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HomeMy WebLinkAboutMiscellaneous - 21 FIRST STREET 4/30/2018Xv 0 o PD T O � O Cn O --1 V Cn O .Z7 o m o 0 Date. C/�1 !` .`" ...... i 'i TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....r�......'..... ..... . has permission for gas installation .../J. /7/ ../,. C s' : ....... in the buildings of .. !?t .`.`.`r ................... .. . at .` .f ..: .............. . North Andover, Mass. Fee. .).,.... Lic. No.. ��.'.... Qi.. �`�� .� -�' ^L ........ ! GAS INSPECT&R Check # '3 G G 3 1 6812 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 6�t w0R7H AnlDoyCR. , Mass. Date �� Permit# L C Building Location -11 FIST L Owner's Name�IU,UE OC -SMO OD LQ KTH Type of Occupancy 51 NJGLE MLl L� New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 018 4 1 - 2312 Business Telephone g 7 lB- 6 8 7 -110 5 EXT *30/6 Check one: )0 Corporation ❑ Partnership ❑ Firm/Co. Certificate # 1862 Name of Licensed Plumber or Gas Fitter Francis X. Corkery �- INSURANCE COVERAGE: I have a current liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent 171 hereby certify that all of the details and information I have submitted (or entered) in ab are true and accurgte to the best of my knowledge and that all plumbing work and installations performed under the permit s acation will ,beancompliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G(� T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter City/Town Master License Number _-374-5 APPROVED OFFICE USE ONLY) Journeyman ■��if�t����f��■KINNONE OMM1 NI INN ' • •M ■MENNEEMEMENOMEMEN on Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 018 4 1 - 2312 Business Telephone g 7 lB- 6 8 7 -110 5 EXT *30/6 Check one: )0 Corporation ❑ Partnership ❑ Firm/Co. Certificate # 1862 Name of Licensed Plumber or Gas Fitter Francis X. Corkery �- INSURANCE COVERAGE: I have a current liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent 171 hereby certify that all of the details and information I have submitted (or entered) in ab are true and accurgte to the best of my knowledge and that all plumbing work and installations performed under the permit s acation will ,beancompliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G(� T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter City/Town Master License Number _-374-5 APPROVED OFFICE USE ONLY) Journeyman ui w z U !- I w X N z O U W CL cn Z 2 J 1 OI n Z F- r LL N J n Z _. O O _.W -O N M r W ~ U � u¢ LL O w O z a a ¢ O o LL ?ti } z c c J w r W Q U_ J a a Q w w LL ui w z U !- I w X N z O U W CL cn Z 2 J 1 OI J4 2 Location No. / / Date �/ f' NORT1y TOWN OF NORTH ANDOVER O,�t�•n •. O o ; , Certificate of Occupancy $ sCNUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # lo Building lnspe�o TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING V, A, BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Properttyy Address: 1.2 Assessors Map and Parcel Number: ©lO Map Number Parcel NAber 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 Required Provided Required Provided 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owher of ppRecord Name,(Print) Address for Service . i ?c � `�'�-�1 2 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed ConstructionSupervisor: Not Applicable ❑ (f M -AQ � `. r � t l Vl. Licensed Construction Supervisor: License I� umber Address -S-1 X1444` �� �/ � 1 Expiration Date Signature Telephone 3.2 Registered HomeImprovement Not Applicable ❑ �Contractor (�//� 7 .1 ? 2 Company Name Z� P1M S+f e4 �1_ Registration Number b j(��2p�c� Address Go? --6f `��� Exptratlon Date Signature Telephone Milt A O z�q M 90 0 mn rM r _r Z Q SECTION 4 - WORKERS COMPENSATION (M.G.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 ....... 