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HomeMy WebLinkAboutMiscellaneous - 23 MIDDLESEX STREET 4/30/2018 23 MIDDLESEX STREET 210/043.0-0032-0000.0 i 7/14/2016 a 4. Date:July 14,2016 20883 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.coml#/records/20883 • 5�.t��Drya . � TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION _ 0 This certifies that Robert J Salemme has permission for gas installation Install new gas stove in the buildings of MADDEN, PAUL W. at 23 MIDDLESEX STREET, North Andover, Mass. Lic. No.3349 1/1 7/14/2016 Date:July 14,2016 20882 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20882 ` ' • TOWN OF NORTH ANDOVER � PERMIT FOR PLUMBING ❑� r This certifies that Robert J Salemme has permission to perform Moved drain line plumbing in the buildings of GRIFFIN.ARTHUR at 249 CARLTON LANE , North Andover, Mass. Lic. No.3349 1/1 7/14/2016 Date:July 14,2016 20881 This is an e-permit.To leam more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20881 TOWN OF NORTH ANDOVER � A� PERMIT FOR PLUMBING r This certifies that Robert J Salemme has permission to perform Replace tub and shower valve plumbing in the buildings of ELLIS,SCOTT at 5 GREEN HILL AVENUE,North Andover, Mass. Lic. No.3349 1/1 Date............................................. OF NOgTFr,� TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ...........OL4 ................................................................................................................. has permission to perform ............r5/'\ .......................................................................................... wiring in the building of..........P( ................................................. at A i jd C, North Andover,Mass. .......................................................................... ....... ................ '** Fee5 . ..... .......... ..............Lic.No. A 5`73� ELECTRICAL INSPECTOR Check# 2 12910 -/ Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked s BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07) (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code CA�m 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: jZ � City or Town of: NORTH ANDOVER To the Insp ct r of Wires: By this application the undersigned gives notice of iii or her intention to perform the electrical work described below. Location(Street&Number) l Owner or Tenant n l Telephone No. Owner's Address Is this permit in conjunction with a uildin mit? J Ys No ❑ (Check Appropriate Box) Purpose of Building t ! 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: Completion of thefollowing table may be waived by the Inspector of Wires. No.o Total No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators l KVA-03 Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. rnd. 1:1 Batter 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 Devices g Tons g No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent 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 Electrica :-- (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 ins ce including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such Covera sin force,and has exhibited proof of same the e t issuing office. x CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I —X I certify,under the pains and penalties of perjury,that the information on this application s true and complet FIRM NAME: . (/ (, tC�'1 LIC.NO. 3 Licensee: (/ Signature LTC.NO.: (If applicable,e "exemp "ir�the Z'cense number ) Bus.Tel.No.- Address: /114r- Alt.Tel.No.: *Per M.G.L c. 14'[,s.57-61,security work requires Nparleent of Public Safety"S"License: 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 PE�tMIT FEE: $ 5S�— Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the K notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he " or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending-through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass R Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: a_4 Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: tA Inspectors Signature: Date: 1L - - l s i FINAL INSPECTION: Pass 0 ✓ Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com Dated/, .... .. V ORTM ,x141 02 6 TOWN OF NORTH ANDOVER !� PERMIT FOR GAS INSTALLATION � SACHUS This certifies that . . ./... . . . . . . . . . . . . . . has permission for gas installation . in the buildings of . L'.1.4 r./G. . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee.-)a./. . . . . Lic. No.:1.)3.?. . . . . . . . ... . . . ..-o.Y�. . . . . . . GAS INSPECTOR Check# 7/)/ / f 4172 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI TTING (Print or T ) e, Mass. Date 1.a 2co-2- P rmit # _ Building Location /` Owner's Name ! bia f V'eAzidve-rType of 04u6a-icyFS I z) N T irl New ❑ Renovation ❑ Replacement 2* Plans Submitted: Yes❑ No ❑ N N ¢ W N 59 Z ¢ y y ¢ M ¢ 0 z 0 = W ur ¢ O 0 m r r c� I- ¢ m W 6 y W F N d C < W z W WLLS r s GW7 pW. 2 j M 2 W W O > W r V J Z O 2 O N = < W < ¢ '= 010 =1 0 3 0 d J 0 ¢ > o d O ' SUB-BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name r'A[=(2 T A . `.AM MA T A r Q Check one: Certificate Address 30 126A C H 1h A,y 4—KI. ❑ Corporation 111 _ T H U e rj r11 A • 0 (k q L ❑ Partnership Business Telephone /ro 91—17 -7"7 f 0- F-irrn/Co. Name of Licensed Plumber or Gas Fitter "'R t)A E e.T A• 5A m M 0 7A Pr D INSURANCE COVERAGE: I have a current iy'�Wity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes i No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box A 