Loading...
HomeMy WebLinkAboutMiscellaneous - 140 FRENCH FARM ROAD 4/30/2018 / 1FRENCH FARM ROAD - --- J -,210/035.0-0079-0000.0 l L R Date..:......�.... ..... ... d raORTp, 3j°r�`'°-,•:"�,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING r : r • oma+ ��� ss^CMUS� This certifies that . ..............•................ ...... .... .................... has permission to perform y;,s..i-� -. ... wiring in the building of ...... .. .......................................................... at Zye....... - .... -►r-�� .:,North Andover,Mass. FeeAl. ..'...... Lic.Na�? .......\` .J .... ffrr ... ............ ELECTRICAL IIvSPE Check # _� U 6 7 5 40-NCommonwealthof Massachusetts Official Use Only I hPermit No. Department of Fire Services Occupancy and Fee Checked t:iejb BOARD OF FIRE PREVENTION REGULATIONS [Rev. H/991 (leaveblank) l APPLICATION FOR. PERMIT TO PERFORM ELECTRICAL WORK All worn to be perfonned in accordance with the Ma.sachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR T f11,1,INFORM ION) Date,_ 6"6 -© 6 Ctty or Town of: 6 tl To the Inspector of Wires: By this application the undersigned gives notice of his or her mtentiot to per for he electrical work described elow. Location(Street& Number) 0 Owner or Tenant. � _ Telephone No. Owner's Address ~ za Is this permit iti confiinction with a building perinit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building T Iitility Autltorlaatiou No. Existing Service Amps Volts O�erhead❑ Utidgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampocity _ Location a Nature o Propose Elects• al Worle I �� w&cc/��y�_Q� Con )1eiiorr pf thefollowing[able may be waived by the fns ector of Wires. No.of Recessed Fixtures No.of Cell;•Susp.(Paddle) Fans No.o ata Trattsfat•mers IGVA No.of 11ghthig Outlets No. of Hot Tubs Generators KVA No.of Lighting Fixtures s' et A ow c Ell ❑ . EmergencyLighting i. rad. Baottoe Units No. of Receptacle Outlets _^ t .of Oii flu rnerT jFIRE Aii.ARMS No.of Zoites No.of Switches t. . vas Burners o. o Qelection an _ initiating Devices No.of Ranges No.of Ait•Cond. Total No.of Alerting Devices R _ Tons No.of Waste Disposers p Nutttber Tons �M No of Self-Contained Heat bum Totals: Detection/Alerting Devices No. of Disitwasbers SpnceiArea heating 1:W Local [] Municipa Other Connection 1#catin 4 liances ecurity S--tems: No, of Drycrs fi pp _ �' No,of Devices or Equivalent No.of Water KW o. of No.o Data Wit-Ing: Heaters Signs Ballasts No.of Devices or E ulvalent No. Hydromassage Bathtubs No. of Motors Total NP Telecommitnicat ons lrifig., No.of Devices or Equivalent OTHER: a riarir additional dciait it desired,or ns r•ertuircd by die Inspector of Wires. INSUR..A,NCE COVERAGE: Unless waived by the o«ner,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 coves 5 in force,and has ea.hiLited proof of same to the ermiIt,iissCu1ing office. 1 CHECK(3v'E: iNSI)RANCE BOND ❑ OTHER (] (Specify: ur (c Estimated Value of Electrical Work: (When regtnred by municipal policy.) (Expiration,Date) Work to Start: 'C)rp Inspections to be reeluested in accordance with MEC Rule 10,and upon completion, 1 cHr�i,p, under the pains and penalties of'perjuq,, Haat the itt formatio nn this application is true and Complete, FIRM NAME: 4��_f_� LIC. NO.: Licensee: `signature LIC. NO.: (if applicable, et ter "exempt"in the hmisc number ire.) / Rus.Tel.NO.: _6 ' 77S' Alt.Tel.Na.: OWNER'S INSURANCE WAIVER: i aln aware that the Licensee sloes not have the liability insurance coverage nonnally required by law. ey mys[gnafure bcivw, I hereby svaivc this recluircment. 1 ani the(cliecic one ❑owner ❑ owner's agent. Owner/Agent Signature feieplione No. _ PERMIT FEE: �� J Date. �!� a.�. . . f / q "OR7M TOWN OF NORTH ANDOVER .r Of�,�w `PER111fIT FOR PLUMBING ,SSACHUS� This certifies that . . . . . . .... . . . . . . . . . . . . . . . . . . r has permission to perform . . .r plumbing in the buildings of . .��!r.�t. . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . .9-*'. ' . North Andover, Mass. Fee. �.�r . .Lic. No. .3l. . . . . . . . . . . . . . . . . . . . + PLUMSIN�ECTOR Check # 6 P 4 6978 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) F �C)elD i/-2!— Mass. Date6 1-7Permit # 7 III i Building LocationCin (-eenc �n� wner's Name j 4 9 -766 ]Z Type of occupancy Residential New ❑ Renovation ❑ Replacement IN Plans Submitted: Yes❑ No ❑ FIXTURES x 'n or,F to J N O Z r 41 OL (01 W Y J N 4 v f- Z O Z N 0. N i- !A Z LU Q OC _ N - OJ N W V) N I:F- WF U W N Y Q ,A U. rr W O 7 W W W z 4 X � O Z S Y 0. Q ~ 4 Z .