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HomeMy WebLinkAboutMiscellaneous - 183 PLEASANT STREET 4/30/2018Date ..... I...... ... �. �). TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... C..:.......1.....�t!............................................ has permission to perform..............cc.........................!. e ........................ wiring in the building of ...................�?�4 A—v:.................................................. F ........ ..5.., ! i�'-Cm> North Andover Mass. Cc)p� ,/. Fee..-............ Lic. No..aD.q;. y........., .............. ................ ELECrRicAL INSPECTOR Check # 9253 m w o f ci O ti N, Q a w Q� �l 'v U,. ti. � � o � •s w o U � ooz aoL) 3 tp aki �r to U � � :--. yam.+ •� y N U ..., U b-0 `p g UOoG•� t^C b� o CN"o y t ❑ N .'�. —C3 'DC7,• O m O .0 C fbJ—p +wm N P. p� N� N N A. U 3 bo 00 N O .O i..O a• In p 0 +-+ O 0-0 aaiw Y of o o N o 'o L3 a> C o' bo' 0 0o o El cw.S L '� c C 0 1- o -s+ 3 °� 5C, ou a o+� �w o E ca G �bo 73 3 c bo � c pp V1 y a 4UOi G a) N 74 N I O. o a� P� N P. 0 �aao�,. // 00 c� Ccco.M wnweaUit W Ma.�iuls16 ��n a1 p.,t."t Serviced BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2Z 13 Occupancy 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 ( MC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORAMTION) Date: �/J 1 / 0—&10 City or Town of: AD . AMTo the I nrCnspector of fres: By this application the undersigned gives n77,0f h7,05 or her intention to perform the electrical work described below. Location (Street & Number) / 7 Co Mro-0 ti Owner or Tenant f V1 I KF Telephone No. Owner's Address 5aync, -j Is this permit in conjunPy with �,�"building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building I j) n C 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: &as f—t f Eo urnaC� Comoletion ofthe followine table may he ivaiwd by tha In-rnerrnr of FYira v No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No, of Switches No. of Gas Burners j' No. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alertin Devices g No. of Waste Disposers Beat ump Total s: umber - Tons _ o. of e - ontaine Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unicipal ❑ Other Connection No. of Dryers Heating Appliances I(W Security Systems: No. of Devices or Equivalent No. of Water I(W Heaters o. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of !fires. 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 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 coveLw is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under 11 sins nd p tatti��snnojperjrrry�'%t t the ittfornratlon oI his application i rue and complete FIRM NAMF.44 LIC. NO.: TVA Licensee: ti/'t5 1046 Signatu LIC. NO.: (If applicable, ere�Ppt' ur the license number line.) /J �An � , /� Bus. Tel. No.:g 7 J Address: Pb"Y C0 Y- l l � NO . /-f/1✓�1�� / "V 1 0 7' Alt. Tel. No.• *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Ageut Signature Telephone No. PERMIT FEE. $ y�v,..i� TOWN OF ANDOVER ELECTRICAL PERMIT FEES �E ctive March 12, 2003 MI)�IU1YI t1�0`la�;: Ah�zt-Ic.k �3 HT a F F11"7tr y` ' a OlVIME' c1 tl�S..�O�OQ NO SE CABLE ON OUTSIDE OF BUILDING Air Conditioners: $40.00 each Alarm Systems Security: (for fire systems see smoke/heat detectors) Residential: $40.00 Commercial: up to 10 Devices $60.00 additional devices over 10- $1.00 each Carnival Equipment: $50.00 each Ceiling Fans: $1.00 each Commercial New Construction or Alterations: $100.00 per 1,000 Sq. Ft. of Construction Space Commercial Service Change/ Repair: [Viust have Utility Authorization Number $100 (fust 100 amperes or fraction, one meter) a) each additional 100 amperes capacity or fraction. $30.00 b) each additional meter $25.00 Commercial Temporary Service: $100.00 Must have .Utility Authorization Number Commercial Repair and/or Maintenance Permit: (Blanket Pern:it).up to 2 Electricians $150.00 per pair of Electricians over 2 $50.00 Data/Telecommunication: Residential: $1.00 per port Commercial: $30.00 up to 10 devices over 10 - $1.00 each Dishwashers & Disposals: $5.00 Each Dryers: $15.00 Each Emergency Lighting (Battery Units) $ 1.00 each unit Feeders or Sub -feeders: each 100 amp capacity of fraction thereof Residential: $5.00 each Commercial: $15.00 each Gas/Oil Burners: Residential: $20.00 each Commercial $20.00 each Generators Residential & Commercial: a) including photovoltaic & generating Equip Per KVA $1.00 b) un -interruptible power systems, per KVA $1.00 c) batteries over 100 amp. hours, per cell $1.00 Heat Devices: $1.00 