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HomeMy WebLinkAboutMiscellaneous - 209 Berry StreetNvR�ry _6 0TOWN OF NORTH ANDOVER p PERMIT FOR WIRING x � �•" a �SS�ICIIU`�� This certifies that 1`.,:!!....{.....—C:��!C�.:................................... j (// �'� has permission to perform ......,�...�.....�..�............................................. wiring in the building of ..: <.!....... �.t r .............................. j at, ........ , North Andover, Mass. ... .... ..... ... .., I�q9� Fee...... ..:.......... Lic. No.....,.....,.. .�...........��.�........................................ %/ELECTRICAL INSPECTO _ Check # ffi/� t1!/fn U y 553_) A q�FiT C09"0. ALWOT 911 Department ofrPu6Crc Safety BOARD OF FIRE PREVENTION REGI. APPLICATION FOR PERMIY TO All work to be performed in accordance Ith the (Please Print in ink or type all information) Town of North Andover V The undersigned applies for a permit to perform Location (Street & Number f� Owner or Tenant Owner's Permit No. ��✓� vsE�is --� NS 527 CMR 12:00 Occupancy & Fee Check' PERFORM ELECTRICAL WORK Massachusetts Electrical CodeZ`7 EMR 12:00 Date Z 2�'_ 6; y To the Inspector of Wires: electrical work described below. Is this permit in conjunction with a building permit Yes 0 Purpose of Building S111-V66L 71-1i7IJe,1/ /AQ1 Existing Service%,J Amps fJ ,PO Voits New Service Amps Voits No 0 (Check Appropriate Box) Authorization Overhead 0--_ Undgmd 0 Overhead 0 Undgmd 0 No. of Meters /_ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work V' G r ,✓ 79fa �lJ�J3ZG J ,t +INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES �NO C, have submitted valid proof of same to the Office YES O NO C\ tf you have checked YES please indicate the type of coverage by checki;19 the appropriate box INSURANCE e'BOND C\ OTHER 0 (Please Speciry) Estimated Value of Electrical Work$ C-0 (Expiration Date) Work to Start�n - /Z • r1 el Inspection Date Resquested GViGto L.'. LL Rough __ Final Signed undeTfhhe Pena 'es pf eryury: FIRM NAME 4 -Gs -0 LIC. NO. Licensee 7% t!i/(�-C7�c Signature _LIC. NO.�/3 _ Address�V L�%l "Y�t 1�� Aft T.I. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantlai equivalent as required by Massachusetts + General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Jfj Telephone No. _ PERMIT FEE $ (Signature of Owner or Agent) { Total No. of Lightin2 Outlets No. of Hot fuse No. of Transformers KVA Move 0 In 0 No. of.Lighting Fixtures Swimming Pool. gmd 0 grnd 0 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 I Initiating Devices _ J Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained - ro. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of Dryers HeatingDevices KW Local Connection No. of No. of _ Low Voltage No. of Water Heaters KW Signs Bailases I Wiring No. Hydro Massage Tuds No. of Motors Total HP l �i ,t +INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES �NO C, have submitted valid proof of same to the Office YES O NO C\ tf you have checked YES please indicate the type of coverage by checki;19 the appropriate box INSURANCE e'BOND C\ OTHER 0 (Please Speciry) Estimated Value of Electrical Work$ C-0 (Expiration Date) Work to Start�n - /Z • r1 el Inspection Date Resquested GViGto L.'. LL Rough __ Final Signed undeTfhhe Pena 'es pf eryury: FIRM NAME 4 -Gs -0 LIC. NO. Licensee 7% t!i/(�-C7�c Signature _LIC. NO.�/3 _ Address�V L�%l "Y�t 1�� Aft T.I. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantlai equivalent as required by Massachusetts + General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Jfj Telephone No. _ PERMIT FEE $ (Signature of Owner or Agent) { Name: Location: -� Ci Phone I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Com an name: Address C_ itv; Phone #: Insurance Co Policy # Company name: Address Ci!y: Phone #: — Insurance Co - Poli # — 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 $1,500.01 and/or one years' imprisonment -as _w.efl as_civil.penaltiesin.the fam da STOP WORK_ORDFR_and_a fine -of -(.$1A0.00).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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # official use �only do not write in this area to be completed by city or town official' City or Town Permit/Licensina — -- ❑Check if immediate response is required Contact Li Building Dept p Licensing Boar F-, Selectman's Oi Health Departn Other r 1^ Date. -37' /4"' c � — TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. {�."!.'..<< J/ has permission to perform ... ! !.kl':..0....................... plumbing in the buildings of ...Gr. t t . G ....................... at ...% 3 ..Q�/ ley..." ........� North Andover, Mass. Fee. -3.0. Lic. No..2 G tr i PLUMBING INSPEC OR Check H 1/G/f7 6449 C i MASSACHUSETTS UNIFOIXM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location of New M Renovation 1:1 Replacement FIXTURES Date S- a - o ),— Permit Permit # C VY Amount :3o Plans Submitted Yes No ❑ (Print or type)t / i ; Check one: Certificate Installing Company Name �,1`!' F '`, �: !1� ._; p,� Corp. LJ. s! ; Address i° °`4 l% Partner. Business Telephone Firm/Co. Name of Licensed Plumber: f Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 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 F1 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 Massamh !2ttsitat- Mumbin �d Chapter 142 of the General Laws. By: Signature of LicenseurJUMDer Type of Plumbing License Title r2' City/Town icense 1,41117157 Master ❑ Journeyman APPROVED (OFFICE USE ONLY Date....s...'�., . lJ..�J NORTH T °f<�``°:•�"� TOWN OF NORTH ANDOVER $' PERMIT FOR WIRING This certifies that ' has permSsion to perform.......-.P/'Ji ..............r.............�G ............ wiring in the building of ............7 .:........... ` .. . =.................................. 1 J (/ f L? t D,/ J at ....... ..... ...... ............ i..... r. � .:.......... .......... M<:�, North Andover, Mass. Fee .7.S .............. Lic. No./r j�l� ..... .:.-' .?.x... ............ ELE=ict:[ MpECTOR Check # (�• , LL1iC8 ThiECONIMONWEAETHOFIVIASSA!'HUSETIS Office /Use fonly DEPARTA1E 0FPUX1CSAFETY Permit No. BOARD OFFIREPRFVF.NTIONRFGUTATIONS527CMRI2.00 Occupancy & Fees Checked APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, S2% CMR 12:00 i/ Z (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. ;;� �G1, Location (Street & Number) / 'j t' r S r Owner or Tenant s g e r Owner's Address Is this permit in conjunction with a building permit: Yes No © (Check Appropriate Purpose of Building Utility Authorization No. J Existing Service Amps (Zs/Volts Overhead ©Underground No. of Meters 1 New Service 4--C� — Amps 2s- L yb Volts Overhead ® Underground No. of Meters _ Number of Feeders and Ampacity Re -1219 Ce 014 5o%- v t e .Q r%d 'Xs o r.+ Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ^� round round No. of Receptacle Ok4 cts No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets i 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 Pum s Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW + Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Masspge Tubs No. of Motors Total HP OTHER. lamu oeC mage. Pt>ss�ntlDtheregtritar�tsdM Get�alLaws Ibaveamnatimbt7dykmr&rePokymdAgCmplce2L YES M NO IhaNcabrrmtedvafdptoofofSMMIDdrOffiM YES rT Eyoubmec}rdWYES,plemi theNrofcovang--by INSURANCEBONDD OtIHQt ftaseSpecify) ©© FxpnatimIX e k//c- EMrn*dVakrofEbcfiralWcdc$ WotkoStatt /Z, ^t. . 1rgpecfimDai:�Ro4xsted Rough Final FIRMNAME q Lic > Rd' b w'� /�/ b tr8 hc1-M Signattne C", I I w\ • Ark}n'cc Al Tel No. OWI,'SNSURANCEWAiVER;IamawarethattheLmwdoesnothavetheirm>wmcoveragecritsabstntialegavalfftasrecltmadbyMam chusettsC3enaalLaws and that mysignatureon thispemritapplictr waives this requu� v (Please check one) Owner F-1 Agent F-1 14�,<_ Telephone No. PERMIT FEE $ rgna ure ot uwner or Agent Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone # I am a homeowner performing all work myself. _ I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: } �e Insurance. Co. Policv # Company name: Address City: Phone #. Failure to secure coverage as required under section 2M or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,50( and/or one years' imprisonment as-YwiLas_civ 4xmakmss-olheimn-fes-STOP.Y1[DWDRDJ=Rand-afine-fj$1D W)-aliay.-gairmtme, I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for overage verification. r / do hereby certify wrier the pains and penalties of pefjury that the infvrmatiarr provided above is true and correct Signature Date Print name Phone.# Official use only do not write in the area to be completed by city or town officiar City or Town Permit/ticensing D Building Dept ElCheck #immediate response is required 0 Licensing Board E] Selectman's Office Contact person: Phone # E] Health Department O Other Location 4319r No. ` 'Y -,J-3 - D Date $ ` �` ft `.r 3 iGG3 r9 TOWN OF NORTH ANDOVE% Certificate of Occupancy $ Building/Frame Permit Fee $ Foundattiijo'[nlf��Pe�rmit Fee II ``IF'erfllIt ree Sewer Connection Fee Water Connection Fee TOTAL $ $ i $ 2 5 cru e . / Building Inspector Div. Public Works PERMIT NO. 23 - APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. f Y I I. PAGE 1 MAP 4-40. �t7 / I C� LOT NO. 0e75 -S 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. — iOCATION (Z� n PURPOSE OF BUILDING � _ M ok, 6WNER'S NAME .1 v NO. OF STORIES SIZE dWNER'S ADDRESS' � y 3QU V-wuo,\ ` N AQNQ= N\J VQl BASEMENT OR SLAB ARCHITECT'S NAME _ - SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAME N��TZ���.i� I ��f- SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "" POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS �C-Lt,�r���TlOv �O'YL�t.�TTC of SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2+FILL OUT SECTIONS 1 - 12 -rL, (-I '-V-- a ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR �PATENFILED SIGNATURE OF OWNER OR AUTHORIZED AGENT -A c A, FEE o'�5 0(::)1552 PERMIT GRANTED pu 19 103 2-9 3 PROPERTY INFORMATION LAND COST EST. BLDG. EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPRCTOR 1OWNERTEL. #(107-) V21' 22"7"'0 XONTR. TEL. # ✓CONTR. LIC. # H.I.C. # 1 OCCUPANCY SINGLE FAMILY S.