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HomeMy WebLinkAboutMiscellaneous - 176 MIDDLESEX STREET 4/30/2018Date .....�3-4^0& .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........,(,Je� , 1-46 has permission to perform ...z S;Rvcr c 2• ! "�? tL �a ons S 4 wiring in the building of ............ �....... � �F. Gl;e¢! ........................ at ........ /T .IDA(E.S�x . T' , Nortth.,Andover, Mass. Fee f1.� ....... Lic. No................: ��....... L• ELECTRICAL INSPECTOR Check,# __L2-01 644)6 �J-, q -7b 6o,?-g5y5 01? 00 �. Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services i Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOl9 Date:' Z City or Town of• Ok rte,. nom, �v ^� To the Insp for f Wires: By this application the undersigned gives notice of his or her inten'iion to perform the electrical work described below. Location (Street & Number) Owner or Tenant (,Jo Telephone No. FW .49 -W7 f Owner's Address 1-7a 1 Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building MOS 3- vr„ . Utility Authorization No. 5-00 3� Existing Service /00 Amps j 2t, / 2 - Volts OverheadiF 1. Undgrd ❑ No. of Meters �. New Service 5-100 Amps / 2 dvolts Overhead i2k, Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ` J,- oZ lei,J PC" e t ,be),q.As `F-- % w 1--lotinn of the fnllnwinQ table nuty be waived 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.) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ?-/? 2_ _ Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th pal s and penalties of perjury, that the information on this application is true and complete FIRM NAME: �,r ( 1 r''+� LIC. NO.: qO Licensee: � ) Signature ] LIC. NO.� -Z (If applicable, nn a nipt" i the license numberjine.) .� I Bus. Tel. No.• Address: cp , �-}- GroteK Alt. Tel. No.: 7 837-3 LW OWNER'S INSURANCE WAIVER: I am aware that the Licensee -does not have the liability insurance coverage normally ,coutred by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑owner C1 owner's agent. Owner/Agent PERMIT FEE: $ 9Q Signature Telephone No. et- 411e136V ZI1/a4, No. of Total No. of Recessed Fixtures No. of CeiL-Susp. (Paddle) Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures AboveIn- Swimming Pool rnd. E]rnd. ❑ o. o Emergency ig mg BatteEy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ElMunicipal ElOther Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of WaterKms, No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent. Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: 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.) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ?-/? 2_ _ Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th pal s and penalties of perjury, that the information on this application is true and complete FIRM NAME: �,r ( 1 r''+� LIC. NO.: qO Licensee: � ) Signature ] LIC. NO.� -Z (If applicable, nn a nipt" i the license numberjine.) .� I Bus. Tel. No.• Address: cp , �-}- GroteK Alt. Tel. No.: 7 837-3 LW OWNER'S INSURANCE WAIVER: I am aware that the Licensee -does not have the liability insurance coverage normally ,coutred by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑owner C1 owner's agent. Owner/Agent PERMIT FEE: $ 9Q Signature Telephone No. et- 411e136V ZI1/a4, Date .7: ... 1.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..1.l� /.'- It- ..1.?.!. (. T. .. . has permission to perform ... plumbing in the buildings of .. l -i .`..` .1 C .`.'. t ..... !... r ...... , North Andover, Mass. at .... �..� .:... �'. � ... . Fee ......... Lic. No.. f.. . ....... ..7........ . PLUMBING INSP&TOR Check # 5288 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS -741 Date C Building Location � � i DT) S7-2 Permit # /, Amount Owner -PAI Z t C!, &,',r Lr 6,4xJA New ri Renovation IJ Replacement Plans Submitted Yes No FIXTURES (Print or type)''' Check one: Certificate Installing Company Name Ed id? P 1P-4 AwAl RP%IA, / NC . ©-e—rp• MPartner. 11 Firm/Co. Name of Licensed Plumber: A,/14 - G • kZ'�/ e{1 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 3Other type of indemnity 11 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 0 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 Pl g Code ndChpter 141 of the General Laws. BY mer Type of Plumbing License Title City/Town icense NumDer Master journeyman ❑ APPROVED (ONCE USE ONLY Location ` ' ' " cjj` � -e Y No. Dater-) OZ Check # �A S t'r- 154.)5 TOWN OR NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ a S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i �� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .i, �.� . x. 241: art••rt;ss •-•.•n sa. S.n _2,�:: .>. 