HomeMy WebLinkAboutMiscellaneous - 33 MOUNT VERNON STREET 4/30/2018N Q J Q O O V 0 0 0 0 // 4166 Date &........••"•.. .. ..........- TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ..../................................................................................. . }has permission to perform .....�` �C ?.!°�.. y ....................... wiring in the building of ... le.f... 6 ...................................... r 3 3 V 4 J S .... orth Andov as . at . ....... Fee. S.. 0�.. v Lac. No .............. .................. ................................... LECTRICAL INSPECTOR Check # THECOMMONWF,ALTHOFMASSACHUSEnS feo se onI y f P ermit ermit No. BOARD OFFMPREVEMONREGUTA770NS527CMR12.W ccupancy & Fees Checked APPUCATIONFOR PERMIT TO PERFORMELECIRICAL 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 WWdr=GJWVW Hualat> lDftia4z=ff&ofMa%adut Cx2 a Laws :ha�aamentLi�lrtylrmuatrepblicyuichmgCotl�lCovaa�ordssubsta�alequiva YES NO have rr>rteclvalidpto�ofsarnetothe 0&m YES hedarlecidwgtj� lf)whaw d� ekedYES�pkeiridc*the tyro'co�by box L..J `ISURANC E BOND r7 OTHER (p spedy) ExQitafionD* �otktoStartg Est m&d VakrofE�chxal Work $ irnxrl, nriart�,a Rx,�tr� , o : .. hispearortDa�Re d Roup /O -eL rf - O. Fmal RMNAME V, ell L omseNo. _ �.4 Sr/ I=wNo �SaZ. 9 / BusmTciNo. NNER'S NSURANCE W Alt Tel. No. ATVFR; I am aware that the lio�e does not have the inst trance cow -age or its subs�n�lial equivalerrt as ralttired by Massx}Itu�ts C Laws I ffilmysigrMnonthis 1=on waimNft qn anmt leas e e) Agent 0 2 12- 'p-44— Z p� Telephone No. / / PERMIT FEE $ �® Igna ure wner Or gen To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 3.� *4v �� ��►� �� • Owner or Tenant s �� Owner's Address �..3 /�T ,��P.. �/©► p/ �`� Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ��- Amps / Volts Overhead ID _ Underground M No. of Meters New Service Amps / Volts Overhead Undergiound M No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting OutlefflSo;1HTubs No. of Transformers Total No. of Lighting FixtuPool Above Below KVA Generators ri round round No. of Receptacle Ouurnerscy KVA Lighting Ba[tery Units No. of Switch Outlets Bumers No. of Rangesond. Total FIRE ALARMSNo. of ZonesTonsNo. of Disposalsat Total Total No. of Detection andm s Tons KW No. of Dishwashers Space Area Heating KW Initiating Devices No. of Sounding Devices No. of Self Contained No. of Dryers Heating Devices Katy No. Detection/Sounding Devices Local � —� Municipal Other Connections of Wa?r Heaters KW No. of No. of Si ns Bailasis No. Hydro Massage Tubs No. of Motors Total HP- OTHER- Cl) L-A /L/N6- /"/��✓ WWdr=GJWVW Hualat> lDftia4z=ff&ofMa%adut Cx2 a Laws :ha�aamentLi�lrtylrmuatrepblicyuichmgCotl�lCovaa�ordssubsta�alequiva YES NO have rr>rteclvalidpto�ofsarnetothe 0&m YES hedarlecidwgtj� lf)whaw d� ekedYES�pkeiridc*the tyro'co�by box L..J `ISURANC E BOND r7 OTHER (p spedy) ExQitafionD* �otktoStartg Est m&d VakrofE�chxal Work $ irnxrl, nriart�,a Rx,�tr� , o : .. hispearortDa�Re d Roup /O -eL rf - O. Fmal RMNAME V, ell L omseNo. _ �.4 Sr/ I=wNo �SaZ. 9 / BusmTciNo. NNER'S NSURANCE W Alt Tel. No. ATVFR; I am aware that the lio�e does not have the inst trance cow -age or its subs�n�lial equivalerrt as ralttired by Massx}Itu�ts C Laws I ffilmysigrMnonthis 1=on waimNft qn anmt leas e e) Agent 0 2 12- 'p-44— Z p� Telephone No. / / PERMIT FEE $ �® Igna ure wner Or gen x ' c o w a (n O 4, 0 w z 1+ Y C x ' c o w a (n O 4, 0 w 0 u: 1+ Y C O ��� w O w W SOD a ' e cn w a O w a °�° 1:4 co w W rf� cn o co 01, O D h .y CD L- CL O O O V _R H 0 Q CIO O C.3 C cc CLH E 0 U) w crW W irW uiw :i; = O 44 ;� O r o� N • r 0 'ate .� C _ IL 3rr o .m �: '"• o ape CD N EE mt E h IM:Vi v m 3 r tm �:m `�c� v� CD 0 :s:s tm 40, N acr � m o r co CCD Q m C.c �� y O c •c = m CL p N *- Nor ~Fi r •y AD C H W •E = M Z U -0 2 •N O m t C. O. Vp m� _ y 4D m C2 O G.r..m > 01, O D h .y CD L- CL O O O V _R H 0 Q CIO O C.3 C cc CLH E 0 U) w crW W irW uiw .0t, L.- r I Location -??.