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HomeMy WebLinkAboutMiscellaneous - 117 MILK STREET 4/30/2018 117 MILK STREET 210/060.A-0014-0000.0 9806 NORTH `90 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS�� s. This certifies that ............... ......D.64GPII................................... has permission to perform ..... l.l. !�l�K.�.. .......................... ` wiring in the building of ........ �h/1 ..Gl. ,l........................... at......I. .7.....M.04r........ ,77......................... ,North Andover,Mass. 70 Fee..?-r~oo...... Lic.No... d 7� ,t .. .a�1 1�5............ ni.Ir��cnx 7 Check # © f/ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 14W BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (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 W INK OR TYPE ALL INFORtYIA770N) Date: // -- 01,°7` / 0 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 Tenantt�/G L Gjf/L��j�J AlTelephone No. Owner's Address S /~ Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building k-rl-N0JGL Utility Authorization No. O k?,Existing Service t 0 0 Amps 120 /24 0 Volts Overhead [�J 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: New wi',-ir7d.— Fop- K4,ckxi AIL wt r i✓7 d- F o- &d k/0o^1 i Mi Completion of the ollowin table m be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets p2 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool ove ❑ - El o.o mergency Lighting rnd. !!!d. Battery Units No.of Receptacle Outlets 3 ( No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1Vo---o-TVetection an Total —Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat um um er ons ntame Total: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipa Connection ❑ Olher No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.o Water o.o o.of KW Data Wirin i Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: 84 pry^ L7- yAv-U&+ 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: t p 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 cove office age is in force,and has exhibited proof of same to the permit issuing oce. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) 3(o0003 39 f : /*19 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: &JJI yAr :r- nL.A I�z:OJ /tierS-�f z- Ele ,fri[tip a LIC.NO.: Ro1/°70 A Licensee: Pd�nz --r bgAf,-d/I Signature t a e Z fD6,; _ LIC.NO.: /p (If applicable, enter"exempt"in the license number line.) / Bus.Tel.No.: �7�� 0"�„Z�, Address: Lit? AS;h I rid 1�G V__ 14'e-4 3 A) N4 0/9ytf e Alt.Tel.No.: *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 signatur, below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. 91 0!V PERMIT FEE. ,$ 31. M �x Date. . . 88u „pR,: p TOWN OF NORTH ANDOVER 16 PERMIT FOR PLUMBING r SSACMUS�� This certifies that . . ./. l./;� .r y. ,/l. . . . . . . . . . . . . . . . . . . . V has permission to perform . . . . . . . . . . . . . . . .fG . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . at . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee-� Lie. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: 0 P ,MA. Date:1c ?F—Za/�' Permit# n D r _ Building Location:// �ffo Owners Name: C i Type of Occupancy: Commercial❑ Educational❑ Industrial❑ 'Institutional❑ Residential ] New:❑ Alteration: Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED SYSTEMS 1/ z0 Ln W Y ')/ > Z of LA 2 iii p D 0z LU a Z ~ Y Z Q a 'n Z M N LA LU Q z W ' 13 -jQ H i a Z Q W Z W J O a LL J W 4` 1111 w u F=- = a C 3 u Z a p 3 a Y Z v=i FW- FW- "' p O' Q } vii CA > > o o Z a a a u a c a CC m m c e � °x Y g g ° h CA 1 3 3 3 o a c� c� 13 3 SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR e FLOOR 7T"FLOOR 8T"FLOOR Check One Only Certificate# Installing Company Name: P[V1ti n ❑Corporation Address: re LjYl City/Town: / V15 State: d6& ❑ Partnership Business Tel:6 03 3 6e--, y/rFax:6Q 5 .36 Z 7 3 tIR(P Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes-Z No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy"q 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only r , Owner El Agent E] �. Signature of Owner or Owner's Agent f' I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r By Type of License: Title ❑ Plumber Master Signa ��I�-LiCesi&d Plumber t '!� City/Town iJourneyman License Number: �Z / APPROVED OFFICE USE ONLY FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT o.r e s C*X-G` ��dr- PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET 1'`1 STREET NUMBER l ............................................................................ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS INNER"Ron CNx 0 a DATE APPROVED ONSERVATION ADMINLSTRATO No DATE REJECTED 711, oZ COMMENTS No ?I p-t Tia w af4u e- S e-d kome,ov-)n Q_C 1000_1 b5 h0 toPro ve-A - w/rn 5-0/ no- le DATE APPROVED TOWN PLANNER DATE REJECTED CONRVIENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED CONRAENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Tis Set>t>EO�=fdE (?ffId tlsC'OIiI BUILDING PERMIT NUMBER: DATE ISSUED: R X SIGNATURE: Building Commissioner/I for of Buildings Date SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O �--�'" r�p60 ® 01LI Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Suppty M.G.L.C.40. 34) 1.5, Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: C Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Lic used Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: O License Number Address Expiration Date signature Telephone r 1.2 Registered Home Improvement Contractor Not Applicable ❑ v ;ompany Name rn Registration Number r Adress z Expiration Date 0 i¢nature Telephone Y I SECTION 4-WORKERS COMPENSATION(MG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result P PP in the denial of the issuance of the building permit. -Signed affidavit Attached Yes....:..❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Desc,pilirtion of Proposed Work: �i. �� ,W• [;off-. � q fl w r clt-�nA-� S 'A , tpS G♦2()�S.` o.S he Tw.�� LL A�.p,re `-o� .A Pot L45"­-u'cP♦oL-, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be YgmQ01 Y Completed by permit applicant , � 7k F , 1. Building 5e (a) Building Permit Fee 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(.,�x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) E ' a a 00 Check Number SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, � �,♦ �-`2 S ���` �,� - as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf in all in tters elative to rk authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 2 3RD SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFENINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ' I y � ROGERS POOL, PATIO & TOY CO., INC. Over 56 Years of Quality Sales and Service 150 Middle Street LOWELL,MA 01852 (978)454-5517.1-800-698-7946 DATE z` 200 —2— SOLD TO C q .. C J 1 d f? e,r ADDRESS CITY Nior 6 crtr-g- ff(� TEL`O 2iP -697'c;; ! ,J -+ PLEASE PAY HIS INVOICE-NO STATEMENT WILL BE SENT QUAN. ARTICLE AMOUNT POOL FILTER or 0 SAND Z&S 25-lbs;:DE LADDER: -FRAME IN30L --' IN-WALL SKIMMER 3 PC. DELUXE WEIGHTED f VACUUM SET l ;STARTUP CHEMICAL KIT i LINEROF - MAINTENANCE KIT -� �► k � .7S P- r Normal Dig (Flat Grade) Pool Installation • Blocks • Base Btrfas: Final Payment Due on Pick-Up. Cash or Bank Checks ONLY. REORDER FROKARADV BUSINESS FORMS LOWELL•MA•1-800-8920572 SIGN CUSTOMERS SIGNATURE Z.W_Construction PHONE NO.. ::..9783460902 Mar. 13 .2002 11:52AM P1 . G.W. CONSTRUCTION CO. P.O.BOX 162 MER AC*MA. 01860 (978) 346 8902 GENERAL INFORMATION FOR ABOVE GROUND SWIMMING POOL INSTALLATIONS THE FOLLOWING STEPS MUST TAKE PLACE,INVADER TO INSURE A PROMPT, COURTEOUS AND GA URENTEED INSTALLATION. PLEASE TRY TO BE FL&VALE IN YOURSCHEDULE. 1, Customer must contact Rogers Pool to make anw4ement for the delivery of swimming pool. 2. Installer will contact the customer to discuss the approximate time for installation. 3. Customer will be contacted by the machine operator to schedule a time to excavate the pool site. Normal excavation consists of no more than 1(one)hours time or no more than 2' (two)out of level. Normal excavation is$100 for round pools-$150 for oval pools. Overtime for the machine is$75 per additional hour/additional two feet. The machine operator is to be paid in full at the completion of the excavation. 4. The customer must provide a 6' (six)opcnin�,for the machine to enter the pool site to excavate. 5. T11e customer must provide a 10' (ten)opening for the dump truck to enter the yard to deliver the peel base to the pool site. If no access can be provided, the will be an additional charge of$75 per every 25 feet to wheelbarrow the pool base to the pool site. The customer may pay driver for delivery of the pool base. Pool base charge is deducted from balance. 6. After the above steps are completed the installer will contact the customer with a firm.date for install. 7. Upon completion of the pool installation,the installer must be paid in full and in cash S$$. 