1 •' W. i 1 DINUMBER: ..p , , r. Building Commissioner/12ECEtor of Buildings Date SECTION 1- SITE INFORMATION 1.11 Property Address:. {^ 1.2 Assessors Map and Parcel Number: A / Map Number Parcel Number do irev 44 4 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Di;-Uic-t Proposed Use Lot Area Fronts 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required Provided Required Provided 1.7 water Supply Mal. -C.40. !q 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal system: Public ❑ Private ❑ 1 Zone Outside Flood Zone ❑ Municipal . ❑ On site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZE] 2.1 Owner of Record l Name (Print) 1.2.2 OwrW of Record: Name Print Signature T Address for Service: 7? Address for Service: elevhone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ LL 4 Licensed Construction Supervisor: C/ License Number Address l� Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor I/ 13,2 7 7 Company Name v 2a cu hC P_/fry / Dh � Address QQ (V -r /fid, 1f � t A47� 0 � 20 �o v � acv Not Applicable ❑ 1326 ?7 Registration Number 1/ ) L Expiration Date SECTION 4 - WORKERS COMPENSATION (NLG.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 unit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 DesciA tion of Proposed Workcheck all a 6le New Construction ❑ Existing Building ❑ Repair(s) 0 Aherations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition Other 0 Specify Brief Description of Proposed Work: 641' _,,aerP.I�Ne �r,rl Ld-41��� ,c/'I C>/ h,`rn �zaa of DIES SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by applicant (a) Building Permit Fee Multiplier a 1. Building ��DD 2 Electrical / j� (b) Estimated Total.,Cost of Construction 3 Plumbing Building Permit fee (a) x (b) _ p.- 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 1 �/ /at lll.lnv[ / �,✓t�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,- �,-- -" Y_ 3-d a i tore of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION .1 ,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 J Si afore of Owner/Amt Date i NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR MoIBERS 1 2 ND 3 RD SPAN DMENSIONS OF SILLS MIENSIONS OF POSTS DUVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEV NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688_954; 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 iri a properly licensed solid. waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: r (Location of Facil' ) Signature of P i Appli�nt Date NOTE: Demolition permit from toe Town of North Andover must be obtained for this project through the Office of the Building Inspector 3 Driver`s License 10-20-75 10-20-02 M 5'05" D S33064172'& Date of Birth Expires Sex ai.19tt Class Number PERRY (— LAWRENCE P JR e 80 GUMPUS RD rc �- 1 7 7 DRACUT, MA 01826-6101 j r r U 472 HOME IMPROVEMENT CONTRACTOR Registration: Expiration: 131677 03/20/2003 Type:Individual LAURENCE P. PERRY JR. �A`6'"'-"ENCE PERRY ADAMNISTRATOR 80 GUMPUS RD. + DRACUT 01826 Location: 1761/� `�✓ QX S7 + A = am a homeowner all work myself. Print �I am a sole proprietor and have no one working in any capacity Ci am an employer providing workers' compensation for my employees working on this job. cyy: , 4A _ _ Phone#: 5� 7� l- 741 /f ') i'2 T,�✓f/-P,,S � , Compares name: Address Clty: Phone # Failura to secure coverage as required under Section 25A or M SL 152 can lead to the itriposition of criminal penalfies. of a fine up to $1.-r,00.00 and(or one years' imprisonment m well as clod penalties in the form of a STOP WORK 0Rt)ER and arm of ($100-00) a day against me. understand that a copy of this statement may be forwarded to the Office of Investigations of the IDA for coverage verification. I do herby certify under the pains and penaties of perjury Chet the information provided above is true and correct Signature_ /�1,CL1)_�/ ��>Z.c/l�, Date ` 3 " � o P-rint name L a cvre 7 Phone # �7 � t Official use only do not write in this area to be completed by city or town otricial' []Check if immediate response is required Building Dept Contact person: Phone RM WORKMAN'S COMPENSATION C7 Building Dept ' p Licensing Board p Selectman's Office 0 Health Department 0 Other Cl) C a) M: 0 m CCD O .. 0. CO) CD 0 CA d CA O n C O C CA d CD 0 CD CD CA CD CO) O S. N V Q y a o S m •0 C* WP »m 0 m C) C c F- 06 m Z � �•p vi �i o� so ._-► .d► m CL G T mn =rd Fn Wm m y o N o CD 2 O m O 0 O y n CA • O C, =y = :� :.. �c o C/)�o Amy: C/)m C,)=0 CD m ca 1 � J r••► d y � � ;\ 0 �-: y d ►may C/ /�/•� h CCD CD go d y O PD, ;; O zo �CD o :� CD CD 0 .+ cn cn o CD alaw� CIO O :Q z 0 s m C/) � orDr C z W OQ v '7d O Irl O ) -n d L y 0 0 c / / Z 2-- - Date.................................. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .....:....... .:............................................................. has permission to perform ........................................................... wiring in the building of .. at./2k ..........................................:.............._..... , North Andover, Mass. `�. _ Fed-' :................. Lic. No. 1...7........................... ..................................... / ELECTR]CAL INSPECTOR Check # y— Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. (�J Date Issued: �Q APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:---? I / -VQ City or Town of. /Uar-4.,, "dry- To the Inspector f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) / A t 6)) X <Z Owner or Tenant Telephone No. Owner's Address 51A � I Is this permit in conjunction with a building permit? Yes d4 No ❑ (Check Appropriate Box) Purpose of Building &�Je ,4Q 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: () ,1`e _ wZ 8r t Completion of the fnllnwinv tnhle mnu ho wnivnit hu tha 1--tnr of W:roo No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans A v No. of V v Total Transformers KVA No. of.Lighting Outlets Z No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above [DIn- E] No. o Emergency Lighting rnd. rnd. Batte Units No. of Receptacle Outlets �� No. of Oil Burners FIRE ALARMS I No. of Zones No. 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 Wase Disposers Heat Pump I.Number Tons "'"""" """""""""' KW """"""" No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water K`,�, No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach addttional detail J 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 licen- see 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 R BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: I certify, under t FIRM NAME: Licensee: �} (If applicable, enter )Z— Inspections to be requested in accordance with MEC Rule 10, and upon completion. and penalties of perjury, that the information on this application is true and complete. " in the license number line.) Signature OWNER'S INSURANCE WAIVER: I am aware at the Licensee does not have signature below, I hereby waive this requirement. I am the (check one) ❑ owner Owner/Agent Signature Phone: LIC. NO.: A: f 4,gA7 Llr. LIC. NO.: E:12,01r3y6 Bus. Tel. No. - Alt. Tel. No. A 14K_3014 the lia i ity insurance coverage norrnally required by law. By my ❑ owner's agent. Insurance on File: Will Fax: Permit Fee: Receipt #: Date: -7b 6 08— g 5y5 0 „ 01; Q0 4 G� - `X Commonwealth of Massachusetts Official Use O,nply2 Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATIOA9 Date: _2 n _ City or Town of- To the Inspe for f Wires: By this application the undersigned gives notice of his or her inter ion to perform the electrical work described below. Location (Street & Number) Owner or Tenants - T k {.Joy td.ir. _ Telephone No.��- Owner's Address I /„Z Midr)l fetact 3 J I -- is this permitin conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building jLiy�-ivt,t . Utility Authorization No.����7 . Existing Service/QD Amps jZ-0 / 2 Q Volts Overhead�� Undgrd ❑ No. of Meters w Service L� D Amps L 20 / 2 (yVolts Overhead R�jk, Undgrd ❑ No. of Meters of Feeders and Ampacity 1{�a_tion and Nature of Proposed Electrical Work: t� AAO,,, i mmnlvtinn of the following table may be waived by the Inspector of Wires. of Recessed Fixtures No. of Ceil.-SusP (Paddle) Fans N-0.0 f Total Transformers KVA of Lighting Outlets No.. of Hot Tubs Generators KVA of Lighting Fixtures Above In- Swimming Pool r ov ❑ rnd. ❑ o. o Emergency Lighting Batter Units f Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones Swltches No. of Gas Burners No. o Detection an Initiatin' Devices f Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Waste Disposers HeatPump Totals:Detection/Alerting Number Tons KW No. of Self -Contained Devices Dishwashers Space/Area Heatin KW g Local ❑ Municipal ❑ Other Connection Dryers Heating Appliances Security Systems: No. of Devices or uivalent aterKW Heaters No. of No. of Signs Ballasts Data Wiring: No: of Devices or Equivalent dromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. CE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless 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 t& BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work (When required by municipal policy.) Work to Start: 2-/7 2 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thb pai s and penalties of perjury, that the information on this application is true and complete FIRM NAME: t LIC. NO.: - q % Licensee= Signature _ LIC. NO. -Z�3`I (If applfcabl t, t" i the license number ire.)d G(�t� � Bus. Tel. No.! 'ot 53000 Address:Q►�� e ,"1_ Alt. Tel. No.: 7 OWNER'S INcr we" i�r'.R� I am aware that the Licensee -does not have the liability insurance coverage normally , equired by law Owner/Agent ;signature _ By my signature below; I hereby waive this requirement. I am the (check Telephone No. L ?(, &-e 21thc. Cv nv'eJ-5c�-M.. J