HomeMy WebLinkAboutMiscellaneous - 33 DAVIS STREET 4/30/2018Date.. ...........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that...........................................................................................
has permission to perform .......:..
wiring in the building of ..... �'.: :''` u�...................................
................!9....................................OLECTE�ALNSPECTOR
,North Andover, Mass.
Fee ..`..'........... Lic. No... y'.� .............
i
Check #
9668
r
\ Coma onweala o f Maddac"M Official Use Only
cc��pad..t 4Jim Se�7 rviced Permit No.
aL Z3(,,
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
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 INFORMATION) Date: ;G� 0Q?0? I ( 2lj 1
City or Town of: lfld44 4u-NWCX To the Inspector of Wires:
By this application the undersighed gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) _ 'YE�A11! S 37—
Owner 'or Tenant
Owner's Address
Telephone No. 6A2 -�2Z2
Is this permit in conjunction with a building permit? Yes ❑ No El (Check Appropriate Box)
Purpose of Building --L-,tU6-661n !3 Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampacity /— /�,p 2,5-6 V
Location and Nature of Proposed Electrical Work: s7=7?,,A;T0.�7e eff• X/l?
Completion o the followingtable may be waived b 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 ❑ In- 1:1
rnd. rnd.
o. o Emergency Lighting
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
of Detection and
o. Initiating Devices
No. of Ranges
No. of Air Cond. Tons /. ota5-
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Number
Tons.
KW
.......................
No. of elf -Contained
Totals:
Detection/Alertin Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal [I Other
Connection
No. of Dryers
Heating Appliances
g pp KV'
Security Systems:*
No. of Devices or Equivalent
No. of aterKms,
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 E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:G(, (When required by municipal policy.)
Work to Start: Zkf/,/p/L 207(3 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 El OTHER F1 (Specify:)
1 certify, under the pains and Ities of perjury, that the information on this application is true and complete.
FIRMNAME: Aries Electrical Service and Controls LC LIC. N015650a
Licensee: Nor and Michaud Signatu,,-- - -' C.NO.•345e
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: ()TA 687 0 544
Address: 290 Broadway suite 117 Methuen ma 01844 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) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ `moi
,. The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Mass 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual)`,ELECTRICAL SERVICE AND CONTROLS LLC
Address: 290 ngnAnwAY SII= 117
1
•- _
City/State/Zip: _Mpt-.hutant Ma n1 R44 Phone#:
978 687 0544
Are you an employer? Check the appropriate box:
1. ❑ I am an employer with
4. ❑ I am a general contractor and I
employees (full and/or part time).*
have hired the sub -contractors
2XR I 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.
employees and have workers'
[No workers' comp. insurance
comp. insurance. $
required]
5.0 We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption perm MGL
insurance required] t
c. 152, § 1(4), and we have no
employees. [no workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
105aklectrical repairs or additions
11. ❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If
the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that isprovii ing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address:— ,�j�j �DAI/1S T City/State/Zip: tt/lj/IT- ,4N-p6u6e MA 01845-
Attach
184-5Attach 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 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for cove=e verification.
I do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: —� �7 Date • -G% Apn ie. 24111?
Print Name: Normand Michaud Phone#: 978 687 0544
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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact person: Phone #•
!1
Location_
Nlo. Date
(� 7380
TOWN OF NORTH ANDOVER
Ui
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation , Permit Fee $
her rmit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $��• �j0 -j_
Building Inspector
Div. Public Works
PEbt 2IT !Si % �U
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAS' KdO.
I LOT NO.
2 RECORD OF OWNERSHIP iDATE
BOOK 'PAGE
ZONE
,-=
SUB DIV. LOT NO.
I
�-1
tttt
LOCATION }!� �d AL1 1 1b
r/�
!�
PURPOSE OF BUILDING � R!�
`` a'„GJ
%%C0
OWNER'S NAME AL)i
(^h � SOA
NO. OF STORIES 11Ez
OWNER'S ADDRESS 17 y� \ L 1 C'Tn A e)' ®}� br
a J/TV/ ,,7 /VV /7�y��J
BASEMENT OR SLAB
NC'
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND
3RD
BUILDER'S NAME � /v c
SPAN '
DIMENSIONS OF SILLS
POSTS
DISTANCE TO NEAREST BUILDING
DISTANCE FROM STREET
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
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION Y ZFE�7
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM T6 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 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
9 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE
SIGNATURE OF OWN
R OR AUTHORIZED AGENT
FEE 'f/J-vy
PERMIT GRANTED OWNER TEL. #
CONTR. TEL. #
19 �-- CONTR. LIC. #
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
���
mulmilNa INSPECTOR
1 OCCUPANCY
SINGLE FAMILY 5-o"",_
MULTI. FAMILY OFFICES _
APARTMENTS
CONSTRUCTION
2 FOUNDATION _ 8 INTERIOR FINISH
CONCRETE _ 3 2 13
CONCRETE BL K. PINE _
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WAIL
UNFIN.
3 BASEMENT II
AREA FULL
FIN. BM TAREA
WOOD JOIST
'/. 1/1 ''/.
PIPELESS FURNACE
FIN. ATTIC AREA
_
N_O B MT
FORCED HOT AIR FURN.
FIRE PLACES
_
HEAD ROOM
STEAM
MODERN KITCHEN
_
HOT W'T'R OR VAPOR
4 WALLS I 9 FLOORS
CLAPBOARDS
_
AIR CONDITIONING
B
1
2
�_
3
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
_
HARD"J D
COMMON
VERT. SIDING
ASPH. TILE
STUCCO ON MASONRY
NO HEATING
_
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STIRS. & FLOOR I_
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I�NONE
ADEQUATE
5 ROOF II 10 PLUMBING
GABLE HIP BATH 13BATH 13 FIXE _
GAMBREL MANSARD TOILET RM. (2 FIX.) _
FLAT I SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
TILE F
BUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
0
ik
6 FRAMING
I 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
IAS
B'M'T 2nd _
1st 13rd I
ELECTRIC
NO HEATING
0 NO
PAP
OFFICES OF: Tower oY
APPEALS
NORTH ANDOVER
;t;.�
BUILDING DIVISION OF*
HEALTH
CONSERVATION
PLANNING PLANNING & COMMUNITY DEVELOPMENT
PLANNING
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North Andover.
Massachusetts o 1845
(617)685.4775
r'+ •
�� J
In accordance with the provisions 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 prcpedy liccnscd solid waste disposal facility as dcliincd by MGL c 111, S
150A.
The debris will be disposed of in:
i/f M107 --o N , A /� I -!D vA f'
(Location of Facility)
Signature f Permit Applicant
Date
NOT7-: Demolition permit from the Town of north Andover must be obtained for
this project through the Office of the Building Inspector.
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