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HomeMy WebLinkAboutMiscellaneous - 1 WILLIAM STREET 4/30/2018Date..7�47I�� ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING A -� — 5 "r e-��'7 I �-' - - . This certifies that ........................ / ........................... . . .... !�& 40 at ce ..................... has permission to perform ....... wiring in the building of ....................... ......................................... at ..... L L -37 . ...... /NNorth Andover, Mass. .......... Fee ..................... Lic. No.. >/ . / .... ..... ....... i Check# :� ti 6o 4 r) 8 8 6 U P :r Official Use Only ' � (�O�nn,.aniusaCLh o� ��Ucthxiafi! . Permit No. -t — �a ar�nf o�Jirr `jsiviCL1 WM '� P Occupancy and Fcc Checked _ BOARD.,OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank; APPLICAT.M FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performcd in accordant- with the massaehuscrts ElccLr-ical Code (MEC), 527 Cjv1R 12,00 ("PLEASE PRINT IN 4{ 1K OR TYPE ALL INFORMA77ON) Date: ��. To the Ins o Wires: City or Town of: /U` Pectc f By this application the undcrsigncd gives notice of his or her intention to perform the elceirieal work described below. Location (Street & Number) <<L`�5 Dl' __q Z4 _ Owner or Tenant C �< � Telephone iYo_ &f 7 — 2_0 dEl Owner's Address —�— Is this permit in conjunction with a building pe.*mit? Purpose of Building E -;sting Service Amps / volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No- of Recessed"Luminaires No. of Luminaire Outlets No. of Luminaires No. of Swit.-.hes No. of Ranges No. of Waste Disposers No. of Dishwashers p No. of Dryers i o. o ater Heaters No. of Rer_eptacle Outlets Ys Cl No � .(Check Appropriate Box) Utility Authorization No. Ovcrhead ❑ Undgrr,' � No. of Meters Overhead U Undgrd ❑ No. of Meters >-tzt l ` cL t cry a C u r p r—t rc t-} C tt rm Completion of the No- of CeiL-Susp- (Paddle) Fans No. of Hot Tubs Swimming Pool v No_ of Oil Burners No. of Gas Burners --- �j LA S -•re -M ihz table m be waived b the lnsveetor,O Wire. — �fe o ora ITrarsformers KVA Gcaerators KVA ov_e �- —^i{o. of merg id_ ❑ grnd_ ❑ IBatterY Units 1 oral Nom- of Air Cond- Tons eat ump um er ons -F Tota ls- �Spacc/Area Heating KW Heating Applianers KW c. o KW Sizns Sal;asts INo. of Motors Total HP • No_ Hydromassage Bathtubs 1 FIRE ALARMS No_ of Zones INN. o ,lemon an Initiatins, Devices No. of AIerting Devices No. of 5e ontarne Detection/Alerting Devices Local ❑ f uctcrpal ❑ Other Connection ecuriNo nTeviccs or Equivalent Data Wiring: No. of Devices or E uivalent 1 e ecommunIcanons• tang: No. of Devices or Equivalent OTHER: �'l_ o� T. Z� -I g Attach additional detail if drsirc4 oras required by tfie Inspector of Wires. Estimated Value of Icct-ieat Work ��"� (When required by municipal policy.) . Work to Startl. Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for tFc performance of electrical workq ay issue unlcssr the licensee provides proof of liability insurance including "completed op-: cov-rag- or its substantial c uivalcnL Th_ undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Z BOND ❑ ' OTHER ❑ (Specify:) I certify, under, the pains and penalties ofperjury, that the information on lhir appr'caiion is true L C_ tete 1 5 el FIRM NAME: lc ZZ7 Se -Se -r ' ScrUCCPS IC. NO.: .�aL�S-� yfo/Z Signature 5Q Licensee: C /.'//%� /7 r1. T'¢ Bus. Tel. No.: (ifapplicaNe. enter � eo mpt''� tL IGtCI i"G� <r of . . /(S k) a �e�9 AIL Tei. No.- Address: !' 