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Home My WebLink AboutMiscellaneous - 29 MARK ROAD 4/30/2018N? C" O� go (D > j j No 6 — i; / 1 (" 7 Date . . . ,J- . . . / ........ . I ...... .. ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...................................................... ................. has permission to perform ..... ...................................... wiring in the building of ..... / ..................... ................................................ An at ..................................................................... . North dover, Mass. ................... I Fee�'3 .............. Lic. No:-':��,.? Z/ ... I ................................... ELEC rRICAL INSPECrOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TaEC0AM0NWE4LTH0FALASS4CRVSE77S Office Use only DEPARTA1EVT0FPUR1CS4FL7Y Permit No. 3y �1 BOARDOFFMPREVEMONREGULAHONS527CM12*00 Occupancy & Fees Checked APPLICATIONFOR. PERMIT TO PERFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspedtor of Wires: The undersigned applies for a permit to perform the electrical work descr%ed below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes 12 No (Check Appropriate Box) Purpose of Building c) Utility Authorization No. Existing Service 00 Amps GO f,��40 Volts Overhead Underground No. of Meters New Service alk -20 Amps)D,() fC)\W Volts Overhead Underground No. of Meters I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7(-)0c-\V\t 1-1 . �01) V-� + Rs,,- S -74-- No. of Lighting Outlets I? No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures -Z\ Swimming Pool Above Below Generators KVA 0 ground 1:1 ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units 3o No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zone No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW 1:1 Connections No. of Water Heaters KW No. of No. of I Signs Bailasis No. Hydro Massage Tubs I No. of Motors Total HP OTHER- lrwranceCoWrdg�. RUROttDdleOWMffZOfMMXIU9Mam-a]I-aws IhaveawmiLmNitykmrmmFokymchdTCon4)iole-,.�GDVaag�OfitSgbSLfflhWe@iValat YES NO '1have%ibmiWdvWproofofwneiotheOffm YES r -7p F)mhaNedrckDdYBplemnhcaletbe�Wofoovwa,--by INSURANCE BOND ORIER spa*) EVira1iori Date EtmalodValtieoffi�arimlWbdc $ WotkloStart kqectionDaleRoqueod Rough Fmal S1gr)edundcrTrRnaJtmofpqJury: FIRMNAME LimmNo. L "I i :a A E- icmm sigivaure Q04;1� LiowNo 90 Bu4ne% Tel No. o V\ Mr.. \ �dp- AILTUNo. ONW�SINSURANCEWAIVEP,Iamawmdiadrllomsedoesnothawdiemumxcc)NuaWorZabsutaloqLuva�asogmedbyNb%adusettsG=iWLam and duirrrysigiabmondnspenitapphcahmwaiNeshsioqLu*oymt (Please check one) Owner M Agent M Telephone No. PERMIT FEE$ signature of Owner or Agent Location MA K K 61 No. C�?36 Date /0—. 19-01 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 90 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 15099 Buildi ng Inspector t L TOWN OF NORTH ANDOVER BUILDING DEPARTMENT A APPLICATION.TO CONSTRUCT. REFAIR, RENOVATE, W.DEMOLISH-A�0NEORTWO FAMILY DWELLING C �TIQN; 'VLD B DATE I 4BUILDING PERMT NUMBER: SSUED: 0 '/0 -o7001 SIGNATURE: lel,� Building Commissionerfin-spector of Buildings Date SECTION I- SITE INFORMATION 1. 1 Property Address: 42 CA 1.2 Assesso�s Map and Parcel Number: 0 00.).Ll Map Number Parcel Nuni6er N)r-, AL, ok4 L_� 1.3 ZoriingInf ati6n: 177) Zoning Distrid_ .,_,,pjoposedqsp 1.4 Property Dirneasions: Jvea (sf) Fr (k) 1.6 BUHDING SETBACKS (ft) L Front Yard -Side Yard Rear Yard Reqtfired Provide Provided— Required Provided L7 3tTp1yZ.G_LC.40. 54) 1:5. Flood Zone Infonnation: W Public re 0 zone Outside Flood Zone is S 1346sallsytt&mi municipal On Site Diip6�sal S SECTION 2 - PROPERTY OWNERSHW/AVTHORIZED AGENT, 2.1 Owner of Record --- --- Name n Address for Seivice S,,%e k Telephone 'j U -J 2.2 Owner of Mecord: e nt Address for Service: I clupflone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Appficable 0 ,icensed Construction Superviso . (2 573 0 Is License Number ti A,- Wdress S-7 Expiration Date :ignaturel, 'k.