z/ ph Baty®� ®�,� ® ; To the In pec or of Wires: By this application the undersigned gives notice of�or her intention to perform the elec tr ical work described below. Location(Street&Number) �p %; ✓ />'T ' � - cel-`r�L� ��- � Owner or Tenant `N s? 6'1449 _ Telephone No. pr rra�u u V Owner's Address ---- " Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building r Utility Authorization No. Existing Service Amps /f L Volts Overhead Undgrd❑ No.of Meters New Service Amps Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity ,W,-1 Location and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In-."- o.o Emergency Lighting No.of Luminaires Swimming Pool o e ❑ rid. ❑ BatteryUnits groiNo,of,Receptacle'Outlets V.. ' Nb.,bf Oil Burners 'ALARMS No.-of hones No owan Nor of Switches ; Ilio:of Gas Burners. ,;.,. .' Initiator :Devices - - Total No of Alertin Devices No.of Manges No.of�iir Cond. Tons g Heat Pump;Number Tons-._..KW ..No.ofSelf-Contained No:of Waste Disposers """"""'"' Detection/Alertin Devices Totals: - Municipal No.of Dish-washers Space/Area-heating--KW Local-❑ Connection ❑ Other Heating Appliancest Security Systems:* ea No.of Dryers No.of Devices or Equivalent No.of Water- -No.-.of_._.__..__....._... No._of. . . Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiringg: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uiva]ent OTHER: Attach additional detail ifdesired,, or as required by the Inspector of Wires. "'- When re`uired b- munici al` oli-c -- -n - —-"-----"Estimated Value of•Erectric�fi Work:' e°l" ( q Y p P Y�' Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,.no.permit for the performance-of electrical work may issue unless - - -fhe Ii`censee prsvi es proof o lraGlity=insurance msludirrg somplefed=operd on-"coverage or its-substantial equivalent. The undersigned certifies that suchcover "ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Speci-fy:) I certify,under thepains andpenalties ofperjury,that the information on this dpplication is true and complete. ---. .. .... ..... . LIC.NO.: 1 7 0 31 A FIRM NAME: Perin & Cam be _ (,li`alye e. ek" Signatuare Licensee. LIC. .:�-h��Z it s!- (1f_applicable,..enter "exempt"in the license.number line) ' . - Bus..Tel.No.: 781 -245-0921 ti. Address 1.7 2 N „+ + Make f i e l d: MA 01886Alt.Tei.No.: Security System Contractor_Lfcense"required.fo�this work;:if applicable',.enter the license number here: OWNER'S INSURANCKWAIVER: I am aware thafthe 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 ❑owner's agent. Owner/Agent PLld11�I7 �E�: $ Signature Telephone No. . �� �� i �� p�,�-� � � � � � � � � I _a Comnionwea/th of Massachusetts Official Use Only Department of Fire Services Peet No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.9/05] _..— APPLICATION FOR PERMIT TO PERFORM (leave blank) All work to be performed in accordance with the Massachusetts Electrical CELECTRICA oo WORK (PLEASE PRINT ININK OR TYPE ALL INFORMATION City or Town of: Date: _ 6 By this application the undersi ne ° ' To the Inspector of Wires: g gives notice o his or her intention to perform the electrical work described below. . Location(Street& Number) Owner or Tenant fir^ c� dl�J�N �yg h Owner's Address Telephone No. Is this permit in conjunction with a building Purpose of Building // permit? Yes ❑. No (Check Appropriate Box) Existing ServiceAUtility Authorization No. Amps / Volts Overhead 1���- � Und rd New---Sergi Amps / g ❑ No.of Meters _Volts Overhead ❑ Und rd Number of Feeders and Ampacity g ❑ No. of Meters _ Location and Nature of Proposed Electrical Work: c6L a `- Completion of the followin table ma No. of Recessed Luminaires y be waived by the/nspector of Wires. No.of Ceil.-Susp.(paddle)Fans No. of No. of Luminaire OutletsTransformers Total No.of Hot Tubs KVA No. of Luminaires Generators KVA Swimming Poolrnd.Above ❑ 0. 0 mergency 19 mg No.of Receptacle Outlets In-nd. ❑ .Batter Units No.of Oil Burners No. of Switches FIRE ALARMS No. of Zones No. of Gas Burners No. of Detection and No.of Ranges Initiating Devices No. of Air Cond. Total No. of Waste Disposers Heat Pum Tons No. of Alerting Devices R=Number Tons KW No. of Self-Contained Totals: ................ . ........................... . . No.of Dishwashers Detection/Alertin Devices Space/Area Heating KW Local E] Municipal No.of Dryers Heating Appliances Connection ❑ Other No.of Water KW Security Systems:* Heaters KW No.of No.of No.of Devices or E uivalent Si ns Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if required desired, or as re Work to Start: o (When required by municipal policy.) 9 d by the Inspector of Wires. j �`3 -f�L Inspections to be requested in accordance with MEC Rule 10,and upon com le INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electric the licensee provides proof of liability insurance including"completed operation"coverage or its subs p hon. undersigned certifies that such coverage is in force,and has exhibited proof of same to the al work may issue unless CHECK ONE: INSURANCE substantial equivalent. The I certify,under the pains and pen/❑a/Itie�sOv D e permit issuing office. ❑ OTHER `❑ (Specify:) FIRM NAME: ! fperjury,that the information on this application is true and complete. en Licensee: ��� ` LIC. NO.. _,t,4— Address: ente "exempt"in the kc�e number line.) Signature ���Z LIC. NO.: 8. *Security System Contractor License required for this work; if applicable,enter the license Bus. Tel No.: _ Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not required by law. B number here: By my signature below, I hereby waive this requirement. I am he(chelckbolne)ity�[�uownercov l ow normally Owner/Agent Signature El owner's agent. Telephone No. PER114'IT FEE: 1 I • 1� -To - = � Comnronweau o`mdace[fa Official Use OnlyIfterem 1 cc�� ' [� Permit N1 0- a 2eparfine spire Jervicuts Occupancy and Fee Checked 0(2t aft BOARD OF FIRE PREVENTION REGULATIONS Rev. 111991 (lcas,e blank) */0T APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachuscus Electrical Code(iMEC),527 CNIR 12.00 (PLL':1SL• PRINT I,V INK OR TYPG.4LL iyr01 1.1170N) Date: �(�A7O City or Town of. V., . r,4Y1 i P,r- To the Inspector of fYires: By this application the undersigned gives notice ooriiis or he /uuentton to perform the electrical work described below. Location(Street S Number) d dl Owner or 1'enannt Al a o v P f .i j h Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No' (Check appropriate Box) .1 W' Purpose of Building Utility Authorization No. Existing Set-vice . Amps / 1'olts OV cnccad ❑ Underd❑ No.of Meters . New Service Amps1 Volts Overhead❑ Undord ❑ No.of Meters" Number of Feeders and Ampacity 1 1 Location and Mature of Proposed Electrical'%Vork: SS C/ecfri C e T�o 4/ J - Cum letiwt vjthe jollauutQ table maybe naiird ba the ins cctor ollVires. t o.of Total No.of Recessed Fixtures No.orCeil.-Susp.(Paddle)Fails Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KYA ' AboveIn- o.o Emergency rg umg No.of Lighting Fixtures swimming Pooi rud. [Irnd. C1t Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARIMS TNo.of Zones No.of Gas Burners t o.of Detection and . No.of Switches Initiatin Devices No.of Ranges 1 No.of Air Cond. T No.of Alerting Devices Heat Pump I umber ons KW No.ofSelf-Contained No.of Waste Disposers Totals:L Detection/Alertina Devices S acdirea Heating KAY Local ❑ t umcip$1 ❑ Other No.of Dish_washers P g Connection Heating Appliances Kai: ecurity vstems No.of Dryers No.of Devices or Equivalent No.of WaterIiW `o.of ttio.of `l Data:'firing: ieatcrs Sion Ballas '� No.of Devices or E uivalent I'clecommunications Tiring: No.Hydromassage Bathtubs No.of Motors Total IIP No.of Devices or E uivalent OTHER: � ��'l-1L' � -�,S 1-tach additional detail if desired.or as required ky t/te Inspector of Wires. INSURANCE COV EI AGE: 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 operatioli'coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office CHECK ONE: INSURANCE Rr BOND ❑ OTHER 0 (Specify.