Loading...
HomeMy WebLinkAboutMiscellaneous - 193 GREENE STREET 4/30/2018 (2) 193GREE NE STREET 210/045.A-0003-0000.0 r " N° J . . J Date............./........:........ 1 N°RTN °f'"`°:• '"a TOWN. OF NORTH ANDOVER o p PERMIT FOR WIRING ,SSACMUS� I � This certifies that ........................................................... ............................... r has permission to perform wiring in the building of at........................................ ................I......... ,North Andover,Mass. Fee/................... Lic.No.............. ............................................................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 1ACt'AJUft1t/V1UPFUIfLI(,.WA1r Permit No. �c S BOARDOFFIBEPREYEMONREGUTAT101KSSr MR12.M VA Occupancy&Fees CheckedPPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. i Location(Street&Number) Ay3 Owner or Tenant Aorl C Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building 5, (21, Utility Authorization No. Existing Service AmpsVO4 Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No.of Meters _ INumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work' No.of Lighting Outlets No.of Hot Tubs No.of Transformers i I KVA No.of Lighting Fixtures Swimming Pool AboveBelow Generators KVA andgiotaid No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total. No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained �..�. 1 Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Oth-;r, Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- hmrxtoeCo►s�AawatrtblhetequcanatsodtisetlsGerla�alLaws Iha%eaametLrabif h stra=Pb ya idrgC.aq*k C0&2Wer9ssubstat0leWivalat YES NO alha%eabtnkodm&ploofofsamebtheOffm YES NO IfywhawdxckedYES pimeat kxi3 3etmxofineaWbycliadmtgthe II�.SURANCEBOND F-1 01HR la spa!Spm') l/'-CrV f l ! D l31m*d ValueotE 1mhnl Wait$ WakIDSW hVecfimD bRgjxWd Ra* FmW Sigttadunda�iel�ltie;afpajtay. ��t1(� (_����� ���-�G'<<, FIRMNAME / ,� Feria .�36�d r Lim= /�'CJ'y C!Z . C4�hm q^ Stene `-�';" , Lic=e b BeskmTel.Na 1^2-23 1-�5- o-TJti -S,\\C)o US () AltTdIsh OWNMSDqRRZANCEWArvTR,IanmvmhtibeI doss metheilstrameeommFoilsWAvt& ridatasmgtmWbyMass d setCrxalLam andthatmysig�taern thispa�tnthsta�neni. (Please check one) Owner a AgentED Jv��l Telephone No. PERMIT FEE$ 'L3 Location 5K3 Cr-e PN No. t13 Date •?�--Z4/ NORTH TOWN OF NORTH ANDOVER 0? •. • L9 i wqqw • + ; , Certificate of Occupancy $ �'�•°',�• <� Building/Frame Permit Fee $ a?�cHust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check # 0 C 'I �� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. V3DATE ISSUED: P/ X SIGNATURE: /UC rc.. Building Conunissioner/IRECEtor of Buildings Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 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 RegWred Provided Required Provided 1.5. Flood Zone Information: 1.8 Sewerage sal 1.7 Water Supply M.GL.C.40. 54) IftieraB �-GP° System: Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record ( Name(Print) Address for Service: I Q Signature Telephone 2.2 Owner of Record: j Name Print Address for Service: Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ V4- ( J a Z- AZd Licensed Construction Supervisor: d 0 60 w J3 S te License Number n ✓ r � ress �--�Z d 0 2 kv,�ti Expiration Date ic Si'gnaluk Telephone 3.2 nRe`gistered Home Improvement Contractor Not Applicable ❑ Company Name 1 0 -Ll 7 M 111-14 Registration Number Address REM ©—tle J a�T/ Expiration Date Si nature Telephone I SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) P 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 i Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be x UI�FICIALt)SE 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 / l 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, V4 L L-A " 7-4 as Owner/ uthorized Agent f subject property Hereby authorize to act on My behaW matte r ive to work authorized by this building permit application. Signature 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 Signature of Own er/A ent Date NO. OF STORIES SIZE ; BASEMENT OR SLAB d' SIZE OF FLOOR TUABERS I 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover tAaRrk C& Building Department o� y _��- �� 27 Charles Street ~ + North Andover, Massachusetts 01845 (978) ax. �688-9545 F (978 688-9542 l l '1s,4 °q�re° rP`y�5 SSAC�IUS�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and 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 cl 1, s150a. The debris will be disposed of in/at: f � �-,e� l2ri��i s� �l� s G'dr•� � Facility location Signature o p Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: 0&t L nc1 S Location: I CL_&It a2 'y. I z S7 City oy"12't✓/Ln 211iJ4 Phone am a homeowner performing all work myself. FF-1am am a sole proprietor and have no one working in any capacity ERI l am an employer providing workers'compensation for my employees working on this job. Company name: 1 f2W 1 1G-4,fN® C V Address 12-2-6v G L wn/-f' ST City: W1 dti i d Ae kl?A Phone#: `� 7 0- lr .��— 4&8,1 Insurance Co. `�/Z/4yI-r L m4 S Policy# 2 00 j1 e.�?3'Y/6r8 Company—name: Address City: Phone#: Insurance Co. Policy# 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 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. I do herby certify under the pains and peneltie f perjury that the information provided above is true and correct. Signature Date 7— OV Print nameVPhone#�7 '� d � Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION n �fe �an:manu�eatl�i a�✓Gl'�Jdru�tu6e�d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 008828 Birthdate: 04/20/1951 Expires: 04/20/2002 Tr.no: 4 p 1951 Restricted To: 00 VAL J LANZA 34 BIXBY ST REVERE, MA 02151 Administrator I I �I I! NORT#i ED own of 3 _- n over, Mass. ARRA T E D /'Pa\,`.�5 S BOARD OF HEALTH PERMIT T . D Food/Kitchen Septic System �N/V I•.s � � � BUILDING INSPECTOR THISCERTIFIES THAT.... .......................................................r..o.O....f...... ........................................................... Foundation has permission to erect...S /t p............. buildings on ....I...IM.. �'.t.l�.........&4%............. Rough to be occupied as rt Q�ht00 '�' V�N � .S �/ ! v �� CO& r'A91I Chimney ....................................................................... ............. ............... ...................................................... 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-Laws elating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. i/S-A PLUMBING INSPECTOR �7 AP7.3, Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMEXPIRES IN 6 MONTHS Fina' IT UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 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. SEE REVERSE SIDE Smoke Det.