HomeMy WebLinkAboutMiscellaneous - 214 BLUE RIDGE ROAD 4/30/2018N
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N2 2 6'11 7 Date ...........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... I . . ............................................................
has permission to perform .....................................................
, r-- (�-;, � -"/ ...........................
wiring in the building of ... .............................................................................
................................... -�) ................
at ....... Z-- North Andover, Mass.
Fee -b ................ Lic. Nol�� ... . ........... .. .......... ..............................
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
commonwealth of Mal'sachiusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Oficial Use Only
Permit No. L24�
Occupancy and Fee Checked
[Rev. 11/991 (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: jam- a(o G a
City or Town of: /U' o'beye2 To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) ,:� 14 /" L.Lle n(��
Owner or Tenant
Owner's Address
-91
Telephone No, 978-x/ -q'? 9/
Is this permit in conjunction with a building permit? Yes ❑ No 0(Check Appropriate Bos)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
Location and Nature of Proposed Electrical Work: ,o Urq(el r
No. of Recessed Fixtures
additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no pennit 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.
. _.. ..
No. of Ceil: Susp. (Paddle) Fans
__.. .Attach
u�.� n.uv vu nu,vec. uv uie crls ecwru hires.
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool boy e ❑ In- ❑
Swimming grnd. grnd.
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
No. of Alerting g Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
KW
.........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Arca Heating KW
Local Municipal ❑ Other
--'Gaflnpaclion
No. of Dryers
o. of Water Kms/
r,Heaters
Heating Appliances KW
o. o o. o
Signs Ballasts
ecuritysystems.*-,)D
s or Equivalent
Data Wiring•
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work:. L??, Date)
��, (When required by municipal policy.)
Work to Start: a Q D Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjurv, that the information on this application is true and complete -
FIRM NAME: ADT Security Services 111 Morse Street, No!Lioo#, MA 02062 LIC. NO.: 1533C
Licensee: John S. Bassett Signatu
(If applicable, enter "exempt " in the license number line.)
Address: cl
OWNER'S INSURANCE WAIVER: I am aware that the Li nsee does
required by law. By my signature below, I hereby waive this requirement.
Owner/Agent
Signature Telephone No.
LIC. NO.: 1533C
Bus. Tel. No.: 781-278-1169
AIL Tel. No.: 781-278-1131
not have the liability insurance coverage normally
I atm the (check one) ❑ owner ❑ owner's agent.
PERMIT FEE: $ 36. M
L ation
91c
No. Date
"ORTof
TOWN OF NORTH ANDOVER
so
OA
Certificate of Occupancy
$/
Buflding/Frame Permit Fee
$
,4C
Foundation Permit Fee
$
I'll,
Other Permit Fee
$
Se nnection Fee
$
�Vater Connection Fee
$
TOTAL
Building Inspector
Div. Public Works
0, t - � f
-c-;
Wcation -ILI
No.
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
w,'HEGFoation Permit Fee $
COLUBRIPermit Fee $
$ t 11-0o
Sewer Connection Fee
U V
.:47' , Water Connection Fee $
DEC 0 1— gr 42r A L r, /9
'13judirig inspebtor
17
Div. Public Works
Location
No. I .� --
Date
1401t I T TOWN OF NORTH ANDOVER
0
Gettilicate ol Occupancy zb
Building/Frame Permit Fee $
C U Foundation Permit Fee $
pAID By cHBGKPermit Fee $
NOMANDOMCO"Aonnection Fee $
Water Connection Fee $
$
Wilt
Building Inspector
Div. Public Works
S _
Pmgmr ri�o - - APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS/i j A pi -:?y g / % PAGE 1
MAP h-40.
LOT NO.
2 RECORD OF OWNERSHIP
BOOK ;PAGE
ZONE SUB DIV. LOT NO.
