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HomeMy WebLinkAboutMiscellaneous - 105 CARLTON LANE 4/30/2018_N O n� n O Date o.. 1. c� .�........... powrh ? ;tiooL TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING # i JiC 38�►CHUSfc This certifies that ..........0 ... ` ....... ........ ......... ............... has permission to perform ..... Gv ...U... S e_...: -, ,. wiring in the building of.... b.� r - yj.....U ...........�.......J......fOI G.L.b......................... at ........G. �..!......... i�! ..!.. !.A..�1.....Q.Yl.e.......................... > North Andover, Mass. Fee.)..?5.:.. 1v4" A ......Q .. .... 1 '.t `— Lic. No .................. ....................... ELECTRICAL INSPECTOR Check # 1 5 1 7 12594- .4 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8- j q- 16- City 6City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) I O'S C A e `.A,P-1 (14 f9e Owner or Tenant &k1tka^ caeaw Telephone No. 617- 33; 1707 _ Owner's Address [ O C w r � kc,., Lan e. Is this permit in conjunction with a building permit? Yes L Purpose of Building Poo\ 4.05" No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service 'dco Amps 1.\0 / a'' Q Volts Overhead ❑ Undgrd ® No. of Meters V New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �,l�u �� oc a\ �„s5t a El• Sy � D Completion of the followine table may be waived by the Insnector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) FansNo. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires bove In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Batter 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 Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons I KW I No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Si ns Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:' �0 �D (When required by municipal policy.) Work to Start: e -1 c1^ 15 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 the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: a tk, <, LIC. NO.: `a.o I Licensee: (; a,. ��� S�c�1 Signature LIC. NO.: (If applicable, enter "exempt" in the lic se number line.) Bus. Tel. No.: 9)e -ft -111U Address: eAw " 4L 35 Alt. Tel. No.: 01-19--376- (10 *Per M.G.L c. 147, s. 57- 1, 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 a ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. Date ......`..CQ....� f��... ORT#j 3� k.N'';;';�aot TOWN OF NORTH ANDOVER _ p PERMIT FOR WIRING a ":•:ter Ss�CHU This certifies that ......... IfS S t .../ A O v x` '? . .................................................................. has permission to perform ........hP� ....................................................................................... wiring in the building of ................ 4......tcr..✓y....................................................... at............ < ........ .. .... :North An ndoue-,•, Mass /....................... ................ Lic. No. .7r.x.................. nFee...... z.......... ...r... .4. ......;.......... ELECTRICAL NSPE616 Check # 1 y I &, Commonwealth of Massachusetts Official Use Only Permit No. �Z Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] aeaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN.INK OR TYPEALL )NFORMATI0A9 Date: /2 C) I City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant : I Le, Pd to fy-D Telephone No. Owner's Address 1 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building S w ° <�•� ,�.�_�, �d o Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C� (lam4 dg -,v L Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KWA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grad. o. o mergency Lighting Battery 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 Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number..Tons KW ............ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW 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: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: l'Spp (When required by municipal policy.) Work to Start: Za t ` 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 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: INSU-RANGE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: PS LIC. NO.: Licensee: e—. 5s e L i L Mat, Signature��a j� /� LTC. NO.: 2 Wapplicable, enter "exempt" in the license number line) Bus. Tel. No..=q -230 a5PJ y Address: _�afs_/��, t e & rc.1 e , QuZ/�;_. !til !4 O 15"? � Alt. Tel. No.: e5'trB - N, t -S936 *Per M.G.L c. 147, s. 57-61, security work requires DcpartmQ& 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: $ �S Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed o on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shallbelimited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass ❑? Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass I Failed M Re- Inspection Required ($.} ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: em -D Inspectors Signature: Date: FINAL INSP ON: Pass ' Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Sign Date: — /G DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMe (Business/OrganizatiorAndividual): .155 i i L Address:_ Z Zn tet 1.e City/State/Zip: Phone #: -7?q - 2"3 c_,� -- S;o Are you an employer? Check the appropriate box: 1. Warn to 4. ElI am a general contractor and I Type of project (required): ' a y emp er with 6. New construction ❑ employees (full and/or part-time). � 2. ❑ 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # �• E] Remodeling ship and'haveno employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. insurance workers' comp. insurance.g 5. El We are a corporation and its ❑ Building addition [No workers' comp. required.] officers have exercised their 10. ❑Electrical repairs or additions 3. El am a homeowner doing all work right of exemption per MGL 11. F1 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] f employees. [No workers' 13.[i Other comp. insurance required.] *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. i -Homeowners who submit this affidavit indicating they ire 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the polley and job site information. Insurance Company Name:. Policy # or Self -ins. Lie. #: /� Expiration Date: Job Site Address: /0 S (fc f- (4-- r,- Za „ 2 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 requiredunder 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 $250.00 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. I do hereby certify under the pains andpenallies ofperjury that the information provided above is true and correct. Phone 4: -7% `f 2-30 S ° l 2( Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Z0l Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 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 including the legal representatives of a deceased employer, or the 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 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 or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not producedacceptable 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 completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) 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 maybe 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 law or if you are required to obtain a workers' compensation policy, please call the Department at the number 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 perruit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license 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 license 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 Cooumonwealth of Massachusetts Dopartmont of Industrial Accidents Office ofInvestigations 600 Washington Street - Boston? MA. 02111 TO, ## 617-727-4900 oxt 406 or 1-877:MASSAFE Revised 5-26-05 Fax #k 617-727-7749 wWwMass,govIdia OF MARIkiih-ul' u. I - cc-r-r location No. y J1�--3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1 Ss4CHU5Et Foundation Permit Fee $ �Y�Eg9ther Permit Feed/ $ RE�EI�ED P sewer Connection Fee $ --~ C� 19 Water Connection Fee $ 03 �? (1 dove` Go11e-�TA� $ s Building Inspector Div. Public Works r- 1 -P�3a�tT•T-i v. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP KBO. �0&� LOT NO. � n�CFL ! 2 RECORD OF OWNERSHIP iDATE BOOK PAGE . ZONE SUB DIV. LOT NO. I — ��� 8 Z00 LOCATION PURPOSE OF BUILDING OWNER'S NAME Ocd1 ®r l `�^` NO. OF STORIES NO SIZE ' OWNER'S ADDRESS /,`�11� L� J BASEMENT OR SLAB ARCHITECT'S NAME �1�rpp a �rR rte^ SIZE OF FLOOR TIMBERS 1ST -zU j®e5 2ND 3RD BUILDER'S NAME nOJ OWN SPAN --71- DISTANCE TO NEAREST BUILDING UFCK "131.W n'M IMUISF DIMENSIONS OF SILLS DISTANCE FROM STREET 80 --- POSTS DISTANCE FROM LOT LINES - SIDES 5V REAR ✓ V a GIRDERS Vo J F "'A I l is �G e7 A FRONTAGE / AREA OF LOT 3,3)-70Z �i X� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING 11 ftocA t•�� S644.'17 eE ZUC.f 16 3laY/`K1 ��+p IS BUILDING ADDITION A C ,�01.n01.,' IS BUILDING ALTERATION Cj►, ( / �R&E J��, �— MATER:AL OF CHIMNEYG IS BUILDING ON SOLID OR FILLED LAND 1500 11 V WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �,,y,�S �OJJ IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ' ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED /�j t9g)'7 ^ n) ` SIGNATURE OF OWNER OR AUTHOOyyRIZED AGENT FEE ,� 3 C1 OWNER TEL. # 2fx-ef: 0 PERMIT GRANTED CONTR. TEL. N r CONTR. LIC. 0 is U 3 PROPERTY INFORMATION LAND COST EST. COST �� 000 EST. BLDG. COST PER SC. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN t lVd4 �. Wwlu mw miraciTVR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S"WIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH a 112 I3 PINE HARD_ D _ _ PLASTER CONCRETE CONCRETE BL K. BRICK OR STONE PIERS _ DRY WALL UNFIN. _ _ _ 3 BASEMENT AREA FULL FIN. B'M'TAREA 1/. 