0 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 Work: hJr — e'er t,� 4 a.yt1' 00-7,^ % NNI' 2af keit R1 ! Pa JKvwr " hhW Ciz6y'A WwGk CQvI it�P1� 1 a e, PI&Ilt'V- t1//c I-&-, 16�s' +'�� 11�rUt?r (k'714 le A'R1n 1 C&-04* SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant „OFFICIALUS 1. Building (%Q O (a) Building Permit Fee Multiplier 2 Electrical Z 5-0 b ©O (b) Estimated Total Cost of Construction 3 Plumbing E7 p oo Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection p 6 Total 1+2+3+4+5 UC1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 6 as Owner/Authorized Agent of subject property Hereby authorize d+ (&wlt � tJ/ to act on My behalf, in all maUrs relati tq=authorized by this building permit application. Signature of Owner 66 Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, J 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 t P12tZ RAM - ' Print Name Signature of Owner/Agent / Date �J NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD 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 Boston, Mass. 62119 Workers' Compensation Insurance Affidavit am a homeowner perrorming all worK myselr. �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. ,nnv name., _ (NOVWTt'11t/ . (0 -,iii( Address 2 � A `i.y �-? --Ov Company name: Address Ci Phone # 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. understand that a copy of this statement may be forwarded to -the Office of Investigations of the DIAfor coverage verification. I do herby cerffy under the pains and penalties of perjury that the information provided above is bye and correct Signature Oi Print namPhone 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 El Licensing Board Q Selectman's Office Contact person:_ Phone #. 0 Health Department 0 Other FORM WORKMAN'S COMPENSATION �1:e l�oamz�ruhuoea� a�,.2�z�raaGr , BOARD'OF BUILDING REGULATIONS License: ON�STRUCTION SUPERVISOR Wa Nu-rr043865 "P1 Tr. no: 976O.'l.' 00 MARKS RATTE 7 LAUREL AVE = `�"« G mow«. �► f METHUEN, MA 01844 Administrator 74 f, Board of Build r`tloup and Spindard fiOME IMP OVEMbft CdNY OR'. 1 Reisfrapn'� r` 1 532:. Exp^t�ati �-c 91 12002 , $fYy.PE CORPORATION.., r • TTE Co RATTE 1:52,528 PLEASANT'STREI'i ; k 4.11H EN' MA 01844 Administrator 17. ---------------- 7 0 ID u GULP OIAL spNe .Sp; a I De Az tN91 o?% T i S fz,� ' OW'-'- OF NORTH NNDKO V1L:R Office o1` the ,Budding Departmeait commu,nity Bevejo'p a en avid `pec% -ices 27 Oarles Stn,,et NjG rth Andover, Muss chasetts 01845 D. Robut Nicctta, 73milding Commissioner April 14, 2003 Katherine Deming 21 First Street North Andover, MA 01845 Dear Ms. Deming Telej:hone (9 78) 68S-954.5 FAX (.97S) 698-9542) Please be advised that upon an inspection of the rear garage structure on April 14, 2003 it has been deemed that the structure is in an unsafe condition which may result in injury to abutters or abutters property, local children or anybody utilizing the structure for its intended use. Please accept this letter as a official notice under the Mass State Building Code (780 CMR) section 121 Unsafe Structure which states in part "The building official immediately upon being informed by report or otherwise that a building or other structure or anything attached thereto or connected therewith is dangerous to life or limb or that any building in that city or town is unused, uninhabited or abandoned, and open to the weather, shall inspect the same; and he shall forthwith in writing notify the owner to remove it or make it safe if it appears to him to be dangerous, or to make it secure if it is unused, uninhabited or abandoned and open to the weather." The State code also has serious penalties for failure to make a structure safe section 118 states in part " Whoever violates any provision of 780 CMR, except any specialized code referenced herein, shall be punishable by a fine of not more than $1000. or by imprisonment for not more than one year, or both for each violation. Each day that a violation exists shall constitute a separate offense. Please contact me so that we may begin the process to remedy this in a timely fashion, I may be reached between the hours of 8:30 —10:00 AM at 978-688-9545. Respectfully, ,Oj�". -,,a ee,�� Michael McGuire Local Building Inspector T011,7i OF Y'YOd..