LOCATION `Sj
--
PURPOSE OF BUILDING
I;DATE
—
OWNER'S
NO. OF STORIES SIZE
uo i
^/_�,./
OWNER'S ADDRESS � C/i
A
BASEMENT OR SLAB/
//
ARCHITECT'S NAME b '3-/��
SIZE OF FLOOR TIMBERS 1ST ifs/� 2ND a/� �� 3RD
L
�/1 l�
BUILDER'S NAME
SPAN -1�
DISTANCE TO NEARESf BUILDING g
DIMENSIONS OF SILLS
DISTANCE FROM STREET /S
jXl.fO
POSTS 3�s
DISTANCE FROM LOT LINES -SIDES 3 REAR Jv�
GIRDERS �il1 lC'
V
AREA OF LOT /, LOC- ��2 FRONTAGE�7-4ad �
v��^
HEIGHT OF FOUNDATION �!%S
THICKNESS/,o
IS BUILDING NEW
SIZE OF FOOTING /D // x
�a e"
IS BUILDING ADDITION J�
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS CODE A//�
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY �OyF�
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS -LINE
INSTRUCTIONS
SEE BOTH SIDES BLDG. PERM FEE Or-rD
1
PAGE t FILL OUT SECTIONS t - 3 LESS FDA FEE 640, u d�++i•+++�
PAGE 2 FILL OUT SECTIONS 1 - 12 DUE FRAME PERMIT $ �� d'f• 15 �
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
s
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILEDG
SIGNATURE 6F O ER OR AUTHORIZED AGENT
FEE C?
06 a
PERMIT GRANT
EM - 7 1992
OWNER TEL. # 4�A d'�66, ?
CONTR. TEL. #-�
CONTR. C.C. #--Cjl
e3;1-
3 PROPERTY INFORMATION
LAND COST 6 S d d
EST. BLDG. COST �b l 6a 4, o d
EST. BLDG. COST PER SQ.$lw-
s---
EST. BLDG. COOT PER ROOM
BEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
- BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY $TORIES
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
� � 1
APARTMENTS
CONSTRUCTION
2 FOUNDATION —I
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
PIERS
_
8 INTERIOR
3
PINE
HARDW 0
PLASTER
DRY WALL
UNFIN.
FINISH
1
2 13
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
_
'/, 1/7 '/,
FIN. ATTIC AREA
NO BMT
FIRE PLACES
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
B
_
1
2
�_
3
_
_
CONCRETE
EARTH
HARD",/'D
COMIACN
VERT. SIDING
_
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. 8 FLOOR _
CONC. OR CINDER ELK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIORI� POOR _
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE I
BATH (3 FIX.)
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR 8 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
WOOD JOIST
11 HEATING
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. R COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
GAS
7 NO. OF ROOMS
OIL
B'M'T 2nd
to In 13rd
ELECTRIC
NO HEATING
� � 1
FORM U - IAT RELEASE FORM ~'
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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT:yy jGc
Phone 0y> 00 f
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street 7 St. Number
************************Official Use Only************************
RECOPENDAT,IoNs OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Town Planner Date Approved 3
Date Rejected
Comments
HDate Approved
Health Agent
�1 Date Rejected
Comments
Public Works - sewer/water connection
- driveway permit it yz a�C
Fire Department f ,LLwu
n 'Y C,
PW
Received
Received by Building Inspector
Date
DEC -- 71992
,
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CERTIFIED FOUNDA TION PLAN
LOCATED IN LJa rz-r-µ A ►-� n o.� r�,,_►�(� .
SCALE I"= 4 DATE _ V i iga
Scott L. Gi/es RL. S.
50 Deer Meadow Road
North Andover, Mass.
1p— , pG1 0
I �
52'} ,
p ( d[v4
[o550
3UILDING DEPARTMENT
/ CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS OF THE SU/L DING /NSPEC TOR ONLY
SHOWN COMPLY AND SUCH USE IS FOR THE s .
WITH THE ZONING DETERMINATION OFZONING v Es
Q rA
BYLAWS OF CONFORMITY OR NON- CONFORM/TY �FGISTf J.-
U—=::U A"cc:,v9,E WHEN CONSTRUCTED. L WO
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......................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........... & .... / ... 5 .... POW
.....................................
-53t7Z,:�- /2 f,>— /
has permission to perform ........................................ :� ........
P 67 6-'ew
wiringin the building of ...................................................................................
at ........ dZY ...... q .. ....... North Andover, Mass.
. .............
Fee..-.—') ....... --. Lic. No.3.nO-670 ..................
