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HomeMy WebLinkAboutMiscellaneous - 300 DALE STREET 4/30/2018 (2) i I PHONE CALL) DATE Z� TIME '3d R.M: FOR � M ✓ 2. OF ONEO �y RETURNED RHONE 1 23a -7Z S � YOUR;CALL AREA ODE NUMBER EXTENSION MESSAGE ASE CALL WILLCALL p Q { AGAIN CAME TO p SEE YOU WANTS.TO �, who✓ o e.;qo Ya� / �a-. SEE YOU. SIGNED ��� f 2iverSal" 48003 NOTES Town of North Andover, Massachusetts Form No. 1 NORTH ••-- BOARD OF HEALTH r-4 3�0 ,�t�ED /bq-rOQL Q «.., .:..u:4 0 APPLICATION FOR SITE TESTING/INSPECTION QONA ED �SSACHUS�� Applicant NAME 0 ADDRESS TELEPHONE Site Location `O—k-- 'c��v� � Engineer NAME ADDRESS TELEPHONE`:' Test/Inspection Date and Time_ '.. . ..r. CHAIRMAN,BOARD OF HEALTH Fee Test No. lQ S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH o��T`-ED 'bg1'o 0� 19 APPLICATION FOR SITE TESTING/INSPECTION ACHUSES�S Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME .ADDRESS TELEPHONE Test/Inspection Date and Time e A' .f CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH ,jvN©Fi:ORT NORTH ANDOVER, MA 01845 1 BOARD OF HEALI h. 978-688-9540 APPLICATION FOR SOIL TESTS . DATE: MAP MAP &PARCEL: LOCATION OF SOIL TESTS: app CA L ✓ OWNER: -4j TEL. NO.: �7v, 7ai�3 7Z✓`� 447 PA-r TY X15 C ADDRESS: —Aw'--ir u� ENGINEER: TEL. NO.: CERTIFIED SOIL EVALUATOR: r-le Intended Use.of Land: Residential Subdivision y e Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: 3 Check Amount: 7 Check Date: �-�Io �s , �� � 4 �� 20 SEE PLAT NO. 104 a� 19 b1448 i IVA 17A l ' \s.: CswU' x.11 ll ltx " 01 <i'Rl'lI AKI>'•\'I:R 1'1.•1\-\ I.Xlcm IS i `I la,a ni .7J• \1 97 :n 21 \I rl \0 o \lL 6;P 14 u.65° .7 lyaa. U1 \•tib by 1:!X11 li!N 1 .It.l !T �'r o )U 96 aew Im1. ROAD SS IS I:Jy Sy,t:. ae: It1i:Vt .. t.r » 70 ,� l a Y q ;SII �a n., 66 Ai 13; 6/ 13 It /> I SEE PL T NO. 37 FISCAL 2001 MA DRAWN BY FRANK S. GILES. MEASUREMENTS ARE S LED ONLY NOT FOR SURVE) BOARD OF HEALTH NORTH ANDOVER, MA 018451;,1:{��//�'�^rt1_ z �{ y 978-688-9540 2 9 2002 APPLICATION FOR SOIL TESTS DATE: •- `i •-02, MAP &PARCEL: Z-6; LOCATION OF SOIL TESTS: ;�06> h � OWNER: TEL. NO.: Z3j � P-h�"Y To► r5 ADDRESS: 5d�Qp �ArLt.� ENGINEER: Ll TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended Use.of Land: Residential Subdivision 5ingl" - ` y e Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes. No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownershipTax bill ( , or letter from ownerermittin p g test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is$75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and°at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This e N.A. Conservation Commission Approval: ,/��fi' l (J Date Received: Check Amoun : Check Date: I i i c zo SEE PLAT NO. 104 x 'T ISA aA 17A \(s \su 0 0 1;1 11 i YA 1a*ri \\\ \lp�i. I J1 Vii' qty a^ �If• ,,N,\i I i INA\' ?ll :i•H"Ill:\\Ih•1'I:if TI.1l'\ I.11U1 ,1 24 1r •1 D - t .�- •\I �V Or 1 I \ i 7 1. _« I. Fh .\l:. b wl 1 t� All14 NIR A[. It a- �_I• FI:K:_ b - u • �A • W tt1 as ix Al:. aa: I.: IM 0o. u 7y ;ill !. 70 1S o= m• 7t 66 ,e.a N Lulni. \.3 .. t_I 134 y �..ry.le 61 x /r SEE PL T NO. 37 FISCAL 2001 MA DRAWN BY FRANK S. GILES. I MEASUREMENTS ARE S LED ONLY NOT FOR SURVEY —=-� BOARD OF HEALTH — NORTH ANDOVER, MA 01845 �� BOA D CAA 978-688-9540 r 2 9 2002 APPLICATION FOR SOIL TESTS a DATE: - i I --©7/ MAP &PARCEL: rj LOCATION OF SOIL TESTS: �7 OWNER: f Vt—�`j � �� TEL. NO.: PA- v-( -p s C ADDRESS: —A w! 124-L j 5 Gj(l'e� ENGINEER: Ll VjAC-k,- fK6tNICE41JL4 TEL. NO.: CERTIFIED SOIL EVALUATOR: ! Intended Use of Land: Residential Subdivisioningl" y I- a Commercial Is This: � � - Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes ( No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is$75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and`at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Receiv • �-Qj'Q Check Amount: V Check Date: c� SEE PLAT NO. 104 . a` 19 a y 1aA 8 y i8A 05 17A \ 00 il 1.11 'l; < 1�`3 1At1 11 1\>< 3n \4"•fi 2p :i-•K'I'Il.\KUB•l'IiK Tt•l1"\ I.1K\I 1� y A i� 2.4 \� S a nt. - -- - I 16 \ll= .ItM1N(a .� S 6' �7; 14 aMA � '7 1Y4 .•Sl' \� u rc k ,69 a, :F + 67 to . )U 9li s!,t S. oAll R 70 79 nt 66 ni I31 t.03 AC. \� 1 n 61 \l SEE PL T N0. 37 FISCAL 001 MA DRAWN BY FRANK S. GILES. P.. MEASUREMENTS ARE S LED ONLY NOT FOR SURVEY F �m2;,awnsa.r-.+w.,.R.�.•�.�,..-1-�:>>o..,-• •.•' -•---+,.s..