HomeMy WebLinkAboutMiscellaneous - 104 COLONIAL AVENUE 4/30/2018c
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Location /�
No. Date
4
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T;�y° TOWN OF NORTH ANDOVER
c p Certificate of Occupancy $
'► *s �, Building/Frame Permit Fee $
sa..,s t� Foundation Permit Fee $
c Other Permit Fee $
Sewer Connection Fee $
� a
Water Connection Fee $
d TOTAL $
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Bull di g I nsp or
Div. Public'works
Location ' /Q / CD16A)/ A-1 "E_
No. ; 3 Date i
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ sv
Building/Frame Permit Fee $ t0�
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
cn
8 Water Connection Fee $
TOTAL $
Vwilding Inspector
Div. Public Works
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FORM U - IAT RELEASE FORK
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT:
APPLICANT: _A • C. 6u; 1(5 Inc, Phone �05-835a
LOCATION: Assessor's Map Number b Parcel
Subdivision WOOD 10AJ ESllU IlCS Lot(s) 6
Street 16, Co I D h lid ha St. Number 104
************************Official Use Only************************
RECO ATIONY O70GENTS:
Date Approved
Cons ervation Adminis -ator Date Rejected
Comments
'1 (rLAl q Q Date Approved
Town Planner Date Rejected
Comments
Food Inspector-He///���nalth
z2v "'
Septic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway permit -T
Fire Department J
c�
Received b1Y Building
Date .
0
0
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Date ..... 7/.7/
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... x
ec
...... ...................................................................
f
has permission to perform ....... -f.
wiling in the building of ...... .4. W. A.....IZ ....................................
at../ rtWAn pr.�
.... . . 4e No ov
d
Fee ..... Lic. No.. ......
....... . ...................
RICAL NSPECrOR
Check #
5327
T
Commonwealth of Massachusetts Official Use Only
�Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION EGULATIONS [Rev. 11/99] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance`with the Massachusetts Electrical Code (MEC), 527 MR1 .00
(PLEASE PRINT IN INK OqT A INFORMATION) Date:
City or Town of: To the Inspecto ofWires:
By this application the undersigned ivei notiJ*of is or her i tent' o perform the electrical work described below.
Location (Street & NuAber) //)* (1/1, ? (7,40
Owner or Tenant L-A/a�-e_ �z l Telephone No.
Owner's Address %
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Yes.. ❑ . No [g (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters _
Overhead ❑ Undgrd ❑ No. of Meters
Installation of Security system -
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above ❑In- ❑
rnd. grnd.
o. of Emergency Lighting
Battery Units -
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers .
Heat Pump
Totals:
I Number
I
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of DishwashersSpace/Area
Heating KW
Local ❑ Municipal ElOther
Connection
No. of Dryers
Heating Appliances KW
Security Systems: .
No. of Devices or E uivalent
No. of WaterKW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
ijuacn aaamonal aerau rJ aesirea, or as requlrea by the inspector of wtres.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of El trical ork: - _ (When required by municipal policy.)
Work to Start: 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME:LIC. NO.: 1 r,
Licensee: John S. Bassett Signature LIC. NO.: 1533C
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 59 8
Address: Alt. Tel. No. -
OWNER'S INSURANCE WAIVER: I am aware that the Li see 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.
Date.....1. l/
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ /-I. ..... ...... ......................
has permission to perform ..........
IV.................. ; .................
wiring in the building of ...... ............ ............
at /d
..... do ... ... .............. E IvJJL
00
�ee ....... ...... Lic. N01.1.0 .... ..............
ECTRICAL INSPCTOR
Check it
5321
Official Use Only
THE COMMONWEALTH OF MASSACHUSETTS Permit No. ---3,52/
�'• Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked --- —_____
APPLICATION FOR PERMIT TOjPERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date__
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number _—__�Q61___��ITIJA �t-__ IV 9:14 w6 _—
Owner or Tenant R•1}W N RotJ
Owner's Address (O'iiA40N�h�) VENsLLr 1VoR �n/DpVELi AAA Ot�Y,S
Is this permit in conjunction with a building permit Yes No • (Check Appropriate Box)
Purpose of Building_____ —_ ----------------- Utility Authorization No -----------
Existing Service_______ U0 Amps _______ Voits Overhead • Undgrnd No. of Meters
New Service ________Amps—_Voits Overhead • Undgmd • No. of Meters ---
Number of Feeders and Ampacity—_..........
