Loading...
HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (54) _ __ Q 1 O �- _--- i Date.! . HORTp °!t"`°i•,"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUS� This certifies that E 5.... . ..... . ...?�i!!�N...y.. ..".......... . L c has permission to perform ....... ./J�2A—6.6,©M................................... wiring in the building of..........Ilk..........4 V1 T1?................................ at � !�1S I.., ......... ..y ..... ..f................................ .. ,North Andover,Mass. ,a Fee..:3.s "- Lic.NoFS1 V144.......... <-+., ...�...... . �,, j 6ECTRICALINSPECTOR I ti Check # 102- 7353 D27353 Commonwealth of Massachusetts ore�ial Use Only ah5--7 h Department of Fire Services Permit No. .. `! Occupancy f ' BOARD OF FIRE PREVENTION REGULATIONS and Fee Checked [Rev. 1 1199] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1200 (PLEA SE PRINT IN INK OR TYPE ALL INFORMATION) Date: r11 aG o7GG- City or Town of: /yb,rH,�All VP_C 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). MC41;1 St -5 +Iorn 02nd Cot^do # 0- /0/ Owner or Tenant IVC,,Cc.4 11/1:+.0 Telephone No. Owner's Address Sr,rwn Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building2 St'den�l G�/ Utility Authorization No. Existing ServiceGc� Amps iaG /auo Volts Overhead❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: JRc4room t Com letion of the jollowino table maybe waived bZ the Inspect of Wires. 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 FixturesSwimming Pool Above ❑ In- ❑ o.o mergency ng nng rnd. grnd. Batte Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches3 No. of Gas Burners No.of Detection and nitiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection Other No.of Dryers Heating Appliances KW Security Systems: No.of Water No.of Devices or E uivalent Kms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Vv'iring: t OTHER: Re,lace thNo.of Devices or E uivalent e P-xestt:x L'ltetrtee.+ eviies LlcY1f IX3 S Ghc� u b-ulu 4- tach additional detail i/desired,or as required by the Inspector of Wires. 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:) Jj,t / riRRJ //_ /u_ a0a-7 Estimated Value of Electrical Work: fit' (Expiration Date) G OG. — (When required by municipal policy.) Work to Start: L/-a q-G r] 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 trite and complete. FIRM NAME: SI i 1,4 I PC,r+c 1, LIC.NO.: 1,/CC Licensee: 501;4-rn ID_ lJ1,14)-t!4 Signature (If applicable, enter "exempt'•in the license-dumber line.) LIC.NO.: Address: 1314 west SF (�Qvu)�S /�/� al LFc Bus.Tel. No.:SG a-uGd- 1360 OWNER'S INSURANCE WAIVER:�I am aware that the Licensee does not have the liability nlsurance coverage,<<ge,norn I y ��� required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEF; $ � �rsvt-irhe� Aye�c� wl'll �x M� Prod a� �r7Sc,r,nrr. P,hk fib`,i r Location A/1? we-Ai No. _'_/740 Date „oRTM TOWN OF NORTH ANDOVER 3?0',,�`o I•,�o so 0 A + • Certificate of Occupancy $ t Building/Frame Permit Fee $ s+cHus Foundation Permit Fee $ Ar Other Permit Fee $ TOTAL Check # 17987 Building lnlnsp�elor v TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMQLISII A ONE.OR TWO FAMILY DWELLING. T BUILDING PERMIT NUMBER: DATE ISSUED: r R SIGNATURE: Pj Building Commissioner ctor of Buildin Date z SECTION 1-SITE INFORMATION I.1 Property Address: 1.2 Assessors Map and Parcel Number: J N I T o -/610 0 y p 004M ,-1 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin Distrid ProposedUse Lot Area(SO Frontage ft 1.6 BUILDING SETBACKS ft Front Yard. Side Yard Rear Yard Required Provide Reqwred Provided Required Provided Q 1.3. Flood Zone Information: 1.8' Sewerage Disposal System: I.Mater Supp�XQLC.40.954) Public 0 Private 0 Zone • Outside Flood Zoa° 0 Municipal 0 On Site Disposal Syttem. 0 �J SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record I Name(Print) 7— Address for Service t Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 6 Ejo (,1 r Licensed Construction Supervisor: License Number ~/ IV, tq Address —�� � ti— r- r! 