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HomeMy WebLinkAboutMiscellaneous - 267 WAVERLY ROAD 4/30/201800 i 5--- 3 - C) --� Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... .......................................... has permission to perform .... ....... 1�rewx-.FF ...................... wiring in the building of ................. .......................... at ....... /2.40 ... 7 ... .............. . North Andover, Mass. Fee. ....... Lic. No.33.7 ... .. . .. . . ......... / ................. iLECTRICAL INSPECTOR Check # 7364 b I 1 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. —7:� y y Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ()MEQ, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspe for of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) r 1jG(. Owner or Tenant Owner's Address < ,,,-,'o Telephone No.�7d— 1/y Is this permit in con.unction ith a building permit? Yes ❑ No (Check Appropriate /Box) ,! Purpose of Building I br1 Utility Authorization No. Existing Service rbc _ Amps /o7 Q Volts Overhead Yo"" Undgrd ❑ No. of Meters New Service QLTf� Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following 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 Above n- Swimming Pool 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 Totals: I Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. o No. o Signs Ballasts Data Wiring: 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 6Vires. Estimated Value of lett ical Work: /S'C/U GU (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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the ains and- �enalties of perjury, hat t e information on this application is true and complete. FIRM NAME: n(� �t�C.kre It>c'�ILIC�(\ LIC. NO.:f2djig Licensee: (,! 1Enn Beck i'-' Signature LIC. NO.: (If applicable, enter "erenzp " inlie ie license number /ifry�e.) f Bus. Tel. No.•G7 ._ / Coa Address: �,5r ti � S /�Gr� , fj & &, WAlt. Tel. No.121- /LP�cs *Per M.G.L c. 147, s. 57-61, security work requires Department 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 PERMIT FEE. $ Signature Telephone No. �Aor-t> 5-�- I At/ 0 0 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 Lellibly Name (Business/Organization/Individual): I00f` Address: City/State/Zip: . _enCf7_ Phone 16 `3U Are you an employer? Check the appropriate box: I. ❑ 1 am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).* 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. ❑ required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F-1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t 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 ah employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 of 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 and penalties of perjury that the information provided above is true and correct. �. 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: -\ iwAS 'AU A 11sETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER, , Mass. Date Ig 6 7 Building v —7 _ F5 0 / � 00 Location q� V [ � � �Permit # '� C � � . Owner's instafiin Addres New ❑ Renovation ❑ Name V k Replacement Ek'� Plans Submitted: Yes ❑ No Check one: Q Corp. [I Partnership ❑ Firm/Co. Business Telephone ��— 1 Name of Licensed Plumber or Gas Fitter _ I/L Ca G� -e. C- C:)� -e INSURANCE COVERAGE: i Check one have a current Ilabflfly Insurance pollcy or Its substantial equivalent. Yes 9 ---No 11If you have checked ", please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity D Bond ❑ Certificate 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: %natute of Owner or Owner's Agent Owner L1 Agent ❑ I hereoy certify that all of the details and Information 1 have submitted (or entered) M above application are true and Occur Mo to the best of my knowledge and that eN plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Oods and Chanter 112 of the General Laws lay Title Ctty/Town NTFIDWO (OFFICE USE ONLY) T e o nse: Gasmtiler Signature of Licensed / um ear as Filter Master Ucense Number / S D Joumeyman �NNNNNt1 ANN�wN/11/11■mumEN NNNNNNENNN 0ONEno NNORN MONO NNONNINNONNINNON Check one: Q Corp. [I Partnership ❑ Firm/Co. Business Telephone ��— 1 Name of Licensed Plumber or Gas Fitter _ I/L Ca G� -e. C- C:)� -e INSURANCE COVERAGE: i Check one have a current Ilabflfly Insurance pollcy or Its substantial equivalent. Yes 9 ---No 11If you have checked ", please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity D Bond ❑ Certificate 