•_.. :,r-�- , --, ..,. -a-aa t Location w No. a Date / ,.3©4 b� �ORTh TOWN OF NORTH ANDOVER + ; . Certificate of Occupancy $ CNUS<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ �© Check # S 17674 r C Building Inspector { F TOWN OF NORTH ANDOVER BUILDING DEPARTMENT i APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: C DATE ISSUED: 5;e SIGNATURE: Building Commissioner/InaWor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number/ Parcel Number 1V,)4 k Ald6v-t-d- 1.3 Zoning Information: 1.4 Property Dimensions: I' Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided 1.7 Water SuPPIY M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: [side Flood Zone 0 Municipal ❑ Cm Site Disposal Public ❑ Private ❑ Zone Outside P Poral System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZEDAGENT eN,7c)C1t; District Y'.5 �!n 2.1 Owner of Record C_, ✓I n Dl� �f0 , A- c PEI Address for Service 1 i Signature Telephone 2.2 Owner of Record: ame Print Address for Service: S' nature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address i® Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1 Conip"y Name Registration Number Address Expiration Date G) Si nature Telephone l 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 checka ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J l�G �l� O l00 � Gc�_�vci7- t�a.1 �(J.r2-G-) ✓)c�o�' SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE.ONIiY Completed by permit applicant 1. Building (a) Building Permit Fee DO d Multiplier 2 Electrical (b) Estimated Total Cost of 00 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, as Owner/Authorized Agent of subject property Hereby authorize_ to act on My'!!hal i a matters relative to authorized by this building permit application." � Signature of Owner �� Date Cf SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION `I. ,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 Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST TO3 SPAN DUVIENSIONS OF SILLS DIMENSIONS OF POSTS j DMENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X — ' MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE µaRrk Town of North Andover ° Building Department �I 27 Charles Street North Andover, MA. 01845 1SSACHUSES D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION I Please print. DATE JOB LOCATION Number Street Address Map/lot l A( "HOMEOWNER L l V, �.t�lc�n �QWj� V7, 2 9;e Name Horne Phone Work Phone PRESENT MAILING ADDRESS Ivor-]k j)-ver NA ©/��5 City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings individual for hire who does of two units or less and to allow such homeowners to engage an i n not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) i DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one.home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL i moi.. a w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 W � V�+ S,• Workers' Compensation Insurance Affidavit Name Please Print Name: Location. City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity F7 I am an employer providing workers'compensation for my employees working on this job. Company name: Address City Phone# Insurance Co. Policy# Company name: Address City: Phone# Insurance Co. Policv# 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'imprisonment_as.yell_as_civil.penaltiesinfheform aa.STOP WORK.ORDER..arnd..a.fine.of(.5100.00).ajtay against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. L I do hereby certify under the pains and penalties of perjury that the information provided above is true and connect. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensina Building Dept []Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone#. Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM i In accordance with the provision of MGL 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 MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolitionermit from the Town wn of North Andover must be obtained for this project through the Office of the Building Inspector i it C NORTIy '9 TONNM of : tAndover 0LAK E - over, Mass., C OC NIC ME WICK A. ADRATED PPS\ �Cy S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /.. N BUILDING INSPECTOR I THISCERTIFIES THAT.............................................. ..d.f. .............................................................. .......................... Foundation 5T R i I� 300 �.� I E S has permission to erect........................................ buildin s on............ .............. .................................................................. trough to be occupied as * iroo 10 es 1gWWV ' Chimney provided that the person accepting this permit shall in every respect conform to the terms o*ft'h**e application on'file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town.of North Andover. em 4/ S PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. trough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ....... .. . .............. A Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rou Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE:]j Smoke Det. Location 266) 46K -4 No. Date Ip-,/ -0 � 40RTN TOWN OF NORTH ANDOVER f 9 Certificate of Occupancy $ s °mob•..,.:.. • + err sCMus t� Building/Frame Permit Fee $ l� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15776 Building Inspect TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING00 1 Lia BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: ze�.- Building Commissioner/1or of din Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: t .e4U2 D,4/e -S V v .�/ ��lS� V. A�t�-e.c, Map Number l Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �I Zoning District Proposed Use Lot Areas Frontage R 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Reqtlired Provided v 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 ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record / (� yi til �olan J00 09L� T-ee� N AID), . r Ntpne(Print) Address for Service: &17- 7F�1-io t�P- Signature Telephone i 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number r Address r Z Expiration Date /� Signature Telephone G) 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 checkall applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify c Brief Description of``Proposed Work: > /� .r�^ ►, 3 ;' Ne,1 C.,b/y._T' i,✓ K/ C it/ A,i uocl 14CC.6 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Dollar ( Completed by permit applicant 1. Building (a) Building Permit Fee vU o' 6o Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection `7v 6 Total 1+2+3+4+5 B Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN ` �1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUR DING PERMIT I> V as Owner/Authorized Agent of subject property Hereby itho '.e to act on My as i a matte t w authorized by this building permit application.-- L✓ Ll__'� -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,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 Print Name r Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2Nr5 3 SPAN DfMENSIONS OF SILLS DIMENSIONS OF POSTS DDvMNSIONS OF GIRDERS -HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE fiv en Date OT,'$iFth Expires 5ek Height Class ber' -. P S 12=02 J9 @ndorse issued Cab ELV.W F -'40 ,ROACSSIVAY E ApT #A$ Iia`�je� __^ LYNN. M_ 4 I'�r'tev:ti Eb yr i01�04-1:84• ,�. � Y� .o'.._,3a� I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL 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 MGL c11, S150A. The debris will be disposed of in: (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 TAU rT I tj E Town o over No. CIO over, Mass., c0cmic ME WICK 0RATED C7 WARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................i............7777T77.....T................................1.0 Foundation has permission to erect........................................ building on Rough ................................................. ............................ Chimney to be occupied a ....................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application an file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR I UNLESS CONSTRUCTION START Rough Service ......../.... ........ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE Smoke Det. IEVERSE SIDE Date... .:::I..................... ,kORTAI TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SAC14US This certifies that ..........:�/j............. ...... ......... has permission to perform ........ . ............. ............................................... wiring in the building of .................................................. .......................... .North Andover,Mass. Fee ....... .... Lic.No .. ': E: '��..............e... ....................... -ELEMICAL INsPBc-r0R Check # A-7) Comnmonmueai�o� asear�iusells Of' mal Usc 'Permit No.'' .Uepa. -w-1 o�;�ira services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS . Rev, 11/99] (cave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(vtEC),527 CbIR 12.00 (PLEASE PRMT IN INK OR TYPE.4LL JiVrOkkf.I TION) Date: 9 �c 7 0 3 . City or.Town of: aM }w.��i1i,t, To the Inspector of yYires: By this application the undersigtied givcs•notice of his or her intention to perform the electrical work descnbcd below. Location(Street S Number)_ p 4,97 r 7 Owner or Tenant / L t/t k� e o 1• o tr, Telephone No. 