't7 2,0 1Expiration Date re Telephone 3.2 Registered Nome Improvement Contractor Not Applicable ❑ Q Company Name &w E 9✓C ' N Registration Number r. Address n r 0 ® 7J0 Expiration Date ^ re Telephone �1 f ` f SECTION 4-WOOERS COMPENSATION Workers Compensation Insurance affidavit must be comp eGd and.su mittedsw th).this:a licatio in the denial of the issuance of the buildin rmit. PP n. Failuie to provide this affidavit will result Si ned affidavit Attached Yes ;....., No.......p . SECTIONS Descri tion of Pro osed Work check all a lleable New Construction ❑ Existing Building ❑ Repair(s) AlterationsI ❑ Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J qJ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated•Cost(Dollar)to be L Building Com Ieted b ernit a licant O Q'Q (a) Building Permit Fee 2 Electrical Multi lier (b) Estimated Total Cost of 3 Plumbin Construction 4 Mechanical HVAC Building Permit fee 5 Fire Protection 6 Total 1+2+3+4.+5 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN Number OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 'Iereby authorize as Owner/Authorized Agent of subject property Yfy behalf,in all matters relative to work authorized by this buildingto act on permit application. i nature of Owner ECTION 76 OWNER/AUTH' ED AGENT DECLARATION Date .-tJ E E� nJ "per`y >a Authorized Agent of subject bel declare that the statements and information on the foregoing application are true and accurate to th d belief. e best of my knowledge n e ue of er/A ent. "Z, Date r OF STORIES >ENIENT OR SLAB SIZE . OF FLOOR TRvMERS N 2 3' ENSIONS OF SILLS _ F,NSIONS OF POSTS FN;iI01VS OF GIRDERS irff OF FOUNDATION OF FOOTING THICKNESS ERL4L OF CH1MNEy X QLDING ON SOLID OR FILLED LAND LDING CONNECTED TO NATURAL GAS LINE NORTH '9 Town of : tAndover 0 No. Lf 7k - dover, Mass., �� 8 ' �S COCHICHEWICK y 7��ORATED �� '7 V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT077.'A m ... ............!..... .................................................................. .... Foundation has permission to erect. ...................................... buildings on ..IAIlj....... . ..... .......... .... .. ............................I.... Rough to be a occupied Chimney .......................................................................................... provided that the pers n 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO;�11 S Ti�� �fi Rough ................................................................................................................. Service 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. ~ BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR i Number:-:C5. 058245 ` Birthdate 10312411943 res 3/24/201)6 Tr.no: 21031 Restricted: 00 KENNETH B KEEN. 21 HEWITT AVE ,, Q N ANDOVER, MA 01845- Acting C mis oner k f tie -�am�nan_cuP,altl o�✓�aaaac�ivartta is Board ofuilding,Regulations and Standards { 4 HOME IMPROVEMENT CONTRAGT(�R + Re&tratian\ 108383 } E�rtsirati�er:=1.8,2006 i ' T p=D ; KEEN CONSTRI�6f O.N?C10 - I Kenneth Keen I 21 Hewitt Ave No.Andover,NIA 01845 . Administrator {{>_•_ --=_____:� The Commonwealth of Massachusetts � _ ��'e Department of Industrial Accidents Office vf/nrrestigalIgNs 600 Washington Street Boston Mass. 02111 .Workers' Compensation Insurance Affidavit ,.�,,•.. �;:� .r .w . .. ease};<I�.Y. . eat name: £ At N F_ r,t,a-a"i location: 21 ;Yf0U i 1/ if'�fJ t.— city N rt'7/►/'f3. O L�£K /�I'g' Qhone# / 7�" 6 (�/�S Z.O ❑ I am a homeowner performing all work myself. L14 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 mime address: ' phone:-#L insurance co. Wick* ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: compi;ny name. address: ,. city' phone# insuran a co: ohc # company name,• address. �ltY. nhone# ` insurance co policy# R;hnalhee Ie�cssa�r 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 51,500.00 and/or one years'imprisonment as well as civil penalties in the fortis of a STOP WORK ORDER and a fine of 5100.00 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. !do hereby certify under the its and penalties of perjury that the information provided above is true and correct. Signature Date Print name_ riia��� !� 'C$�. ..... . .. . . ..._ ._. ._.._. . r a Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department []Licensing Board' check if immediate response is required C]Selectmen's Office []Health Department contact person: phone#; Other (revised 3/95 PJA) "`'� � • r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: L �'c�af�; w rL v ; c t (Location of Facility) 06Signature of PermifApplicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector weu uJ lJT lu:.Ca me n rte crl D.mpen afO-OOC_7G.dl �.i,C KEEN CONSTRUCTION CO. N°- 1633 a 21 HEWITTAVENUE P" R("I""W0SAL - NORTH ANDOVER. NAA 01845All home irnmrovement contractors and subcontractors Tel: (978)691-5201 engaged in home improvement contracting, unless Fax:(978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with ! SJbnilted T, , moo: _.. �}^..C..