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HomeMy WebLinkAboutMiscellaneous - 208 SOUTH BRADFORD STREET 4/30/2018N oO .P n O O O O O O O r �- Location No. a Date 3 NORTh TOWN OF NORTH ANDOVER • . ' OL 9 Certificate of Occupancy $ �S CHUS Building/Frame Permit Fee $ a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a' O � r Check # (0 b l "1673) I l k t I l-_ Building Inspector Date ..... .1`-..137755 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �Cu ....................................................................................... . has permission to perform wiring in the building of ..........>. }s!5 ....................................... at .... .02.......5....1?.#Akc ?1I.....5.; ....../.. N�ortrtth�Andover Mass. �,� Ac> '7097-5'e- ��til.rf.�f7r�1/i'1 Fee .... Lic. No. z .f) ............... -;/......... 5 S e2 Z 11 Yy ELECTRICAL INSPECTOR Check # IS�l -�-5- 77L 04 LanlntnnuraaLtli. of 1Y/addac/Uldeild offioinl Use Jnfy Permit No. ;r '� 2e/)arlmeul. ol�irp �aruicnd -77)27 Occupancy and Pec Checked ��/ BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07) (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All worle to be performed in uccordnncc; wl III Ilse Manaoehuseus Bleetricnl Code (IVEC), J27 CMR 12.00 (PLE/1L7E PRINT fN INK OR TYPEALL INP ORAIMTION) 1Dn te: 11-3-0-) City or Town of: A /Q/t oou-4z. To the hispeclor' of Wires. Hy this appGuntion the undersigned gives notice of his or her intention to perform the electrical work dmeribed below. Location (3treet & Number)'20'$ Syti(h fV40fo ko 51- Oivner or "I'aunnt g 1 c h /AAViNeSS.d Tolephone No. Q—/T'4$l 0171 2 O wner's Address le fills pormit in eonjunchon with n building permit? Purpose of Building E, xlsting Sarvico Amps 1 Volts Now Service Amps / Volts Yes ❑ No W (Check Approprinte Box) U(il(ty Allkhorizntian No. Overhead ❑ Undgrd ❑ Overhead ❑ Ilndgrd ❑ NO, of Meters No, of Meters Number of Feeders and Ampaclt)' Location and Nature of Proposed Electrical Wor•lc Conmlellna oflhe follotvinp table nrav be maivcd b), the /nsoecror ol"YPi)-as, No. of Recessed Luminaires No, of Cell.-Susp, (Paddle) l''rim No, of ata Transformers KVA No. of Luminalrr. Outlets INo, of Hot Tubs Gonarators KVA Na. of Luminaires ADI -I've n- swimming Pool �'rnd. ❑ arnd, lNu. of +mervency Lighting Il3attory Units No, of Receptacle Outlets No, of 011 Burners _ FIRE ALAS INo, of Zones fvo, al et�nd j No, nfSwltehm No. of Gas Burners Initiating Devices No. of Rnnres No. of Air Cond. Tons No, of Alerting Devices ea�1�t��lc L....u.ns,,,,,,,,,,,,,,,,,,,,,,,,,,,, tie -1 nntnV edDevices, No, of MInste Disposers ,f�umber, Detection/Alertin � Devices � No, of Dishwashers 5pncelAroa Ilaating ICS' Murucr pal 0�0 m=.11i l D Other No. of Dryers Ileofin A ulinnces g p, Kl� ecurlty SYV ms; No, or bovices r L ulvalani No. n ater 1C>�1 Heaters No. W n. a Sl ns B;dlnsts Data No, or Devicos at' T IIII alL'nt No, I-Iydromnssngc Bnthinbs No, of Motors Totol HP l elecommunicutions n'tng: No, of Devices or E ulvniont OTHER: Ifthu:ll addilioml datall 1/(/csu•ed, or a8 requirud by dye Insperlor orIVires. Estimatod Valeo or Electrical Work: w (When required by municipal policy.) Worl( to S turt: Inspections to be mILIM(ecl in accordance will) IviEC Rulu 10, find upon completion. INSURANCE COVERAGE ; l)nles;, waived by the owner, no pemtil for lite perfarrnnucc of eleclrical work may issue unless the licunscc provides prnnl'of liobility insurance including "eornpleletl operntion" covurago or its mbsumliol equivnlenl. The uncleraigned curhlics tint such covzrago is in force, and liar oxhibilod pruul'of came to (he permil issuing orficc. CHECK ONE: INSMANCL BOND ❑ OTFIRR ❑ (5puuil'.:) I CCPl1%Y, « llrler (Aa pains 111111 pellid(hss of pcijnrp, tial IIIc iri%nrrrrarin r arr II1i1' applicalinn i.