8. Installer will advise customer where to bring the water level to full using your garden Dose. If a water truck is Aecessary,customer must,contact tho water company in accordance with the advice of the installer. 9. Customer may now contact the electrician to begin the ekctrical work. The electrical trench r ould not be dug prior to the installation. 10.Installer will inform the customer the proper procedure for backfill around outside of pool. Failure to backfill around outside of pool will result in washout of the insigy covin,:, *** Once pool is full, backfilled and the electrical work is completed,the customer should *** #°�* bring a water sample to ROGERS POOL to have water computer tested. '�*` y G. W. CONSTRUCTION CO. (978) 346-8902 INSTALLATION CONTRACT G.W. CONSTRUCTION CO; hereinafter called the INSTALLER,and hereinafter called the CUSTOMER.of Telephone# for the installation of one Above Ground S%imming Pool for the sum of S Pool Modcl Size Purchased from: Consisting as follows: Deck Walk Fence Extra Digging Hauling Wheelbarrow Base(more than twenty feet) In order to maintain the lowest possible installation price of an Above Ground Pool,the following conditions must be agreed to: The pool liner will be installed in a professional manner,but due to the fact that all Above Ground Pool liners are made oversized allow for shrinkage,we can not guarantee a wrinlde free liner. Site preparation, including the removal or protection of trees, stumps,boulders, ledge or other vegetation which constitutes obstructions to the installation,shall be at the expense of the CUSTOMER Removal of pipe lines, dn•wells,non-functioning septic systems or other facilities,shall be at the expense of the CUSTOMER- is USTOMERis not responsible oriiable f6r remving sod, rocks,:edge or dirt rcimilnin—f&u,the excavation of tate pc-)I.siu urrlessa—miigement has been made prior to excavation. There will be an additional cliargc t^raui. The INSTALLER is not responsible or liable for any damages to the grounds, such as driveways, lawns, trees, shrubbery, sidewal patios, sprinkler systems, drainage pipes or underground utilities from equipment used during installation. The INSTALLER is not responsible or liable for any,damages to the cove inside the pool, the pool structurd or the outside areas c to the poor water drainage surrounding the outside of the pool caused by rain, floods,acts of God or any types of storms resulting the emptying of the pool water. The INSTALLER is not responsible or liable for any damages caused by failure to winterize or improperly winterizing the pool. The INSTALLER is not responsible or liable for any damages to the pool,if the pool is filled with trucked-in water that is pumps in with such force that results in the structure of the pool shifting or the twisting of pool liner. There will be a service charge if an ! adjustments have to be made from the results of any damages from this procedure.There will be an additional charge if the pool t must be reshaped,removed or new base trucked-in. The INSTALLER will not guarantee the pool structure against sinking into ground consisting of.clay. The INSTALLER will not assume any cost of supplying water to refill pool in connection with the performance of warranty service. - Dates of installation are subject to�change•at the discretion of the INSTALLER due to bid-weather or installation delays. ` WARRANTY All workmanship pertaining to the installation of the Above Ground Swimming Pool,when performed to the terms of this contract, shall be guaranteed for one pear from date of installation. The INSTALLER must be notified on or before this time of ani•problems involving the installation,to ensure proper performance. P The INrSTALLER will: a I. Level the pool site, up to ONE HOURS TIME or NO MORE THAN TWO FEET OUT OF LEVEL,with machine. For OVERTIME there will be an additional charge. 2. Place excavated earth within 20 FEET of pool site. 3. Deliver to pool site a base of dead man's sand to manufacture.'s specifications. 4. Assemble,erect and leycl pool structure with patio block under each upright. 5. Install liner and begin filling pool from customer's water supply with garden hose. 6. Assemble and connect the filter system to the in-wall skimmer. 