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HomeMy WebLinkAboutMiscellaneous - 148 CROSSBOW LANE 4/30/2018 (3) �-- 1 �h�' C2osS [3 a w � �t[ , --- 42 �- ' Date. .. ....... 'j TOWN OF NORTH ANDOVER 00 p PERMIT FOR WIRING ,SSACMUS� I r=-�j.7 ;f� f This certifies that l -' �.�!......../-;:../.�. .C..J'.':.'�':/.......'�i��/� f has permission to perform .... .......................................................T.. ' W. : � . ............... r ... Lai ,.-1 t ' v�frin in the building of ' ............ ` J C 'S 1 �" l North Ando v _er,- as , . ...... 1 � , Lic.N014i. n .Fee . C �� ......... ELECTRICAL INSP R Check # i as.-0 r-<.'- a 7 ,tl.✓x.,70.,..� ,r-�*�- t����c� rn The Commonwealth of Massachusetts Permit No. Office Use Only �- Occupancy dt Fee Checked Department of Public Safety 3/90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMH 12:00 RULE 8 Effective 1/1/78 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code,527 CMR 12:04 (PLEASE PR 'T/INT IN INK OR TYPE ALL INFORMATION) Date -7� � d a- City or Town of--1-10,2 TA To the Inspector of Wires: The undersigned applies for a permit toerform the electrical work described below. Location(Street& Nu ber) [`-i' k,,--A<- Owner ,cnOwner or Tenant tc enc-.t.. Ct-tom;, ,(V\c 1-/Nno C-h L-,;' Owner's Address Is this permit in conjunctio with a building permit: Yes ❑ No 13 (Check Appropriate Box) Purpose of Buildings- Utility Authorization No. Existing Service-.-..4-0 Q_ Amps ) a-(o Volts Overhead ❑ Undgrd. {1] No.of Meters / New Service Amps Volts Overhead ❑ Undgrd. ❑ No. of Meters Number of Feeders and Ampacity t Location and Nature of Proposed Electrical Work /'ySky-r II 1.41 No.of Lighting Outlets No.of Hot Tubs ` No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above In-rnd. Generators KVA cad. ❑ ❑ No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS . No.of Zones No.of Ranges No.of Air Cond. Total No.of Detection and tons Initiating Devices No.of Disposals Total Total sP No.of Heat Pumps Tons KW No.of Sounding Devices F t No.of Dishwashers Space/Area Heating KW No.of Self Contained Detection/Sounding Devices No.of Dryers Heating DevicesKW Local ❑ Muntctpal ❑ Other Connection ` No.of Water Heaters KW No.of No.of Low Voltage Signs Ballasts Wiring No.Hydro Massage Tubs No.of Motors Total HP Other: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insuran Policy including Completed Operations Coverage or its substantial equivalent. YES R NO ❑ I have submitted valid pro of same to this office. YES E& NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE U BOND ❑ OTHER ❑ (Please Specify) (Expiration Date Estimated Value of Electrical Wbrk$ '�;oO-00 Work to Start -Tk qV019- Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME ��1""`g_TT tCTRcc�?L a,-1 (61P C. LIC. NO. /5'7/9 ft Licensee ^ �2- -^-� -Signature /S 7/9 d4 � �a LIC. NO. Address -�i�1 O 19 Bus.Tel. No. ?�? �0 8 9- 5'7 70 Alt.Tel. No. 4 'eK ?d' OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivale as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner ❑ Agent ❑ (please check one) Telephone No. PERMIT FE $ (Signature of Owner or Agent) y Location �. ��. No. Date NORTH TOWN OF NORTH ANDOVER i + ; , Certificate of Occupancy $ �+cMus Building/Frame Permit Fee $ s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5 5 5 U Building Inspector i f TON" OF NORTH ANDOVER ' BUILDING DEPARTMENT ' ! !`rPPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: _ DATE ISSUED: . © � �- i-Q SIGNATURE: d Building Commissioner/Inspedror of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1:2 Assessors Map and Parcel Number /y g (, 055b 6 w (,c o-e / o (oX17 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use -Lot Area Fronds ft ~ 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R Provided 1.7 Water Supply MG LC.40. 54) 1.5. Flood Zone Information: 1.8SewenV Disposal System; Public ❑ Private 0 Zane Outside Flood Zone 0 Mgoicgnl ❑ On Site-Dispml System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record _ G�i�r�ho>° Mc- � l s aw a> Name(Pont r Address for Service: Service: Si a Telephone 2.2 Owner o/f�ecord: m f 0� av�v 114 Name Print Address for Service: Signallure Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor Not Applicable It Licensed Construction Supervisor. License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 111; Company Name Registration Number Address Expiration Date Signature Telephone j SECTION 4-WORKERS COMPENSATION(ALG.