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HomeMy WebLinkAboutMiscellaneous - 268 DALE STREET 4/30/2018 (2)Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ........... ................ ........................................ has permission to perform,.-,.---/ ................................... wiring in the building of .... J��- 4.7-n—, ............................... at ........... .... . . ......... . North Andover, Mass. Fee..--��7 .. . ..... Lic. .................... 1'-'(�:-7_.'._',.-.. �.. ELEcrRICAL INS /_ - Check # %5 6' 74'12 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. AIK/01- 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 (M�C) 527 CMR 12 00 (PLEASE PPJNT IN INK OR TYPE ALL INFORIIA TION) Date: 7 City or Town of.- NORTH ANDOVER 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) �\69 — ID Q (R -� IL Owner or Tenant i-1 (- �, -e /- /)?C, �-o Telephone No. Owner's Address sc�,(,L Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building CC, (-- I- k Ill �)L)Je I � � �\O) Utility Authorization No. Existing Service Amps Volts OverheadEl Undgrd 1-1 No. of Meters New Service Amps Volts Overhead El UndgrdF-1 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. 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 Above Ei In- 1-1 grnd. grnd. No. of Lmergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches 3 No. of Gas Burners No. of—Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I Number Tons I ..K.W...... I - I No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 0 Mun'c'PP' El Other Connection No. of Dryers Heating Appliances KW Security SVstems:* No. of 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 IOTHER: Attach additional detail if desired, or�iirad 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 [:] OTHERE] (Specify:) I certyy', under the pains andpenalties ofperjuty, that the information on this application is true and complete. FIRMNAME: Y),Qc�-C),' LIC. NO.: OK� Licensee: Signature LIC. NO.: 8 9o-:;� (If applicabl ent "exempt" in the license numb line.) 1:?/- /37,7 + Bus. Tel. No.::::;4;, I � ') 7YI Address: r, __ �� �) U V's US Alt. Tel. No.: RVY *Per M.G.L c. 147, s. 57-6 1, 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) F1 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ R�-�e, ov, ��, The Commonwealth of Massachusetts 0 Department of Industrial Accidents 7 Office of Investigations 600 Washington Street Boston, MA 02111 UIP. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Ce �, Address: I u� G c-c7/s+orQ_ ��u — City/State/Zip: SCQ VY\ 0— 0 1 W6 Phone 4: ?R� – 9_�a/ —/ _:�7 ? Are you an employer? Check the appropriate box: 1.17�j am a employer with S 4. El I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 3. El I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. r_1 New construction 7. �KRemodeling 8. EJ Demolition 9. EJ Building addition 10. 0 Electrical repairs or additions 11 . E] Plumbing repairs or additions 12.E] Roof repairs l3f� 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 an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site information. Insurance Company Name: UJ I C� V_-� Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address:_gG,�? - o,- (e City/State/Zip: C) 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 under 7thains andpenalties ofperjury that the information provided above is true and correct. D <, <�;: I 'D _ 1 --9 / C) Signature: L�C�� 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Date. .10. VORTFI 'N'DOVER 0 ..... ... TOWN OF NORTH A PERMIT FOFjIkU M BING This certifies that ..................... has permission to perform ..... ............ plumbing in the buildings of .......... at ... .............. Nor-th Andover, Mass. Fee. . Lic. ....... P MBING INSPE�G Check # 2, 1.(' -3 7, -6 .0, !Z" MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS ,t� " Building Location . � Date S �-1-0-7 Permit # -2 ; 9' t Amount vi Type of Occupancy New 0 Renovation Replacement 0 Plans Submitted Yes E] No Q "&' 03 *1 V-1 k7-14 �101J I NIUVII (Print or type) Check one: Certificate Installing Company Name Corp. Address /Po A,�5;,y TI) C/ 7 r Partner. Business Telephond--' 0 Firm/Co. Name officensed, Plumber Insurance CqygWe: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond Insurance Wai L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mac t Plurnlintode and Chapter 142 of the General Laws. By: _ _ =IlLn::� — i algikaturu of Eicensea ri Der Title Type of Plumbing License City/Town I -- 0=533 1-41mver Master Journeyman rTt--" APPROVM (OFFICE USE ONLY I L—Li, 06cation l,io. Date TOWN OF NORTH ANDOVER Building Inspector Div. Public Works Certificate of Occupancy $ Building/Frame Permit Fee $ AcmU Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works PEWMIT NO.. 3 v t L IF 5 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAG -E 1 MAP �-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. OCATION �PU RPOSE QIF-B04"DAWG. 9KNER'S NAME NO. OF STORIES '00, slzs000, qVVNER-S ADDRESS' BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATER;AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS I - 3 PAGE 2 FILL OUT SECTIONS I - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS S MUST BE FILED AND APP 0 D BY BUILDING INSPECTOR DATE FILEPI SIGNA-IlnE OF OWNER OR AUTHORIZED AGENT F E E OWNER TEL. # PERMIT GRANTED CONTR. TEL. 0� �SA6 19 CONTR. LiC. 0 0 -7 3 PROPERTY INFORMATION LAND COST _XST. BLDG. COST C/O EST. BLDG. COST PIfR SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 414-611W - (12, NUIL"INIA lm*rrkUMR OCCUPANCY �INGLE FAMILY S;ORIES I MULTI. FAMILY WOOD JOIST APARTMENTS PIPELESS FURNACE CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE TIMBER BMS. & COLS. STEAM 2 13 CONCRETE BL*K.