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 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Omer or Owner's Agent Owner❑ Agent C1 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and aw rate to the best of my knowledge and that all plumbing work and installations performed under the pe ' r ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of nor Laws. BY T of License: G� Plumber n ure of Licensedu _ or Gas rtter Title tter et License Number City/Town Journeyman APPROVED O IC N i BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. _ APPLICATION FOR PERMIT TO DO GASFITTING NAME S TYPE OF BUILDING LOCATION OF BUILDING 10 PLUMBER OR GASFITTER LIC. NO. - I PERMIT GRANTED DATE OAS INSPECTOR Location o23 No. 3-3 Date �ORTh TOWN OF NORTH ANDOVER O? • • OM h 9 Certificate of Occupancy $ Building/Frame Permit Fee $ y sACNUSE t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ii a 16248 AA( �e- --,--- Building Inspector � 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENON}VATpE(,y OR DEM.}yyO�YLISH`A ONE OR TWO FAMILY DWELLING--cD `a"°'P",�x�+ rn BUILDING PERMIT NUMBER: 2 DATE ISSUED: X SIGNATURE: Building Commissioner/In or of Buildin Date Z SECTION 1-SITE INFORMATION O /j1.1 Property ddress: 1.2 Assessors Map and Parcel Number: GU 3 2 Map Number Parcel Number a^� 1.3 Zoning Information: 1.4 Property Dimensions: A' Zoning District Proposed Use Lot Area Frontage ft v" 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of R rd Q t Name(Print) Address for Service: _n Signature Telephone V" 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Tel hone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number a t Address ic Expiration Date Signature Telephone r 3.2 Registered Rome Improvement Contractor Not Applicable ❑71.Al L) C",-51n, v r Company Name rn Registration Number r tti,� �.z-� r- A j a: - ?`i a � Z Expiration Date Signature Telephone- v, 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 a,I a licable New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: N SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be (?FICIAL USE ONLY Cfflnpleted by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X(b) 4 Mechanical HVAC f 0 5 Fire Protection ` 6 Total 1+2+3+4+5 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 i I, as Owner/Authorized Agent of subject property Hereby declare that a statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief D �t_V )- (� -.-'� -Y A Pria I --nA-A ,Y r_ Si g h'aTner/A g et n Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlMBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DM ENSIONS 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 `. The Commonwealth ofMassachusetts Department of Indust7ui1Acd4nts Office of Investigations :600 Washington Street Boston, WA 02111 Workers'Compensation Insurance Affidavit APPLICANT INFORMATION 1 Please PRINT Legibly ,A Name: /"1. z Location: e�3 !"�l!�!i S /1- c City: A)0, o izle/� Telephone ❑I am a homeowner.performing all work myself. 1 am sole proprietor and have no'.one working in my capacity ' 13 lam an employer er roviding workers compensation for mYa employees working on this job Company Name: Address: _9 LL7—F i2 S 77 City: A-)O RTl� 41 19a V F R Telephone#: �I Q 6 g:3 Insurance Company: .5 Luo A441 C Policy#: nn Q X 2g 461 111 am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the•followiag workers'. compensation policies: Company.Name: Address: City: Telephone#• Insurance Company: Policy#: ' CorApany Name: Address: City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B 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. I:, .understand that a copy of this s temenf may be forwarded to the Office of Investigations of the DIA for coverage verification...: I do hereby c rti der the ns and penalties of perjury that the information above is true and correct c Signature: Date: J1.2—.2-�Zd 3 Print Name: Dj#y1D- c.A 5 rA e.CA Al E Phone# Official Use ONLY-Do not write in this area o Building Department City or Town: Permit/License#: o Licensing Board o Selectmen's Office o Health Department o Check if Immediate response is required ❑Other Town of North Andover o� t%°oTH Building Department o 27 Charles Street North Andover, Massachusetts 01845 978 688-9545 Fax 978 688-9542 7 A�RATfD 'PA`y'�5 LIS DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, sl 50a. The debris will be disposed of in/at: r Facility locatio Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. IOU 141 Town of '. Andover 0 �L 43 3 4 - _- O� COCHIC A40,0;? CII' dov4a Y 44 0 0 43 er, Mass., 3 2 ATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT..... AAWY �'r v %q BUILDING INSPECTOR ................................ ..................%............... „ ,............. Foundation has permission to erect...ISI^�...P....... buildings on ...., ..3.......# I�., �. W ...... •1t.....••• Rough to be occupied as rWec R�� �!� ! . Chimney .................................................................. ............................................... provided that the person accepting 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 action, Alteration and Construction of Buildings in the Town of North Andover. 4%1 Ins a qO ® PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Vmds this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S TS ELECTRICAL INSPECTOR Rough .............................rI...�....00a....... .. ............... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Fi ugh Fnal 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.