-Jelenhone .2 Registered Home Not Applicable 0 Registration NumT)er Expiration Date SECTION 4 - WORKERS CONMENSATION c M § 15c(6) Workers Compensation Insurance affidavit must be completed and submitted with this a pplication. Failure to provide this affidavit will result in the denial of the issuance of th2 building permit. S igned affidavit Attached Yes ... SECTION 5 Descdp� tibfi of Pio'poied Work'(c&ck i p44ble)_ New Construction 0 Existing Building 0 'Repair(s) 0 _[Zler—itions(s) 0 Addition Accessory Bldg. 0 Demolition 0 Other El Sp ecify Brief Description of Proposed Work: AAJ Ur V rM SECTION 6 - ESTMATED CONSMUCTIONCOSTS Item Estimated Cost (Dollar) to be pa M Copipleted by permit applicant 1. Building 6p, J�/ . (a).Ouilding Permit Fee Multipiief 2 Electncal '-.0), Estimated Total, Cost of -Construction 3 PIurnbJJrig_... .-BuildingPermit fee (a) x (b) 4 Mechanical,KtE�C) 5 Fire Prot tion, Total (l+2t3+4t5) SECTION 7a OWNER AUTHOR17ATION TO BE COMPLETED WIIEN OWNERS AGENT OR CONTRACTORAPPLIES FOR BUUDING PERIVUT W") as Owner/Authorized Agent of subject property k__ U Here ithorize to act on h in a tt r to or autholizecAby &s building permit application . T (Y t LL (Sig4at��q(pf VJwnet-/ Date \StCTXO - MAU 111ORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statemeni d r, Qti n on the foregoing application are t.rue.and accurate, to thebest of my knowledge and belief Print me Signa wner/A ent Date NO. OF STORIES SIZE BASENIENT OR SLAB SIZE OF FLOOR TINMERS ND 3 FJ) SPAN DR, ,IENSIONS. OF SILLS DMENSIONS OF POSTS DINIENSIONS OF GIRDERS SignaZ�,., tvk HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEWNEY IS BUILDING ON SOLID OR FILLED LAND FORM U .-LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro m Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE_1,1�_k -5733 5— LOCATION: Assessor's Map Number Oct ?J PARCEL SUBDIVISION LOT (S) STREET___��l �kC_ ') 01 ST. NUMBER—, USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATEAPPROVED, Z6)11b10,1 DATE RF.1Fr_TFn TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FQJOD INS -HEALTH z _7Z SEPTIC INSPECTOR -HEALTH COMME DATE APPROVED DATE REJECTED DATE APPROVED 1z /,ATE REJECTED - PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 im .TE_ Of JOHN S, LA U R ETA N;11 # # 34311 rs skoM N k W, �ROFESSIONAL LAND SUR—VEYOF, ) HEREBY CERTIFY THAT THE 1OVE MORTGAGE INSPECTION AN WAS PREPAR Z� 4JD F IMFOR-0 -SA "i )NNECTIO WITHANEWMORTW 8v D IS NOT INTENDED OR REPRE- NTED To BE A LAND OR PROPERTY JE SURVEY. NO CORNERS WERE T- IT CANNQ BE USED FOR ES- BLISHING FENCE, HEDGE OR ILDING LINES. THE LAND AS SHOWN REON IS BASED ON CLIENT FUR- 3HED INFORMATION AND MAY BEI 11JECT TO FURTHER OLrr-,qAj ;:p I MARK Ro/-\L-) LOCATION OF STRUCTUFIE( 13ASED ON LVSOF OCCUPI�TION ONLY. A. MORE ACCURATE LOCATICIp WILUL REOUIRE AN IN , UMENT 31JAVEY, Scale: AMERICAN SURVEYING COMPANY 1264 Main Street, Waltham, MA 02451 (781) 893-6477 PREPARED FOR INTEGRATED MORTGAGE SERVICES, INC. Mo THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON EITHER WAS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BYLAWS IN EF. FECT WHEN CONSTRUCTED WITH RE- SPECT TO HORIZONTAL DIMENSIONAL REQUIRFmr.MTQ eNkle Inspectl' on Plan I RECORDED AT=05� �WOK COUNTY REGISTRY —4J-b2L- PAGE —LR_ L C. Cert # FDEEDS PLAN REFERENCE: DRAWN PER TOWN OF ASSESSOR'S MAP # -- �- PARCEL # ADDRESS:.;—":) MA DATED The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print ,:)2 Ci!Y K,0�� - k—A-4-� L�t,� Phone F-1 am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. I k �, %—. A /A C-7) I J -- r 1 .1 Address Qz Phone #, I n�,i minnp Cn C-) %-I 'A Policv # 1pt v Lc— &,oar -6 Company -name: Address Cily: Phone #: Insurance Co. Policy # Failure to secure coverage 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' imprisonmq%A&.w_ell as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand 14t a copy cf,#A statemehk maybe forwarded to the Office of Invesbgations of the DIA for coverage verification. I do herby certffy und_ePfh9Xtns and perkpities of pplj* that the Print provided above is true and correct. Official use only do not write in this area to be completed by city or town official' C]Check if immediate response is required Building Dept Contact person: Phone FORM WORKMAN'S COMPENSATION V M Building Dept C] Licensing Board F-1 Selectman's Office E] Health Department 0 Other CO m m :0 m m m Cl) m U) 0 m CA 10 co cl) z P.O. C* CD CL W CL 0 dc CD CL cr =r CD 0 I -W -WE 0 1 a] a: t= to CD CD Cl) CA "0. Cl) CA ELIP, cu Cl) CD =r CD CD a rA . 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