1/1 1/ FIN. ATTIC AREA _ N_O BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH HARD_'0 8 1 2 3 �_ I_ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING _ VERT. SIDING _COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY BRICK ON FRAME CONIC. OR CINDER BLK. ATTIC STRS. A FLOOR I_ WIRING SUPERIOR POOR I ADEO ATE I-1 NONE 10 PLUMBING STONE ON MASONRY STONE ON FRAME 5 ROOF GABLE GAMBRELMANSARD I I HIP BATH 13 FIX.1 TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ to 13rd I NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM -LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. J FORM U - LOT RELEME FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: PK 11.1 O G tt T �o c Phone _-799 6 2jo LOCATION: Assessor's Map Number )O <o Co Parcel 19 Subdivision " �Yc�{.YYIS Lots) 3 Street I�'(2 t T� r`i-Y�-rt� St. Number O S ************************Official Use Only************************ OMMENIDATIONS OF TOWN AGENTS: Conservation Administrator Date Approved Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved f4!/Q/97 �eal`thAg`ent Date Rejected Comments Public Works - sewer/water connections driveway permit Fire Department ' Received by Building Inspector Date 11 11 O y 'f 0 Lo a 6) z Itl p: z� 7- — — -- — VE:Tf) \ l s i" NOTE ALL FLoAnHc. rzDtwrs QkDE at -k laol�i COLLA2 %E"5 G' F4'N s 1'k -o o ziz- 1®�5' CAriLMt,4 LP,+4F Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE ©ctoe tZ JOB LOCATION 0-6- umber ,6-umber 0_1aQLr0N Lam+E_ Street Address binc ror4 Wins Section of town "HOMEOWNER" 914kLIP 0� Gll9- I -Q S `7_"-P, 201 Cfol-7) 76-3-0108 Name Home Phone Work Phone PRESENT MAILING ADDRESS 9b5 CI�QLZ?n L(�P{� Mt pxv ow Fam� of�g5 City/Town State Zip code 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) 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 to six family dwell- ing, attached or detached structures accessory to such use acid/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, on a form acceptable to the Bulding 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. I ma e CL cr \WJ n Rw in m O O O 3� 7 0 j mEr T r mC r1 c ` 0 v n m ; v n z z v C c� o z M T Dn _ -4 -4 -4 O 0 0 _ x �a v m 2980 Date./.l� `NORr TOWN OF NORTH ANDOVER pfAt,.o<,tio 3? ' PERMIT FOR GAS INSTALLATION F 9 s �SSAGHUSE This certifies that ?'� o� 9 has permission for gas installation . j ?.Y. 1 z ............... 1 in the buildings of . �!/,11'41 .. �.......................... . at . %C> ..�'f1,2 (�c, v�- .............. . North Andover, Mass. Fee.. U. ' . Lic. No..57 ?... .......................... GAS INSPECTOR WHITE: Apalicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI + ING (Print or Type/) /. 7Yi JtW Mass. Date 19 Permit # o Building Location /D S l L17'�_ PV 2,0 Owner's Name rp /p� i' /^fs �-0 Ado GL'6 ^. Type of Occupancy E51 i D N Ti rq L G New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes❑ No ❑ Installing Company Name e ,Ae(Z TA .:'-AM Ma T it �0 Check one: Certificate Address 3 -1 00 A C H ih A ri KI, ❑ Corporation fl1 F T U int 01 t4 ❑ Partnership Business Telephone a<o . 2 -17 9'7 f 2--firm/Co. Name of Licensed Plumber or Gas Fitter "ROOF- Lr A - 58mm 0 z e INSURANCE COVERAGE: I have a curre�ntjability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ga' No ❑ if you have checked Yes, please indicate the type coverage by checking the appropriate box A liaAbility Insurance policy Other type of Indemnity ❑ Bond ❑ 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 Owner's Agent Owner❑ Agent [I I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of V ner Laws. By T of cense: L� Plumber n ure of cen u or Fitter Title tter Ler License Number 9333 Cityliown Journeyman N • ao PON Installing Company Name e ,Ae(Z TA .:'-AM Ma T it �0 Check one: Certificate Address 3 -1 00 A C H ih A ri KI, ❑ Corporation fl1 F T U int 01 t4 ❑ Partnership Business Telephone a<o . 2 -17 9'7 f 2--firm/Co. Name of Licensed Plumber or Gas Fitter "ROOF- Lr A - 58mm 0 z e INSURANCE COVERAGE: I have a curre�ntjability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ga' No ❑ if you have checked Yes, please indicate the type coverage by checking the appropriate box A liaAbility Insurance policy Other type of Indemnity ❑ Bond ❑ 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 Owner's Agent Owner❑ Agent [I I hereby certify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of V ner Laws. By T of cense: L� Plumber n ure of cen u or Fitter Title tter Ler License Number 9333 Cityliown Journeyman N • ao W W LL < W Z \, I Date ... � .. � 4 0.��.... . 0FHORT1i 1ti ow °` � TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION h SACHUSEtt This certifies that .... .. Y.....t. P :. .. ....... . has permission for gas installation ................ in the buildings of V'!. ......................... . at ... O %S .. �.... z r 1.4 `' ... .... , North Andover, Mass. -c Fee. Q� . Lic. No. g�. 