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HomeMy WebLinkAboutMiscellaneous - 116 WAVERLY ROAD 4/30/2018I P 35(/7 Date.�2--.A-)... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ........ ................................................. has permission to perform .................................. winng in the building of .................................................. at ....... .............. . North Andover, Mass. Fee-,�S—'��... Lic. ........................... LEcrRICAL INSPECMR Check # LI'Ll 7 .. T1E00W0NWE4LTH0FMASS4CHUSE77s Office Use only DEPARTAfiM0FPUB1ICS4FM Permit No. 26`77 BOARD 0FMEPREVEW0NRFJ M4TI0ANV7CMR LZW -- Occupancy & Fees Checked _�� (OATPLICATIONFOR PERMIT TO PERFORM ELECTRICAL 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 Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1 1 LV L )4U GI' _`L A Owner or Tenant LF r6 h ; `, t Owner's Address i t u to rwu .t Is this permit in conjunction with a building permit: Yes [2yNo (Check Appropriate Box) Purpose of Building XAE,� tp.A Utility Authorization No. ■ .��.■�M��I. ■■III■■�■ Existing Service ■ I= Amps iZt: / 7.09 -Volts Overhead Underground M No. of Meters New Service I Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Tis No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA i� ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units Lo No. of Switch Outlets e No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total i Tons No. of Detection and No. of Disposals No. of Heat Total Total 0 Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other ko. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of 1 ,No. Si Bailasis Hydro Massage Tubs No. of Motors Total HP OTHER - - - - hstranoeCaeage RnstmiDthetegt>it=crtsdNbsmdus&Ga=alLaws Ihma=utLiabt*h&==Pbl yurhnj¢gCar#&CovwdWc'ilsstkgm>5alegivalat YES NO F1 Ihawsthn ted Vdhdproo(afone1otheOffim YES r7 NO M If)cuha%ednialYES, pk=ffdi*theiWofaaaWbydrdagthe apptopebax INSURANCE © BOND MIER M ftweSpeffy) ,I D* WadcbStait "L-- K> -(51, hgxtimD*Regttes1ed Sigtted tntdm'& Petahim ofpedW.. FIRM NAME Estim*dV"dFJo1 al Wade$ Re* 2 - 13 0 2- — Fetal Lim=% (g Lica>sae r rat 1`���� j�w...�v Sime Lim rwlb iGLAco,& A Ili Btsc>le IldNia Lq7I95)y19-3EL-iZ, ArN AkTdNa L9 -i OWNER'SPWRANCEWANER;IanawatethattheLioawdocsnot #ritsr&=wvaa on1s akstiMequiwktasmgzedbyMassah&%GeneralLaws andthatmysgt�taeonthispa�v�thisteguQat`Ialt. (Please check one) Owner Agent o Telephone No. PERMIT FEE $ �U� � Date. ;/�. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...................... has permission to perform._ f4 ..................... plumbing in the buildings of ................ at. . /�� ... . �40 .......... North Andover, Mass. Fee,;? -5 ...... Lic. No. PLUMBIXG I' ECTOR .41-,9 ;PISIP Check # , k 5134 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS r Date Building Location 1& W Uew ?d. Owners Name Permit # 3 Amount p y J l / i�f'I/���j n Type of Occupancy / G% � 1 New Renovation 21— Replacement Plans Submitted Yes ❑ No ❑ FIXTURES (Print or type) � Check one: Certificate Installing Company Name �JO ���-%�� �� 1-7z%fe n ri Corp. Partner. .Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ 'Y 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 11 Agent El 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 ayj installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ma husetts Spte ¢ing C,po and Chapter 142 of the General Laws. y: (APPROVED (OFFICE USE ONLY V Type bf Plumbing License >✓ c�'1Qum er Master 0 Journeyman Location No. 262, Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 220 0'6' CH Foundation Permit Fee $ Other Permit Fee $ $ 9 rfv TOTAL Check # Building Inspector 15 2/ 7 8 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: u3 &P Im.. DATE ISSUED: SIGNATURE: Building CommissionerA or of Buildings Date. SECTION I- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number lu, 1wbov(AL 1.3 Zoning Information: Zoning District Pr Proposed Use 1.4 Property Dimensions: Lot Areas Frontage (ft) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.I-CAWO.. 54) 1.5. Flood Zone Information: Public 0 Private 0 zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record � U"v ame (Print) Address for Service F1V w 4f1 "12. 