-�-- No. 49 Date NpRTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ sACMUS t� Building/Frame Permit Fee $�- Foundation Permit Fee $ Other Permit Fee $ TOTAL $© " Check # 15762 -. Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: 8 7-3 c SIGNATURE: -A Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 3 3 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ' 1.3 Zoning Information: Zoning Dkad 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 Recmired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 21O 4 1-4Vewt.e 6, 3 3 iA-rl'. ame (Print) Address for Service : Signature C Telephon -,.2 Owner of Record: ��Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: ,Address S1.nature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T M X Z O 'V Q O z M 90 Wn r M r r z^ V/ 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 check ali a licable New Construction ❑ Existing Building [IRepair(s) ❑ Alterations(s) 11 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ` 9 1�o -P SECTION 6 - F.STIMATF.n CONSTRITCTInN CnCTC a Item Estimated Cost (Dollar) to be Completed bypennit applicant UIFICtAL USE ONLY ' r ,. Building +l� g /�' 1S � / Permit Feee'1 (a) Building Petmi Multiplier .� jam- j�' >n � � r e z. 10 :DeC 1< 5 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (e) 3 a 0 j. 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number NEUHON ?a OWNER AUTHORIZATION TO BE COMPLETED WHEN OW _ T TRACTOR'APPLIES FOR BUILDING PERMIT �.� as Owne uthorized 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 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 Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2 ND SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMIENSIONS 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 3 FORM U - LOT RELEASE FORM • INSTRUCTIONS: This form is used to verify that all necessary approvals/permits f m Boards and Departments having jurisdiction have been obtained. This does not relie the applicant and/or landowner from compliance with any applicable or requirements. . *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT / 4 (fi~S q tee. ,ee 614-i 4 ' z 2­1��Z PHONE --7 LOCATION: Assessor's Map Number / � PARCELZ SUBDIVISION LOT (S) STREET 3 3 M% k E PA, S ST. NUMBER -33 ***************************************** OFFICIAL USE MENDATIONS OF VATION ADMINIST TS On 4941trv, AGENTS: TOR DATE APPROVED DATE REJECTED in o D t TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm TE Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 :(978) 688-9542 Fax HOMEOWNER UCENSE EXEMPTION Please print DATE _ c, JOB OCATION 3 3 / Number "HOMEOWNER PRESENT MAILING ADDRESS r.R City Town et Address Map /lot f 2 E - Home Phone Work Phone gate Twp Code The current exemption for "homeowners" was extended to include owner-0ccupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Budding Code Section 1 o8.3.5.1) .DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which there is, or is irrtended 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 beconsidered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the Stere Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that helshe understands the Town of No. Andover Building Department minimum inspection procedures ents and that helshe will comply with said procedures and regyicenTerft HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC J O z I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BYLAWS OF NORTH ANDOVER CERTIFIED PLOT PLAN LOCATED 1N NORTH ANDOVER, MASS. SCALE) "=30' DATE:3/11/2001 Scott L. Giles R. P. L. S. Frank. S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. ues y 13972 ,�� 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) Sigrfat71.z Permit Applicant -G o 2 Dat NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Cl) m U) 0 CIS ,00,,, Z CD O d CL �. a� .p O o p CL Q � d CD O to CD C/! 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