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HomeMy WebLinkAboutMiscellaneous - 33 LINCOLN STREET 4/30/2018I -N° 1640 R .rf Date.. �.�... .77 / % ............. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .......�... �.�— - '.................................................. 401 has permission to perform......."`""`",."`�t!....................................... wiring in the building of ................................................................... at'.�?.................... ........ � ! ........................ .North Andover, Mass. Fee �`? ..�............. Lic. 4%3r!.... ...�. �!�,.�..... 04/29/99 14:50 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THE 09W0NWEALTHOFARMCHUSEM DEPARTHEAT OFPUBLICS-4FE7Y BOARD OFF7REPREVEM7ONREGUL4770NS527CAM 12.00 Office Use only Permit No. 1(O,1U Occupancy & Fees Checked j APPLICATION FOR PERU! U TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 i (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 8 Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [= No (Check Appropriate Box) Purpose of Building (�� [ t Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Vo. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA . No. of Lighting Fixtures Swimming Pool Above Beiow Generators KVA ground round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones 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 Connections No. of Water Heaters KW No. of No. of Sins Bailasis No. Hydro Massage Tubs No. of Motors Total HP J OTHER• lr>Sm=Cove� Rnsu 1othemqu=xMdMassadiisaMGatealLaws Ihmeaaata�Lebtlity�=Pobcym6xbngC,ar� CoAagecrks a4uvakrt YES � NO F iharesutx i&dvalidptocfofsamelothe0ffi)F-- YES a If wha%edxdcedYES, pleasenhmtethetAxcfw&aWbyd=kingthe WSIJRAT U F�J' BOND F-1 LLOTHE 11 a fteseSpeffy) ti Vab&dE1ecb 1Wok Wcdc$ c} mSlart L Es c h I�Requ�ad' Ragh Fatal Signed underthie anahies cfpe jw FIRM NAME c (L2 [ licaiseNa o? d Lim e c1C Sigiahae / L>ca�eNo , f / Busirrss Td. Na A %a ��t f %� d� f �P V I% l�y Z/1 r' Alt. Tei.Na OWNER'S INSURANCE WAMER;Iama%4=that the Li=w dom nQt how the msuWxt ortsstksMrtWeWnWataste*mWbyMsadnseisGaiedlaws and that my signbaeon this pamit appfirit wane s this ta*Xienat (Please check one) Owner F-1 Agent a Telephone No. PERMIT FEE $ Location -3- 34 Q No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #��-1�►^" 18469 /. Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1 SOH #Y Owl" BUILDING PERMIT NUMBER: / J� DATE ISSUED: SIGNATURE: Buildin Commissioner/I — -for of Buildings Date SECTION 1- SITE INF RMATION Property Address•,[ 1.2 Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red . Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public 0 private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Lut �. 2.1 Owner of Record / > Al C 1t,4c- D©,I„g Name (Print) Address for Sei vice r �e��ati X03 �QD-G 3 � Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: l Address Signature Telephone Not Applica License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone no rn X Z O O Z M 90 0 r v rn r r Z ^ Q SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 Workers Compensation Insurance affidavit must be completed and subn in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work (check all aonlicable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) Accessory Bldg. ❑ 1 Demolition P" I Other 25c(6) I ;d with this application. Failure to provide this ❑ I Alterations(s) ❑ I Addition ❑ ❑ Specify. • it Brief Description of Proposed Work: idem ov2 R'Tb Ln' G I SF.CTION 6 - F.CTTMATFn rnNQTiJiTrTinN MCTc will result Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL USE ONLY 1. Building d (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing 0 Building Permit fee (a) X @1 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number --- .a 1 1a v♦•11rn[ v111vJMLZ, 111V1l 1V, Dn l,VD7rLis1LD wrltr4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 71h OWNER/AUTHORIZED AGENT DECLARATION nL rnac Dana[ property Hereby declare that the statements and information on the foregoing application are U and belief 1�a<<,e. rr1Rc�'�onai(, Print Name, A of Owner/. eq J Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Agent of subject to the best of my knowledge a v 0 b z I N ki 4-J V cm i O 32 CDA ■— O O 'r m m CD 0 CD CD �3 O m 0 O _cv o a e F. Ca C* cc c a OC C Z CD CL V CO) O C C cc y 0 a a 50 •as ww�' a w c w a w a n�' chi ca w n°' w rA cn cn 4-J V cm i O 32 CDA ■— O O 'r m m CD 0 CD CD �3 O m 0 O _cv o a e F. Ca C* cc c a OC C Z CD CL V CO) O C C cc y 0 50 •as c c� O L C y O C y u •a � d C CD C :Z O Ea ��. C � O V; 0D. y EC C ++ 42 yC, :z Of i m c E O o m V) cm CD t �+ •> Cc s > N cc cc •�+ y Em � a�� m :gym; = o cm C •� CL 0 O O m 0 2 o C Z p 0 mC CL O cm C •E C m s �.- .moo CO2 W CO =r m = C ++ cc &=oc •� Z O V•Q �0 o c H O _ a o m � -L C 4-J V cm i O 32 CDA ■— O O 'r m m CD 0 CD CD �3 O m 0 O _cv o a e F. Ca C* cc c a OC C Z CD CL V CO) O C C cc y 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: G\^ Q C. 4 n C Location: City til or-� YnA 0 1 &qS Phone # L 0 I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity 0 1 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 .well_as_civil.penaltiesinfhef=. d-,a.WORK.ORDER..and_a.fine of_(.$1D.0.O0.)..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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. % Signature :��� Date g ` i /&5 Print name FZV1ti e s%1 feh4 ✓r/ e4 'c_ eQ� Phone# 663 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept []Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: R, G6n s4r V CA Q 1 Est. Cost &� Address of Work IS Lir\ Cb`n s4cee-i Owner Name: F,� C� k 1 'n'1 � C Oona t U Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner -occupied Owner pulling own permit Other (specify) Notice is hereby given that: For office Use Only Pemit No. Date OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: <6' /I o /6,5� &,-. 9, .'e— Y��- Date Owner Name 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 at: `.2c4 s 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: UMP64er l`ef\i�� Fire Department Sign off: Dumpster Permit (Location of Facility) r Signature of Permit Applicant Date