-ORIES _ MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE SL K. PINE _ BRICK OR STONE P PIERS PLASTER _ DRY WAIL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/. '/2 '/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 _ DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMGN STUCCO ON FRAME I I I I BRICK ON MAS NRY ATTIC STRS. 8 FLOOR BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING 1 II ADEQUATE I I NONE I 5 ROOF 11 10 PLUMBING F TAR & GRAVEL BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. Y 'a 6 FRAMING I 11 HEATING r WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING CERTIFY ATE OF INSURANCE ____________________________________________= DATE 04/11/98' PRODUCER THIS CERTIFICATE ISSUED AS MATTER OF INFOR- LEO RUSi INSURANCE INC MATION ONLY AND CONFERS NO RIGHTS UPON THE 131 MAM 0TH ROAD CERTIFICATE HOLDER; IT DOES NOT AMEND, EX--- PlLHAM, NH 03076 TEND OR ALTER COVERAGE AFFORDED BY THE POL- CODE ICIES BELOW. CMPANIES AFFORDING COVERAGE: COMPANY LETTER A WORKECOMPENSATION PLAN OF MA COMPANY INSURE LETTER B ESSEX NSURANCE NEPTUNE DEMOLITION COMPANY 70 TENN Y STREET LETTER C GEORGET WN, MA 01833 COMPANY LETTER D COMPANY LETTER E ; COVERAGES: THIS CERTIFIES THAT INSURANCE POLICI.ES-BELOW HAVE BEEN ISSUED TO THE ABOVE INSURED FOR POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR DOCUMENT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE HEREIN IS SUBJECT TO ALL TERMS OF SUCH POLICIES. CO TY ,E OF POLICY POLICY POLICY ALL LIMITS IN LTR INSJRANCE NUMBER EFF DATE EXP DATE THOUSANDS $ GENERAL LIABILITY TO BE ASSXGNED 04/11/96 04/11/97 GEN AGGREGATE $300 CO MERCIAL GENERAL LIABILITY PR-CMP/OPS AG $300 CL MADE XOCCURRENCE PERS&ADV INJUR $ 0 ER'S & CONTRACTORS PROTECTIVE EACH OCCURENCE $300 FIRE DAMAGS $ MEDICAL EXPENSE AUTOMOBILE L.IAB _ AN AUTO CSL $ _ ALL OWNED AUTOS BODILY INJURY (/PERS) _ SCHEDULED AUTOS. $ HIRED AUTOS BODILY INJURY (/ACCID) NON -OWNED AUTOS $ _ GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH OCA$GREGATE _ OTHER THAN UMBRELLA FORM $C A WOR ERS' COMPEN- TO BE ASSIGNED 03/21/96 03/21/97 STATUTORY SATI N AND $100 EMP OYERS' $600 LIA ILITY $100 OTHER DESCRI WRE IN CERTI TION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS KING CONTRACTOR: INCIDENTAL PLUMBING AND ELECTRIC WORK IS COVERED HIS GL POLICY. KATE HOLDER *m=rmsrssss==a=s===_a.c CANCELLATION SHOULD ABOVE POLICIES BE CANCELLED BEFORE Town Of North Andover *EXPIRATION DATE, COMPANY WILL ENDEAVOR TO 126 MainStreet *MAIL 10 DAYS WRITTEN NOTICE TO CERTIFICATE North Andover, Ma 01845 *HOLDER (AT LEFT); FAILURE TO MAIL NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF *ANY KIND UPON THE COMPAY, OR ITS AGENCTS OR REPRESENTATIVES. AUT RI D R RESENTATIVE: SO H 603/ 36-2639 - - - �_- _ -- ' ^-..,•::a _ noon. - _ .: _...-.�`�_ :r .._ :33a.. - _ as�-""�",,,j� F ._ OFFICES OF: --_--_ ToWIl Of - 120nStreet Al'PE.A.LsH��n • ;.�►: NORTH ANDOVER - Andover. BUILDING MassdchtjLSetts O I s4s CONSERVATION DMISiON OF HH-1LTH In acr^rdarce with tale ire -sic _S MG:. S 54, a con-iilien of Building Permit Number yam. s^ :::nt t.^.e dc*-; is resulting rCm this work shall be disnose�' of in a orene:. .,cz7sc..._ _clid wast. "�,^sc. `c_.. .� :..rd - by `t G i., C i I i, S i ne debris will be disposed cf in- /-Q-fLA-4e--'`— tLz-:icr. ct =acait ; Ll JJ22— ©a 97 - lc:. ...tnit Acoficam Date f; NOTE: Demolition permit fr= the Tocn of NTorth Andover must be obtained for this project through the Office of the Building Inspector. .. . . � ... . . .. . . . . .. . . - a" . ' £5:y25 §� - a22 . . rj R26E2! S, 9 4 : / ! 2I { 2 g22 v C d x o Q Q v o 00 E T cf)a = = O v� z .O G GO p v L ro G O w z z s p rz co G ii O w z a U U Wc 00 r4 cn C w O U W C7 a0 G iL w w Q w v CO ° z v V) Q O cn O :U :W^ F�1 z z :Q L� CI l • O P 7. 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