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HomeMy WebLinkAboutMiscellaneous - 150 HILLSIDE ROAD 4/30/2018 150 ILLSI AD 2101098001-- Date...�.Z"�. .` .... r f NCRTM� 4L TOWN OF NORTH ANDOVER p PERMIT FOR WIRING sSACHU This certifies that ....................... L............��E�Tfli.�:. .............. w . . ..... a has permission to perform ........s ....................... �STp.,l... .......... ....... x wiring in the building of (A! f�.E U!w �� . � s �/�� b , at..........j j9...Q�. .. North Andover,Mass. Fee... ......... Lic.No..� 1.?2 ........ ./ !.� y .... ..`� ..... r f ELEC Mc L INSPECTOiE Check it 8535 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. (J�' BOARD OF FIRE PREVENTION REGULATIONSOccupancy 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 C 12.00 (PLEASE PRINT IN1AW OR TYPE ALL INFORMATION Date: f �.-j�._p City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of 1So her'intention to perform the electrical work described below. Location(Street&Number) ISO Owner or Tenantry V Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ( k A(Check Purpose of Building ( Appropriate Box) 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. Completion of the followin table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil;Susp.(Paddle)Fans -S-0.01 Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool. Above ❑ In- ❑ o, o mergency ig g d• rnd. Batte Units — No.of Receptacle Outlets ets No.of Oil Burners FIRE ALARMS S No.of ZonesNo.of Switches No.of Gas Burners No..of Detection and initiating 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 elf-Contained Totals: Detection/AlertingDevices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent KW No.of Heaters Data Wiring: Si s Ballasts . No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent , } OTHER: Attach additional detail if desired, or as requiredby the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: - Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 covera 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 o er u that the informadoon this application is true and complete. .fP .1 rye FIRM NAME: , L-e C i C Licensee: LIC.NO.: 1/ ignature LIC.NO.: (If applicable, enter"eze t"in t e Licen�nlnbe,line.) Address: A Bus.Tel.No.t'od:'t *Per M.G.L c. 147, S. 57-61,security quires a Alt.Tel.No.: o. OWNER'S INSURANCE WAIVER: I am aware that the Licens a does not have the liability insurance License: Lic.lcovera e normally 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 FEE. $ _,t, f /) � Q� �� r ,� F 'l The Commonwealth of Massachusetts ka ! Department of Industrial Accidents Office of Investigations 640 ffrashington Street Boston, M4 02111 Workers' Comwww.mass.gov/dia . pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant,,Jnform2tion L Please Print Legibly m Nae(Business/OrganizatiWlndividual) L Address: rl 1 LAAR � e\ - City/State/Zip: 01 Phone #: �(� ? ril-r-) '` /� _ Are you an employer?Cheek.the appropriate box: 1.❑ Iama em to er with 4. Type of project(required): P y ❑ I am a general contractor and I tam loyees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. a.sole proprietor or partner- listed on the attached sheet.t 7. Remodelin ❑ g ship and have no employees These sub-contractors have 8. ❑Demoliti.on working for mein any capacity. workers' comp. insurance. [No workers com .insurance 5. 9• ❑Building addition ' p ❑ We are a corporation and its required-] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGG 11.❑ Plumbing repairs or additions myself. [No-workers'comp. c. 1.52, §1(4),and we have no required.]t 12.❑ Roof repairs insurance re ] q employees. [No workers' comp. insurance required_) 13.❑.Other *Any applicant that checks bwr#I must also fill out the section below showing their w,orkets'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 mustattached an additional sheet showing the name of the sub-contmetors and their workers'c_.- pi., inflormadon. I ant an employer that is.providing workers' -ontpensatian information. insurancefor m1'employees: Below is the pOlicy and job site Insurance Company Name: A Policy#or Self-ins. Lie. _ lIII`( C � Expiration Date: Sob Site Address: 1 ��J1LP City/State/Zip: ------------ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure 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 Si Lure: Date: Phone#: E:alonly, Do not write in this area,tO be completed by city or town.official n; Permit/License# ority(circle one): ealth 2. Buildin De rtment 3.Ci /Town Clerk 4.Electrical Ins ector 5. Plumbin Ins g Pg pector son: Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,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 includirig the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'iiowever 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,§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(7)states"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 out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if 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 cant'workers' compensation insurance. lf.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,notthe 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 dine. -� 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 information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy ofthe 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 bum 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. #617-72.74900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7740 Revised 5-26-QS vvww.mass.gov/dia Fr' `'� The Commonwealth o Massachusetts office Use Only �7 Permit No. Department of Public Safety Occupancy&'Fee Checked t BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 / 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 663"-ytq&*" Date A41//�- A-A- , 97 City or Town of V'4Wev '0e_ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number O Alictsipt a Owner or Tenant GAC Owner's Address F_ Is this permit in conjunction with a building permit: YesNo ❑ (Check Appropriate Box) Purpose of Building