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Home My WebLink AboutMiscellaneous - 228 PLEASANT STREET 4/30/2018 228 PLEASANT STREET 2101085.0-0017-0000.0 i I� Ii I Date........................2..... HORTM °f<��`°;•�"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING s c• �~�1 ,SSACMU`�� . � I� S¢t�tJBO/z -� Sys Thiscertifies that .................../.................................................... .......... has permission to perform V'1f37. r,Tv P wiring in the building of.......... Z4l.I, . .............................. J .............:5............. ..... ,North Andover,Mass. .. � F ....�........ Lic.No.....1.3Z........9J�..�.......... ......... ELECTRICAL IN E Check # "10828 (fommonweaR o f Maddachudettd Official Use Only r c� Permit No, 2apartmant ol5ire Serviced ro Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev, 1/07] leaveblank 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 TYPE ALL INFORMATIO Date: /-2– City City or Town of: /J/,= f o„�;,� � 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) t,2„Z ;,',� j Owner or Tenant .LY'�/ .C' Telephone No. Owner's Address -5,9,4 L Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building / E,...: Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / -Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:( 6-In-1 Rtit� i�c��j• Completion ofthefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool A ove [JIn- ❑ o.o mergency rg ng rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners No.of Detection and .j Initiating Devices No.of Ranges No.of Air Cond. Total No.ofAlertin Devices Tons g No.of Waste Disposers eat Pump um er ons o.oSelf-Contained Totals: ""' " """""""'"" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Connnneectioctio n ❑ Other No.of Dryers Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent No.of Water Kms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications icing: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Elect 'cal,Work:,t° (When required by municipal policy,) Work to Start: .s ' /l, 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [I BOND ❑� OTHER ❑ (Specify:) p I certify, under the pains andpenalties ofperjury,that the information on this a pli tion is true and complete. FIRM NAME: ALK S,q 2N u•'lf ec • LIC.NO.: Licensee: 1'.--4 i C-AdZ SA6j-bcgj Signature LIC.NO.: (If applicable, enter "ext"in the license number line. Bus.Tel.No.: 92y--5--r-- Address: G � -` G.�r p Alt.Tel.No. *Per M.G.L. c. 147,s. 57-61,security w requires Department of Public Safety"S" icense: Lic.No. 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: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nari1e (Business/Organization/Individual): 31`1: ��.�i3e,z•� v- -e,� ��SC�y,; �� Address: 3 RCI City/State/Zip: —�,vfstS� i Aii3 60/j Phone #: Y"5-s3 A71--ana'a olt n employer?Check the appropriate box: Type of project(required): 1. employer with_ /5 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 2• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition ' working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10,.X Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. 1'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /l��c �s / cf eit0iZr- Fit Iintsa nQ uCo(j L Policy#or Self-ins. Lie. #: y SIJ j�� Expiration Date:/0 Z/ Job Site Address: �r `.�' Aj j' City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties o`a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th airs and p nalties ofperjury that the information provided above is true anti correct. Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I 41 } Locations No. Date `/ NaRT►, TOWN OF NORTH ANDOVER 3? � . 0� 0 9 ` Certificate of Occupancy $ ��s'�•°•E�� Building/Frame Permit Fee $ AC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # .44 —. — 17388 -Bu lding Ins or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. i- DATE ISSUED. J� M SIGNATURE: Buildinj Commissioner for of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number P rcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide ReqWred F Provided Required Provided 1.7 Water Supply M.G L.C.40. 54) 1.5. Flood Zone Tnformation: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION Z-PROPERTY OWNERSHIP/AUTHORIZED AGENT Q 2.1 Owner of Record Name(Print) Address for Service L___ r 7,-A� Signature Telephone i 2.2 Owner of Record: Name Print Address for Service: z M Signature Telehone SECTION 3-CONSTRUCTION SERVICES 3.1_Licensed Construction Supervisor: Not Applicabl Licensed Construction Supervisor: License Number M Address Expiration Date ic a® Signature Telephone ra 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number Address r a2M Expiration Date Signature Telephone f. 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 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify +, Ajit Brief Description of Proposed Work: olo SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be sOFFICIAL USE(NY Completed by permit applicant _ < 1. Building (a) 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 Q D —2100 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1/ 42 AA:!� kh ARC as Owner/Authorized Agent of subject property Hereby authorize to act on My b alf,in all matterstwiative to wor a y this bu'dinTpermit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Print Name Signature of Owner/A en t Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 213RD 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 • @ t4ORTFt.q Town of North Andover Building Department 27 Charles Street " r �µo North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. / DATE /t7 JOB LOCATION [ `ffT�511117- ST F� / Number Street Address Map/lot J "HOMEOWNER l ftl fi'S Name Home Phone Work Phone s Q PRESENT MAILING ADDRESS—CW 101 1*�/17 /V0 kv-ce C,�CK A City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than onehome in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. P HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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 Permit 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 ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector VAORTH Town of ..: - T No. 76A 0 K dover, Mass., COCHICHEWICK X1,95 RA TE D PPS`�.(5 u BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT....................................................................... ....................... ..................................... Foundation has permission to erect................... .................. buildings on ........ ..................... . ......... Rough to be occupied as ..................................................................... chimney .... ... . . .. ...................................................................... provided that the person accep g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. I Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TAS S�j�r Rough J�'� .. Service . ....... ................... BUILDING INSPECTOR 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. NORTN O� tN• •1qO !O- 9 NORTH ANDOVER BUILDING DEPARTMENT ,=ao � 400 Osgood Street ,SSACHU Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: Cell C17g-go7— e?coS3 NAME: S �rcvcr �n #�My �i'�oc�k ievca ADDRESS: o�o`�� plQaSaxi ZONING DISTRICT: l� TYPE OF BUSINESS: Y BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: e/n ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE Revived 11.5.04 BUSMESS FORM FOR TOWN CLERK -