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HomeMy WebLinkAboutMiscellaneous - 23 ARDMORE COURT 4/30/2018 DIU 0 f. Date. .,. . . . . . . . ti HOR7M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMU`�� / This certifies that .!.! .Gt-.t.- �:t!. . . . '. . . . . . . . . has permission to perform !fit- �./�U :C: :/.lam%!tL�. . plumbing ;n the buildings oft! l( /. ., � . . . . . . A�f�f_ C� . . . . . at�!l . . . ��. . . . . . . . . . . . . . . . . . . . . . . . . . . North /nAndover, Mass. f. Fee . U � l-� 1 ' . f 4% E PLUMBING INSPECTO�., Check # / 6386 MASSACHUSETTS UNIFORM APPLNATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Q Building Locatior )'Jc.<DDf2 t JQ F Owners Name �yZII)111- to. Permit# #off � I�iitZC C�Ov� Amount r TXpe of Occu a/ New Renovation Replacement F Plans Submitted Yes No FIXTURES rf &SEM06 MR" 3*.II HDM �)HIDQi 41HIt" SII3 H�(R sII3)EIDOt 71H HDD j SII iHIDCR (Print or type) / f Rem one: Certificate Installing Company Name/i( 1/�C)�( � lnk l MQ� Rem N 6-- El Corp. Addr 7 0 Partner. o> a R11usinessTelephone, s '',—O/ Firm/Co. Name of Licensed Plumber: i Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy t 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 I hereby certify that all of the details and information I ubmitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work install 'ons rformed under P 't Issued for this application will be in compliance with all pertinent provisions of the sachuse S Plu ng o nd Chapter 142 of the General Laws. BY: Signature of Mcenseam Type of Plumbing License Title -3/ City/Townisc NumuerMaster1-3Journeyman APPROVED(OFFICE USE ONLY 38 ; 3' TOWN OF NORTH ANDOVER PERMIT FOR WIRING S US This certifies that ..... ........ ...... .,/"' .......................... has permission to perform ......... 'C /? C)/*Ie V-"o . .................................................. wiring in the building of.......\,AJ.0r,) \A.!4.1..f.....tvdvu... .............. ........ ..... ...... ... ...... ............ North Andover,Mass. at...................... Fee i)-\�6.: Lic.No�. #,c�......... . ....... . .......... '�7........... ELE CAL 1�'PeCTOR Check # (�ommonwea[l�a� a9�ac%wajfd Official Use Ont it 77 Penn it No. �3. k 1Jeparinranl a�.,tira arnicas Occupancy and Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/991 heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK nil wurk to be performed in accordance with the Massachusetts Electrical Code(MEC),327 CMR 12.00. (PLEASE PRINT ININK OR TYPE.ILL ItYFOR AT'ION) Date: 2 d Z City or Town of: AAaaumei2 To lite I�ts�eccot•o Wires: this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & `'umber) z 2 . z-3- 4aomogA e4 Owner or Tenant (,[)(�cf l`Lt�� flow,rA C�—. — Tciepltonc i\'o.478 ' -?OF3 Owner's Address /j) l�JDdd�li1g,r �t2eA Is this permit in conjunction with a building permit? Yes r,1 No ❑ (Check Appropriate Box) Purpose of Building CSjj,eKlta—k WilityAuthorization No.� 68O?7, E CIStIng Service _, 6d Amps j2d/d4&j Volts Overhead❑ Und grd �. No.of Meters*. New•Service 5A* P- Antps / Voll$ Overhead ❑. Undgrd ❑ Noe of Meters.' Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I w-e N a Completion ol•the/ollorviire table play be waived b+the his'cctor ol'IVires l No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Facts 1 0.0 otal Transformers KVA } No,of Lighting Outlets No.of Ilut Tubs Generators KAVA r A ave ln- i o.o mer encp tg No. of Lighting Fixtures Swimming Pool ntd. ❑ rad. ❑ BatteryUnits e t tag No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 110-of Detection and Initiating Devices x No.of Ranges No.of Air Cond. T°cal No.of Alerting Devices Tons No.of Waste Disposers Hcat Pump INumber Ions 1%1 No.oCSel- ontained Totals: - Detection/Alerting Devices No.of Dishwashers S ace/Area Heating lY amici a P g K`V Local ❑ Conne cion Other No.of Dryers Healing Appliances1{W Security Systems: Plo.of Water No.of No,of Devices or Equivalent Heaters KW Bal21 °t Data Wiring Signs Blasts No.of Devices or E uivalettt No.Hydromassage Bathtubs No.of 11°fors T°cal T-;p 1 clecommumcatlons 