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 buildingpermit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all a licable New Construction 0 Existing Building 0 Repair(s) 01 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other B Specify (r Ace m e rt Brief Description of Proposed Work: ltLc4- o, h w cLe c-(c SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicant 1. Building (a) Building Permit Fee oaa Multiplier 2 Electrical (b) Estimated Total Cost of N/4 Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical AC 5 Fire Protection ni/A 6 Total. 1+2+3+4+5 F1.0 U 0 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 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, XV75&f A4 GGH.4h It f 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 Si tore of Owner/Agent Date T� NO. OF STORIES SIZE r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Isr2ND 3RD SPAN DRVIENSIONS OF SILLS DDdENSIONS OF POSTS DDviENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE p The Commonwealth of Massachusetts Department of Industrial Accidents Office-of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: GVlyie'- i`yt e Al Al -Lc u! � i n Location: C('V 5S 196v-.) Lac. VI-f c r City tl d-OVt.(/ i4 A l6 0 'I S� Phone 7 V—(, �a.X710 2 am a homeowner performing all work myself. ® F-1I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policy# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or 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 herby certify under the dins and penalties erju t r on pro e bove is a and correct. Signature / Date Print name X57'/f'LP � Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION 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: (Loc/a/tion,of, citify) Signature of Permit plica �Z�� Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector J d! FORM U - LOT RELEASE FORM �,��� o Z— INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION**"**************** /7 ,L r APPLICANT �/ ���7 IIP MG(� y �1 �- PHONE LOCATION: Assessor's Map Number /D 6 f PARCEL SUBDIVISION_ T�1Is v//�SS�y`�ff LOT(S) STREET VU SS OW (�Gt.VI _ ST. NUMBER—_� * OFFICIAL USE ONLY ************* REC MMENDATIONS PE.TOWN AGENTS: CONSERVATION ADMINIS TOR DATE APPROVED—_S b DATE REJECTED COMMENTS_ WPiTI as,d_5_ n 160/ Bf "r( TOWN PLANNER DATE APPROVED _ DATE REJECTED COMMENTS------------- ------- ------- FOOD INSPECTORtH _TH___ DATE APPROVED _ DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED_QT —__ DATE REJECTED COMMENTS —_--- PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT _ RECEIVED BY BUILDING INSPECTOR -- DATE Revised 9197 jm i i w I I F I j I _ I 200'NE POWER CO. �44•9� j EASEMENT LOT 12 PROP\ o ' 54,393+1- j Q DECK c — 89.3- 'Qcy CERTIFIED PLOT PLAN w 00 LOCATED IN m j NORTH ANDOVER, MA. 6o PREPARED FOR: C. MCLA UGHLIN s � OLD STREET LINE �A0A12 148 CROSSBOW ROAD M z NORTH ANDOVER, MA. F:, cn 292 33 150 I Z SCALE.•1 INCH=50'. DATE:MAY 3,2002 ti � _— I ���,p+OF Al Cn 37.4Z �° GEORGE NEW STREET LINE I CERTIFY THAT THIS PLAN WAS MADE FROM BOSTON o C °p AN INSTRUMENT SURVEY ON THE GROUND " COLLINS AND THE STRUCTURES ARE LOCATED AS SURVEY INC No.41784 LACONIA CIRCLE SHOWN HEREON AND MEET THE SETBACKS uNir C a sHiPwnYs Pv+ce ! gss�O�'PyQ REQUIREMENTS OF CITY/TOWN OF NORTH ANDOVER. UNITCHAC- SHIPW Y PLACE qy0 SUR,4�y� DEED BOOK 5474 PAGE 24 (617)242-1313 PLAN 8384 JOB#01-11180 i NORTH own o R over No. 00 _ o A o dover, Mass., C OCNIC ME WICK V ADRATED 7 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System M / BUILDING INSPECTOR THIS CERTIFIES THAT........ n1, 1N 1" C � �� ` ..ti .... ....... ........................................................ Foundation has permission to eresIR..... M O.Y....a........ buildings an ... y8......101 0$ ko!..... L./.. .5Rough R �4C � � � rM14odPChimney be occupied as.. . . ...... .. . . .. 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 relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. Q/�� X&W . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS . Rough 000 L 4 111..... ......A1120101160 ......................... Service #400..#.A BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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.