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HomeMy WebLinkAboutMiscellaneous - 108 LIBERTY STREET 4/30/2018 108 LIBERTY STREET I 210/090.13-0055-0000.0 1 0229 Date.... .' O'<•o oT a,h0 ar o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING •D'��TfD �'`� ' ,SSACNUS� This certifies that ...... ....... �.rt. W. ..........�`��� s � has permission to perform........... ....�.................................. ................ wiring in the building of..........(� uL. .K/................................................... i at.........1..Q. - .............. ...._..'... - SNoh.A. ndover,Mass.T ...... . Fee. �Q .. .Lic.No..,.3 .7/57 ....... kl;' ! 1 LECTRICALINSPECfQ / Check # / / Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 l,Wi I (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: 5�- J�, p City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice oi f his or her intention intention to perform the electrical work described below. Location(Street&Number) W I- bedl / F0117 Owner or Tenant f\11-N, -r QIk ,i Telephone No.l-I)-+g- Owner's Address J O$ + Is this permit in conjunction with a building permit? Yes ❑ No [a"� (Check Appropriate Box) Purpose of Building Utility Authorization No. 1 \14 g 1 61 2� Existing Service QOD Amps !� dyoVolts 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: �O,r -�a t.e r Sdde,,- ale Com letion of the following table may be waived by the Inspector o 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 KVA AboveIn- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. [:1rnd. ❑ 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 No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number I Tons J.KW No.of Self-Contained Totals: Detection/Alerting Devices F 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 WaterKms, No.of No.of Data Wiring: Heaters Signs Ballasts 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: (When required by municipal policy.) 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 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 0 BOND ❑ OTHER ❑ (Specify:) a-- I certify,under the pains and penalties of perjury,that the in ormation on this application is true and complete. FIRM NAME: a. rr-� r LIC.NO.: 3 g Licensee: -,,,e --r M�r-��,��. Signature �.�p� LIC.NO.: 38 -1 'S E (If applicable,enter exempt"in the license ber line.) ,L Bus.Tel.No.: Es 1 �---.x� 5 -a414 um Address: r� � �\���CI,F �a J r cc-'1T Alt.Tel.No.:(.14 -e1,5�4-a 7 *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 Owner/Agent PERMIT FEE. $ SignatureturaTelephone No. I /////� tQ� �/7 .-. V �./,2 O r � L I f The Commonwealth of Massachusetts r Department of Industrial 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/Organization/Individual): Address:�a City/State/Zip: � 1c` � --I�� Phone#: _a,YIYL Are you an employer?Check the appropriate box: Type of project(required): t LEI❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling At ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no ' 12.0 Roof repairs insurance required.]t employees. [No workers' 13.❑Other 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. Contractors 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 policy and job site information. Insurance Company Name: s Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip:O , ADS-�%T�At— C Jg y S— Attach a copy of the workers'compensa ion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 certif der tl: pains and p—ennaallt-ies ff erlury that the information provided above is true and correct. Signature: �� L`'� Date: �I Phone#: 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 6.Other Contact Person: Phone#: Location r No. Date i NpRTM TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ i > ; ; Building/FrarrIgRermit Fee $ •^o, s ' 'TT ,S1AMUSES Foundation Perm �Fp pi�D $ Other Permit F Sewer Connection F.9?,Ifj ,V _IES Water Conn d„_,� e $ TOTAL 0/14to! 44 Building Inspector Div.Public Works PER3i:g Nor —St APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. t/PAGE 1 MAP 4.4 d. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE . ZONE I SUB DIV. LOT NO. �I I LOCATION '16 PURPOSE OF BUILDINGrf x ' (�,I1`e C OWNER'S NAME �X NO. OF STORIES I f SIZE Kt✓U/ 1.. OWNER'S ADDRESS C( BASEMENT OR SLAB ARCHITECT'S NAME VV n� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME LF SPAN T' DISTANCE TO NEAREST BUILDING r DIMENSIONS OF SILLS -_ L/�,( O . TT1L-� I DISTANCE FROM STREET POSTS51 ^ C 7 DISTANCE FROM LOT LINES-SIDES REAR "' "' GIRDERS Ic1 AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION �/V'G THICKNESS �/IS BUILDING NEW SIZE OF FOOTING X V1BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER OARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ISS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS W ore V, n21°IZ 3 PROPERTY INFORMATION L, 111-3 Qq- Foo g .I�• LAND COST SEE BOTH SIDES S�'oY wo,e/� �.S9u. �0'-Q EST. BLDG. COST 'r) (- PAGE 1 FILL OUT SECTIONS 1 - 3 + M� EST. BLDG. COST PER SQ..FT. j PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG.COT PER ROOM SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY {� 1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILE('D,f ANDPPROVED BY BUILDING INSPECTOR DATE FILED �� j BOAR F HEALTH I U• SIGNATUR O W ,R OR AUTHORIZED AGENT 1' OWNER TEL q a F E E A� Jr�•�— CONTR.LIC.# (AFr-IbnY)I7 PLANNING BOARD PERMIT GRANTED s BOARD OF SELECTMEN BUILDING INSPECTOR _ � I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED.THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION S INTERIOR FINISH CONCRETEI _ d 1 2 13 CONCRETE BL'K. PINE' BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ '/. 1/1 1/1 FIN. ATTIC AREA _ N_O BM'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ'D —{I_ ASBESTOS SIDING _ COMMON — VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ a SUPERIOR I� NOOR ADEQUATE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.1 GAMBREL MANSARD TOILET RM. 12 FIX.1 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 ... ..—.•«. e„to. ,�?j ..vim .,{ _ t 6 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS.&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 IL O B'M'T 2rd _ ELECTRIC ! 1st 13rd I NO HEATING �4oRTH .�, F ��� oven of �� c�r� 6Andover 4200 tri 44 . A �-<�_ DRIVE `SAY ENTRY PERMIT � r_ � E` over, Mass., A RF O C� S' Pte. i E BOARD OF HEALTH PERMIT T LD 1-e-�Ll Kan;1 21C� THISCERTIFIES THAT........................ ....................... ............................,...... .... . .. die.. bund gs on ... . ... . . ......���......... Rough UILDING INSPECTOR haspermission to erect .... r...>. .... ... �/ —.�^.... . ....r.7./..,.. 7� •�t1}! . 1JOo�.. L`�� !.4?.. SN�....WC.LVII�� Chimney to be occupied as.. ....... ......... ................ Final provided that the person accepting this permit shall in every respect conform to-the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit.PERMIT EXPIRES IN 6 M 0 NT'.+1� -_ ELECTRICAL INSPECTOR Rough _ UNLESS CONSTRUCTION .STARTS Service St� iL10�L ©v ' Final 13 .�• A LQPqiDA-1 , ........�.......... ....... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector 3 Suggested Affidavit for Home Improvement Contractor Permit Application For Orrice Use Only / NAME Cf C1 OWN Permit No. RAI D Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142Arequires that the"reconstruction,alteration,renovation,repair,modernization,conversion,inprovement,removal,demolition. or construction of an addition to.any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adiacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Est. Cos �� r Address of Work Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under 51,000 _Building not owner-occupied `Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. ? OR: Notwithstanding the above notice hereby apply for a permit as the owner of the above property: ( � -- Date Owner Name i ---------- __ _.... . i I tG a. I s F -7-1,v x FA d Iry F• I.3 i A✓� F I I a I 3 4 • , ! II • _ 0 ,. FAX COVER LETTER s DATrJ f TOTAL NUMBER OF PAGE : TO COMPANY J, J, FROM - PHONE NUMBER OF FAX MACHINE SENDING. ----- c - RHONE NUMBER OF FAX MACHINE RECEIV?NG: � 1 _ TIME SUBMITTED:-- IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL BACK AS SOON AS POSSIBLE THE FOLLOWING PFIONE NUMBER : C E _ Lil U; SEP 2 5 i�,