'I Owner's Address �"A m -P Is this.permit iii conjunction with a Building permit? ' j Yes `'No .❑ (Clicclt Appropriate Box) I'uril.ose of Building / , , Utility authorization No. Existing,Service l�f y .Amps 2'W Volts Overhead Q' Undgrd No.of A'Ieters f New Service a Lkic, Anips' -2W1 , Volts Overhead Q Undgrd No.of11•leiers t Number of Feeders and Anipacit} Location.and Mature of Proposed Electrical Work: SL�i2yl u C2 Com letion of'dre olloitriim table nmay be natieml by dmc h ector ol'lYires. No.ofRecesspd.Fixtures D No.of Ceiil Susp.(Paddle)Fans No.o Total Transformers I%'VA No.of Lialiting Outlets No.of Hot Tubs Generators l.'VA Above In- No-oL.Emergencya,1,1itin,.. No.of Lighting Fixtures Swimming Pool m nd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners ( N'q FIRE ALARMS No.of Zones No.o.o Detection and No.of Switches v No.of Gas Burners Initiating Devices '• \'o.of Ranges No.of.Air Cond. To 3%dw No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons W o.o Self-Contained : Totals: I Detection/Alertine Devices '. No..of Dishwashers'.* SpacelArea.Heating XNVLocal ❑ Conn ipalln ❑ Oilier'. No.of Dryers : - Heating Appliances LN Security ystems: No.of vices or Eq uivaIent o.of waterNo.OF-77—Data Wiring: Heaters `,:-Suns Ballasts Nm of Devices orEquivalent No.Hvdromassabe Bathtubs No.of Motors Total HP . TelecommunicationsWiring:. ' No.of Devices or E uivalent a OTHERc r Attach additional detail ijdadred,or as required by.Me hespertor ojlYires. INSURANCE COVERAGE: Unless%•aivedby the ou mer,no permit for the performance of electrical work finny issue unless the licensee provides proof of liability nisurani a including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in farce,and has exhibited proof of same to the permit issuing•office. .CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify.) /� v d3 (ExpiraWn Date) Estimated Value of Electrical Wor ` �—y-,> ' (When required by municipal policy.) Work to Start: ections to be requested in accordance.aith MEC Rule 10,and upon completion. I certify, underthepains and pemiltiesojperlur} t t the Information an this application is trite and cmnplete- FI LNE NAME:, k k (w : . � LIC.NO.: a Ya'•a Licensee: Sibnatur LIC.NO.: (ljapplicable, ter "ecertt t"in le license Munber line.) / y� Bus.TCI.No.Lt 2- Address: � .�d3�wie1�- /�/�Gni ,lK- Alt.Tei.No.- OWNER 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%sive this requircmciiL I ani the(check one).❑ o%lier ❑owtices anent. _ Owner/Agent . : Si-nature Telephone No. P.t.ERAMT FEE: S �� a 1� �� � ``� �, � COMMONWE LA TH OF MASSACHUSETTS' . OF ELECTRICIANS REGISTERED MASTER ER E LECT RIC IAN � i ISSUES THIS LICENSE TO ' ANTHONY S VOZELLA a 63 BROADWAY CHELSEA MA 02150--2605 4224 A 07/31/04 350757 � Fold.Than Datsch Abnp AM Padmb" t -- cOMMorvw EAL EN O�" A - • SACH ,77s _ II OF ELECTRIC AS A EG JOURNEYMAN IA NS ILIC ANTHONYSyQIELLAEnsE C TR r C Z A K 63 BROADWAY CHELSEA v 5413EE MA" 02I50-260 r 07/31/04 3774,76 �{ Fpy rtw 1)1 Ab^D All PgKtia s r Driweer's 'License 1048j331.4io-l98=05 'AA 5 0 D 024249334 Dat:of Birth Ezpiras six - _H.igttf� Class•. hltxniar ... VOZELLA' - ---•} ANTHONY 63 BROADWAY'ST y) CHELSL"A l N1A 02160.2606 L7 nlj r Iv i 4• 1a'� f A ; Date. . TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING SSACHUSE� This certifies that f! `. .` • • • • {'• • • • • • • • • • • • • • • • • • • • has permission to perform . . . .€L ` `.` '{ ° ' plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .j.�: G. . p� �' . . . .74. . . . . . . . • . . • • •North Andover, Mass. Fee. . , . .Lic. NO.)•G . . . . . . . . . . . PLUMBING INSPECTOR Check # �� { MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS / Date Building Location -500 Owners Name Y U t�11� Permit Amount �j, j Type of Occupancy New ❑ Renovation Replacement Plans Submitted Yes E] No ❑ FIXTURES Cr H a o F w w w a a 'A x a 3 w o H x z RAWVavr ISTHAOCIRa ZID 1-OUR 3MIWM 4MWM 51H H AOM 6M H-OCIR 7M 1t" sM lFi" (Print or type) Check one: Certificate Installing Company Name l a(4 / l f ❑ Corp. Address -3� f y S FlPartner. Business Telephone _ Firm/Co. Name of Licensed Plumber: ' i,(/�idJ r- df�/n e> Insurance Coverage: Indicate th�f insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner ❑ Agent 0 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 erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse S Plu 2nQ o d Chapter 142 of the General Laws. BY1gna ure ol Licensea Ftumoer Type of Plumbing License Title li s City/Townicense um er Master ❑ Journeyman APPROVED(OFFICE USE ONLY