EI,Ecrm� A** L-i�i�R-
Check # 2-
71,17).0" 4
4111\, Commonwealth of Massachusetts Official Use Only
Department of Fire Services
Permit No. -7131 3
Occupancy and Fee Checked
MY BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC 527 CMR 12.00
(PLEASE PRINT IN INK OR TAPE ALL INF RMATION) Date:
City or Town of: llUV t Jo ux1 To the Inspector o Wires:
By this application the undersigned gi; es notice of his or hey intention to,Rerform the electrical work described below.
Location (Street &
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No
Purpose of Building Utility"
Existing Service Amps / Volts Overhead ❑
New Service Amps Volts Overhead ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Telephone No.y k• 16 3 - r?a`J
(Check Appropriate Box)
tion No.
Undgrd ❑
Undgrd ❑
No. of Meters
No. of Meters
A Com lesion of thefollowing table may be waived by the In ecwr of W;,,,
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
i es.
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators K"VA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. rnd.
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
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
g
No. of Waste Disposers
Heat Pump
Number ..................................................
Tons
KW
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local Municipal
El Other
Security S stems:*
No. of Dryers
Heating Appliances KW
No. of Water KW
No. of No. of
uivalent
Data Wiring:
Heaters
Si ns Ballasts
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.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 ❑ OTHER ❑ (Specify:)
I certify, under ains at d na t s f perjury, that the information or: this application is true and complete.
FIRM NAME: l LIC. NO.: G
Licensee: D• >�' Signature LIC. NO.:
(If applicable, enter "ezem t" in the license number line.)71 Bus. Tel. No.
Address: -� rM i 1 �� Alt. Tel, No.:
*Security System Contractor License rehired or this work; if appl' e, cii{er is nse number here:55C
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent `
Signature Telephone No. PERMIT FEE: S S: D�
DUTTERWORTH & O'TOOLE, INC.
P.O. BOX 8294
SALEM, MA 01971-8294
TELEPHONE (978) 741-5731
June 8, 2009
ADJUSTERSIAPPRAISERS
FOR INSURANCE COMPANIES ONLY
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 3B
TO: Building Commissioner or
Inspector of Buildings
ADDRESSES
City/Town Hall
North Andover, MA 01845
RE: Insured: Tom and Suzanne Regan
Address: 214 Blue Ridge Road
North Andover, MA 01845
Policy No:: HMA0137856
Loss of: January 15, 2009
File No.: 093-0558
Origin:
Ice dam
FAX (978) 740-9109
Board or Health or
Board of Selectman
City/Town Hall
North Andover, MA 01845
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1,000.00 or causa Mass. Gen Law Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen
Law Chapter 139, Sec. 3`3 is appropriate, please direct it to the attention of the writer below and include a reference
to the captioned insured, location, policy number, date of loss and file/claim number.
If no reply is received From your office within ten days, we will assume you have no liens of any type against this
property and we will recommend to the insuring company that this claim is paid.
Thank You,
Paul Trainor
Adjuster
BUTTERWORTH & O' T DOLE, INC.
P.O. BOX 8294
SALEM, MA 01971-8294
TELEPHONE (978) 741-5731
June 8, 2009
ADJUSTER&APPMSERS
FOR INSURANCE COMPANIES ONLY
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
FAX (978) 740-9109
UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 3B
TO: Building Commissioner or Board or Health or
Inspector of Buildings Board of Selectman
ADDRESSES
City/Town Hall City/Town Hall
North Andover, MA 01845
RE: Insured: , Tom and Suzanne Regan
Address: 214 Blue Ridge Road
North Andover, MA 01845
Policy No.: HMA0137856
Loss of: January 15, 2009
File No.: 093-0558
Origin: I Ice dam
North Andover, MA 01845
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1,000.00 or cause Mass. Gen Law Chaster 143, Section 6 to be applicable. If any notice under Mass. Gen
Law Chapter 139, Sec. 33 is appropriate, please direct it to the attention of the writer below and include a reference
to the captioned insured, location, policy number, date of loss and file/claim number.
If no reply is received from your office within ten days, we will assume you have no liens of any type against this
property and we will recommend to the insuring company that this claim is paid.
Thank You,
Paul Trainor
Adjuster