'Per M.G.L. e. 147, s. 57-61, security work rcquires Department of Public Safety -S" License: Lince c. S Gt OWNER'S INSURANCE WAIVER: I an. aware that the Licensee does not have the liability insurance coverage normally owner ❑ agent required by law. By my signature below, 1 hereby waive this rrquircmenL I am the (::heck one) ❑ owner's Owner/Agent pEK1�l7T 1 EE: $ = Telephone Nc_ �------ Signature ..✓ co rn Ei-- — m Cf) p 'LW U [� �-- c a f- _ ' Z ' - w Qi Co ~ U O J �NQ LL O C: c� (DCD Q, •airnn+6� J U) N co �~ s- Q Cov � � � w G :1 LU rn Cn , 00 n- Q d L LL W co U LLI uJ O Q L2 to Z o > Q N Q c Cr o = 1 a J L j \ to QLU U M (�S U mW n �- E Z OLO LL cY, �a U ~ V E ; a = r o o (n O r` LL LL o. ) U N U M Q) t11 �n O O o w C) a Z _ \�� Q O z vWi v 1\ _ r U 0 Q W Q V � ll w rn Coe- � [] Z v� O U I- 2 O U F q UJ l U O z v w W v J ¢ L7 3 0 U d z m \oU a U p a) w :- w � U > ul UJ -Im LC C 0 0 O W Z {, L a� E x ZZ Q O rn U = O Q z vi C7. N o i— CL O t �tily ,.el - v IY i m0 3:CLN o �-7 6 rp Date A Z�. �?. . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . .......... has permission to perform .................... 40 plumbing in the buildings of ............................. at. �<4 .......... North Andover, Mass. C Fee ...... Lic. No.. . ..... ........ T PLUMBING�JN Check # cz/ '� . 5PECTOR 6 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS /'2 l Date Building Location/ b,711 �/ S `� S �% Owners Name Ar AJX u Permit # Amount -).o� Type of Occupancy e New Renovation Replacement �� Plans Submitted Yes No ❑ FliTlRES `� ------------------------- r,'mmmmmnmmmmmmmmMMMMMMMMMMM . eC' mmmmmmmmmmmimmmmmmmmmmmmm C (Print or type)/� {� N Check one: Certificate Installing Company Name !'3 u V'S e S O r,5 1 � ❑ Corp. 1 Address C 6/ d P ti 4 // a Partner. 05S o v- 0 /"15' 61975 Business Te ep one 7 v / S" — f ? E] Firm/Co. Name of Licensed Plumber: A S lr ' 1 A V' -S e.Sf Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: Signatureice�nse Pum er Ty e of Plumbing License Title /�g S / Mn City/Town cense lNumDer Master Journeyman El (OFFICE USE ONLY Date .... �.27..-.-� ....... ........ N2 3 il. 7 ill TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... ; ...... ...... ............................................. has permission to perform ................................................................................ wiring in the building of ......... ....................................... at .............. ...... ...... :� ........ ................................. . North Andover, Mass. ...................... Fee. . : .................. Lic. NoA�.� ... . . ..................... ...... : ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7 8 1712d72Zf/�ff.C'? 07 ?XSS,4e;*S-677S a 4P-A�-S* BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No. Occupancy & Fee Checked_.2Z5 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) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number / /,0/ G,!� ) . moi < Owner or Tenant Owner's Date i - d5-- d / To the Inspector of Wires: Is this permit in conjunction with a building permit Yes Cf No ❑ (Check Appropriate Box) Purpose of Building-�l ��' �- i /?/ CT Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Vats Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work. E fYJo�CL d Cl C� OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YE = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type o coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ ' /� Work to Stan`. y Inspection Date Resquested Rough I.Vl L L C A `- -Final Signed FIRM NAME rtg)Aenalties of�pq� pequry(' / �61 r LIC. NO. 14b 36 49 NO.6 - /7r7d tea- Bus. Tel No. / ZP Address Q S7Q Ch'l J/ h%� V Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) ��SS� Telephone No. PERMITTEE $�" (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA / Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units / No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YE = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type o coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ ' /� Work to Stan`. y Inspection Date Resquested Rough I.Vl L L C A `- -Final Signed FIRM NAME rtg)Aenalties of�pq� pequry(' / �61 r LIC. NO. 14b 36 49 NO.6 - /7r7d tea- Bus. Tel No. / ZP Address Q S7Q Ch'l J/ h%� V Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) ��SS� Telephone No. PERMITTEE $�" (Signature of Owner or Agent) E ,-3Q#"-"Usr`TTS UNIFORM APPLICATION F-- PERMIT t. ( TO DO QASFITTINO Print or Type) R NORTH ANDOVER , Maas. Date �g L Building , Location�y�r yy? S Permit #_ Owner's Nam�?r �vS7i�✓ N me _ � New ❑ r1AGIM EHT OOR OOR !RD FLOOR 4TH FLOOR GTHFLOOR STR FLOOR TTH FLOOR !TH FLOOR Renovation ❑ Replacement Plana Submitted:. Yea ❑ No ❑ a a , h K C h < W •i O a 0 V a' p h �1 310 M a = 0 H 0 ° 0 arc 1.h h y< i K Y d J K o w 4 < O b p F- ~ O w = s Z Y cc w r at h .. A = e # 00 1 Z Replacement Plana Submitted:. Yea ❑ No ❑ Check one: Installing Company Name Y7 e,r Address_ ar 0 Q Corp. EJ Partnership UVB uOf X ` Firm/Co. Business Telephone l _ 5 Name of Licensed Plumber or Gas Fitter �S7` t°✓�l �'�� ,C��,� ./,� � Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent. Yeac ne It you have checked yes, please Indicate the roprlate box. type coverage by checking th . a . A IlabNity Insurance policy Other type of Indemnity O Bond O OWNER'S INSURANCE AIV R: 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: nature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that an of the details and Information 1 have submitted (or entered) its above application are true and accurate to the best of my knowledge and that all Plumbhe Massachusetts work and Instellatlons performed under the permit Iss for this application 11 be mpliance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the jausm� n"'THIe rna ute nse u er or a er r �/TOW" ust eyman License Number Ar'f'r10'VED (OFFICE USE ONLY) a , ee w o C h < W •i O a 0 V a' p h �1 310 s K tl 0 ti a = 0 H 0 ° K h O 0= ee arc 1.h h y< i K Y d K o 1 Check one: Installing Company Name Y7 e,r Address_ ar 0 Q Corp. EJ Partnership UVB uOf X ` Firm/Co. Business Telephone l _ 5 Name of Licensed Plumber or Gas Fitter �S7` t°✓�l �'�� ,C��,� ./,� � Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent. Yeac ne It you have checked yes, please Indicate the roprlate box. type coverage by checking th . a . A IlabNity Insurance policy Other type of Indemnity O Bond O OWNER'S INSURANCE AIV R: 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: nature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that an of the details and Information 1 have submitted (or entered) its above application are true and accurate to the best of my knowledge and that all Plumbhe Massachusetts work and Instellatlons performed under the permit Iss for this application 11 be mpliance with all pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the jausm� n"'THIe rna ute nse u er or a er r �/TOW" ust eyman License Number Ar'f'r10'VED (OFFICE USE ONLY) �MEtJT Date.. . .-E'VEt)pA ........ I 19�2 Ot t%ORTH -1 OWN OF NORTH ANDOVER 61 Mk*TGAS INSTALLATION ARM This certifies that .4 e ..... has permission for gas installation :I. in the buildings of .............. .............. at North Andover, Mass. Fee. .......................... GAS INSPECTOR WHITE: AppllcA V—C �NA.1: Building Dept. PINK: Treasurer GOLD: File Location 1 4"" / / � 1 -7 ',' No. o2 01,=2 Date //--?g TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Pe 2 2 rmit Fee $ CHUS Foundation Permit Fee $ Other Permit Fee TOTAL Check# / /2 / �-- 15182 v Building Inspector r TO" OF NORTH ANDOVER BUILDING DEPARTMENT ,PPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 3UILDING PERMIT NUMBER: r� DATE ISSUED: 6/ iIGNATURE: 7n.,;tiii_ rnmmiccinnPT .ngnectOr Of Btuldlnes Date M1, t IUIN . i- al i lv Jul V Uri.us a X- a.i.1.1 1.2 Assessors Map and Parcel Number: 1. 1Property Address: C 015- q I � Map Number Parcel Number Ilio 2 •j- � � �+. U •-�� (� 1.3 Zoning Information: 1.4 Property Dtmwnsions: �ottin District . Use ' Lat Area; s Fronts IE 1.6 BUn DING SLTBACKS ft From Side Yard nt Y Rear Yard Required Provide R' `'ied Provided ReqWred Provided 1.7 Water Supply M,G LC.40. Sq) 1.3, Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal Systcm: ❑ On Site Disposal System I1 . ublic ❑ Private ❑ SECTION 2 - PROPERTY 0W"RS1HP/AUTII0RI7ED AGLNT 2.1 Owner of Record ` x" 5V 1�iVYa.v M1"�.�e�A✓ S� Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: f JL'l.liU19 J - l.yL�Jl icva. a-av 1 3.1 Licensed Construction Supervisor: v, - Licensed CcAtruction Supervisor: j Address Signa re Telephone 3.2 Registered Home Improvement Contractor Company Name S�- Signature T q­�-S-<b%-7-303 Not Applicable 0 C S '7.1 46 License Number Expiration Date Not Applicable 0 j2pact Registration Number (at IDL001 Expiration Date s L cc cc n r r I'- 1 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(b) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure. t4 provide this affidavit will result in the denial of the issuance of the buildingpermit. Si ned oflidavit Attached Yes .......❑ No.......0 SECTIONS 'Dew' tloh 4f.Pro keid Work check all: a Lcable . New Construction ❑ Existing Building ❑LRpa*-s)— e ❑ Alfeiations(s) 9/ Addition ❑ Accessory Bldg. ❑ Demolition ❑❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS77 Item Estimated Cost (Dollar) to be Com leted,b permit applicant 1. Building a j y O ()Butlding Permit Fee 4 lvittit� Tier 2 Electrical (b)stiruated TotalCost :of i %Construction 3 Plumbrn Building Permit fee.() .x (b) 4 Mechantcal ;HVAC. 5 Fire Protection 6 Totai .. 1+2+3+4+5 Check Nurtebet ._ SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i 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. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,as Owner/ thorized Agent o 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 S -T-e- S+ VA . Print Nam Qc'� OSi�2nature of caner/A ent Date F STORIES Spm BASEMENT OR SLAB SIZE OF FLOOR TI1VMERS 1 2 No3 SPAN DINIENSIONS .OF SILLS DM ENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF ClMvfNEY IS BUILDING ON SOLID OR FILLED LAND IS BUMDING CONNECTED TO NATURAL GAS LINE Name: `:S ;,,-e S -e S -- -A Location: 1 a c3 \ 1 S Cit, —FOR S �; < 1 rv-) A ©1 g'6 3 Phone = am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity oI am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance Co. Policy # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature, Date / / 1 P% 0 1 Print name -:T� me S --.e S Phone # 9 l& "'�S 7 3 0 3 3 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept F-1 Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSAVON 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 a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector m 7) x m 0 m H 'v C — d CO) Cl) CD n Z y C. 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