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: %natute of Owner or Owner's Agent Owner L1 Agent ❑ I hereoy certify that all of the details and Information 1 have submitted (or entered) M above application are true and Occur Mo to the best of my knowledge and that eN plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Oods and Chanter 112 of the General Laws lay Title Ctty/Town NTFIDWO (OFFICE USE ONLY) T e o nse: Gasmtiler Signature of Licensed / um ear as Filter Master Ucense Number / S D Joumeyman � I i ru r 'n m O ` 2 > C Cf > z � A C V v m m C) -4 10 O m 0 n` = W O -1 m 0 O m p > W• 0 N O O � A i C r O Z rfl L7 d 1 A � O N r v m � r 0 � 1 i � Z ru 'n m z ` > r z � N V v m C) -4 O Z n` m m v n` D W -1 m O Z O O � A i � = O O N v m � 0 0 i Q Z N � -1 •i Date ... TOWN OF NORTH ANDOVER 16 0 0 0 PERMIT FOR GAS INSTALLATION SSACHU This certifies that ... has permission for gas installation d-.."'. in the buildings of .... ............ at Z!./...., North Andover, Mass. Fee../�'..:-:� Lic. No./.,; .... .......................... ( 1", (- e / 7 GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File i a � 4 a IL tri 0 0 0 Q W H a - W N U) n a X y p� W W Z 3 c 0 z 0 S it it m y W ILlz 0 0 0 p o W W ry I g o O N n z m 0 1� F W d 2 P z ..1 � f a I> N y C W 10 w J r Q m J y0 y y p yILm 0 0 0 JO Z r Z LL 0 f 0 z N it i m y y O U) q�[y s W a i Q Z < O 0 z < F y YI a W W JJ 0 0 y W U) y W z Y u_ x r z 0 h- O Z 0 LL LL 0 r S l7 W I W t, a r Z 0 rc LL W Q O u LL 0 W F W rc 7 � O Z W < C LL_ O r Z f 0 0 U LL < Z y U J 0 W _Z d L Q < J LL j 0 m Q rc J < m z 0 a z W L � r a o u Q z M I m C 6 r r In u uu 0 J J 2 8 N V � Q V LU ui 0 �- r• Z_ yl W F O Q 'o � o � 0 U v I I N IL t - O _J z W N M m r z YI I ill I z 0 Z z I J 0 Zw H r ! 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O CD b 8 w chi a p w O w v U c w" a a WO rL=O.� 0 0 w r� w rr� o z vi o cn uj z C Z C/) 0z .0 z� 1�1 1�1 �z w0 U C/) F�1 0 4 h �I Q E CDL ts 03 Z p, O y � C C! I C y G CD 'E m43 oco m a. H 4-0 60 G3 -a z1ft 3� CDL � 0 d o- c a co .0 'O O CC V c co Z C CD ci vs c C C C cc CO) is c c m c /� O_ ca C y.. O CD C0.1 C-3 rL=O.� 0 0 -t O . rr t O W : o c o0 'v IJ_ o a E5 cO �cm m c R E � N f►, v o N N 3 N ._.. cm O �v E m O . = O Of ��Z C C C y Q dct m a�+ •_ m H G) Z p C cm c N 0 C _ N ~ •O+ C2,O y m 0 ~ 0 W CODEK O O� m -O •+ 'p •N 0 O H - � d= C = + m r.m�c co,N O V CD o M_- COD 0, CIO co O - 0-.- -= O 2 =4-a�m> C Z C/) 0z .0 z� 1�1 1�1 �z w0 U C/) F�1 0 4 h �I Q E CDL ts 03 Z p, O y � C C! I C y G CD 'E m43 oco m a. H 4-0 60 G3 -a z1ft 3� CDL � 0 d o- c a co .0 'O O CC V c co Z C CD ci vs c C C C cc CO) is Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 I LIAM J. SCOTT Dire,7:or In accordance with the provisions of MGL c40, 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 c 111, S 150A. The debris will be disposed of in: E) k _��L (Location of Facility) Signature of Permit Applicant /1 Date NOTE: Demolition permit from the Town df North Andover must be obtained for this project through the Office of the Building Inspector. 0 7 ' iOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 00 , �pl,YfYTiq T C7 'R M k �$ �SS4CHU..r'a+� Zoning Bylaw Review Form Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 Street: a g rl W A y Map/Lot: I I Applicant: o r p, Z)e s are s Request: Ib d t .P„vr- Scaso,, Zc-" ioyett, -►. .cxi5 oPeN Dec KS Date: 9-a-0 3 Please be advised that after review of,yourApplication and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning �- Remedy for the above is checked below. Item # Special Permits Planning Board Item Notes Setback Variance Item Notes A Lot Area Common Driveway Special Permit F Frontage Variance for Sign 1 Lot area Insufficient R-6 Density Special Permit 1 Frontage Insufficient 2 Lot Area Preexisting S 2 Frontage Complies 3 Lot Area Complies 3 1 Preexisting frontage e S 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required 1-1 e S 3 Preexisting CBA `1 ,� S 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height S 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient p41>, '0ecK I Building Coverage 6 Preexisting setback(s) Cy' -54-1 54-LAM-1Coverage exceeds maximum 7 Insufficient Information 2 Coverage. Complies D Watershed 3 Coverage Preexisting H S 1 Not in Watershed H r s 4 Insufficient Information 2 3 In Watershed Lot prior to 10/24/94 j 1 Sign Sign not allowed N A 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E 1 2 Historic District In District review required Not in district `lam K 1 2 Parking More Parking Required Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parking Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit Setback Variance Access other than Frontage Special Permit ---Parking Variance. Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Independent Elderly Housing Special Perm FF Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit Special Permits Zoning Board Special Permit Non -Conforming Use ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but'Similar Special Permit for Sign R-6 Density Special Permit Special permit for preexisting - 1c� nonconformity Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new permit application form and begin the permitting process. Y � © ,�� S z� Building Department Official Signai:.uf�e Application Received Application Denied Plan Review Narrative The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: Referred To: Fire Police Conservation Plannin Other Health Zoning Board Department of Public Works Historical Commission Building Deoartmant S a s or •.'+. P 09 M 1z O z M 00 O MnM z^^ G) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING 016 l•t 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: Map Number Parcel Number U v A , '}t V �(p 1.3 Zoning Information:'[ 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage 11 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: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone D Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Naive (Print) Address for Service Signature l lephone 2.2 Owner Record: ALze't-T c2" Name Print Address for Service: -X Signature Telephone SECTION 3 - CONSTRUCTION SERVICE_ S 3.1 Licensed Construction Supervisor: Not Applicable ❑ A4,11A o.�3ca ► �c j 3 Q Licensed Construction Supervisor: / tp License Number 2 2 / , , � Z lJ , vA) AN y O� 57 [iw Add s 120, '2 -09 Zf Expirati D te Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Aoz (0.Aoma w s cua. - 1/ Company Names ,22 j Q ,/J/ / /� fCa /Cl �4 /_ I / 0 j� /t/]�/ ? Registration Number 9 Addre s ' z�� Expirati n Dat Signature Telephone 09 M 1z O z M 00 O MnM z^^ G) +­ ,�G'1 SSP � 11 dl �� 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 ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ I Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t lo 4pyt 4-4!>W OAJ r1C Y" /zWN44i70N `%O Cid fS7-T ^n 7 0,960 W/ �e' ,I >�L y�Y�l Ab _51S,59, 2Kkg A FZ SN ,�2oC lS !m .- d V1141, A740frn6W7- 4W6*.JS'v a vm R&Nff OW&C WU✓66Ca � 19 '571n4,t 9750 1 /I0Sn'I CLL 10"ee ZM<A7 owmir ca/pd05 t L y SECTION 6 - ESTIMATED CONSTRUCTION COSTS ` Item Estimated Cost (Dollar) ) to be ' _ FFICLAL JS Completed by permit applicant 1. Building `� (a) Building Permit Fee V Q Od 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 Check Number SECTION'7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, . D, t 11 es I, S as Owner/Authorized Agent of subject property Hereby authorize ,(J/� J A . / L- Su %Qx to act on _ My behalf, in all matters relative to wnrk authorized by this building permit application. Z! r rf SigAture of Owner Date S CTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject prope y Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief `Q .` A 1e s k /-hc- S' Print N e SignatUY6 of Owner/Agent Date 7— „; NO. 6F STORIES SIZE BASEMENT OR SLAB 5 LN 15 RD SIZE OF FLOOR TINMERS 1' j(/ X 2 3 SPAN 10pr DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND p IS BUILDING CONNECTED TO NATURAL GAS LINE tLo. re- Ar E K SURVEY INC ' 0 HAVERHILL, MA 0 ,Phone 978.469.1985 0 Fax 976-46fl 7D46 MORTGAGOR n�Z�o� iiDi .�% f�pr�S ADDRISS OF PRINCIPLE BUILDING DEED REF. 3�7 PG. PLAN REF; DATE OF INSPECTION• - SCALE: l" = 30 ' `e C iC S--P4SOti eOC) -,w T G� RUDE'. N No. ' :ERTIFICATION 1 O: k• The location of the princip46 ructurels Mortgage uhis Mortgage nd itPlot Ps not inlan tended or reprared reesentlly ed for �'�✓�ro� s`1 y with the local zoning bylaws In effeat.."an�constructed p y and/ or is exempt from violation et torcemnom o be o property lino or land survey. This plan Is not to be used action under Mvos S.L Tige W. Chap. 40A, Sec. 7. o establish any of the property lines for any purpose, No ® Subject bulldUt7 Is not In a Flood Hazard Area. a6ponstbillty Is extended to the land owner or occupant. O Subiect bultdinp ie in a Flood Hazard Area,. rhls cenincatton Is ousev on the location of survey marker Flood Hazard determined from the FIRM ma rf others, Dated - ,t