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HomeMy WebLinkAboutMiscellaneous - 284 MIDDLESEX STREET 4/30/2018K) m Cl) C/) m m ........................ Date ..... 7 7 TOWN OF NORTH ANDOVER 0 - PERMIT FOR WIRING (f V/ �t ........... This certifies that ........................................... has permission to perform Ouvl? ....... (S-5, 7 wiring in the building of ............... ............................................ at ... J. eY.. /%1.0N If —.5 . . ......... 5,; ................ . North Andover, Mass. Fee. -37P S'�� Lic. No...j�� f 2-7 4C- '4 ..... . �.. ................. .... ...................... P '01M ELECTRICAL INSPECTOR Check At 7647 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 7 6 -/r/ ? Occupancy and Fee Checked [Rev. 1/071 '(leave blanlo 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 INF0RJVM TION) Date.?—/ V-0 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) M J'r Owner or Tenant Owner's Address Is this permit in conjunction i h building permit? Yes El Purpose of Building Z5)=C Existing Service Amps Volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. No Lc�' (Check Appropriate Box) Utility Authorization No. Overhead [:] UndgrdF-1 No. of Meters Overhead n UndgrdF-1 No. of Meters -S- AD 0J 0J Completion oJ'the following �, able way be ivaived by the Insl3ector ofkVires. No. of Recessed Luminaires No. of Ceill.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above El In grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS JNo. 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 No. of Waste Disposers Heat Pump Totals: I Number Ton I - , No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E] Municipal El Other Connection No. of Dryers Appliances KW —J Security Systems:' No. of Devices or Equivalent JEHeating No. of Water Heaters KW 0_ of No. of Signs Ballasts Si Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs f m No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent IOTHER:- iluach additional delad ifdesired, or cis requirecl' b�,,; ihe 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 Unlel the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. Th undersigned certifies that such coverage is in force, and has exhibited proof of sarne to the permit issuing office. CHECK ONE: INSURANCE [I BOND OTHER [] (Specify:) I eerl?fy, under t" it�kntdp� Zna;ld f ti Iti information o�,Jis application is true andcomplete. Ces o perju la FIRM NAW: A trul t, 'r 77/ ell I U /op LIC. NO.: Licen JU ( &J q Signatu LIC. N (�fapplicable, ter -e enfp�t �-e licenSe 17114'el, 11 e.. Bus. Tel. NoV"4-4-1-11 Address: 2 Alt. Tel. No.--7r—L. "Per M.G.L c. 147, s. 57-6 1., security work requires Department of Public Safety "S" License: Lic.No.vl all f OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage nornia required by law. By rny signature below, I hereby waive this requirement. I am the (check one) [:] owner owner's a! Owner/Agent Signature Telephone No. PERMIT FEE: $ f ly Q k I l! Location No. Date c� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ —3 co Check # 17657 Building Inspector 1.1 Property Address: Cb 'A a)e 5 ic-- x S 1.2 Assessors Map and Parcel Number: Map Number Parcel Number N 0 J Name (Print) Address for Service 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: LA Area (so Frontage (ft) 1.6 BUILDING SETBACKS (ft) 2.2 Owner of Record: Front Yard Side Yard Rear Yard Required Provide Requi red Provided Requig:�— Provided Signature Telephone , SECTION 3 - CONSTRUCTION SERVICES 1.7Water Supply M.G.L.C.40 34) 1.5. Public 0 Private 0 Zone Flood Zone Information: Outside Flood Zone 0 1.8 Sewerage Disposal System: municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSEIIP/AUTHORMED AGENT 2.1 Owner of Record Name (Print) Address for Service 60 <3 Telephone 2.2 Owner of Record: 4 Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 S4 Licensed Construction Supervisor: C .5 - C) S License Number 5- A 'S Addre . I U " � -F D, Expiration Date Signature / Telephone 3.2 Registered Home Improvement Contractor 1 �—t e- S Vvo, C b-jq� -4 4b C� 4L Not Applicable 0 at C6mpany Name 01- Registration Number 4 5- A 'S Address Q,,, Expirati6n Date Sianature I Telephone I M I SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6) I 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 build�jtpermit. Signed affidavit Attached Yes ....... ir No ....... 0 SECTION 5 Description o Proposed Work (chmck applicable) New Construction 0 Existing Building 0 Repair(s) R---- I Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: rR'e-9'ri\'A '? 0 M. C' SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant FFICLAL V.SE' I . Building '5�0 Cc) (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction Plumbing Building Permit fee (a) x (b) .3 4 Mechanical (HVAC) Fire Protection .5 Total (1+2+3+4+5) Check Number -6 SECTION 7a OWNER AUTHORIZATION TO BE COWLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERIVHT T 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, 7� el-ve— A 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 —Te- s. -t Print Name Signature of 0 er/A ent Date NO. OF STORIES SIZE BASENENT OR SLAB I ST ND SIZE OF FLOOR TBABERS 2 3KO SPAN DEMENSIONS OF SULS DMIENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEMNEY IS BUIIDING ON SOLID OR FILLED LAND IS BUELDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations V Boston, Mass. 02111 Workers' Compensation.Insurance Affidavit Please Print Name: Location: ;LT4 G e x '5 city No rL, -i- L-\ 40,/ -C� Phone clW- am a homeowner performing all work myself. A F—L -4anTTs-61e proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address Cily: Phone Insurance Co. Poligy # Company name: Address Cily: Phone #� Insurance Co. Poliof # Failure to secure = as, required under Section 25A or MGL 152 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 statement may be forwarded to the Office of investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of petiury that the irdbrmation provitled above is true and correct. W11 Print Official use only do not write in this area to be completed by city or town.official' E]Check if immediate response is required Building Dept Contact person: FORM WORKMAN'S COMPENSATION A. Date 9/11 /0 Y # (615 ;�L - -x a .1, 1 0 Building Dept 0 Licensing Board 0 Selectman's Office 0 Health Department El Other North Andover Building Department Tel: 978-688-9545 .DEBRIS DISPOSAL FORM In accordance with the provision of IVIGL 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 IVIGL c 11, S 150 A. The debris will be disposed of in: e (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector (A m m X m m x CA m m z CD 0 CL Polio CL A . >um 10 cl CD CL C7 CD 0 EL— CD CD CO) CD CO) CM) CO) 10 . CO) c") CD 0 CD Mo IN CD a. cop) CD CO) z CD CD 0 cr CA EL- 4c CD to m CD Cos C2 z =r= co) 0 Im — CA =r CL CL m =r 0 0 P -P CD CO) CD -40 coo 0 *= : -4 Er !R . C -DI m a CA A4116, CO .00- 0 I = '. cc oc so z S. n C.) 41 Ce CD Er CL 0 L cc W CD CD 71 C'3-0: : ;% 0 CD CL -4 -mb C= 0cA 0 ca co, N4% = "CL cr CD CD 'AM CMQ : 0 cn SO cN =CD C, 0 Col Cl) cv Cir 0 D Cf) CD Go.*) CD 0) co C=L C2 =1 cn 0 Xll et cn z W Ei n :v (n COD -x Ix n 0* cp ;p 0 . jib 0=3 0 GENERAL BUILDING NOTESICHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipelstonelfabric filtedcover and outlet connection. FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. WaUs at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. .Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations YS" air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x3O w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. % of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspecfions at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36 " high, Baluster max space 5" on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $30.00 (Be Ready). Certificate of occupa ic reauired orior to occupjjn structure.