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HomeMy WebLinkAboutMiscellaneous - 1405 GREAT POND ROAD 4/30/2018 1405 GREAT POND ROAD 2101090.C-0040-0000.0 95z- 4 Date........ HORTM 3: ,•,� -- ._�. o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING i • AcNusE� This certifies that ................. ' �.......we'- 6--s',; i�4.. ..... has permission to perform .......... SGti2.T y......Yfv .l J wiring in the buildin of.......................G... F// ...............................: i at..... .yf�t�r....�. !. A?'!`....kb .......... . R,ICNAorth ACnTdOoRver,Maas, . Lic.No. 7Pl �� * LINSPE Check # 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 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 r 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 shall-be limited as to the time o£ongoing construction activity,and may be.deemed-by the.Inspector-of_Wires abandoned.and-invalid-if11e—. ._ 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-temp economic recovery and the Permit Extension Act furthers this puipose 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 An t 15,2008 and extending through August 15,2012. le 8—Permit/Date Closed: f ***Note:Reapply for new pernKO 0 Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusetts Official Use only A Department of Fire Services Permit No. 47,;r-�Z- •2.,. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 (PLEASEPRINT OR TYPE ALL INFORMATION) Date:_ 0 City o Town f: (� To the Inspector of Wires: By this applicati ersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) )Q0,5 (�rto, IS Ocq . Owner or Tenant kdy I o i L M C N4c E r Telephone Nog3 =U7y 033 Owner's Address Sam)/— is this permit in conjunction with a building permit? Yes ❑ No x BLDG PERMIT # Purpose of Building 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: Install low voltage security system at above location Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total 4 Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. rnd. BatteryUnits 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 No. of Waste Disposers Heat Pump I.Nu.mb.er Tons 1.KW No.of Self-Contained p Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ElMyy unicipal Other No. of Dryers Heating Appliances KW No.ritof De is s or Equivalent 1 No. of Water No. of No.of ' in : Heaters KW Signs Ballasts No.o evtces oruivalent J 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: Z> (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 ® BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Broadview Security LIC. NO.: 7067C Licensee: David Holton Signature �')� l�jt` LIC.NO.: SSCO 001352 (Ifapplicable, enter "exempt"in the license number line.) Bus. Tel.No.: 978-657-0443 Address: 155 West Street Suite 6 Wilmington MA 01887 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 signature below, I hereby waive this requirement. I am the(check one)E] owner ® owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $�/ , Residential Property Record Card PARCEL_ID:210/090.C-0040-0000.0 MAP:090.0 BLOCK:0040 LOT:0000.0 PARCEL ADDRESS:1405 GREAT POND ROAD FY:2008 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 04961 Road Type: T Inspect Date: 08/24/2003 Tax Class: T Sale Date: 02/10/98 Page: 0002 Rd Condition: P Meas Date: 08/24/2003 Owner: Tot Fin Area: 4359 Sale Type: P Cert/Doc: Traffic: M Entrance: X KIRKILES,JAMES J Tot Land Area: 1.08 Sale Valid: F Water: Collect Id: RRC JEAN M KIRKILES Grantor: KIRKILES JAMES J Sewer: Inspect Reas: C . Address: 1405 GREAT POND ROAD Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION NBHD CODE: 5 NBHD CLASS: 5 ZONE: R5 Style: CL Tot Rooms: 6 Main Fn Area: 2611 Attic: Seg Type Code Story Height: 1.75 Bedrooms: 3 Up Fn Area: 1748 Bsmt Area: 2332 MethodSq-Ft6Acres Influ-Y/N Value Class 4 Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1166 1 P 101 S 43560 1.000 197,326 Ext Wall: WS Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.080 608 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 4359 VALUATION INFORMATION Foundation: CN Bath Qual: T RCNLD: 385643 Current Total: 583,500 Bldg: 385,600 Land: 197,900 MktLnd: 197,900 Kitch Qual: T Eff Yr Built: 1965 Mkt Adj: Prior Total: 609,000 Bldg: 400,600 Land: 208,400 MktLnd: 208,400 Heat Type: HW Ext Kitch: Year Built: 1960 Sound Value: Fuel Type: G Grade: AG Cost Bldg: 385,660 Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val 1: Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Att Gar SF: %Good P/F/E/R: /100/100/77 Porch Tyne Porch Area Porch Grade Factor P 252 W 208 SKETCH PHOTO 9 " 63 s S4.'fit ' FBMl.75 FM a` - _ - 2331 Sq.Ft 280 Sq.Ft 37 � 35 + _ 14 4 2�12 Sq.Ft 1405 GREAT POND ROAD a Parcel ID:210/090.C-0040-0000.0 as of 12/31/08 Page 1 of 1 Date. � �.`�. �.�/. . .... . TIy Of6. pOR 1ti . or p TOWN OF NORTH ANDOVER PERMIT FOR GAS-INSTALLATION p9 �,SSACMUSES { This certifies that . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . :D.6l .r. in the buildings of ��.�,G.�5".,./r at . . �l.G. . .Gr. .�?�.�� ��°. `. .`� . .�t North Andover, Mass. Fee. 3 9.} Lic. No.b).7, y. . . . . . . . ... . . . . . . . . . GAS INSPECTOR d Check# 6677 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING _ (Print or Type) t— 1 1-2Al2(.iNe—r Mass2000) . Date Permit # - Building Location_,�Q��rP � ►�(� Owner's Name ye ts, 4'J Type of occupancy--,Q New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No❑ Uj N: CC yZ y¢ 0 V) 40. W : ONSrt.:..