`AT-i.N_ [Qt SRI �%G Tri .t'_":i COffice of the Building Pepail�� ent Corn unity Ir`�e elopa ent and Sei.-sri:d e s 77 Cbm D. Robel. Nicetta, 81d4 inn-61punissiorle April 14, 2003 Donald & Virginia Foulds 25 First Street North Andover, MA 01845 Dear Mr. & Mrs. Foulds TdcPh011e (978-)688-9545 FAX f 978 688-9542 Please be advised that upon an inspection of the rear garage structure on April 14, 2003 it has been deemed that the structure is in an unsafe condition which may result in injury to abutters or abutters property, local children or anybody utilizing the structure for its intended use. Please accept this letter as a official notice under the Mass State Building Code (780 CMR) section 121 Unsafe Structure which states in part "The building official immediately upon being informed by report or otherwise that a building or other structure or anything attached thereto or connected therewith is dangerous to life or limb or that any building in that city or town is unused, uninhabited or abandoned, and open to the weather, shall inspect the same; and he shall forthwith in writing notify the owner to remove it or make it safe if it appears to him to be dangerous, or to make it secure if it is unused, uninhabited or abandoned and open to the weather." The State code also has serious penalties for failure to make a structure safe section 118 states in part " Whoever violates any provision of 780 CMR, except any specialized code referenced herein, shall be punishable by a fine of not more than $1000. or by imprisonment for not more than one year, or both for each violation. Each day that a violation exists shall constitute a separate offense. Please contact me so that we may begin the process to remedy this in a timely fashion, I may be reached between the hours of 8:30 — 10:00 AM at 978-688-9545. Respectfully, ,/ llla,�Nl Michael McGuire Local Building Inspector Date......'..`... `........ ao ,° 'ryO ° °' TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ` ............. . has permission for gas installation i.': f....:...!�.� in the buildings of . . �.....f ..(........................... . at ....................... ' ......... , North Andover, Mass. Fee..'........ Lic. No......!.`... ...................... GAS INSPECTOR Check # O 11 6 J MASSACHUSETTS UNIFORM APPL ICATON FOR PERMIT TO DO GAS F=G or print) PIUKIH ANDOVER, MASSACHUSETTS Building Locations New ❑ Renovation 15 Date}• � 7 ' aC� hx�� r '` Permit 9 Amount S Owner's Name Replacement ❑ Plans Submitted ❑ (Print ortype) Y /� � /YMA- __ A -T j.,� Name Y (x,�,C.X.., / ' ,�(.li'V�.� j � Check one: Certificate Installing Company Corp. INSUR,-kNCE COVERAGE Check one: I have a current liability Insurance policv.or it's substantial equivalent. Yes ❑ NO r7 (fyou have checked yes, please indi e the type coverage by checking the appropriate bo c. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 1=I21 of the ✓lass. General Laws. and that my signature on this permit application waives this requirement. Check one: ❑ Sienature of Owner or Owner's Agent Owner ❑ Agent 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 in tions pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa use Status Code an ap / - ofthe General Laws. IBy: Title City/Town ,APPROVED Il)Ff IC ii USE')NLYI lure of Licensed Plumber Or Gas Fitter Plumber ❑ Gas Fitter (cense Ivumoer aster ❑ loume,/man a������������■�������� (Print ortype) Y /� � /YMA- __ A -T j.,� Name Y (x,�,C.X.., / ' ,�(.li'V�.