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HomeMy WebLinkAboutMiscellaneous - 164 VEST WAY 4/30/2018N O p� A v b N b S 0 b ��� I A 4 Date's .. .. .... . "O RT" rho TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING •'.'s CMUS _y - /................. This certifies that ... .............. ..... . has permission to perform u� -. �— plumbing in the buildings of ... r='r/. ...................... at. .......... .... ?........... , North Andover, Mass. .Ti Fee y�' ..... Lic. No..,. / . ..... �.�f .......... . .g PLUMBING INSPECTOR Check # / 1� / v 5183 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Vr Building Location L t° / G✓,' LLPermit # l Owner 4/7 A��� Amount is � A New ml-� Renovation Replacement FIXTURES Plans Submitted Yes No E (Print or type) IT Check one: Certificate Installing Company Name/PY❑ Corp. Address ���� > Partner. Ivausmess a ep one — Firm/Co. Name of Licensed Plumber: J Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent E I hereby certify that all of the details and information I have sub 'tted (or e, ed)Ne plication are true and accurate to the best of my knowledge and that all plumbing work stal ' s perfo a unde6r thi plication will be in compliance with all pertinent provisions of the Ma a setts tate ing e eneral Laws. By: re icense V,ri-cLense ype of Plumbing LicenseTitle City/Town um er Master Journeyman E]APPROVED (OFFICE USE ONLY 36 9 Date. ... / RTN TOWN OF NORTH ANDOVER PERMIT FOR WIRING M J.t(vf/l F-- lr�- TO ( - Thiscertifies that ........................... I ................................................................. ll W --- has permission to perform ......... A /1 / ...................................................................... wiring in the building of ..... 1,..q .. . v ......................................................... at ... L/f5t k.,, Ck ..... . 7, North And ------- ............. I .......... *'­ ,.t7oel. T.. .... ... .... ....... ..... ...... ....... F .......... Lic. No.,,.�. 71d 7 ELECTRICAL AL INSPEMR Check #Uj Af i Commonwealth of MassachLosefts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Permit No. Occupancy and Fee Checked [Rev. 11/991 (leave blank-) -� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,r�'1 � �, �2 aD City or Town of; /7/ 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) /j 1l-- Owner or Tenanty Z-,oq-l< b V Telephone No. Owner's Address /�7r e,,,' Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) -10 -9VZ Purpose of Building /-/z; 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: 2, my v4� Com letion o the ollowin table ma be waived hy the Ins ector• -1 bY' No. of Recessed Fixtures / No. of Ceil.-Susp. (Paddle) Fans gyres. No. of Total Transformers KVA No. of Lighting Outlets S' No. of Hot Tubs Generators KVA No. of Lighting FixturesSwimming Pool Above ❑ In- ❑ rnd. grnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets /D No, of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. a Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No, of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number Tons KW No. of Self -Contained Detection/Alerting Devices 1-��e Are No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW ecurrtySystems: No. of Devices or E uivalent No. of Water Heaters KW No. o No. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunicatiarls Wifing: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no pen -nit 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 0 BOND ❑ OTHER ❑ (Specify:) (Expiration Date) 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. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: Nr; ; „o, , �, o,.� r; „ T-- ., LIC. NO.: T -7 IN Licensee: F r ak F- (` as .F a n 7. a SignaturF�� ,,`� LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.A 7 A - 7 7 a - 2 9 5 7 Address: One Oberlin Rd Danvers MANo.:A79-77-4-9446 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the ha i ity insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. OlIvner/Agent Signature Telephone No. PERMIT FEE: $ YD `f'0 LocationsI/ / ,r No. 7 Date 3 1y C 14ORTN TOWN OF NORTH ANDOVER OL 9 Certificate of Occupancy $ Building/Frame Permit Fee $ L ss�CHU ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y Check # c 26 0 I '+5300 �Pele" Building Inspector �TOWN OF NORTH ANDOVER I BUILDING DEPARTMENT A ONE OR TWO FAMILY BUILDING PERMIT NUMBER: r / � � DATE ISSUED: SIGNATURE: Building Commissionerfl or of Buildings Date SECTION 1- SITE INFORMATION 1. Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use I 1.4 Property Dimensions: Lot Area Frontage 8 1.6 BUILDING SETBACKS ft Front Yard - Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 water Supply MGLC.40. 34) PabGo ❑ Private ❑ 1.3. Flood Zone Information: Zone Outside blood 'Lone 0 1.9 Municipai Sewerage Disposal system: 0 On Site Disposal System ❑ 0M%-aAW1,q i-rLlvrL'ill Z vVV1,zAWaXXW1AU111V1 LAMJJAq.,im 1 2.1 Owner of Record Name (Print) Address for Service Telephone X 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Licensed Construction Supervisor mol-- l � Signature Address for Service: (,,o3 7Yy oC9 60 3.2 Registered Home Improvement Contractor Company Name --1 L�Do (,-"iu _ Aviv -Aid ri�Aaw G T, 6 Not Applicable 0 b-7;�P�0 License Number Expiration Date Not Applicable 0 Registration Number Ir Expiration Date .ti a 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 .......X No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building 9-' Repair(s) ❑ Alterations(s) [9,"Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 1. Building =-� ? ) 3 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical AC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,'/ G % C��y� s,�� It 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 1, 4—:z�% G A4 ��'-- /�l %� ,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 Name -<- Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 3RD SPAN J ! DIMENSIONS OF SILLS DIMENSIONS OF POSTS L� E 1jo S , , DIIv1ENSIONS OF GIRDERS 5 l:;L HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X . MATERIAL OF CHIlvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �I A,),gLX abDL-�-e_ ef lr( +- GA"V Co r - FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that allnecessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. �,■...■■,....,.,w,■.■■..w,.,■wwwwwww,■.....■•r................r..■,,.......■ APPLICANT ��,/ �;�(/sZ, PHONE �.3 - Z�-z)!7 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET 145-:S7— l✓tJ STREET NUMBER l �` OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADNMUSTRATOR DATE REJECTED CONIIVIENTS DATE APPROVED TOWN PLANNER CONtMENTS FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED y SE'PnC INSPECTOR - HEALTH �z DATE REJECTED COWVMNTs Q. x� f4a k o LT* 16to tI A 5TS fi� PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONQvIF.NTS RECEIVED BY BUILDING INSPECTOR DATE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: �� C �- e 4S /AA,1' .v ��vG���e l Location: = am a performing all work myself. I rp�l I 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 # Company name: Address City: Phone # Failure to secure coverage as required under Section 25A or MCL 152 can lead to the irrlpMition 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, t do herby certify under the pains and penaRfes 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' OCheck if immediate response is requbed Building Dept Contact person: Phone R,St WORKMAN'S COMPENSATION E] Building Dept p Licensing Board E] Selectman's Offrce r-1 Health Department ©fher D. Robert Niceita, Building Commissioner TOWN OF NORTH AANDOWR Office of tine .Building Department Community Development and Sen ices 27 Charles Street North Andover, Vassadiusetts 01845 DEBRIS DISPOSAL FORM Telephone (978) 688-9545 11 -AX (978) 688-9542 In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at / in: ,41S - — (Site location) Signature of p t applicant s,4L Date Michael McGuire, Local Building Inspector James Decold, Electrical Inspector James Diozzi, Gas/Plumbing Inspector -. '�fIC t<f3�lY:(ktlt{XRT#fJ# G��. F1Q.f3Ylfi�ttt'3 .� BOARD OF BUIL€�ING REGULATIONS x License: CONSTRUCTION SUPERVISOik Number: CS 072869 Birthdate:' 08/01/1972 Expires: 08101/2502 Tr. no: 72869 Restricted To: 00 ERIC MCGLASHING r 362 BARTLETT ST 2ND FL�td` Pt}RTSMoum WH 03801 Administrator i »arttaicr�a�(� oil � / Yi{ tWi(,r c p nnaS5t4 %-an�d1aikf'Tstid e 6 ho !MPRC51ct+lcryr CS)i •.�� Retiiritra'� 127 � �� - i`arpera#iryi� �"QQ0. T. Tree: £sA MCGLASHING CO#NSTPI.Cr ON ..=ERIC MCGLASIHiNG ; 302 BA- ?' iLETT`5T - .` PO'i7'S,Mo UTH, NH 03801 '� *✓_ p Ad;ninistrator �x $ AbSTS WCDT) h�- T 0 (I -J x A W O G u O u°. a cn ° z z r•r Q C 7 w° v U ro w a a�' cd w a .� 0.4 w Lti 7 w0' Ch ro x w Ow z co W. z W �•+ 1..1 w z cn D O cn uml m C C2 C H O C O •dam • p, C N A m C � O �om N L•+ Ea t0 ra:mo t5 :gal E c ? m CM ate` E • � •mm cm co CA Q Q• Ecoo c \ p Z m O e � CL L) Cl cm : S � =. r C r0 : os p c c Q _ 2: rd act CA p V y O 13 O %'C0c c_ O. 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