7. Pile empty boxes in the yard. We are not able to remove'boxes.fro ill the yard. 8. Guarantee workmanship fully. The CUSTOMER will: 1. Be responsible for obtaining a building permit, if required,which specifically represents that there arc no violations of anv building, zoning, municipal regulations,ordinances or..statutes and specifically assumes sole responsibility for the exact locatio of the pool. 2. Provide access to the pool site for a small digging machine and dump truck. If access is not available, there Nyill be additional charges for digging the pool site by hand and wheelbarroNyipg the pool base to pool site. Charges quoted by the INSTALLER i an individual basis. 3. Be responsible for payment to machine operator at the completion of the dig. 4. Supply sufficient water to fill the pool including making arrangements for water to be trucked in. 5. Be responsible for procuring an electrician for the ground,and the electrical supply for the.filter system. 6.Be responsible for any landscaping and back-filling Nvith crushed stone around outside of pool. 7. Be responsible to assume any cost of labor incurred during site preparation,of abnormal ground conditions, resulting in cancellation. 8. Be responsible for assembly of the pool ladder as well as other pool accessories. PAYMENT: . The CUSTOMER shall pay the foreman the total balance due at the time the pool is completed in CASH. Tire T�iSTAIXER-can not-warranty installation if Pay_11r'mf lis nofl.r 7- T'LL. TOTAL PRICE S BASE S BALANCE S I HAVE READ AND ACCEPT THE ABOVE CONDITIONS. (SIGNATURE) DATE G.W. CONSTRUCTION CO. (978) 346-8902 DATE RRR*R***R#***#R*#R************R**RRRRR###**RR**RRR#**R*R*AR#*R*R#*R*#*RR#*#*R#**###RR*#*RBBB*RR*RBBB#RRR*RRRRRR I� acknowledge that G.W. Construction Co. properly installed the (SIGNATURE) SAFETY SIGNS supplied by the manufacturer. Date....... . .�.� ,f Y Ot NC 61 IO ..°T., o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING Ss"CMUS� This certifies that ....... ,,��...Y .....�. ... �.� has permission to perform ...S ... .................................................................... Ah wiring in the building of........� .la......P2.......................................... at..,c .� ...................................` . ......../,. , orth Andover�Nlas� ..V ! .. �� Fee-S ......... Lic.No l.: �/„............ ...........11.................. LE RICAL INSPECTOR Check # 01__ 454 Commonwealth of Massachusetts Official U e n Permit no. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 (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: 5-14-2003 City or Town of: N.Andover To the,In ect re off Dire By this application the undersigned gives notice of his or her intention to perform electrlcaYwor�C delcnbe�below. Location(Street&Number) 117 Milk St Owner or Tenant Charles Galaher Telephone No. 1-97&687-2786 Owner's Address 117 Milk St N.Andover MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building home Utility Authorization No. 148723 Existing Service 100 Amps 120 / 240 Overhead ❑ Undgrd ❑ No of Meters 1 New Service 200 Amps 120 / 240 Overhead ❑ Undgrd ❑ No of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: service upgarade from 100-200 underground with trench i p 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 No.of Emer�ency Lighting rnd. ❑ ❑ Batter Uni>Fs 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. No of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained R Totals: Detection/Alerting Devices No.of Dishwashers _S­p_a_ce7Area HeatingKWoca MunicipalOther ElConnection ❑ *o.of Dryers Heating Applicances KW Security5yystems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters I Signs Ballasts No.of Devices of Equivalent No.of Hydromassage Bathtubs No of Motors Telecommunications Wiring: Total HP No.of Devices of Equivalent OTHER:— ---------------......--- -------.-._.._...--- I INSURANCE COVERAGE: Unless waived by the owner,no permit fort ie per``onrmance OT efeetiica�sw�r Yema�lssuepeC es°srt�ieeS' 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 Electrical Work: 3,050.00 (When required by municipal policy.) Work to Start: 5-14-2003 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 Expert Electrical Services,Inc. LIC.NO.: 17222A Licensee: Stephen Decker Signature , LIC.NO.: 1-800-418-3221 (If applicable enter"exempt"in the license number line) Bus.Tel.No.: Address: 44 Stedman St,Unit 2, Lowell,MA 01851 Alt.Tel.