� j � Check one: Certificate Installing Company Corp. INSUR,-kNCE COVERAGE Check one: I have a current liability Insurance policv.or it's substantial equivalent. Yes ❑ NO r7 (fyou have checked yes, please indi e the type coverage by checking the appropriate bo c. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 1=I21 of the ✓lass. General Laws. and that my signature on this permit application waives this requirement. Check one: ❑ Sienature of Owner or Owner's Agent Owner ❑ Agent 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 in tions pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa use Status Code an ap / - ofthe General Laws. IBy: Title City/Town ,APPROVED Il)Ff IC ii USE')NLYI lure of Licensed Plumber Or Gas Fitter Plumber ❑ Gas Fitter (cense Ivumoer aster ❑ loume,/man T N2 4S11 Date.�1, .:�('-'.:. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 7 This certifies that .............. has permission to perform .....P: ............ plumbing in the buildings of ... ..... ... `.................. . at ... .............. North Andover, Mass. Fee. S ........ Lie. No.. . ...........'......<:.. : ......... . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer F MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Lam, '1 � i �" Date Building Location a 1 /� Owners Name Au Permit # Amount Type of Occupancy 2L New Renovation Replacement M Plans Submitted Yes M No (Print or type) Installing Company Name 11 /Y7 n Check one: IFA Corp. FlPartner U Firm/Co. Name of.Licensed Plumber: Insurance Coverage: Indicate the surance coverage by checking the appropriate box: Liability insurance policy CT Other type of indemnity ❑ Bond ❑ Certificate 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 I hereby certify that all of the details and information I hav itted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and' tallati s performed under Permit or this application will be in compliance with all pertinent provisions of the Massa us tate m ' C a e neral Laws. By: SignaiiaeolLicenseanumber Type of Plumbing License Title 1123 9-0 City/Townice�nse Num er Master Journeyman APPROVED (OFFICE USE ONLY N° 3 G Date.......... `a -.y.. pOR7M TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 14 !��YiCcC.C`rc 1 ucck This certifies that ................ ....................................................................... has permission to perform ....� .!.. c � P , R `e w,,/e,................................................................ wiring in the building of .....:.... / at 9/ ..'l .. f .S ................ . North Andover,Mass. Fee.. .(....... Lic. No..1.!/., ��. ......'y?.. fl.`..�.......... ELECTRICAL INSPECTOR Check #/ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ``•� TRFC0j 0AWE4LTH0F R ` CHUS 77S Office Use only _ DEPARTMENT0FPUBLICS4JWY Permit No. —7 A,6 BOARD OFMEPREWWONRWU ATIOAS527CMR 12.00 Occupancy & Fees Checked W04PPUCATTONFOR PFI W TO MFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Z I O 1 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) Z -t Owner or Tenant t/t-A c+ e Owner's Address• Z S Z $ Pc. -A -e A—J—' '57 _ M 6-Tq U" . MA y Is this permit in conjunction with a building permit: Yes IJ No " (Check Appropriate Box) Purpose of Building ��,(;� N11v4-(_� Utility Authorization No. Existing Service Amps�/ Volts Overhead Q Underground 1:3 No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work - L. -A 67 7 , 7 C No. of Lighting Outlets S No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound _ No. of Receptacle Outlets 1 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets (10 No. of Gas Burners 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 Pumps 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 M Connections . No. of Water Heaters KW No. of No. of r Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER 1t1A wxf-:(7veiage Laws Iha�eatztnaYLiabt1>tyhastrairePpticyindudingCoan#eb�Co tetageoriLssubsialec�tn�lai YES NO a Ihawst hmodvalidpoofofsanelothe0ffim- YES =NO If}uuhmdwdtedYES,pimenbc&theWcfwmagebyd=krgthe bm` WotkioStart Sighed uaxiz FIRMNAME ESftm ad Value xal Wcdc $ RAO C A-GX _..