7•lrtmg; No.of Devices or.E uivalent OTHER: Attach additiaral detail if desired,or as required by the Inspectorof IV es. IINSUR2UNCE 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 lite permit issuing office. CHECK ONE: I``SURt NCE P" BOND ❑ OTHER ❑ (Specify:' Estimated Value of Electrical Work:' (When required by municipal policy.) (Ecp_ anon.Date) Work to Start: 5" O2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certifj, under the pains and penalties oJperjuil,that the information off this application is trite and complete: FIRNt NADIEr ; tJ� 1 d ,r S• LIC.NO.:� yt• —�- Licensec: 9fgtG ?4C-a Signature L1C.NO.z p (lJcrpnlicable,enter "ercurpt"irr die license a auber line � �•s3"v Address: �D�. a � ' � 3 Bus.Tcl.No,• 01VNER' li iSUR:�tiCE�YAIVI;R: I ant aware that the Liceltsee docs not have the liability ituur�nce corerage norn�ally required.by law. I3)•my signature below,l hereby waive lltis requircmcut. I am the(check one)�] owner ❑o��•ncr's aLent:' I Ow•ncr/flRcnt b Sitinaturc Telephone\u. PISIZ/lIIT FEL: I I i Location No. <�D Date R NORTH 0� TOWN OF NORTH ANDOVER ,+1ti0 ` Certificate of Occupancy $ +ns 7 � s E< Building/Frame Permit Fee $ s s +c►w Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Or) Check # ��o 16417 ��- 6/ Building Inspectd TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. '47. DATE ISSUED p �/� /I m V(I W SIGNATURE: ✓1 Building Commissioner/Inspector of Buildings DateAP 1o510 d z SECTION 1-SITE INFORMATION O 1.1 Property Addr 1.2 Assessors Map and Parcel Number: 3 a�`(1�V 1,,,.e 5 000 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft N Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.4& - 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ ,. yfpne Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY O NIEkSB IP/AUTHORIZED AGENT M 2.1 Owner of Record AA Name(Print` Address for Service:Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O r• z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Constructi Supervi or: Not Applicable ❑\ _1 GI — �eZ�Y�� CS")o g ( o Licensed Construction Supervisor: License Number Address 46 0 Signator Expiration De Telephone r 3.2 Re istered Home Improvement Contractor Not Applicable ❑ v CkQ "� Cf) a1 Company Name rn Registration Number I"a Address 1/5 Expir tion Date Si nature Telephone Y♦ 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.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction x Existing Building ❑ Repair(s) ❑ Aiterations(sfk ©� Addition ❑ Accessory Bldg. ❑ Demolition b5`❑ Other ❑ Specify "' # t Brief Description of Proposed Work: Fu SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL ISEONL`Y � r Completed by permit applicant 7i"-' , 1. Building j� w 00 (a) Building Permit Fee ! V 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 -00 1 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION -civ ,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 bel' f V► -cl(ao Print Name Si ature of wner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3PD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS Di`MENSIONS OF GIRDERS I-IEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTIy Tovm of 4 Andover No. o _ L Amo dover, Mass., COCMIC ME WICK A0" SATED I"? C2 "i '9S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ................................ • ................................. ............................... ••••• ••• Foundation has permission to erect... �...... buildings on ..�.a............ ........ Rough to be occupied as ...... Chimney .... .. .. ..e......................................................... provided that the person accepting this permit s II i every respect conform the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the In pection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough 0000! .......................................�!