each Heat Pumps: $40.00 each Hydro -Massage Bathtubs/ Hot Tubs: $20.00 each Lighting Fixtures $1.00 each Lighting Outlets: $1.00 each Major Appliances: (not listed) $20 each - Motors: (per hp or fractional part thereof) $2.00 Oil /Gas Burners: Residential $20.00 each Commercial $20.00 each Office Furnishings: per circuit $10 elocatable Partitions/Cubicles) Outlets & Fixture: $1.00 each Ovens Built in/Counter Top Units: $10.00 each Panel Change/Circuit Breaker: Residential: $20.00 Commercial: $25.00 Phone Jacks: See data/telecommunications Ranges $15.00 each Receptacle Outlets: $1:00 each Recessed Fixtures: $1.00 each Re -inspection Fee: $25.00 Repair to Service Residential: $20.00 Residential New Construction (Dwelling): $220.00 (with service up to 200 amps) Must have Utility Authorization Number for services over 200 amps see below a) for each 100 amps capacity or fraction add $20.00 b) each additional meter $10.00 c) each additional panel/sub panel $25.00 Residential Additions/Alterations: $220.00 maximum Residential Service Change or Underground Service: $40.00 Must have Utility Authorization Number a) one meter, up to 100 amp capacity $40.00 b) each additional 106 amp capacity or fraction $20.00 e) each additional meter ..$10.00 Sewer Ejection Pump: $25.00 Signs: $25.00 each ballast Smoke & Heat Detectors & Initiating Devices: Residential: $1.00 each Commercial: $60.00 up.to 10 devices over 10 - $1.00 each Space Heaters: area heating $1.00 each Sub -Panel: $25.00 Swimming Pools: Residential: Above Ground: $25.00 Inground: $50.00 Commercial Pool: $100.00 Switches: $1.00 each Temporary Service: Must have.Utility, Authorization Number Residential $25.00 Commercial $100.00 Transformers: a) capacitors, Per KVA $1.00 b) ducts; conduit & conductors (Associated w/ Padmount Transformers) $2 c). each manhole $10.00 d) each handhold $5.00 e) per KVA $1.00 i) primary feeders, $25.00 each (over 600 volts, non-utility owned) vaults and equip. $25.00 each Washers: $15.00 each Waste Disposals: $5.00 each Water Heaters: $30.00 each *For Multi -Family & Large Commercial Project see Wiring Inspector for pricing: Paul Kennedy (978) b23-8306 (Office Hours 8 am to 10 am) *Inspection Schedule: 1 ROUGH 1 FINAL 1 TRENCH (if applicable) ADDITIONAL INSPECTIONS *$25.00 (if applicable) (revised 07/05) ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mas&govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information II Please Print Le ibl Name (Business/Organization/IndividY �Zrt 5-6o k e % i v` l v1 6— Address: OF o • iUU V_ City/State/Zip: Phone #: 7 Y7'— FW- 7 91? 9 Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.(T Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other •-may ei yuu::ss: UML cur.:xs Dox ff., mus; also illi out the section nAin4. t SnCRRnb^ *"=1y R�Crkers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. Iam an employer that isproviding workers' compensation insurance for ipy employees Below is thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 c underj0pd nd pnRli i y bfperjury that the information provided above is true and correct Phone #: L Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However 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 15.2, §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-contractor(s) 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 carry workers' compensation insurance. If 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 retuned to the city or town that the application for the permit or license is being requested, not the 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 line. 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 of the 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-72.7-7749 Revised 5-26-05 www.mass.govfdia BUTTERWORTH & 01TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O. BOX 8294 SALEM, MA 01971-8294 TEL. (978) 741-5731 FAX (978) 740-9109 claims@butterworthotoole.com 11/02/2012 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall ADDRESSES North Andover , MA 01845 RE: Insured: Jim Vitas City/Town Hall North Andover , MA 01845 Address: 181 Pleasant Street, Unit 181 North Andover , MA 01845 Policy No.: Loss of: 2612229 10/29/2012 Water File or Claim No.: 021-1089 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Brad Doherty Adjuster �z Member of National Association of Independent Insurance Adjusters BUTTERWORTH & 01TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O. BOX 8294 SALEM, MA 01971-8294 TEL. (978) 741-5731 FAX (978) 740-9109 