---- Flt- I�oa�ae(� lC44 A Lti AA A;7b Z)A,, 4 I, Sigt aline \,�"xc„�.. ii i b —Z7 FSa,< B&mTel. Na 3 3�sZ- 2�sy All. TeLNa OWNER'S WAIVER;Iatnatuac b ttheLkmdoe not �eitstranet eragecrihsst larrtralec�ivater astBc aadlryM GmeralLaws anddvtmysig<rahserndsispem- waisesftlec 'mmt (Please check one) Owner M Agent Telephone No. .PERMIT FEE Location No. `� Date 43 Check # if`' 41' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1zo &d 6 3,jj , Building Inspector (57 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH AONE TWO FAMILY DWELLING pO�R �'jiri]Rs{��cs �Hl � . o�" . - - BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1z Map Number Parcel Number p 1 1.3 Zoning Information: Zoning Diarid Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of\ Record Name (Print) Address for Service Cor%vrl,-� - Y. r M a. o l 5 Sig ture Telephone y cr =�,` G,. rte.., L -j 00 NaPrint Address for Service: -J 9, D, b tip -1 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 9- N& Pr N*,JL (-c. Not Applicable ❑ e- 12 6 a 53 Registration Number a'3 -o4 Company Name Name 3yS �.. �.>�� 5 . �oc� .1 kk (An Address � a�)A� Expiration Date Signature Fele4one T M �o Z O v M SECTION 4 - WORKERS COMPENSATION (M.G.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 .......Noo" No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Jt t " Brief Description of Proposed Work: \f, 4'—\ C-) , d ' V. n. �. r r.&- hG vv�,l _. I SECTION 6 - ESTIMATEn CONSTRUCTION MQTc I %J'3 Item Estimated Cost (Dollar) to be Completed by permit applicant OI+'ICtAI USE Ut!ii. 1. Building.. / 0p b ��, (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) l�po 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number aL'1.11V1`I /a Vw1vr.KAu1nVK1GA11V1V 10.15E COMPLEMO WHt N 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 CER/AUTHORIZED AGENT DECLARATION 1, N V A,,— r- yk�i as Owner/Authorized Agent of subject property Hereby declare tha e statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief 1 l Print Name n of Date 0 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2 ND 3 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 h s .I x a pu v O w L aai cn 0 v A a ° p w O cG v C U G w" ° w a to p aG G w" a w u w 0 a: s� aJ U) G w x F z ¢ p c4 G w z w A a 0-4 c crm zto w co v •Q O . cn o CL z a x H W LA - LU W V COO C w O m C O, ;;C O c � 7 C O C N O C CJ V y C C O O O ;L O Cc y ;• EQ =~ CD o • :� i c :tea W W s ow ��~ m ca{gyp C3 d� .E ' cm c a x H W LA - LU W V COO CD 0 co O _o V Z a) 0. CD CO) o c � c cm CO2 o� CO) w '9 m m CD C2 G3 Z �3 .p CD � C o L t0 o d CL cma o � � CL o Z CD C CL V CO) c® c c — '— c cc d CO) is I 0 CO U) w w rrw Cn L m O, m CO c � m J C C � _ m y A y E CD o y m m C Q ;• CL== COi �y O 'Z cvv o� c "a :0Qo W s :o.�o ��~ m ca{gyp •d cc d� .E : C cx.0C� C.2m LJ m O. = C O m cm .=m W �a4 CD 0 co O _o V Z a) 0. CD CO) o c � c cm CO2 o� CO) w '9 m m CD C2 G3 Z �3 .p CD � C o L t0 o d CL cma o � � CL o Z CD C CL V CO) c® c c — '— c cc d CO) is I 0 CO U) w w rrw Cn I may 13 03 11:00a Liberty Liberty Mutual Group 1VIYx slxal�PO Bex 7077 1aortSM0WJt, NR 03802-7077 'telephone (SUO) 6534N 3 May 9, 2UO3 F4. - .(6U3) 431-5693 RE; C'et1!> icate 4 Workerlt COMPecuutior Itnsurunct; lratraarcal: RMA HOME -`?,tiff COBB GAUERIA PKWY _c t'E 2UI1 ATLANTA. GA 10339 Policy Nualber: WC5-3IS-3427534)l3 El'fecuvv: a r30i20o3 L.xpar;Uilttt' a /il!