HomeMy WebLinkAboutMiscellaneous - 29 ROSEDALE AVENUE 4/30/2018N
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TOWN OF NORTH ANDOVER
ULM* 6 PERMIT FOR WIRING
J, 7 -(bm
This certifies that ......... ................. )"*'***"""***"**'******"****'*****"*"""***'*********
(2 h&-, T -g.
has permission to perform ............ ............................
.............
wiring in the building of ................. .............................................
at .......... ........ . North Andover, Mass.
Fee.5�.=—.. Lic. No.11.1P0.0 .......... i "i�E�
Check #
10760
(f.msnoruvealg 0/ )&6acka6etb Official Use Only
Ram 2epa,t.d ol-7in, Smwic. Permit No. /6766
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (lea,ebiak)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work- to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CN4R 12.00
(PLEASE PRINT IN 17VK OR TYPE ALL INFORAM TION) Date: �/� ��, .0 /_� �
City or Town of: d, J4A)&10j1gV To the Inspector oj'[Vires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 2 q fiae_ . I
Owner or Tenant ep &?,4 Telephone No.
Owner's Address or
Is this permit in conjunction with a building permit? Yes El No [A*" (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service
New Service
Amps Volts
Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed E
Overhead
Overhead
UndgrdE1
Undgrd 1:1
No. of Meters
No. of Meters
Comnletion of the followint, table mav be waived hv the Insnprtor of Wirpv
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
— , I -,-- - – ---
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above o In-
- _grnd. grnd. F�
- of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
NO. of Detection a -d
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Beat Pump
Totals:
I.Nurn ber]
............
Tons
...........
........................
f Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
1AX21 [] Municipal
Connection 0 Other
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Eguivalent
No. of Water
Heaters KW
0. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. HydromRssage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
I No. of Devices or Equiv lent
OTHER:
.4 ttach additional detail if desired, or as required by the Inspector of 97ires.
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 El BOND [] OTHERE] (Specify:)
I certify, under thepains and en Ides ofperjury, that the information on this application is true and complete.
—9 - LIC. NO.: :5 -
FIRM NAME: - I 04::f XR
Licensee: Signature NO.:
(Ifapplicahle, enter "exempt" in the licefise number line.) 41/
Address: Z Z,2 - &.*e _�, L., *,,,Bus. Tel. No.: 1? 6 C "a 9 3
1E I M &. An , _ Alt. Tel. No.:
*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) Elowner El owner's agent.
Owner/Agent
Signature Telephone No. FERAHT FEE: $
The Comnionwealth of Massachusetts
Department of Industrial A ccideljt,�
Office of Investig"ations
600 Washington Street
Boston, M,4 02111
:4
F. M:::
PRF
www.mass. govIdia
Workers� Compensation Insurance Affidavit: B uilders/C ontrartors/El ertri Cian s/P lumbers
ADglicant Information Please Print Le!!ibiv
Na= (Busin-�ss/OrLanization/Individual):
Ad&ess: 52 Ii.�l .
City/State/Zip:_ Phone #:
Are you an employer? Check, the appropriate box:
F7 I am a employer with 4. [] I am a general contractor and I
I
e=lovees (full and/or part-time).
L -T -a& a'sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. misurance
required.]
I am a homeowner doing all work
myself. [No workers" comp.
insurance required.]
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
emplovees and have workers'
con -T. insurance.:
5. We are a corpc)ration and its
officers have exercised their
right of exempt*
ion per MGL
c. 15 2, § 1(4), and we have no
employees. F�o workers'
comp. insurance required.]
Type of project (required):
6. New construction
7. Remodeling
8. Demolition
9. Building addition
10. Electrical repairs or additions
11 -[1 Plumbing repairs or additions
12-17 Roof repairs
13. [1 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 hiTt outside contractors must submit a new affidavit indiratin- such.
lContractors that check this box must attached an additional sheet showing the naTn-- of the sub -contractors and state whether or not those entities h`ave
empiovees. If the sub -contractors have, errrPlovm, the), must provide their workers � comp. policy number
I am an empli�yer that is providing workers � compensation insurancefor m�y emplayees. Below is the policy andjob si!te
el
information.
Insurance Company Name:
Policy # or Self -ins. Lic.
Job Site Address:
Expiration Date:
Citv/Stdte/Zin:
Attach a copy of the workers' compensation policy declaration page (showinc, the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can 1fad to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisortment, as well as civil penalties in the form of'a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be for -warded to the Office of
Investigations of the DIA for insurance coverage verification.
C,
I do hereby certify under the p
?ins andpenalties ofpeijury that the information provided above is true and correct.
001
OfJicial use oniv. Do not write in this area, to be completed k), cify or town official
City or Town:
Perrnit/License #
J�
Issuing Authority (circle one) -
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person:
Phone#:
Location
No. Date ;�/-z e)zg
TOWN OF NORTH ANDOVER
o 7.
r* - � - io-- �,
Certificate of Occupancy $
Building/Frame Permit Fee $
counriot on Permit Fee $
& Permit Fee $
Sewer Connection Fee $
W.qtpr rnnnpttion Fee It
TOTAL
C�, Or C3/10134 11:44
- 11) 8 0 P. P.
$
Building Inspect
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All of the above work to be done In a good and workman -like manner.
All men and equipment Insured. Premises to be left clean upon completion of work.
Forthe total sum of —I—LL) 0
U+ a %j \4 �4 %9 Ll C_ dollars.
Entire Sum to be paid Immediately upon completion In accordance with plan as shown below.