claims@butterworthotoole.com 11/02/2012 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall ADDRESSES North Andover , MA 01845 RE: Insured: Jim Vitas City/Town Hall North Andover , MA 01845 Address: 181 Pleasant Street, Unit 181 North Andover , MA 01845 Policy No.: 2612229 Loss of: 10/29/2012 Water File or Claim No.: 021-1089 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Brad Doherty Adjuster �:ufiifs�V Member of National Association of Independent Insurance Adjusters /'/- /Y3 Y-3 No. O'Z 0 Date 19/3 0 NORTH TOWN OF NORTH ANDOVER ` Certificate • i of Occupancy $ s�cMust Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /30 Check # Building inspector C Location Date No. -- G TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ .r TOTAL $ Check # 16.73 Building Inspe49r` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING tion farQt kw" Ilse po BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION Q 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Number Parcel Number DMap 1.3 Zoning Information: ��1� l ZoningDistrict Pr ose Use 1.4 Property Dimensions: koo IN Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R 'red Provided 1.7 Water S° M.GL.C.40. 54) 1.5. Flood Zone Information: Public []/ Private ❑ Zone Outside Flood Zone 1.8 Sew I System: Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Na{rte (Print)ss or Service ©CMZ a, Signature elephon 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature • Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone 00 rn X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25061 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 au applicable) New Construction 0 Existing Building ❑ Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: s r n 1 S�� h �� ' 0J. l p ?a'i' _ d=A-.a d SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 2 Electrical 60 (a) Building Permit Fee Multiplier U (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 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, 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 I, \6'c. ��' �,� (� C� _ ����- �� as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief 1 r V( P int ame S' nature of Owner/Aged L Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS iST2 ND3RD• SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I[EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE at 30 02 11,245 HTTY SCOTT CONSRUL 9788518119 MORTGAGE RTGAGE INSPECTION PLAN 18.1 183 PLEASANT STREET NO. ANDOVER t MASS_ TROY 4Y ERIE F. ASSOCIATEES_ REGISTERED LAND SURVEYOR 1455 MAIN S T- 's EWtKSBURY, MASS. W P.1 PLEA5,4 AIT 5Tk;F9T' <'v, GD�I 5.F I HERE13Y CERTIFY TO THE TITLE INSUR.OR . TME LENIDR46 !INSTITUTION AND OTHERS 2 TKAT, THE DWELLING IS LOCATED ON THE LOT AS S14OWN 3 , AND THAT iT !DOES COMFORIM W!TH THE -Th-klu OF IJs- A,,,jcovez ZONING REGULATIONS REGiARDING FRONT, SIDE .AND REAR LOT LINE SETBACKS_ I FURTHER CERTIFY THAT THIS DWELLING IS No!— LOCATIED IN THE FEDERAL FLOOD HAZARD AREA AS SHOWN CO+iriiwUNi T Y PANEL NUMBER: Z-5iwl8 DATED : jum.15 /4S3 - SIGNATURE NOT VALID UNLESS IN RED INK. � - tJ,,ftaN TrzusY MoiZTGr,46� CotzP IS4A . DATE: 2- 3 -THE BASIS FOR T141S LOCATION IS A TAPED FIELD SURVEY AND IS NOT TO BE USED FOR THE CONSTRUCT104 OF nyCES, SHRUSS , LANDSCAPING OF ANY %!ND,ADDITIONS .POR.CHES,DECKS, OR OTHER ACCESSORY STRUCTURES . A PROPERTY SURVEY UNDER T14E STANDARDS GOVERNING CADASTRAL . ORIGWAL OR RETRACE- NENT SURVEY IS STROR6LY RECOMMENDED BEFORE ANY CONSTRL'CTI0+1 OF THE AFORE MEW•!'IoNED. NOTE: BOUNDARY INFORMATION TAKEN FROM: lJ.e Z.R PLAA! : F3L .182 FG. rano . D. Robert Nicetta . Building Commissioner (978) 688-9545 °(978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street North Andover, MA, 01845 HOMEOWNER UCFNSE E�(EtytpnCN Please print DATE toiZ9I o IOD LOCATION ` " Number Street JOMEOWNER Y P ESENT MAILING Name Home Phone Town Stat .. Map /tot The current exemption for "h of two units or less and to omeowners" was extended to include o►wner�� udwellings not .aUow such homeoWners to engage an possess a inctivid hAre W*0 does DEFINITION OF ►icense. provided that the owner acts as supervisor (Stateauiding Code Section 1*08 3 5_?) HOMEW0INNER: Person(s) who owns a parcel of land on which h0she resides or intends to there is, or is intended to be, a one or two Vie. on which cessory to such use. a'nd/or farm ... ' dwelling. attached or structures . q.persort strex►reS ac_ two -Year- Period shalt not be'cor►sidered a homeowner e ► � borne in a The undersigned -homeowner" assumes responsibility for co Applicable codes, bHaws. rules and regulons, MPkw)ce with the State Building Code and other The undersigned "homeowner" certifies thrat he/she understands the T own of Building Department minimum inspection PrOcedures and requirementsN hn ��tt �PtY with said procedures and requirements_ and tt OMEOWNER'S SIGNATURE 'PROVAL OF BUILDING OFFICIAL 0 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: of Facility) Signat re o Per it ApokicanIf 1014ozo 2 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r Z 0 1 s.