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HomeMy WebLinkAboutMiscellaneous - 203 MIDDLESEX STREET 4/30/2018Na 1573 Date ........ . ........................ 6+0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING Thiscertifies that .. .................................. ......... .............................................. has permission to perform .......... .............................. ............. wiringin the building of ................................................................................... ................................................... ................. . North Andover, Mass. ...... Lic. N ......... . .............................................. ELECTRICAL INSPECTOR 03126/99 08.-53 50.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7BFC0A i 0A +4271QF'ARM' QRS= Office Use only F.PARTMFNlOFP0 CSAFE7Y Permit No. BO OFFIREPRE�FM70NREGUI.4T101�6527CW 12--00 � Occupancy & Fees Checked UIVPPUCATIONFOR PERMIT TO PERFORMELECTRICAL 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 ]Fl,;2j-l-� 4-' Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) C) 3 Z 0 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes r7 No (Check Appropriate Box) Purpose of Building aG✓i— 6 , Utility Authorization Existing Service 0 AmpsS Z. olts Overhead Underground No. of Meters1-2 J New Service 0 Amps&,C�k-,Volts Overhead ( /t Underground No. of Meters i Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Vo. of Lighting Outlets No. ofHpt Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:1ound No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pura s Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipala Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No.)Hydro Massage Tubs No. of Motors Total HP •:. ur.• al•••rr� •I -.il•- J. �� • • ••:•:. .•t. •mac-: ur.•I - •-ru _-. •:.•: •I - •/ •• �- •_J :•ff •: I •' 11 • • It ' . t FAnxied Vater dElmural Wotk $ Fa,al Li=WNTC, Licetsee S �9'i7 Sigr>ahae 1_ Lioe>seNo / Business TeL % G, 7io�j��� Alt. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... .. ..... ......... ................................................... has permission to perform . ........ .................................... wiring in the building of .......... .. .......... .. .............................................. at .....c- . ........N ............. ,North Andover, Mass. Fee..�? ...... Lic. No. .......... .............. ��RICAL INSPEMR Check # ae(raatnrurt o6 �a8!!e Sa�dy BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No. —SI?190 Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number dU cfU� Owner or Tenant i// A.-� fll Owner's Address Date LES -.1 To the Inspector of Wires: Is this permit in conjunction with a building permit Yes O No lam (Check Appropriate Box) Purpose of Building Utility Authorization No.. Ud % go Existing Service Amps Vats New Service '�Q D Amps 1012!&!Z � Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead ❑ Undgmd ❑ No. of Meters Overhead []/ Undgmd ❑ No. of Meters 3_ OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a current Liability Insurance Policy includin%Z,,ompleted Operations Coverage or its substantial equivalent ESL NO = have submitted valid proof of same to the Office ES NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Pe les of F�7lury: FIRM NAME /r..w �/%1/t.l UC. NO. res LIC. NQ.—,ei C �,. A --0 � A � �� Bus. Tel No. Address r P_ �� G fdn iU [f`3_dZ6Alt Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does 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) er/ Telephone No. PERMITTEE $ (Signature of Owner or Agent) 1-/ Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA 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 No. of Detection and Total. No. of Ranges No of Air Cond Tons Initiating Devices I Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Spa ce/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ 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 includin%Z,,ompleted Operations Coverage or its substantial equivalent ESL NO = have submitted valid proof of same to the Office ES NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Pe les of F�7lury: FIRM NAME /r..w �/%1/t.l UC. NO. res LIC. NQ.—,ei C �,. A --0 � A � �� Bus. Tel No. Address r P_ �� G fdn iU [f`3_dZ6Alt Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does 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) er/ Telephone No. PERMITTEE $ (Signature of Owner or Agent) 1-/ i Location°.?' < ^`'1 No. (-y z Date TOWN OF NORTH ANDOVER 17 i Certificate of Occupancy $ Building/Frame Permit Fee $ s4c14Us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6J`� -- 6572 �. Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING P tr.°f;A: .&,,.'s�'7'R3MY ,°k Y r;ln3iY~`�b, ..?nN��A ill}. �1./ii'$ S�,.k k'..- WA �`_: 3 ,�T BUILDING PERMIT NUMBER: v a DATE ISSUED• D •qv�q. . SIGNATURE: Building Commissioner/IETwtdr of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ,2,!Q3 -,20,57 1.2 Assessors Map and Parcel Number: Map umber Parcel Number NdG 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: \ 6,,q / 1� q7�� LA Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re(v'red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private 0 Zone Outside Flood Zone 0 1.8 Sew a Disposal System: Municipal 7a On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Prim Address for Service 4 / ) -/, ,/, 6 V /J/, 21 tune SigB'��jj� Q elep'hone /I,- .- 171e C7�l 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 IV License Number Expiration Date I 3.2 Registered Home Improvement Contractor Not Applicable Ili Company Name Registration Number Address Expiration Date Signature Telephone 0 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 permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building 11,1 Repair(s) Alterations(s) ❑ , 7dition Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: l yd. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE,E3N�:Y 1. Building (a) Building Permit Fee Multiplier f �o n,cn,. 1E1_ 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing--= Building Permit fee (a) X (b) 0 f 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 pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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/Aent Date NO. OF STORIES d2 SIZE BASEMENT OR SLAB A SIZE OF FLOOR TINIBERS 1ST2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS Di vENSIONS 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 FORM U - LOT RELEASE FORMS �d gxlc� 4.��—�3 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT_.ToSe�� �'l{gf�►��i/vF ���/1�ji✓ LOCATION: Assessor's Map Number SUBDIVISION STREET PHONE/� S ?3 99 PARCEL LOT (S) ST. NUMBERd03 a0-' 1.1,sey .r�k ********************************OFFICIAL USE ONLY******************************* If CONSERVATION COMMENTS AGENTS: DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT I RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm Tel: 978-688-9545 Please print. DATE / ` T_ © 3 JOB LOCATI _,>,93- a, as Number "HOMEOWNER`{— Number PRESENT MAILING ADDRESS City Town Town of North Andover Building Department 27 Charles Street ��SSacHusE�� North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Street Address Home Phone State Section of Town Work Phone The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) Zip Code DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. A HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIA Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. 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 Perrnit 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: (Location of Facility) Signature of Permit Applicant Date (VOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector n Cl) U) Cl) m i V) 0 z 0 0 a� d d p.p CL n� .p O o p c acr� coo y CZ) 0 O M Cl) O C CA IM CD 0 CD CD CD 0 CD 0 CD C_ W 5'n p =r -4 O S. y o Q y = 4c Co ti a' o m CO 0 .� T CA cl CD CL CL .. CD �� m m C y N o � ? 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