3 C. . . � ... U z 2 i .. . --. GASINSPECTOR Check # //0 / 8 4369 MASSACHUSETTS UNIFORM APPUCATON FOR PERMFr TO DO GAS FTI TING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations 044-41� Date L2, 3 s Permit # Amount S Owner's Name G tt A- 4 e S New Renovation Replacement Plans Submitted or type) Ce: Certificate Installing Company Name Al— �t �CorP- Address 5-D L 3 v ky �'� _ Partner_ u , 0 v e, -IL �2 f7 �cP El' Business Telephone �_ R- /„ /T 7.;:,> ( Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes QIo❑ If you have checked M, please m e the type coverage by checking the appropriate box. Liability insurance policy ErOther type of indemnity ❑ Bond ❑ 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 Owner's Agent Owner ❑ Agent ❑ 1 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 i tions performed under Permit IssuVZ this application will be in compliance with all pertinent provisions of the Mass�Sta Code anc hapten 142 Generay `"s. Cityffown VED (OFFICE USE ONLY) bTS . ature of License61'Plumber Or Gas Fitter Plumber E] Gas Fitter License NumbFr 0-IGlaster ❑ Joumeyman SUB -B A SEM ENT �����������������i��a■ FLOOR or type) Ce: Certificate Installing Company Name Al— �t �CorP- Address 5-D L 3 v ky �'� _ Partner_ u , 0 v e, -IL �2 f7 �cP El' Business Telephone �_ R- /„ /T 7.;:,> ( Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes QIo❑ If you have checked M, please m e the type coverage by checking the appropriate box. Liability insurance policy ErOther type of indemnity ❑ Bond ❑ 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 Owner's Agent Owner ❑ Agent ❑ 1 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 i tions performed under Permit IssuVZ this application will be in compliance with all pertinent provisions of the Mass�Sta Code anc hapten 142 Generay `"s. Cityffown VED (OFFICE USE ONLY) bTS . ature of License61'Plumber Or Gas Fitter Plumber E] Gas Fitter License NumbFr 0-IGlaster ❑ Joumeyman NORTH 0 P �,SSACNUSE� Date.......! �. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... A. �..q.............................. has permission to perform S ........... .. / ...C ...................................... wiring in the building of ................�f...!�t... f"I.....)..................................... 5 at .................. ... tth Andov Mae �� Fee .(.?..? ....... Lic. No.yf� .... ,..�� l.t%... ICAL INSPECTOR% ✓( Check # 1 4616 y4 j.r� THEC�MNIf7 � MA,SSA HUSMS Offic /Use on1 DBI'A7Z1 7'OPPUBIICSVEN / LPemmitNo. BOARD OFF)REPREVEWONREGUTAT70NS527C1I 12Mcy & Fees Checked ` APPLIGAiTIONFOR PERmrtrTO PERFoRmELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wire The undersigned applies for a permit to perform`the electricalold rk described below. U•�z- Location (Street &Number) s K/►'1 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Boz) Purpose of Building S r.i l Utility Authorization No_ Existing Service __. Amps // -Volts Overhead Underground D No. of Meters New Service Amps ! li" Volts Overhead Underground No. of Meters Number of Feeders and Ampacity �ky A Location and Nature of Proposed Electrical Work`. G'. No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures g Swimming Pool KVA Above Below Generators ]EH4No: RVA round No. of Receptacle Outlets df Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets a 4 No. of Gas Burners No. of Ranges No: of Air Cond. w Total FIRE ALARMS No. of Zones Vo. of Disposals No..,bf Heat Tons Total Total No. of Detection and Pum s Tons KW Initiating Devices —� 70. of Dishwashers S`%addArea Heating KW No. of Sounding Devices (� +� No. of Self Contained Detection/Sounding Devices o. of Dryers Heatihj Dewces i ' KW LocalMunicipal Oth er M o. of W` ter Heaters KW No. c l -# Connections No. of Signs r •.;c Bailasis >. Hydro Massage Tubs No. of Motq, ;4i Total HP anceCovetage R acutimliabEty :. 1. ' . 1.• � tostint Ir�soectiatDta�Rec�Ie�l yu p �J AA NAME sigtla�,re , R'SINSURANCEWANER Iamaware tQihua>sedoesnotha mysgr>aaue on this peimt application waives thisre9uaet mL check one) Owner ® Agent Signature ot Uwner or Agent Stllatmalegtnvakrt yFj ® ®. V)mhmd"JAYES indcatethetypeofcovfra�by /?/d V-1 Dae EstirrmWVaiieolBoanwwc& s Eff" air Li msseNo LxenseNo Bt�lessTelNo. � � 1 At TelNo. ethe instltatxumv2tageoritsabst ntia apvaleriastegtmedbyMassachusetts V Telephone No. PERMIT FEE �! The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02311 Workers' Compensation Insurance Affidavit Name Please Print Location: City Phone # I am a homeowner performing all work myself. 0 I 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 i City: Phone #: Insurance. Co. Policy # Company name: , Address City: Phone #: Insurance Co. Policy #+'' # Failure to secure coverage as required underSection 25A or MGL 152 can lead -to the rmposdiors of airn final penalties of.a fine up to $1,500.00 and/or one years'imprisonment-as_was_civt7.penatiiesjn2hefom-cfs-STOFVjKMOR.Wl�Warid;.a.fined-($I11A.OD)�aidayagainst.me. i understand that a copy of this statement may be forwarded to the Office of investigations of O&DI 1 for coverage verification. n ! do hereby certify under the pains and peneA,-s of perjury that the nr wwtion provided abr ve is true and correct. Signature Date Print name Pb One. Official use only do nct write in this area to be completed by city or town dficiar City or Town PermM icensing O Building Dept E]Check if immediate response is required Licensing Boand p Selectman's ice Contactperson- Phone IV Health Department El Other