�...._.._.t•-' . .................. ....._......_...._..._.... the Commonwealth of Massachusetts. Inquiries about � registration and status should be made to the Director, J'.t /11^ iL 0 _ i d i Home Improvement Contract Registration,One Ashburton :.......................................... Place,Room 1301,Boston,MA 02108 (617) 727-8598, At � ,//�� �1n r 'Owners who secure their own construction related Jv I.711C(C1-,`1;.f— ii11� C 1 9"45 permits or deal with unregistered contractors will 1>e excludaS$ from the Guaranty Fund Provision of MGL c.142A. PMCN: •� "-- D♦�E PEGISTF ATICN NO. F. C•rid. ----MA, H.I.C. 108383 ---04325-8052 C.rS=Customer Supplied S+I=Supply+Install Vie hereby aubrl sx6'icailons and esGmalee for work to be penormod FOG vlalenals to be used: I Roe rY1ode tAnv'nx`Iler. elc dp im. :... .... ... __ .. .. .. ... 1 1 r r E� `5rol��.........�- 'I.r'� C1.C'..1.1_11 ( IL ._t_'�S.TJIr ..lVfl_.._ WORK SCWEDJLE `'"'`" ..- C^ontraac•.ria not begin.the,work or oroer the materials before the third day follomilg tna signing of this Agr—menu unless speCe.cd ne+re in wrung,C.onf ad0l'will begin the aorR on Or about _hdata;. 5arring delay oaused by crcwnsrances beyond cortractor's moue,tae wc•:k.w9l to Comp!etdd by_.—,- --__—(date; The r.�a•nar hereby ackr.ow:edgas and agrees Ilial the Stl'rdunng dates acv:Vprozimaie Old flat su Z dalflys final ere•nit aYoidaS.by the ContlEctor snall not be Considered as viola!ims of this Agmanlen!. 1NARRAWY / The Cionvadtor warrants',hal the a0r6 fun.ahed hill euncor shall Do:roc,Inom deleole in malar ale and w ilm,n nahlp for a Deatd C' j—y}�-�•-7-� f-110"g corr�lalion and shalt enmply wit:,Vie requirements of this Agreemocl. Ir.the event pry]elect In wo•kmansnlp or malerialr.or darnaat caused by the Cor tractol.Ms subcontractors,employees or aydnls.is c!scovereo w111113 one year after bomplCtlon c'any;ab,lr.clvding deenup,rhe Contractor snail,at his own expense,fonnwith remedy,ropair correct.teplace,of cause to ars remedied, 'r[:pe,'e:.or repleted,sllCh damage or auCn detect fir.nlalerl els Cr weltman611i�.-nil fliageing WarralllCS Shall r.Jrvlwn pity in FDCtI�On perforneo in CofU,F.Clion wi?n N.0 agleed-Upcn'wnnl. We PropO5e hereby to furnish tmaieria)l and tabor_complete in accordance with above specifications,for the sum of - - � I{ 1 (-t �Y__ _fi n ►=5 _—dollars _C, ?O an,to a grade as Inlicws (� q upon signing Contract; KENN_ETH_B. KEEN r r.nny VI Ccn:ta:rgrr a,ynmed a�•�i6�urll__ on corns'�i . .-- -------- 21 HEWITT AVE. corns jl:ee:Ajli,5e — --.— t ptn oirnpletion of_---,--� N. ANDOVER, NIA 01845 _ shall be made forthwith,upon' {978)fi82-3231 (978)691-5201 completion of work under this contact, Pe-,^— Notice: e-,^Notice: No agreement for tome improvement contracting work shall require a dawn payment!advance deposit)of more 111811 one-third of the Iota!contract price Dema n15alosraa �, Dr the total amount of all deposits or payments which trip contractor must make,in advance,:o order andlor oth6rfvise obtain delivery of special order materia's and amt r 3puipmeM,WhlChe','ef amG �nl i5 9reater. Duan ir.,x ro -,-d moan:er,,,ayae«ewer.,••,r.,•.x�nwc:mplc:.wnn�r. _�..— r,„yx ACceptarjge of Proposal-I na.,e read bmh sides of this documen(and all attached dccurrents ario accent the prices,specit:cations and cc damn:statec. i ur.de:stand ihatt,pon signing,this proposal becames a binding cc,i raci. YOJ are authorized to do the work as specified. Ragmen!will be made as outlined above. You,1het'84yer,may-cilncel this transaction at any tinge prior to midnight of the third business day atter time date of this%hsq6tion ancaltation must be done in writing, l dO NOT SIGN THIS CONTRA IF THERE ARE ANY 13LANK SPACES. IMPORTANT INFORMATION ON BACK 10 SUTTON POND January26, 2005 To.Whom It May Concern, Please be advised that Ms. Nancy DeVito, Owner of apartment 0-101, has obtained the permission and authorization. of the Sutton. Pond Board of Trustees to exchange the existing cabinets located in the kitchen area of Apartment 0=101 with new replacement units, Sin ely yours, Robert J. 'rowse. President Condominium Homes 148 Main Street, North Andover, MA 01845 (508)681-4567 i