� w ERS* w o A a co , Ll E a cn wLX.° O z z Q 04 w 2) G U C° a p v Z r -i A. cL m w a o w w wo a2 cin c° w p U w z to —Cj w w � w A w opo z cin o cn O • m c c ?: o 0 O N IL o� O •a� �: E a s _s E _ 4 �cc,C c : O �wO IA 0 � C2 mCM c #,i6N R m O �y t i cm : m �. N � E M o __ Ai -E C.3 L.: - o' _ o o amc y = o �� c Qct s: IDo f m Q•FZ o oCD c m N O C C CD ago N ~ y m o m t W W4 -- C -N G= �_ c Z E V O c C C� m p m C VD a m:2 Cl i sam- O 0 L Z ca > O 12 ICD CM C C CO) Q ECD CD CD mm 3 .o 0 Lft' 0 0 L CK CL �4 CO) CD Ccc CJ J .a OD -C Z CD CD CL. C.2 V) co- C c CO) 0 0 U) VJ Ir w w Ir VJ I w O" U 0 w° T cn C/)w° o z A o -0 to U w to a cd w a w U w to d E cn w a O a . d C7 ro w z a A a w w� o ci) i o cn o m c c ca CD C H O C W O e V CZ C m C r y.. A O � m CF o c N CM SOL o O co cc m O N .� m C_ }O C � O A � ' N W .L" N E� Fav N m m N v N O cc '� Z • c o m CL : H CDC = m m=... � � CZ CA 'r � _ �• m LLJ LL O m C •.+ H N .Ci= O C CLLLA •E V .0f01 N C) m p m C CO2 LZ O O 'E = W = ` N.= E a N O zo N A m O cc m m 0 m S C iV m _ O Z co 0 zip O U Q vJ zzk: z U z U 1' O S v I Com_ CO2 Q 'a C M ECD Q CD m m H CL .4-6 � �� co CD CD O to O a CL cmQ y C o 4-0 � O vO —j •Q O � D COD C z CD O C. C..2 CA cc C C� 03 C. CO2 0 Cn w w crw V) of 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that n Sf ( ..............!1.............. .............r. C has permission to perform �1 `� `i ............................................................................. wiring in the building of .......t.. �.�......................................... at �' 1 E �' f...:! ST ' North An ver, Mass. Fee ....;�.:�`�.... Lic.No....�� i �....•::.....1....:.. ................ ELECTR�ICALINSPECTOR Check # � C' � � %i WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Official Use Only 1(3 _. -1 Department of Fire Services Permit No. IMFBOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/991 (leave blank 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 INFORMATION) Date: C',I t 31 t 0 City or Town of: Q p f +h 0 k) LI -)o 0 e. 2 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location (Street & Number) 1 c6 pi_ e ct S cl r) + S � . Owner or Tenant Owner's Address Sc sSXcce_ Is this permit in conjunction with a building permit? Purpose of Building Existing Service _ New Ser%ice _ r ► cL Telephone No. 9 % Ff- 68�� - 6-8 Yes ❑ No (2 (Check Appropriate Box) Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: u r \ Ck r _ v No. of Meters No. of Meters Completion o0he following table may be waived by the Inspector 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 Fixtures boven- Swimming Pool grnd. ❑ rod. ❑ o. o Emergency ►g mg Batten 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 b No. of Waste Disposers Heat Pump Number __-'__1___'_'1 I Tons IKW - ----- "- No. of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local r-1 Municipal ❑Other Connection No. of Dryers Heating Appliances Kit ecurity Systems . o cv►ces or Equivalent No. o Water KW o. o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs 7No.of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Anoch additional detail if desired, or as required by the Inspector of {!Fires. 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: Estimated Value of Electrical Work: eq (Expiration Date) (When required by municipal policy.) Work to Start: 1-14 " Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ojperjury, that the injorntation on this application is true and complete FIRM NAME: ADT Security Services 111 Morse Street, Non4otl„ MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Signatur (If applicable, enter "exempt " in the license number line.) Address: OWNER'S INSURANCE WAIVER: I am aware that the I ensee does required by law. By my signature below. I hereby waive this requirement. Owner/Agent Signature Telephone No. /may LIC. NO.: 1533C Bus. Tel. No.: - . - 1 Alt. Tel. No.: 603-594-.59 resi not have the liability insurance coverage normally ONLY 1 am the (check one) ❑ owner ❑ owner's agent. PERA71 T FEE:. 6S.