4#!k 0 Signature V Telephone 2'72 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone T M z 0 'af 6 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 256(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result , in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 DesciA tion of Proposed Work check ail applicable) New Construction g Existing Building ❑ Repair(s) ❑ Alterations ❑.._ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify' t Brief Description of Proposed SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost ( ) to beDollar Completed by permit applicant (IFIH�ICIALi)SE>l�Y ax. >? . 1. Building �,j0o � �/w 4 (a) Building Permit Fee Multiplier 2 ElectricalO .► (b) Estimated Total Cost of Construction 3 Plumbing Q . Building Permit fee (a) x (b) c 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNS S AGENT OR CONTRACTOR APPLIES FOR MIXING PERMIT as Owner/Authorized Agent of subject property Hereby autho ' e tovct on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TI1VMERS 1 ST2ND 3 ko SPAN DIMENSIONS OF SILLS M ENSIGNS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE F A v D. Robert Nicetta Building Commissioner (978) 688-9545 ' .,'(978)_688-9542 Fax Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please print DATE I I 7. JOB LOCATION / MA 1✓Ft11b_ff_, T Y_/1 "HOMEOWNER Name PRESENT MAILING AD Street Address Phone Map / lot F.4111A Work Phone OWN 0 , Ciiy gown State Zip The current exemption for "homeowners" was extended to include owner -occupied dwellings of two 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 108.3.5.1) .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 or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be'cons idered a homeowner. 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 APPROVAL OF BUILDING OFFICIAL North Andover Building Department Tel: 978-688-954.5 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: Vr (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 e 0 w O 00 W M s. w a v b °o w e v cn o U z A �� ° o w o a: :� U c u. o U a � aa. a o r� cdw w" a ° w � � rs: cn w p F a z a4 coo w H w a W W 6 cn Q cn ui am 5 0 :U :m INTO, 99Z I O O ■ L O s Z O d O y � C CD _ C C O•— � p C A O O •E m m CLte_ � � L m O d CL CM< C O v J.O d O � C Z CD 0 CL V NA O C CL _ C C40) E 0 U) U) Ir W cr W U) =o CD c O i DO N C vO C3 d� CL c O A tt � O � CD c m O o n E� m c� O O 67 r t;cm:mc 0.• C v ; i c I3 N 01 ID mJ c. Co N A Em , CC JD .: y m m 'z� o �coa CL c s 4D.!2 O c o 0 - Q or ma C = m m4- o F- o a oH COD W O A H y C C=.+ LU 0-0 V C V� CL Go a32m 5 0 :U :m INTO, 99Z I O O ■ L O s Z O d O y � C CD _ C C O•— � p C A O O •E m m CLte_ � � L m O d CL CM< C O v J.O d O � C Z CD 0 CL V NA O C CL _ C C40) E 0 U) U) Ir W cr W U) Location No. -V 72- Date 1012- 0/ Of 40RTpl A D TOWN OF NORTH ANDOVER �,,a . . , . , ., 0 Certificate of Occupancy $ Building/Frame Permit Fee $ 0 ITS Foundation Permit Fee -, i Other Permit Fee $ 00 fq-c-oppr-r) &k6t,1,1,DIpVTectlon Fee $ Water Connection Fee $ OCT 2 9TMi Andover C011ecitor Building Inspector Div. 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D3 OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING ORTN F :� °m Town Of NORTH ANDOVER SS�cRu�c` DIVISION (W PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIREM'OR 120 Main Street ,. North Andover, MaSSaChuSCIIS 01845 (t i 1 7) 685-4775 In accordance wit the provisions 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 c 111, S 150A. The debris will be disposed of in: S-1- (Ucation -1- (Location of Facifity) Signatu o ermit Applicant � d pGlrt' Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. � r +,y r Y } i"i"r�' •i�r � xix i �!'` + t {rc^ tl ,t / 15r,]f AM'�s�y �f� S" d � r % }r »,eg w , z, .•. 