� Imre and conrpJc(c. FT RM NAIVIL: LIC. NO.: =FfSj.'rjc.. Licensee: jo1�� �r1Yl(1 ( Signature „ 1 1C. NO.: )(> 7 D l nrnpPlicnbla. F „,a ,b ,4/in Bas. Tel. Na ! I - FiJ 7 /'! AOdresg: L 3 . J., (� ' % Alt, Tol, No.; *leer M.G.L. u. ld7, s, 57-61, securil,y work requires Depnrlnicnl urPublic Safety "S" License: Lic. 1`la. '`. ')CL 55D. I99 01AINEP'S IPIS UT(ANCE WAIVER: I am awom the( the .l.,icensee does not hove (he liability insurance coverage normally required by )aw. By my signature below, I hercb}, vvnive (his reouiremont, I am the (check one) ❑ ommcr ❑ ommer' aecnt. ignR.111-t YFr{AIj7'TEE, S 5 )Yiiv /AC ph . Talenne No S TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: MR vj� SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 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 Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: ,,Name Print Address for Service: Si nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor:Not Applicable ❑ f 0;�C>Gcl �< 4 icensed Construction Supervisor: License Number Address / Expiration Date ature Telephone 3.2 Registered Home Improvement Contractor j/ p Not Applicable ❑ ompany Name Registration Number � Ear I ' lz,v Address Expiration Date re Tele hone Ma M X 3 z 0 Q v m 41 f UV 0 Z M 90 0 Mn r v M r Z P1 SECTION 4 - WORKERS COMPENSATION (XG.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 it. 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 Brief Description of Proposed I SECTION 6 - ESTIMATFD CONSTRUCTION rOSTS I V Item Estimated Cost (Dollar) to be Com feted by permit applicant OFFICIAL USE ONLY 1. Building(a) QQ 0 . �'� 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 6 Total 1+2+3+4+5 Check Number SECl'lUf4 7a UWf4ER AU'1'HUKIZA'flUIV TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner/Authorized Agent of subject property Hereby authorize to act on be lf, ' . �IW,rized by this building permit application. 3 v 3 ature of Owner Date SECTION 7b OWNER/AUTtIORIZED AGENT DECLARATION ti 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 F and belief Print Name of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T.UvMERS 1 ST 2 ND 3 RD SPAN DIN ENSIGNS OF SILLS DIMENSIONS OF POSTS DINIENSIONS 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 ►l r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print —0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F-1 1 am an employer providing workers' compensation for my employees worsting on this job. comtrany name. Address City. Phonic Failure to secure coverage as required under Section 25A or MGL 151 can lead tathe i npce tin of criminal penabn of;a fine up• to 57,5 andfor one years' imprisonment-as-vm Lasmo penalties-n-tbeSmn-afa-S7DPYkORICjDFU)ER.and-arms-f_(,3L[tO M),-*Jdw me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / oro hereby cerfify under th i Pena/tie of perlury��akw provided above is true and correct. Print name �1? -,- c,�, h C- - I -) --e &4< Phone.# 722r-6 2 -1 - Official use only do not write in this area tobecompleted by city or town offiaar City or Town - -- - Permitticensinrr. Building. Dept []Check lFimmediate response is required © [ jcengj j g Boa El Selectman's C Cantact person: Phone #. 0 Health Depart) E] Other y l,o —/2. CUd ��-Duca, S l'ozc�j 4 , .9 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 in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Z9-5� Signdi&e of rmit Applicant 3 25 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1 W W C.? w Ou r� O w iv v U) o. �• a or. co p w O a: C U G w4 o p co G w p y cn G w U z C7 p c� � G w w A w w G 'o,L co ° z cn Q o cn Iz ui z j m c 0 s L .:ter 0 culv •ate CLC &=o y�r Ea Y � c =ts m v0 0 y q 00 m c E 2: ow: CO) � m m i coi CD a E m � goow CLU L� y Imo: =Z O :mom s h 2 O O .... CI r C d 0 c Q i y m = •O _ m COL.. C N 1-- 0 y m S �-LU m CIO Z z MDiz .. c +- LA 010 m.y O .m` v F— Vo O. 4D.5 O = eyv �0LO) •� C F- t $ d «s•, m a I CO) CD .y CDL CL CD c CD V CL COD 0 d CO) C.3 m 0 V co CO) c CD CM c 03 o co m _o U) C/) Ir w w w U)