�!9 Service SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 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 Perr-nit 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 D to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector i it I �_ .. �_ �, F , T ACO DATE(MM1ODf/Y IYj- ,. CERTIFICATE OF LIASIt-1 Y4 IIV'S`IJI ' - D D X -•� � �� c X5%2121003: �PRODUCER THIS;CERTIFICATE ''IS' ISSUED AS A MATTER OF INFORMATION INTERNET INSJRANCE AGENCY, INC ONLY AN®,� CONFERS;.NO !'RIGHTS• UPOII',;THE .,CERTIFICATE HOLDER. ,THIS -CERTIFICATE DOES" NOT AMEND, EXTEND. OR 'tJ, r A R.aTHE COVERAGE,-AFFORDED BY THE "POLICIES BELOW LIE 522.CA•ICKERING ROAD -' IfORTH ANDOVER- MA 018 9 5 INSURERS AFFORDING COVERAGE MAIC 15 INSURED INSURERA:ARBELLA PROTECTION D. G. Contracting, Inc. INSURER®:NORFOLK & DEDHAM 428 Pleasant Street 3 INSURER c:ARBELLA PROTECTION ' INSURERD: —INSURANCE.. .». ..-. .. _. AIG , .... � - North Andover, t�ti. 018;9`5 "' - .. INSURER E: { COVERAGES 7E FOLIOES OF IN&JRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD_INDICATED. NOTWITHStANDING` } -ANY,REQUIREMENT. 1i RM OR, CONDITION OF ANY CONTRACT OR -OTH R_uDOCUMENT W1TH. RESPECT TO VN ICH 'THIS'°GERTIFICATE fkAY�BE ISSUED OR i ,IMAY'PERTAIN, THE INSURANCE AFFORDED.BY. THE-POLICIES'DESCRIBED. HEREIN-IS SUBJECT TO ALL THE TERMS EXCLUSIOJJ�AND'CONDITIONS'OF SUCH' :•POLICIE$:'AGGREFATE!IMII ;.,SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION b �! :LTR INBRD _ •TY OFRNWRANCE POLICY NUMBER - b•DATE(MMIODIYY)' DATE(MMlDDIYY) a .,LIMITS s ®Et� 85'00013599 r07/O12002 07/012003, EACHOCGJRRNC "! (RnLLABLTY j 1;000;000 ' J A 'X_ COMMERCIAL GENERAL LIABILITY ,, j=Y -- -� � � �� � PRE6AISES(Eaoewrenee�—""' J CLAIMS MADE OCCUR i MED EXP(Any one perzomj w` f 5,0 " -0 O . PERSdNAL&ADV INJURY--^ 1",ODO„OO� °G�@NERALAGGREGATE - f 2,000,�,0.0.0 -"OEN'.L-AGGREG"ATELIMITAPPLIESPER. ' q;',. - - 'PROOUCTS--COMPIOP AGGI s2,000- 1 000 'f• ` POLICY- JECT LOC B - AUTOMOBILE LABILITY 90151692 06/12/20021 06/12/2003 31-COMBINED SINGLE UMfT ) r 000 QO0 1( .ANY AUTO .> ti dEa ac6tiont)` ..- ... r .r. ALL OWNED^AUTOS .QDIL-Y,INJURY ,I - X SCHEVJ ED AUTOS Per person) s HIRED AUTOSI - + I , I . _ , I90DILY INJUR . Y NON•c3WNED AUTOS IPer acdtlant),�.,» F-1 '• r PROPERTY DAMAGE 'f GARAG&LWBIUTI',,,.� - - PAUTO OFLY.-EA ACCIDENT :f L ANY AUTO. ....,c [•:' - G ,,,. ` sOTHER THAN »„EA ACC f �IAUTO ONLY: AGG" f C EXCEswmbRELLALIABILTTY 614600020399 1 12/10/2002 12/14/2003 EA&6CC1JRRENCE000.'x:000= X,, OCCUR -CLAIMS MADEAGGREGATE: "S 1,O m.,0 O,O,y . DEDUCTIBLEi t.. _ — f IO - RETERTNU 5 l D WORKERS COMPEN4ATION AND •,•• WC 333•-27.-74 0.3/31'/2003 03/31/2004 EMPLOYERS'LLA®ILITY r . I I .I L`• .. r ANY PROPRIETORlPARTNER1EXtCUTIVE r ` ° E.L EACH ACCIDENT --- f 100,'00`0 OFFICERIMEMBER EXCrLUDED7;-v_4T " E.L DISEASE-EA EMPI,9YEE . Ityea de Wibe unds% - `SPECIALPROVISIONS allow�`. 1 —s ,� ••'� ;''I` ,te•� - P vaCi { ti '` - E,6.:,DISEASE.,POLICY•LIMIT r"[$.,500,. r OrQ,o,z OTHER ... I , DESCRIVION OF OPERATIONS 1 LOCATIuNS'1 VEHICLES I EXCLVSWNS ADDED BY ENDORSEMENT f SPECIAL PROVLSION$ ..-. - •,-aa .. - i i^ s CERTIFICATE'HOLDER �CANICELLATIOPD _ -,� SHOULD'l1NY OF THE ABOVEsDES'CRLBED`POLICIEB•;BE CANCELLED'BEFORE�THE EXPIRATIONrP." V1 THEREOF TH£t1SSUIN4`,yINSURER'W;'ILL''ENDE4VOR=TO",MAIL OZ�O�A DAYS z WRITTEN - - biCERTIFICATE 4&Dot NAMEDTC�THE LEFT. BUT FAILURE TO DO';SO &CALL• ^r;•'.'F�•v�?' .,- �} '. .'.!` „1M OSE.•,•!JO.O ✓,.; .s,b - - . - ,,a :i, DLIt311TION OR'LIABWTY OF,::ANY>XIND xUPON_TFIE"INSURER, ITS AGENTS OFt REPRESENTATIVES tACORD AUTHORIZED.REP NTA5(2001!08) d - ®ACORD CORPORATION Is?— ` FI, .. 4 1 �` '' i { r t ..--��- �t',s r' - � - � a s a j t t ot y er 4 nw Y r � f o r " 37 f Pch \t�' t� ),e - ` `� i Y � ,t YY)f Ju � � e t4d t 46 ))/� a �f'R -f i�J.Yntl% •"C+ � ��! .. w9 ! _. ., � ' ... � ' ....� J , , P BOARD OF 8UILI lj"e ft VUTI0NS t LIOMV! CONSTRUCTIOf�1 SttPei Stl.�s4€� Number CS # g` i3l dato: 101021"1959 t'. Ear ices; 0f= 3 Tr:no. 5959 I' i ReIWCU&- L I? aULI=ZIFd4 ✓ r I. LI:AASAOVEi`t. vA-0184 6'. iA,'m nim T t+ ✓lreognn J��s3ata�it �? Roerd of BuildingRegulations and Standards —HOMEn ov r I< rr CONTRA R-- , Registration: 120199 ,Expiration: 11!1103 ; T'ype: IndhAdual DAVID-GULEZiAN i DAVID GULLZIAN E 428 9LEASANT ST " NORTH ANDOVER,MA 01845 Administrator j