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HomeMy WebLinkAboutMiscellaneous - 163 OLD FARM ROAD 4/30/2018 163 OLD FARM ROAD J 210/035.0-008aooc3D:o 1 Date. .. .. NORTH 1 OF'..ao o� TOWN OF NORTH ANDOVER ' 9 4 - . % PERMIT FOR GAS INSTALLATION 10 h S^ACeNUS This certifies that . .a.Sn~. . r. . . ��" . . . . . . . . . . . . . . has permission for gas installation . . F{i': e. . t n c. in the buildings of . . .43. .O��. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ar� at . . ,. , North Andover, Mass. Fee. ` Lic. No.. LPta.l0 . . : 71o2i µtilt �---- pZ GAS INSPECTOR Check# 4542 I MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS PTrnNG �� I (Type or print) ` : Date 11/25/03 NORTH ANDOVER,MASSACHUSETTS ! Building Locations 1 h 3 Old Farm Rd � � � Permit# Amount$ _ 25.00 Owner's Name _Joyce Bold New❑ Renovation Replacement ❑ Plans Submitted ❑ CA w � w w a a ° H • • it pl ce d H ° z c w ns rt a aG U z w > LA rA 0 o w 3 A o SUB-BA SEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type) Check one: Certificate Installing Company Name Eastern Pro-anP CTaS ❑ Corp. Address 131 Water St. , Danvers MA 01923 ❑ Partner. 1 800 322 6628 ❑ Business Telephone Finn/Co. Name of Licensed Plumber or Gas Fitter 86A 0 6A,u INSURANCE COVERAGE Check_4j e: I have a current liability Insurance policy or it's substantial equivalent. Yes U No❑ ' Ifyou have checked yes,please'ndicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond ❑ i 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 of Owner or Owner's Agent Owner ❑ 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and ha ofthe General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber Com/2�e City/Town Gas Fitter License Number ❑ Master APPROVED(OFFICE USE ONLY) Journeyman Date... f NORTH, "O0 TOWN OF NORTH ANDOVER o . PERMIT FOR WIRING { CHus� Thiscertifies that ............ ......... ..................................................................... has permission to perform ............ .... .... ...................................................... wiringin the building of.....r............................................................................. at...'//'3........ .....�e ..h .........,North Andover,Mass. Fee..................... Lic.No.............. .../ .; ?.a...- �.................. ``ELECTRICAL INSPECTOR Check # 5 "i 52 Official Use Only Permit No. WE C09kfW0AWEALW OAF'911,4SSA SE27S Department of�Pu6Cu Safety Occupancy&Fee Check BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 5 CMR (Please Print in ink or type all information) ate ��' C- Q To th inspector of Wires: Town of North Andover The undersigned'applies for a permit to perform the el ec trical work desbelow. l Location(Street&Number (J3 CJ �I �C11 Owner or Tenant Owner's Address b� Is this permit in conjunction with a building Yes No heck Appropriate Box) Purpose of Building­ �'l2 LAUtility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No.of Meters New Service Amps Volts Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 grnd 0 GeneratorsKVA No.of Emergency'Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices b Heat Total Total No.of Di sal .No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers SDaceJArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES n NO o have submitted valid proof of same to the Office YES C, NO C% If you have check YES please indipte the type of vera by checking the appropriate box INSURANCE t, BOND C, OTHER 0 (Please Specify) ffZ' (Ex i n Estimated Value of ectrical WorkE Work to StartMr Inspection Date Resquested Rough Final Signed underthe ffenatties of pedury: FIRM NAME v �) --d�f1 LIC.NO. c.JJ Licensee U Sig/nature L� LIC.NO. Elus.Tel No. r� Ger Addresses Alt Tel.No. OWNER'S iNSU CE WAIVER: I am aware tha he Licenses d es 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) z a The Commonwealth of Massachusetts Department of Industrial Accidents ' d Office of Investigations w~ Boston, Mass. 02111 °+M 5�lb Workers'Compensation Insurance Affidavit Name Please Print Name: Location: city Phone # F] I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address Ci : Phone#: Insurance Co Policv# Company name: Address Ci!y: Phone#: d Insurance Co Policv# 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.penaltiesin3hefamjofa_STOP WORK ORDER.and a.fine.of_(.$1DO.DD)aiday.against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. V 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required 0 Licensing Board Selectman's Office Contact person: Phone#. ❑ Health Department Other Location No. �r Date Mo^Th TOWN OF NORTH ANDOVER Certificate of Occupancy $ 23 s''•°''I Building/Frame/Frame Permit Fee $ s4cNust 9 .4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /a 3 Check # / 553 3 Building Inspector i/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEyMOLISH A ONE OR TWO FAMILY DWELLING ■®v■ BUILDING PERMIT NUMBER. Vo DATE ISSUED. ic SIGNATURE: C Building Commissioner/Ing3ector of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: nn 11 1.2 Assessors Map and Parcel Number: 10 OLD ss- 9(!�:> Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided Q 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 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record /63 Name(Print) Address for Service 6g3- L(1�i Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone 90m SECTION 3-CONSTRUCTION SERVICES Licensed Construct on Supervisor: Not Applicable ❑ Licensed Construction Supervisor: S D d 19 Nq (� . J , License Number on Address M. on M— �35Expiration Date ic Signa re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name b U \� V�� �� M� Registration Number �a v� U.J J I tt -Address _ �l O R q` 6 35-3 Expiration Date nZ Signature Telephone ®' 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 all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: \ d- t...J 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 Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC / 5 Fire Protection 6 Total 1+2+3+4+5 0 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 CTI N 7b OW R/ UTHORIZED AGENT DECLARATION h 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 Pr m Signature of Owner/A ent Date NO. OF STORIES SIZE f BASEMENT OR SLAB SIZE OF FLOOR TMERS IST 2 ND 3KO SPAN DM ENSIONS OF SILLS DM ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUULDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 000521 THREE SONS HOME REPAIR FROF`UaA�L 18 Munroe Ave. Waltham, MA 02154 Page No.