Location and Nature of Proposed Electrical Work--___�i. _g �S_— t[_ 1r�SsetisE�� a _ eZ-4 e e%t Pe Se- euce
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 YES = NO =
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify) ---- ---- — --------------------- —-------
-----------
Estimated Value of Electrical Work$ ------------ _—_----- ------ (Expiration Date)
Work to Start_-----_------------ Inspection Date ------ Resquested------------ ---
Signed under th enalties of per' - _Rough____ _______Final___—____________________
FIRM NAME R1C
--- _1SL_- LFf1eCdC4----- CY1Oi%I�OW✓)ef'� - ,----=�"�\ LIC. NO.
/ B s. el Nri�_�
-------------------- ---------------------
Address___(0_ CQ(ONI�L H
----------------- - ----
---------------- A el. 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)
_______Telephone No.� z d� ? 4" m ____PERMIT FEE $_
of- rIvzv- —-----------------------------------
of wne t)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above
In
No. of Lighting Fixtures
SwimmingPool rnd
rnd
Generators KVA er
No. of Emergency Lighting
No. of -Receptacles Outlets Z
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone --------------
No. of Detection and
4o.
Total
of Ranges
No of Air Cond le,
Tons
Initiating Devices -------------
Heat Total Total
N . of Di osal
No. Pumps
Tons
KW
No. of Sounding Devices ______________
No./ of Self Contained
)
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices --------------
• Municipal • Other
No. of Dryers
Heating Devices
je
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors Ile
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify) ---- ---- — --------------------- —-------
-----------
Estimated Value of Electrical Work$ ------------ _—_----- ------ (Expiration Date)
Work to Start_-----_------------ Inspection Date ------ Resquested------------ ---
Signed under th enalties of per' - _Rough____ _______Final___—____________________
FIRM NAME R1C
--- _1SL_- LFf1eCdC4----- CY1Oi%I�OW✓)ef'� - ,----=�"�\ LIC. NO.
/ B s. el Nri�_�
-------------------- ---------------------
Address___(0_ CQ(ONI�L H
----------------- - ----
---------------- A el. 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)
_______Telephone No.� z d� ? 4" m ____PERMIT FEE $_
of- rIvzv- —-----------------------------------
of wne t)
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Location
No.
% ! Date �S d
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Check # eA r
r
i 7 6 4 1
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Feepjj9C'. $
TOTAL $ U
- "ON
Com' Building Insp!l..e��c``t''o``r''��""��
D. Robert Nicetta
Building Commissioner
Town of North Andover
Office of the Buildingepartx
Community Development a ' d Services Division
William J. Scott, Div' 'ion Director
27 Charles eet
North Andover, Mas, chusetts 01845
Telephone (978) 688-9545
Fax (978) 688-9542
DATE 7 - S C-) [� PERMIT #
LOCATION /0 C O L 0 All IVZ lq
OWNER'S NAME / /�_ -6-1 J0'r If
(
BUILDER'S NAME
MASON'S NAME1,3
MASON'S ADDRESS __ /
a
MASON'S TELEPHONE (97X) q QJ - G a
MATERIAL OF CHIMNEY
INTERIOR CHIMNEY Sf()h2 EXTERIOR CHIMNEY 2CIC
NUMBER AND SIZE OF FLUES — —
THICKNESS OF HEARTH /p
Will chimney or fireplace conform to requirements of the code and
have rules and regulations been received:
DATE
V SIGNATURE OF MASONT �,,,>/ J��/-20 CONTR. LIC. #
EST. CONSTRUCTION CCO�S /CONTRACT PRICE w ,� r
PERMIT GRANTED ` S! C) FEE
ROBERT NICETTA, BUILDING INSPECTOR���(
INSPECTED
REMARKS
SOLID BRICK REQUIRED
c - THIS PERMIT MUST BE DISPLAYED ON THE PREMISES
130ARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
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Location I� q �0 OA11 l
No. Oa Date