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)❑ownerF__�wner's agent. Owner/Agent 50.00 PERMIT FEE $ Location No. 49 J Date NORTH TOWN OF NORTH ANDOVER � : 9 Certificate of Occupancy $ �'�S'••°•t<�' Building/Frame Permit Fee $ J�CNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 4 � � � , - ``� -Building Ir4pector : TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 2 BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date 6 SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 660 a Map Number Parcel Num er 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronta e ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required I Provided Required Provided Flood 1.7 Water Supply M.G.L.C.40. 1.5. Zone Information:54) 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record C ' -t- le b1e ,r, 117 Nam--(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z Signature Tele hone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �� /® License Number Al ddYs !i - D 0,26— 3 t`1�,� Expiration ate Signature Telephone 3.2 Registered Home Improvements Contractor - Not Applicable ❑ Company Name Registration Number x �9� eUeu- ylL � ,5 A dress 4 LMO-6, 73 9Z9- 3 Expiration Date Si nature Telephone s SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(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.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -� , v �0 L) SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be °f}I+FIIALUE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction �J�J 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5) - (Jz' . Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _ as Owner/Authorized Agent of subject property Hereby authorize to act on e My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 SiNature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1sr2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 tomo Building Departmento c 27 Charles Street North Andover, Massachusetts 01845' z (978) 688-9545 Fax.(978) 688-9542 SSACd-IUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and.a condition of Building-permit-9 the debris resulting from the work shall.bedisposed of in a property licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in/at: C,,. yr Facility locafi , Signature of Applicant r Date " NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts d Department of Industrial Accidents A Office of investigations w Boston, Mass. 02111 `''�,M S�a"`� Workers'Compensation Insurance Affidavit Name Please Print Name Location: K0 t, 6 City Phone # 7A-9-18-ZSLI I am a homeowner performing all work myself. I = I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#: Insuranee..Co.. _ :Policy:# Cornpany.name: . in.4 (,C60 4, . Address e`er—` J Pug. s City Phone# .!9-2 a � —C ti InsurancYe.Co. : C 'ice Poliw#.S�10 l') J�'�� Failure to secure coverage as required'under sebtion M oir.I L 1'52 can lead to the rri.. won.of. nal penalties of,a'fine up and/or one years'iri5pris6nment-as ifcell_as-civil.penalties.in-t elorm-cf-aITQP_NVDt0-10.,DFI .and:afine-of jW—M a-dayAgainstme I understand that a copy of this statement may be fonwarded'to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ains and penalties of perjury that the information provided above is true and correct. Signature:. Date Print name �� 10, ry, j'� � Phone.# Official use only do not write in this area to be completed by city or town official' City or Town PermiULicensing Building Dept EJ Check if immediate response is required .0 Licensing Board 0 Selectman's Office Contact person: Phone#: Health Department Other IAORTiy Town . ofdover No. /C;z T Z ,fy T O LA o lover, Mass. COC MICM WICK �i9SDOATED BOARD OF HEALTH PERM Food/Kitchen Septic System THIS CERTIFIES THAT....... BUILDING INSPECTOR . s r .... ;r. :�..,;....................................................................... :5.7 Foundation has permission to erect.. , , ........... buildings on ......... /.�................ .. .................. ........... Rough ............. to be occupied as ..................... Chimney .................................................................................................................. provided that the person accep g this permit shall in every respect..conform to the terms of the application on file in this office, and to the provisio of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUC'T'ION STARTS ELECTRICAL INSPECTOR • ' Rough .................................. `+���'�1 ".. Service INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT � Burner Street No. SEE REVERSE SIDE Smoke Det.