}{�Q1nlej, �S. �8��_ (Espirati Date) Estimated Value oflectrical Worn:: L CZoe 00 (When required by municipal policy.) Work to Start: 00 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I ecrtif}', trttcfcr 11re ants aiul pc na/toes of perjury' drat the infornation on this application.is true and complete. �) ���� F11 :NI NAME: l 6 LICJNO.:E1Y9 7 / Licensee: Signator LIC.NO.: !� Li cense able,enter"cYCncpt"in!h-lice munber n¢.) j Bus.Tel.No. 'cc Address: ��f� �� y/�5�. ,t �y d•��0� Alt.Tel.No.: OW'NER'S INSURANCE WAIVER. I atm allware that the Licensee does not have the liability insurance coverage normally required by law. By niv signature below,I hereby waive this requirement. 1 am the(check otic)❑owner ❑w nlcr's agent. Opti mer/Aoellt cicpllORe ttU. Pj.1�:;IIT FE S Otq, -f Signature 1'L' I IVI I 1 IN U. C,C�lAI'I'LII.A 1 IUIN 1'UIC t'L' I(IVII 1 1 U ISUILA)------'NUR l 11 AINUUV ER, MA LOi.NO. HE('( RU OT O\1'NF:RSIIIPn T�h��K PACE Z/) SU///B I)[%'. LOT NO. I.O( ,MON A PURPUSE()I 111 III OIN( OWNER'S NAME v \ ( — 1 n NO.OF STORIES SIZE OWNER'S ADDRESS BASEMEDff OR SLAB ARC1111 ECI'S NAME SIZE OF FLOOR I INIHERS I ST Z ND 3 B1111.DER'S N.41.IE ib SPAN DISI ANCE TONEARESI BUILDING DIMENSIONS OF SILI.S DIS I'ANCE FROM STREET DIMENSIONS OF IlOS IS DIS TANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA O F LOT FR(NdFAGE 1IEIGIITOF F(A)NDAl[ON THICKNESS IS BUILDING NEW SIZE OF F(XYTING X IS B1111.DIN(i ADDITION MATERIAL OF CIIIMNEY IS BUILDING ALTERATION IS DUILDING ON SOL.IDOR FII LED LAND WILL BUILDING CONFORM TO REQUIREPIENDS OF CODE IS d1111.DING CONNECTTED"f01"OWN WATER HOARD OF APPEALS ACTION, IF ANY 15 BUILDINGC(NNNECIED 10 TOWN SEWER IS BUILDING CONNEL I ED 1"0 NATURAL GAS LINE INS 3.3. PROPE111"1"INFOR111A7'ION LANDC'UST ESI. Bit x;.COST PAGE I FII.[.OIff SECTIONS 1-3 EST. BLDG.COSf PER SQ. FT. > EST. BLDG.COS i M-R R(X)M ELECTRIC METERS MUST BE ON(Xl"f SIDE OF BUILDING SEI'IIC PERNirr NO. AE-TACHEDGARAGES MUST CONFORNITo STATE FIRE REGULATIONS a. APPROVED Bl" PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BI II I.DING INSPECTOR DA I E FILED �� S� OWNERS]E1. CO HIR.lFI.H COM"R.1.1(H � Sl�Gl 11R1 (ll OWNER OR Al)'IlI/N21LliD aT — PERMIT GRAN rEl _ 19 NORTy Town of :_ - _ over iCl dover, Mass., 19 A �09`cc CH WICK yY'� '9S 0 4E D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................:. .. :Q.v. f .............. .. .P-t.(xeu.........C4�.... Foundation 1� f�' on .......�.(0.A/-F, 1.C).�..........�. Rough has permission to-e�e�ct.............��..�......1. .��.`. .... bmtdtrr�s ..... to be Occupied as.... 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-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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOkT R Rough ......................... . .. ..... ...... .................................. Service LDING INSPECTOR 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 To Be Done _ FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. I'S UNW0.11M APF�ICATKM FOP PERMIT TO PO ;3 . (Pt int or Typo) } ; Fee ; C� t �,� 1 4 y C3 • ..•.o cit�. ' jSS. 7-y �-- rl .ttCjf3t.1:�011 G �� �'I7�G�Gt/CT11r— 1 ciXl1 �UU�( S`.lJ�f1GY�Gn ..GCt,S yr-d t° �' K Uii S7 't"=JVii� .UiC1 Replace I ( P :£1"i r� r+ublttittatj Yes, t.. ill;. Wl 40 ( 1di t WI y' Z w Yr: W, t3 fJJ tuD s. 6i.� Y¢" . 3W WI t 5 G$ I tJ c D'i L un; LJ .W' ' a]:,� 1„h c;t• � d� '. �:. «M a 3 t3 ..S i,:' if: � C:�i n7,. 3Y' 'j; ` � .. , , •Nat ., �W uWNM�n sV.0 uL �a t a tot 47A t{'1 00;li t �b8L t Ltv70it ' Check r7 e` Cjv �3 �1 Cd.te t�dd est l 0. b x Corp, FirtY/Compaviy �G�7 Bus-inns ee ha11 �/3�S 0�3 9 Name of Licensed P1u:'rbar, or Casf3 t.ir~r �h/21- /Z, I hrrcby oit ri, that A of IM- .3etrtls and tnformutiora 1 hara ssbiaitted (or eritercd)in abayra rpptitaatlGir and 4tB13 Wu,d accusla tt►tha b„st of my tuawrwie ,c aria i;tsat st1 pLasnh:at wtrtl znd irascs;littonp pgf,�rneed urcder iumit itsuuci for 14L t4pplieaWII wait vis 41 op{iptius w v►Itit YL^ ptrditxertt proyWoeis 01 W* �” .ViLchla;j16y 3tytY Cit 04S and 0'AP;vr I ii 4f{ha Gjky4eral taunt, t. y - �'�iP LIC'ENSE. . ------ -�- - e. . ._.__w_ F 1 iiibe r iiat,.. p of i,::y.,1"S'c'cvj'taster ka1gb.ar or i`td3 5 .�,tt.er Qgrneyman %03 APPROVED cOFFictr use Oi+eYl License Number