f i
r
Check # CPS
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ D
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
17472
7472 _G Building Inspector
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TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
CONSTRUCT 3VA5 RENOVAT OR DEMOUM A ONE OR TWO b'AMMY DWELLING
APPLICATION'
�1TO
BUILDING PERMIT NUMBER: �D
DATE ISSUED: >
O�
SIGNATURE: (
Building Co unci for of Buildin Date
SECTION 1- SITE INFORMATION
1.1 Property Address
10 j 6-01/444L. qrt Kt
1.2 Assessors Map and Parcel Numbs:
le) 7.6
Map Number Parcel N bet
A/to.-rr �iNa✓Ex, NIA a,gys'
1.3 Zoning Information:
Zonin District Proposed Ike
1.4 PropertyDimeesions:
Lot Area tt
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Reqdred Provide
Provided Rewired Provided
axr tyGLCAO. 34) 1.3. Flood Zen bfi nstim: 1.8 Sew-tteDisposalSyn�e
1.7WS M.
Pobtie Private 0 Zoaie Outside Flood Znee 0 Mmkipw 0 On Site Disposal System X
SECTION 2 - PROPERTY OWNERSHIN/AUTHORIZED AGENT
2.1 Owner of Record
&a,"w J- CiN.FFQ,aff /V om,ai. 4v6V1te A/,,tfd &DP✓e7-
Name (Print) Address for Service:
7 9.z/� 6
Si tura Telephone
j 217
2.2 Owner of R .
Name Print Address for Service:
Signature Tel hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
LIM
O
Z
M
90
10011
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2546) 1
Workers Compensation Insurance affidavit must be completed and submitted with this application.
in the denial of the issuance of the building pemrit.
Signed affidavit Attached Yes ...... A No...... PK
SECTIONS I)escri tion of Proposed Worlt dw&a9 ble
New Construction ❑ Existing Building X Repair(s) 0 I Alterations(s)
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work: / n
-1-I -t: c t, L"/,,.. t nT P )(:-c il,:, a of„I. a n.
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS . I
affidavit
Addition 0
Item
Estimated Cost (Dollar) to be ttr ; ` ;;'A ' ORFfC .USE C)j!iiYz`', '
Completed by permit applicant
1.
Building
(a) Building Permit Fee
3 ow Multiliar
2
Electrical
(b) Estimated Total Cost of
Construction
3
4
PlumbingBuilding
Mechanical HVAC
Permit fee (a) x tel
/� -
C/
5
Fire Protection
Woo j
1
6
Total 1+2+3+4+5
6 Check Number
FORM U -LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT $�X + A-4 T. &.PFI r,G ►4
LOCATION: Assessor's Map Number
SUBDIVISION AA
STREET Coiamt*L, AvewbtE
PHONE Cg%l
PARCEL r3 9
LOT (S)
ST. NUMBER to
************************************OFFICIAL USE ONLY***********************************
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER
COMMENTS
FOOD IN OR -HEALTH
P C INSPEdTO_R-QEALTk
COMMENTS S !�
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERfWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT.
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
Tel: 978-688-9545
Please print.
DATE (,-30— 0'f
JOB LOCA
Number
Town of North Andover
Building Department
27 Charles Street
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
)N,& Avg
Street Address
u6
of Town
"HOMEOWNER (97g) C $S— 33.y8 (178)Sa1-63ffZ
Number Home Phone Work Phone
PRESENT MAILING ADDRESS
City Town
State
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of six units or less and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1)
Zip Code
DEFINITION OF HOMEWOWNER:
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 to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE %)a.
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
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:
E
(Location of Facility)
ture of Permit Applicant
6 —3o- oy
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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