( W LL Y t- U > r- O = a :3rn H Z p O 0 ? x W f- O tJ r I 4 F- 4 4 S W N 4 Q O Q J J 4 CL S a Q O Q f4 W O a J 3 = H rA LL 0 a 0 4 L: m SUB—BSMT. BASEMENT- IST FLOOR ASEMENTiSTFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name Heritage .Htg. &Pig. Co. Inc. Check one: Certificate Address 35 Pleasant Street '1X Corporation 714 Stoneham, Ma 02180 L-.1 Partnership Business Telephone. 781 -438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer ! INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond El., 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: Owner n Agent❑ Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By �.� OYl ,cJ1.Z�/0 4 ) Sign ure o censer Plumber — Title Title Type of License:piaster rX Journeyman 0 City/Town APPROVE (OFFICE S ONLY) License Number 8 3 2 2 boiler %Z"Watts 9D bfp on water line to water ,f BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES _ V�PROGRESS INSPECTIONS FEE - NO. r ..,APPLICATION FOR PERMIT TO DO PLUMBING k - NAME&TYPE OF BUILDING t_ LOCATION OF BUILDING N PLUMBER 1 • ( _ PERMIT GRANTED DATE 18 PLUMBING INSPECTOR � (fr2ov Location { No. Date X/- TOWN -TOWN OF NORTH ANDOVER 3? 0 f AL 9 • ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U Check # 181150 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. /� DATE ISSUED. 3 SIGNATURE: Ca- Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I'-,!� Map Number Parcel Number (CN �4 1.3 Zoning Information: 1.4 Property Dimensions: — "� Zoning District Proposed Use Lot Area(so Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public ❑ Private ❑ zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: l l V/)U 0/1 J t� 4 License Number � r Address %•3/p (^ 9v - 7 n S ?� 3 Expiration Date v 3 Sign a Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name J D M �L Registration Number r Address(�a " I�1 ) 6 � z �S Expiration Date Si nature � Telephone !e' .a 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.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of G} 6 b aConstruction l 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical(HVAC) `� -� 5 Fire Protection ` 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act 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 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 ahue of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB S17-E OF FLOOR TIIvMERS 1 s1r2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIANEY v IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department oflndustrial Accidents office oflm/estfgations 600 Washington Street, ;,Ih Floor - -'% Bostol: Mass. 02111 ~ � Workers' ComTensation Insurance Affidavit: Building/Plumbing/Electrical Contractors r. il`•d.: ^_r>•a - - ;.:o...,:x-: -'•i^. ,;7-' 'a`-h,i°.• ::a'F •Y 1_>rr,.w rb.t.,y...:.: -•4r°'. l I w •i 1. U:=L".LTi:"s .h:.:.r+.t .dl'e•' �4:.m, 1�,1`:a'.•'`y. A.: .Ii'can�1_l�lfo�nla�ti'on'.v�.:tra: c P.T::kS:- '.1�1<��tl:tic':,n: •r: , �� .��sa",`�,r-' ,.,.,;_;•1,n:}:!',.lid-Tw-W��.�s�<<rt.�_tz1-�T.s`.t��:";:,1s7:: p'U )) .<,:..l�ea`sea�12T1yT.]`e�ltilyz. �, �. _ ,.. I...U.,.. •,lw�<h, x:. F4.<. .. name: / /�L� address: -�, 1 city %/� U C— 1`� ' / `�ssttlatee:: {m / zin° O f� �/� phone# work site location(full address): I O 1'�`L NJQ14 / ,/?.*M l `C ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel I am a sole proprietor and have no one working in any ca act ❑Building diti on c1'+"i'S ,. 'rl•;l:�t .t•:dc..:.u::.... .c.=,.....••.... o..:L.."ii:'.fi:c:o�.ne'r.i.n�.$s;is.!_:.:.::':u:'i"iSi7x:'`;..<4.'4.Y.`.:I't`.A.-•...,��E:i� I am an employer providing workers'compensation for my employees working on this job. company name: /—1 L.�.. . V OL-� L /? address: city: :L;.Iv S'J.: lihnne ��' y insurance.co. �' . * .,-— p-v/ t L - "� 1''}• olio # { i ne �e h " , �.:N .Ir a�;VI` �2xl i�l? ,m!..:— a q��s,�,ys•• I',4X: 'T• v t;.. z 1_. '�Nw tk'.:sc;a•.i s t + . _,,r � .� < _ 'r •s� •�; .�:y�.��:- a.ter.,-:•'�:,:�,�r.: i��:.'��'.�s.�,�'�;����a?9A�i t. ❑ 1 am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company.name: ' 4: address: ci ty: insurance:co. ::.53;14`'k,.`iia` �:c,�'c: ��s<�`` � �i �e4�'i�a��_'r�d."•�`�� .'.6�I'G s � �' �� .:.i�f''Tts- II+NaUi� .i'io�r�Y ��: '' �:'"rd�a� i�}"r "�v;•'�ly���4- �+�..,��a`�______ _____ _ company name: ' address city: phone#• ' insorance.eo. tnn olic. # - vy�... ti'f'f.:):•':1:�z14.;65ti`''l..:Y%„YaF"M(�4iS,Jx ! ,,iii:.):-.. i«;r .��'N,: y:' .rn N�.7< �• "�3„I'K ;ti;,j,• I:� ;5�v v".Y✓,�'.P'y.r � •IAV �, �•. Attacli��a�ddt�b�alis�;e;et�fgnerze�nl,;ytc?