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S m °1 �n -v °—' 3 m � m m c'fl :rC ao ®q m � ^ c l O 70 „ y y z v m Z C O en T Z Z T T a O 0 _ �o m m z m I -11 z O 01. c 2 Co m z m z ice° MASSACHUSETTS UNIFORM A WInt a(T PPLICATION FOR PERMIT T(/,DO G� Mass. Date Permit C!' 11 Owner's r — Type of NOW 13 Renovation Q Replacement 1!ff0000' Plans Submitted: a No rri In"Ing Company Namk___ Chedc one. 13 Corporation X= i7 Business Tdeplane_( 6_ of Licensed Plumber W Gas Filter 13 P rtn "P. a" - INSURANCE�C,OVEPA GE: I have a cuff Il y Insurance POUCY, or to substardlal equivalent which meets of. MGtfL the requirements Yes No (9 it you have qho* Ind the Ws coverage by checking theappropriate box A Ilabit "pkY; Other 0 tYPeofimipmrilly D Bond 13 OWNER'S INSURANCE WAIVER:'l am aware that the licensee does not have the Insurance coverage.required h Chapter 142 of the Mass.. General Laws. and that my signature an this Permit application waives thisY, tequIrcjrA Check ale:' Owner(3 Ager 0 _,91 Owner's Agent— I hefeby ac1eeals and Infai*ma1lan I have subrnilled (or entered) In above a 11callon are but and &cmnsle to the best W my knowledge and that &j urnbW work and Installation ISPP of _ s performed under the Permit Issued of this application will be In compliance %".4;, ftlnent P10v`IsWn.4#. J: Massachusetts State Clas code and Chapter 142 of the Ge Laws. lay_ Type of a fill* L_j Numbar na ute a cc um of s I Claslillar et I- eyman ucense Number . - % ..... ..... 1 44 U ic (A 0 Z 0 x fA z A 011.0 cc 9 3�- 0: X 0 1.4 0 .0 CC 61 if 0 ; 4L 0 C .j W&JO 0>tLlm J yCj x 0 a x -It 31* 0 X q IL 0 0 SUB-111IMT, BA63FEMSHT I ST FLOOR 2HO FLOOR 4' 3110 FLOOfl__ 4TI4 FLOOR STII FLOOR GTHIFLOOR TTM FLOOR GTHFLOOR In"Ing Company Namk___ Chedc one. 13 Corporation X= i7 Business Tdeplane_( 6_ of Licensed Plumber W Gas Filter 13 P rtn "P. a" - INSURANCE�C,OVEPA GE: I have a cuff Il y Insurance POUCY, or to substardlal equivalent which meets of. MGtfL the requirements Yes No (9 it you have qho* Ind the Ws coverage by checking theappropriate box A Ilabit "pkY; Other 0 tYPeofimipmrilly D Bond 13 OWNER'S INSURANCE WAIVER:'l am aware that the licensee does not have the Insurance coverage.required h Chapter 142 of the Mass.. General Laws. and that my signature an this Permit application waives thisY, tequIrcjrA Check ale:' Owner(3 Ager 0 _,91 Owner's Agent— I hefeby ac1eeals and Infai*ma1lan I have subrnilled (or entered) In above a 11callon are but and &cmnsle to the best W my knowledge and that &j urnbW work and Installation ISPP of _ s performed under the Permit Issued of this application will be In compliance %".4;, ftlnent P10v`IsWn.4#. J: Massachusetts State Clas code and Chapter 142 of the Ge Laws. lay_ Type of a fill* L_j Numbar na ute a cc um of s I Claslillar et I- eyman ucense Number . - % :� v' 2870 0, 14ORTN -1 16 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CU This certifies that .......... 2. has permission for gas installation pl-mt. ............. 01�. in the buildings of ........ 4 . ........... at North Andover, Mass. .. . ........... Fee.,. Lic. No. /Z. -�'V/ 2 GA IN PE OR hi� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date .. . ..... . .......... I 6'y TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... /C ................. �has permission for gas installation ........... " /. - -a ............ in the buildings of Q -6&t z �—, ............. ............................. at 7,% ... . North Andover, Mass. Fee ..... #... Lic. Nozl� ... ......... GASINSPEC, R Check#_ 3 ", 6 8 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations ej?A Owner's Name New 11 Renovation ©./ Replacement Plans Submitted Date ILL6� Permit 9 .,.a.r-KAmou V0 ej ` o P1 (Print or type) �zP Name o€Licensed Plumber or Gas Fitter one: Certificate Installing Company Corp. Partner. Finn/Co. INSURANCE COVERAGE Check e: I have.a current liability Insurance policy or it's substantial equivalent. Yes 0- No;E3 Ifyou have checked M please indicate the type coverage by checking the appropriate box Liability insurance policy rZl-- Other type of indemmiity Bond 13 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 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 Massacb) 4etts State Cqs Coded Chapq 142 of the General Laws. (OFFICE USE ONLY) Signature ofLicensed Plumber Or Gas Fitter Plumber / _S— Gas Fitter License Number © Master rl Journeyman