— BRICK OR STONE HA RD" D AIR CONDITIONING PIERS PU �–Sl I —R DRY WALL UNIT HEATERS 7 NO. OF ROOMS AS Oil UNFIN. 3 BASEMENT ELECTRIC AREA FULL NO HEATING I . B M T AREA 1/1 1/2 1/1 FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS CONCRETE —EARTH HARDVV'D COMMON ASPH. TILE B 1 2 3 DROP SIDING WOOD SHINGLE�-- — ASPHALT SIDING_ ASBESTOS SIDING _ VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR_ CONC.OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I -�Ip GAMBREL MANSARD —FLATI A SHED BATH 13 FIX.) TOILET RM. J2 FIX.) WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER R01 I RnOFIN(-, MODERN FIXTURES BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DI�IENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W*T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS AS Oil B'M'T 2�d Ist 3rd ELECTRIC NO HEATING co AdO3 u3woism mIc ui UJ ?! . e-,� a 1 1 i - > to 0 j i "o Z zo NJ ix E E s 0'2 g E Z FOLD ALONG 0 E' "o —M 4 7- FOLD ALONG E' NJ ix :2 B E. Z Z, C 0-1 ZWZ gow =0 UAW- \N, \Q 0 w —M 4 7- FOLD ALONG NJ ix Z Z, 0 UN UAW- uj 09 U) tu ZCL W5 cju$ CK 0-J fn 0-i 0. 0 7-L,*.j z 9L t j oz"4 cc > zg 0 IL 8 Zo, VII to Uo jw :1 .J CC a LLI LL -4b IL =1020 > 4 Lui "t ON4C Lu ow -- Z0, LU 0 > 0. 2 z 4 .x w �.Xo zx M.. LA CL 2 C2 6M MJ LL x 13CD IL 0 Q, 0 D o z 0 i5w == cc E: X Lu 4* 0 0 —M 4 7- �j 4 act log IC9 109 1 one 1 1 0 0 0 1.- 0- W u w 0 09 LL. z z LLI ci 0 cd C6 IA z LLI 0 z z cc < 5 an c = 0 >< 4w oo uo LU 40 Lu Co cm C E j 96 cm -A W r- 0 c t :3 :3 V w 0 Z 0 0 1E c 0 S 0 (D S 0 S C6 E cc u iT cc LL cc cn LL c cc LL In U) lo :C& 0 ca 0 C-1 CQ rn C* (s Z w a. F - z LU LU t�o Flqq .0 (A CL CL c .0 iv ow c CL W E r C6 rA Ot c 0� one 601* W 09 ci cd C6 Li rA c = >< 4w uo 40 Lu LIJ __j CWL. t Z:) V w 0 Z c C6 w as c 2 go Go CL. Q t�o Flqq .0 (A CL CL c .0 iv ow c CL W E r C6 rA Ot c 0� one Haverhill Maiden Framingham Brockton, MA 1508) 373-1886 (617) 322-7160 (5081872-6068 1508) 588-1171 VALLEY PREMIUM SOLID VINYL SIDING Quincy, MA Nashua, Hit Portsmouth. NN INSTALLED BY FACTORY TRAINED TECHNICIANS (617) 479-1211 (603) 860-1510 (6031436-7548 Nn. NATIONAL TOLL FREE 1-800-370-1886 DATE SOURCE CONSULTANT ;9� HOMETEL. WORK TEL. MR./MRS. THIS AGREEMENT, made and entered into between VALLEY WINDOW & SIDING, 50 White Street, Haverhill, MA 01830 hereafter 1 . oterred As a contractor AND C TY ADbRESS/STREET_1_(0'L4/14 S,tr I ZJ1,016-f- STATE Ala ZIP hereafter referred to as owner. THE SAID CO ; AITRACTOR hereby agrees that it will furnish all labor and materials necessary to install the following described work at premises located at: JOB ADDRESS 5�,_ �s i., (� — CONTRACTOR agrees to start described work on/or abotit Z , weeks after final fittings and complete described work in about if — ) - working days. CONTRACTOR shall not be held liable for delays due to causes beyond control. The following work includes all labor and. materials needed to complete your job Ina workmanlike manner. Areatobesided Insulation to be used /�,Zz,vt_ Size Starter strip to be used __�LL Siding Brand hL Size 1;'x'V Color — J -Channel Size Color — Corner Post Size Color Nails to be ulsed Style Size Fascia treatment Color Soffit treatment Color JkAl Window treatment Color ksl Door treatment Color _&!2 Shutter brand Amt. Color GutterStyle Gauge _�3_�L_ Color !_-:LUJ� Pipe Style Gaug ;�? Color —L. j1L E -Z Blocks 5 Amt. Color White Dryer Vents '7 Amt. Color White Gable Vents X`5 Size Zi;,'12 Color Spe I I I I?ns- W_1=tu_7t ---- - - ------- TOTAL INVESTMENT $ DEPOSIT $ BALANCE due on completion $ 06, THE OW NER SHALL PAY FOR THE WORK In Cash or Check upon Completion 1:1 Valley Will Make Bank Arrangements By Bank Modernization Loan 13 Owner Will Make Bank Arrangements You may cancel this agreement If It has been signed by a party thereto at a place other than the address of the seller, which may be his main office or branch thereto, provided you notify the seller In writing at his main office or branch by ordinary mail posted, by telegram sent, or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. .All material is guaranteed to be as specified. All work to be completed in a :workmanlike manneraccording lostandard practices. Anyallerationsor,eslimate ,.deviation from above specifications involving extra cosl will be executed only upon Authorized Signature written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes. accidents or delays beyond our control. DATE Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation insurance. NOTE: This propo3al may be wiffidown by us If no- accepted within days. An Interest charge of 11/2% per month (18% per year) will be Date of added to any amount unpaid after 30 days from invoice date. T�rnce S.gnn:.u,e 17 1 In th eveni of default in payment of this order or any part thereof and the. account is refertm.1 to an attorney for collection. the purchaser agrees to pay foa�unahivaitosiiey Signa r