%(1t)3 C(AeJ•;ige 4orded tuider Workers Co,tlpeatsatlou Law of rile foltorYiJlg stote,$): NU Liability BOGY !",jury 19y Accident' lOo)oo EJacl; Actidmu Bodily Injury by DiseAw.:: s 100,0t)() Each Persolt Bodily h1jury by Disease: S 300,000 Poldcy UmAs As of this date, thN above refcrenead policyholder is insured by Lei :tnsuraatcc CorpordtloJt under the policy lista! above. The ed t3ra aniocy afforded n Hae list.d policy Is saabit!ct w a)' tltc testis, c�cluA0Jis and c�unditionsr !Ltd is not altered is uud rcclt:iretneltt, Unh ar condition of;wy or other docu;laesAts with respect to which this certilicate may be issued. This t ertirC tte is Issued as :: matter of irafortnritiou QA"y ;u� d w"fers na right upon you, tile;certi�, cute holdtx. This ctJrtiflcate is not aft insurance policy tuJd docs not antea d, est; id, or alter the coverage ;!i ol-ded by IIIc policy listed ahuvc — ll'this polis:): is cmGdtal barbre the stinted a::Piratios, du:z, 4.ibeny;Matuai will e"deavar to notify you of such ctncellatiorl. _ AU7'HU4 .E13 uyIJtIESLNTAI'!VL' LJ13irl2TY MU'i��A.L JhStlalANC� GiZt�tJP rh>J i uta,• tui. �,..�;.,i by I.lNt -Y, t VI IP AL rN6UPANCE Ci(ut:Y u,•:sp.c:::,u } ,r;.d'.u�eP w iG46U. J uY lkJ44444wjo, cc: lnsurcd. RNIA HOME SERVICES 324h-' C.O9B CALLERIA YKW`a STE 200 ATLANTA. GA 3033,) ZA 3�itid 11LrjS aNV G8vd3H5 hvdawi: of Recoad: S11F.PAbRD & SCOTT CORP ) 45 WEST END AVE SOMERVILLE, NJ va676 I0669%S805 Et7 :cL E00L� �'t/csrJ p.1 -__ Board w Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 126893 ':. Expiration: 3!3!2004 Type: Supplement Card Home Depot At•Home Serv;ces PAUL VENTRE 3200 COBB GALLERIA PKWY #26 ���✓ ALTANTA, GA 30333 Administrator G License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 021 o8 Q -a (��: \r� Not valid without signature TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ` �. `� ........................................................................................ has permission to perform ........... . P ®7. cJ r ....... l....................................... wiring in the building of // F' 't at ......::... .......... ....................... .............................. . North Andover, Mass ,- ° � Fee .....�.�� ....:.. Lic. No...... �.J. ...... � ......... .. �� r..:.... �... /) ,`� r ELECTRICAL INSPECTOR Check /f % v / 41517 Commonwealth of .``:1.gssachusetts Department of Dire Se: Vires BOARD OF FIRE PREVENTION REGULATIONS -- — -- Official Use 01,!11 � Permit No. _ V Occupancy and Fee Checked [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / Fe3 City or 'Town of: L I Oi I&Vel� To the Inspector of Wires: By this application the undersigned gives n tice of his or her intention to perform the electrical work described below. Location (Street & Number) S'� 6 S 9- 1� Owner or Tenant .... j(0Aer' &C Q� /'►j tN Owner's Address Is this permit in conjunction with a building permit? Telephone No.Y1� Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters ' Location and Nature of Proposed Electrical Work: '01vue tri I �c0;N- Completion ofthe 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 Swimming Pool Above ❑ n- ❑o. rnd. gmd. ot Emergency Lighting Battery 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 No. of Waste Disposers Heat Pum Totals Number --' ` "" Tons "" KW -'"-"�""""""' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW tems: Security Sysevices or E uivalent No. of D No. of Water KW No. o No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 ElOTHER ❑ (Specify:) Z/� 6111 Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete- FIRM ompletesFIRM NAME: &LIC. NO.: Licensee:nJ `�// SignatureLIC. NO.. (If applicable enter "exempt`" i the license nIgnber liner s Bus. Tel. No.: 97� Address: 10, kk v/!/1' JC ✓� 1��•r 2��✓��y/t� OWNER'S IN! required by law Owner/Agent Signature _ Alt. Tel. No.. 7 JRANCE WAIVER- I am aware that the Licensee does not have the liability insurance coverage normall By my signature below, I hereby waive this requirement. I am the (check one) [] owner ❑ owner' Telephone N®/��6 PERMIT FEE: $