TOTAL CASH SELLING PRICE .......... S 0,� , C b
DOWN PAYMENT IN CASH .............
DEFERRED BALANCE
UPONCOMPLETION ...... I ...........
The undersigned agrees to keep property mentioned in this agreement properly Insured against loss by fire Including the
Contractor's interest therein.
This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance'
this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements,
written or oral except as herein set forth. It Is the Intention of the parties hereto that this contract shall be binding upon their respective
heirs, executors, administrators, successors and assigns.
Customer agrees to pay a reasonable sum as attorney's fees and Court Costs If placed In hands of attorney for collection.
The owner further agrees that In event of cancellation of this contract after acceptance by the contractor and before the work Is
commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract.
Said contractor shall not be responsible for damage or delay due to strikes, fires, accidents, or other causes beyond his
reasonable control.
We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are
to be performed.
IN WITNESS WHEREOF, the undersigned has (have) hereunto set his (their) hand(s) and seal(s) the day and year written above.
Accepted By Husband ::2
AYM DAMP SSE, JR. AND SONS Wife
ROOFING INC.
Mail Address
(11 different from above)
17-- (Signature and YjK of Official�
RAYMOND E. DAMPHOUSSE, JR. AND
SONS
ROOFING CO INC.
-9
MA. CONSTRUCTION BOX 431 LAWRENCE P.O.
1*4
SUPERVISOR LIC. #046636 LAWRENCE, MA 01842
HOME IMPROVEMENT TEL: 683-4588
."-,.REG. #101862
ROOFING SIDING— INSULATION
Date
1Y_70// I-OA16L
0 C) D,,4z-z
A10
(N &Me) (Address)
Jim 1ATNO13 E DAMPHOUSSE, JR. AND SONS ROOFMC CO., INC., BOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01842
,_4
.11 (we) hereby authorize the Contractor to furnish all materials and labor necessary
to Install, construct and place the
mprovements described below In -on building located a tNo. 42�27
Street,
City' 6,Uj0kj1r/Z State Z" r In the following
-S accordance
with specifications:
2!1
joIn-611JIE-S A 176 L'i -01—"
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All of the above work to be done In a good and workman -like manner.
All men and equipment Insured. Premises to be left clean upon completion of work.
Forthe total sum of —I—LL) 0
U+ a %j \4 �4 %9 Ll C_ dollars.
Entire Sum to be paid Immediately upon completion In accordance with plan as shown below.
TOTAL CASH SELLING PRICE .......... S 0,� , C b
DOWN PAYMENT IN CASH .............
DEFERRED BALANCE
UPONCOMPLETION ...... I ...........
The undersigned agrees to keep property mentioned in this agreement properly Insured against loss by fire Including the
Contractor's interest therein.
This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance'
this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements,
written or oral except as herein set forth. It Is the Intention of the parties hereto that this contract shall be binding upon their respective
heirs, executors, administrators, successors and assigns.
Customer agrees to pay a reasonable sum as attorney's fees and Court Costs If placed In hands of attorney for collection.
The owner further agrees that In event of cancellation of this contract after acceptance by the contractor and before the work Is
commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract.
Said contractor shall not be responsible for damage or delay due to strikes, fires, accidents, or other causes beyond his
reasonable control.
We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are
to be performed.
IN WITNESS WHEREOF, the undersigned has (have) hereunto set his (their) hand(s) and seal(s) the day and year written above.
Accepted By Husband ::2
AYM DAMP SSE, JR. AND SONS Wife
ROOFING INC.
Mail Address
(11 different from above)
17-- (Signature and YjK of Official�
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Date / 1. 11
TOWN OF NORTH ANDOVER
Building Inspector
Div. Public Works
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Avg
C U
FouRdAtion, Permit Fee
$
VO tKer Pe'rmit Fee
$
e !L(tonnectlon Fee
$
Water Connection Fee
$
Gl TOT AL C,
$
Building Inspector
Div. Public Works
PER'mrr NO.. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. !/PAGE I
UP
MAP 4-40.
LOT NO.
12 RECORD OF OWNERSHIF DATE
BOOK 'PAGE
ZONE
Z.
SUB DIV. LOT NO.
I I F—
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LOCATION Rozi�
Ar%)4Z-
PURPOSE OF BUILDING Eli ?J,4(,C
OWNER'S NAME Li SA
NO. OF STORIES SIZE
WNER'S ADDRESS 3 c� KOSENO-le-
Avic-
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2NO 3RD
!rUILDER'S NAME AL86eT- JbEL-1-"07TO
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
b�l
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
oll .
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
��DATE FILED__17-
SIGNATURE 6F OWII�t 6R'A IUTHORIZED AGENT OWNER TEL. N
GUNIX. itl-l-
CONTR. LIC. #
PERMIT GRANTED
4 19
3 PROPERTY INFORMATION
LAND COST
-EST. BLDG . COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
NUILDING INSPECTOR
BUILDING RECORD
I OCCUPANCY 12
SINGLE FAMILY S , -ORIES THI SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY
APARTMENTS LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA.
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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ATTIC STIRS. & FLOOR
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
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SUPERIOR I POOR
ADEQUATE I NONE
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GABLE
BATH (3 FIX.)
GAMBREL]
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MANSARD
TOILET RM. 12 FIX.)
FLAT
I
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WATER CLOSET
ASPHALT SHINGLES
LAVATORY
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SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
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HOT W'T'R OR VAPOR
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AIR CONDITIONING
RADIANT H'T'G
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