- < N oQm O p = lu y ¢WW I- y =W O > W W W x 0 = o► JO H w r 3 < •ru > ¢ w Z. < aC < < o o w ° p x o tl Y >L : 3 o O J U C > o a N o SUS—BS.MT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STN'FLOOR 6TH FLOOR 7TK FLOOR STH FLOOR Installing Cbmpany Name I i'1 Check one: Certificate Address d Corporation t �0 COO D. Partnership Business Telephone �- q Firm�Co Name of licensed Plumber or Gas Fitter r�</Z U-/IC�( 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 yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy E) Other type of indemnity O gqnd ❑ 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 o1 Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all o1 the details and information 1 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 appli ' •II be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General La s. BY J T of License: C% Plumber Title Gasfitter gnat re of Licensed lumber or Gas i ter CirylTown Master License Number APP�,Ep(O 1 ❑Journeyman NL i BELOW FOR OFFICE USE ONLY I FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. i APPLICATION FOR PERMIT TO OO OASFITTING Final Test: ROUGH GAS HIGH & Tag Meter. LOW TEST Passed: NAME A TYPE OF BUILDING Date :Passacl: 4: Date Failed: LOCATION OF BMiLOING - Failed: Date .; Date PLUMBER OR OASFITTER ' }: FINISHED TEST Passed: ' UG N0, Date Failed: Date PERMIT GRANTED . VENT CONNECTOR Passed: OATS ZQ ' Date Failed: Date GAS INSPECTOR The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 M . www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): � ��� //41 C_ �_Address: 1 Ly lvm r t c L b S37-4,ye7 City/State/Zip: �c�14 L3�a��/ /y119 o l Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.( ] I am a employer with A15 4. ❑ 1 am a general contractor and I 6. F-1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling 4 ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Budding addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 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.❑ 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 worker;'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:i�?aclts113�- Policy#or Self-ins.Lie. #: " / QQ,3 Sl4/-• '4 Expiration Date: 01 o oA;Qogt,_ Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Facture 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 certify under the pains and penalties of perjury that the information provided above is true and correct: Signature: c? Date: Phone M C77k- dal-a9 CPQ{ Official ficial 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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 'ursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, :xpress or implied,oral or written." kn employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more )f the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the -eceiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the )weer of a dwelling house having not more than three apartments and who resides therein, or the occupant of the twelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house )r 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 produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C()states"Neither the cormnonwealth 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 t 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 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. 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 permit/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 informtation(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 Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 ;wised 5-26-05 www.mass.gov/dia i (J � Location�`��1p No. Date NORTIy TOWN OF NORTH ANDOVER 0. . p Certificate of Occupancy $ * ; ; Building/Frame Permit Fee $ Foundation Permit Fee $ sAGMUSE Other Permit F $ Sewer Connection F $ Water Connection Fee $ TOTAL $ ding Inspector N° 12 24 0 �/q�9 Div. Public Work 44 PEaatIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40.,P s Po LOT NO. e9 0 L/O 2 RECORD OF OWNERSHIP !DATE OK 'PAGE ZONE I SUB DIV. LOT NO. F LOCATION PURPOSE OF BUILDING _ OWNER'S NAME��),_7E ►/ NO. OF STORIES _T / SIZ OWNER'S ADDRESS �y.v/E� /' �:� �'7c J i2��' BASEMENT OR SLAB ARCHITECT'S NAME .J v` SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME la L- /<`-�' SPAN DISTANCE TO NEAREST BUILDING ✓ DIMENSIONS OF SILLS ! _ DISTANCE FROM STREET '" POSTS DISTANCE FROM LOT LINES—SIDES REAR "" GIRDERS r AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS ' IS BUILDING NEW SIZE OF FOOTING % IS BUILDING ADDITION MATERIAL OF CHIMNEY t IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 / L, / _ / EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING C 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BUILDING INSPECTOR SI AT E OF OW R OR AUTHORIZED AGENT fE E OWNER TEL.# PERMIT GRANTED CONTR.TEL.# /U ��✓ �l 9y CONTR.LIC. H.I.C.k �� �6 r "�^.. � �iie �arnono�uuca�I�i a�../ua�aac%uxda ! HOME IMPROVEMENT CONTRACTOR Registration 102097 Type - INDIVIDUAL Expiration 06/30/98 JOSEPH P. BRADISH, JR 0 Moulton Drive/ Box 448 ADMINISTRATOR E. Hampstead NH 03826 a aln, 1�'a JJl rJ7O7zCUe[L�ht c� 1JLLC JUJc��J ri i' t 'w .y r CiR ' Town bf over dover, Mass., _19 3 I O9`CO CHICKEWICK �_l1 q4 a �7 �G BOARD OF HEALTH ERMI T Food/iGtchen 1 Septic System P T D • • BUILDING INSPECTOR THIS CERTIFIES THAT..... . ................... .... . ..................... Foundation li!5has permission to ere ..... .... . ............. buildings on.... .7...� hough to be occupied as.............. .....� ............................... .......... ............... ............. . .............................. provided that the person accepting thiperit shall in every respect conform to the terms of the application o ......... Chimney s mn file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. hough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ........................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner street No. Smoke Det.