—of _ Pages DESCRIPTION OF JOB 781-899-6353 MA Reg #118807 ARCHITECT DATE OF PLANS PROPOSAL SUBMITTED TO: JOB F . ADDRESS ... ........ ..I......... CITY S E ZIP ....... ...... . .. . ..................................... PHONE................/VDA��(/, .. ...............................I.......................... ...................................... WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: ............ . ........ .......... ...... .... .......... .... ........ O \00 ....... ......YPi P, ................... .................... .................................. ............ a C . too ./....... �.r.�M........... ............... ...................................... .........................................................I.......................................... 9 'e7-� -7',r'�n , e .......... NA �t� 5�. .. ....................IN............................... ..... ....... .......... ..... ........... ....... .... .... .. ...................... 7\...4 ... ......................................................................... . .. ....... GVks>'i C' W�% . ........Opp ......... ........... ....... . ........... ..............:......... .......-.........I.......................................................................................................................... ( .. ............i...........VZ-.'.L0'.e.........P ........ .. .......L--1-- 11\ 0 ....... .... ......... .......... . ....... ............9.........�-o RV-N Vj Vj, ............................................................................................. ...................................................... .............. 5.............t ....... ..a ,.................................................................................................................................................................... .................. .....................I.....................-......I........................................................................................................................ ...........N-1......... ......................... .............................................................................................................. We hereby propose to finish material and labor, complete in accordance with above specifications, for the pQ sum of dollars($ I q, qq0. with payment to be made as follows:— -VL'f'j co r'\ 40A) All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications Authorized involving extra costs will be executed upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon, strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be withdrawn by us if not accepted insurance.Our workers are fully covered by Worker's Compensation Insurance. within days. Acceptance of Proposal - The above prices, specifications and cond- tions are satisfactory and are herby accepted. You are authorized to do the 0,J) work as specified.Payment will be made as outlined above. Signaturpe - Date of Acceptance: & Signatur I u" CNA For F`7 C--d--t, nR r uMohz WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC RO 00 01 ( Aj POLICY NUMBER: (6S59UB 725X472 7 02 i RENEWAL OF I6S59UB-725X472 7 011 INSURER: C:ONIINENIAL CASUALTY COMPANY NCCI CO CODE so381 1. INSURED: PRODUCER: NUTILE , PAUL DBA SELECT FINANC',IAL INS AGY THREE: SONS HOME REPAIR 1579 WASHINGTON ST 18 MUNROE AVENUE HOLLISTON MA 01746 WALTHAM MA 02453 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy periods from 03-22-02 to 03-22-03 12V A.M. at the insured's malting addresss.. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here:. MA _ B_ EMPLOYERS LIABILITY INSURANCE; Part Two of the policy applies to work in each state listed in °-� item 3.A. The limits of our liability under Part Two are: ® Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 policy Limit Bodily Injury by Disease: $ 100000 Each Employee C_ OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here. SEE ENDORSEMENT WC 20 03 06 i : D. This policy includes these endorsements and schedules: `— SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE + 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY Y . DATE OF ISSUE: 03 01 02 we ST ASSIGN-. MA OFFICE: CNA o4,1 S I I L,I(`FP4: F7N ,n4r`Tn TN' r.r .lF "7�Y')n i s',, �� �J09fVlltO?tfl�Pfilflf. I Board of Building Rtguiatio s fdr� . -- ✓llC 10Pf)L?ltOltllJ!-'CL/�IL O�/1�1t8+1ClQItfL6ClI6 I .BOARD OF BUILDING REGULATIONS HOME IMPROVEMENT CONTRACTOR f License: CONSTRUCTION SUPERVISOR 1 Registration: 118807 7 t ExptratiQn: 04!2512003 yNumber: CS 080626,` _ '.i Type: DBA 1q I " Birthdate: 10/13/1961 Expires: 10/1312005 Tr.no: 80626 THREE SONS HOME REPAIR `J'• _ Restricted: 00 PAUL NUTiLE x ,_ PAUL E NUTILE 18 MUNROE AVE. 18 MUNROE AVE r % ALTHAM,MA 02453 - .' WALTHAM, MA 02543 Administratgt t + Administrator � NORTH Tof own y R L -Andover No. STO dower, MaSS. T O '-- LA E 1 COCHIC HEWICK ADRATED P `2 1 H BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System S O� O BUILDING INSPECTOR THIS CERTIFIES THAT........ . ' .... .................. ......... .......«.... ................................................. Foundation has permission to erect....`f Y1.................. buildings on ....Aj....0/`;.... 7few...... .... Rough ................ all �t �� W.1-V 10Q W Chimney tobe occupied as....................... ...Q6... r ........................................... . .. ............................................................... 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-Lawsrelating t the Inspection, Iteration and Construction of Buildings in the Town of North Andover. 3i V Q /p� �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONST TS 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. r SEE REVERSE SIDE Smoke Det.