RFcS'rqul Ut'ity Authorization No. Existing Service © Amps /�� / Q Volts Overhead Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity n Location and Nature of Proposed Electrical Work �� ���f 60K 01,44- -SIP/Al Z� No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA In- No.of Lighting Fixtures Swimming Pool Above md. ❑ gmd. ❑ Generators KVA No.of Emergency Lighting No.of Receptacle Outlets No.of Oil Burners Battery Units No.of Switch Outlets No.of Gas burners FIRE ALARMS No.of Zones Total No.of Detection and No.of Ranges No.of Air Cond. tons Initiating Devices Heat Total Total No.of Disposals No.of Pumps Tons KW No.of Sounding Devices No.of Self Contained No.of Dishwashers Space/Area Heating `KW Detection/Sounding Devices Municipal No.of Dryers Heating Devices KW Local❑ Connection❑Other No.of No.of Low Voltage No.of Water Heaters KW 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 Insurance Policy including Comqi&d Operations Coverage or its substantial equivalent. YES NO ❑ I have submitted valid proof of same to this office. YES NO ❑. If you have c d YES,please indicate the type of coverage by checking the appropriate box. INSURANCE BOND❑ OTHER❑ (Please Specify) /s gs xpiration Date) Estimated Valu ctrical Work$ Work to Start r 5-19,7 Inspection Date Required: Rough 421 U-e,#A 4- Final Signed under the enalties of perjury: FIRM NAME ���` ��iP._1�- LIC.NOXamli Licensee 1 e_*1JiaM_ Signature o' LIC. NO. 6_52W AddressC)t°1t� y/�i L Bus.Tel.No. 573 iiSS� Alt.Tel.No.��' OWNER'S INSURANCE WAIVER: I am aware that the licensee doe not have the insurance coverage or its substantial equivalent 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 FEE$ (Signature of Owner or Agent) IG'`�'•�^sr.-...,F.'-�v��. _.�_:-�,.,,;,,_.,:,�:�,..,��ac�..�:r:�,ar.�;.ux� °tsr.-rte.:?�'?w y�� - �t��e�iy^�a'� Date........ . ...... ........ .... 893 - - f OORTM 1 ° t"`°:° "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ` ssAcaus� This certifies that has permission to perform ................ /... .......................................... wiring in the building of..C /..G' ... .. ....... ......... ..... at.......... . ........ . ..1/ ' ."ELEcrRICAL ffdov ass. Fee..�,� ............. Lic.No............... .............. . ..... WHITE: Applicant WARY`Building D�t� " AK:Treasurer Location fs /J i / t No. fS. C Date n „oRT►, — TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ �_. sAGNtls ' Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ •TOTAL. 5 ••00 t^ llOL Building Inspector 111.16/95 16.01 .0 RAID u 1 - D-,-,3 6 0 Div. Public Works PERMIT NO. J V` APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP iDATE a BO K PAC . w ZONEI SUB DIV. LOT NO. q7" ." LOCATION . !�R PURPOSE OF BUILDING OWNER'S NAME ! _4'/ , NO. OF STORIES ` 1SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ��. p �I SPAN -- DISTANCE TO NEAREST BUILDING •C�'�� DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR "' GIRDERS AREA OF LOT f FRONTAGE �`���' HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW >Le_v / SIZE OF FOOTING X IS BUILDING ADDITION/ MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND 2 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER i7ws� 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 EST. BLDG. COST ISER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS i - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �YILDIN P[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT - FEE ZF1 OWNER TEL.A PERMIT GRANTED CONTR.TEL.# 19 _ CONTR.LIC.k H.I.C.N 3bU Coll ' �'L BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 9 CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE 8L K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ _ DRY WALL UNFIN, 3 BASEMENT 11 AREA FULL FIN. 8'M'T' AREA _ 11 1/2 FIN. ATTIC AREA N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDxf✓'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH Q FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES - LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES e TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st ( 3rd 11 NO HEATING i AORTH ' F ovm Of over No. 5 8 i ►- �, rt " dover, Mass. I C.OC:H I C HLI'v'I C K 1 IYd'QA w DRATED PP��.(� 3 `-' BOARD OF HEALTH — Food/Kitchen �n Septic System 13 PERMIT Tj 7C2�A BUILDING INSPECTOR sN THIS CERTIFIES THATTh�lUVP..' .•......�!0�,...................................................................................... I�. ""' i d Founaton ' 1 >ric has permission to erect..LaooP.. buildings on ... .......�.................................. Rough 93 Chimney to be occupied as...`IZ4.kZ......�.. U�c. S. ............................................ ......................................... ► 3 provided that the person accepting this perm�pshall 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 .08 j Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXP MONTHS Final ELECTRICAL INSPECTOR ),I UNLESS CO TRUC T T 1 Rough 31I a„ ..... ............... ... .... .. ................. Service do BUILDING INSP OR = Final �N IION Occupancy Permit Required t0 Occupy Building GAS INSPECTOR „N Rough a3 Display in a Conspicuous Place on the Premises — Do Not Remove Final )31 No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT >il Burner j Street No. p(. Smoke Det 930 MORTGAGE INSPECTION PLAN BOSTON ' SURVEY, INC. 95-03077 One Thompson Square P.O. Box 220 Charlestown, MA 02129 (617)242-1313 MAIN (617)242-1616 FAX APPLICANT: RUTH-LINDA CLARK&PHILIP CLARK LOCATION: 150 HILLSIDE ROAD DEED/CERT: PROPOSED CITY, STATE: NORTH ANDOVER, MA PLAN REF: 27868-A W � i 184.63 7 / POOL I Z,6 - i i 26.25 y � i � ) i Pow I I i 2 STORY I I I i 19• I 8 ..................... i i i I s i i I � 170.00 Mar -/-a sr-4 1-,@- HILLSIDE ROAD Phil Clark d Tel: (508) 685-4499 Stock list for 12 x 12 shed Unit of Type measure QuantiU 2x8 PT 12' 15 2x6 16' 10 2x4 14' 24 2x4 12' 16 1x8 16' 8 1/2 cdx plywood 4x8 11 5/8 T1-11 4x8 14 16d spike lbs. 15 8d galv. common lbs. 15 type D drip edge piece 3 Roofing shingles- 20 year square 21/3 SHED-STK.XLS 12' 12'