�'i�t�>f�i��:� 'si :;,r =6 ���'� �, �•I�,�,:aF�.?fi �41�._ I., . ��i`���7:� Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the airs an penalties ofperjury that the information provided above is true and correct. a / Signature Date 1 U Print name Itin'1 L Phone# 'T %"vr. a x' t 4 ..pt-. ty a c,••. 3:57 rt."P`<x" Y' :.;:;-G�.+M .•,r C•KY•:ns at'r••, official use only do not write in this area to be completed by city or town official city or town: permit/license# []Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑health Department ;;-� contact person: phone#; ❑Other ;� (� (revised Sepc 2003) y 'Y. •;a^ -:e:�,<?y+� Y ;::.tit � '•�y�.�:�''t�_�.s+!�:,Y�Yin��'�y�:t:T,�s"�`_s3i '4�Si}] 4 .}(�jk,}b?�St'�'. S lxn L'( >i`".�.'S�i�`.�' >a`�rlifi['��ra'�`-'.�'� • �"_f"w'(�irf�aY"",+�S3,F��r�cC2'l'i��.��YfL�iJittiY-3�1". k'�[-'�il<Q�ACI Ai. 1�'t'v2iL•1:� Z• uil i:: Information and Instructions J Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",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 section 25 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 produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be 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. RQV� a 4 u. City or Towns 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 permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. .r, - — ,-a-•• -Tri.: _ '3' -•:iit.is<-.v ry:';id. "•r^:r• �x: :r -.7r: '.4. - :?PL";:[r`- ;:tie ..(:::=.::;.'i?t.:" .'u. „{i St. ,r R,:' A.��.'i�. N ppt .b' :..{tid `t.. _ ..t. 's .}...rr-�'�a..r ,y .r... -.h�.rt+'.�.f��iJti s !. 's: i c' <z ;�- 1 r'{:, rt .r. •'tom u• .i °, M, v �t�,,y. � ,t e. -..i�.��l�. ,,�+£'.:. ., _aif,tr.cr �',,,A:i:;,:;xYraa,.-L'.'�f,:t�'jGt•1.. 'C .'1 -�'� _ �;',,iT�i�;Sr~.n:=,'•roti•:i 1QiV F:4sw�.wW�'.i�x�??fi`4:irt:l4,i�;vi'n✓ 4r".rcfv �::��Z tJ a';.�...4u.yig'�s:7�r':G_ii'>':1.:, '•.e•:6M`7'i.N.'+ Ji...waw�..f1-.�iSri1...< f a G The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7tb Floor Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617)727-4900 ext.406 r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: L 010) (Location of Facility) c4/s S-/v .� Signature of Permit Applicant a#� NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTIy Town of over 0 No. G - _ Wft C 0 t dover, Mass., ft?'& o 7o O COC HICKEWICK 7,95 RA r.E D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 1_6/ BUILDING INSPECTOR THIS CERTIFIES THATP .�..1. .. .�.................................................. .... ...... ......ph.t Foundation has permission to erect.... ��........ buildings on ....N r- .W.V44 F .0w.PT0F Rough ..... ........... .... to be occupied as......... Re re •A.......... f�Cr ................................. Chimney ................... ...... provided that the person accepting this permit shall In every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws r sting to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 9 PLUMBING INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Parr t. Rough 9 g g Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough .............. .................. Service BUILDING INSPECTOR Final . Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. • 1 a1 hNrtd 1 ,' r q . c '-sa , - a Chimneys Residential & Commercial Roofing All Types Of P Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free * Roof Leaks Experts Licensed & Insured 1-800-WAIT-4-us Loca//y Owned&Operated Since 1976 a•••• License#034200 (924-8487) IKO 40ZeV W17CM OV 3vAff - We Work Year Round omit z , - - i V s • 1 t r ft— w Proposal Submitted To Phone Date Street 1Z Job Name City,State&Zip Code Job Location lob Phone We Propose hereby to furnish and labor in accordance with specifications below, for the sum of: jttirrt•cnT v Q/� 6w (c l i`d/�� Dollars ($ • d Q t 0 o All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from specifications be- Signature: -� low involving extra costs will be executed only upon written orders,and will become an U 0 — extra charge over and above the estimate.All agreements contingent upon strikes,accidents NOTE:This proposal may be or delays beyond our control,Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within 6 days. We hereby submit specifications and estimates for: S-r2; + / ° La'Install 3 feet of special "Save Seal" ice and water barrier protection along all bottom edges of roof and.toi) to bottom in each valley.if ref Is stripped,_we will apply conventional ice and water shield