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HomeMy WebLinkAboutMiscellaneous - 33 SULLIVAN STREET 4/30/2018I Y Date .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ P()>� 3fC4111-1:�; .. ....................................................... has permission to perform ....... ........... wiring in the building of..................... ................................... at ........ 3.3... ................. 57— ......... North Andover, Mass. Fee.. LIC. No. ................. INSPECTOR 7 Check # 7982 C ommonwear°t� olaj�acku6ett6 Official Use Only Apartment Permit No. ?WZ Apartment o� ire Service] 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 ( EC), 52 CMR 12.00 (PLEASE PRIN O TYPE L INFO ATION) Date: (� O City r Tow of :� X 1 6 ai To the Inspector o Wires: By this applicati undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3 n4—, Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building Existing Service New Service Utility Telephone No. (Check Appropriate Box) tion No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �Si-ivn la rn 6(1 �A C-ni Completion of the following, table mal, be waived by the Inspector of Ifires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans TransTotal Trsformers KNIA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No, of Luminaires Swimming Pool Above ❑ In- El rnd. rnd. o mergeney Lighting Battery Units Battery No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of No. In Detection and InDetection Devices No. of Ranges b No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump Number KW No. of Self -Contained No. of N aste Disposers Totals: J.Tons Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Loc Municipal ❑ Other on CJ,on No. of Dryers Heating Appliances KW Security S,ystems:* '\ No. of Devices or• uivalent No. of Water KW No. of No. of to WirinLn Heaters Signs Ballasts No. o evices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires, Estimated Value of Electrical Work: Q (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 overage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [] BOND ❑ OTHER ❑ (Specify:) I certify, under the ains and penalties of perjury, that lite infornon on this application is true and complete. FIRM NAME: rljil�S 'ta i coil L1 LIC. NO.: Licensee: �S�n �('1 �r7�ij/ Signature LIC. NO�..''(�_/ (f applicable, enter "exempt ".inthe _ licensenaaiberline.). Bus. Tel. No.f Address: 55 T. i i girt{'t 'L3'��.. `✓rt _1 D G Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requirg Department of Public Safety "S" License: Lie. No. -:�)5 G 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: $ ,ORTH TOWN OF NORTH A DO R P PERMIT FOR GAS INS CATION This certifies that .. �. off 14 L.l ............................ . has permission for gas installation ./A jr.e / . ........ . . in the buildings of ...P.A o Y. ! ............................. at . 3.� . .Y,,. 4 q -.... -4"- ....... , North Andover, Mass. Fee.,S.J:.... Lic. No. .WJ/.3p . ...<::3 r y... '/GAS INSPECTOR Check # IWOk . f' h h — f573 ft MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Loqations _ J Jf f' L,, [`1� zl- `) �r6o V Owner's Name New Renovation E] Replacement Plans Submitted SU B-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR Ca FLOOR 5TH. FLOOR 5TH. FLOOR 7TH. FLOOR ITH. FLOOR c W cc w ---------- z a w z d w d a = F a. a e SU B-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR dTH. FLOOR 5TH. FLOOR 5TH. FLOOR 7TH. FLOOR ITH. FLOOR F U O U O 0 CQ Date Permit # Amount $ �S^ r (Print or type) Name— poPQ Check one FR -yrher- Pe-L<, �,?� G T" - Corp Address _ �I'` C��! G7C>.L l.t.�'�L'% LCGFlLlC2 Part, Certificate Installing Company er. Business Telephoneza _ 0 Firm/Co. Name of Licensed Plumber'or Gas Fitter 7,7:t1,, in -12 INSURANCE COVERAGE Ch I have a current liability Insurance•p icy or it's substantial equivalent. Yesck on If you have checked yes, please i icate the type coverage by checking the appropriate box. No Liability insurance policy Other type of indemnity D Bond 1 Owner's Insurance Waiver: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 13 Agent 1 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate G�Wode and Chapter .142 of the General Laws. A By: Title PPROVED (OFFICE USE ONLY) I ture of Licensed Plumber Or Gas Fitter ❑ P,4umber 0//�0 Gas Fitter License umber Master Journeyman R c ---------- (Print or type) Name— poPQ Check one FR -yrher- Pe-L<, �,?� G T" - Corp Address _ �I'` C��! G7C>.L l.t.�'�L'% LCGFlLlC2 Part, Certificate Installing Company er. Business Telephoneza _ 0 Firm/Co. Name of Licensed Plumber'or Gas Fitter 7,7:t1,, in -12 INSURANCE COVERAGE Ch I have a current liability Insurance•p icy or it's substantial equivalent. Yesck on If you have checked yes, please i icate the type coverage by checking the appropriate box. No Liability insurance policy Other type of indemnity D Bond 1 Owner's Insurance Waiver: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 13 Agent 1 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate G�Wode and Chapter .142 of the General Laws. A By: Title PPROVED (OFFICE USE ONLY) I ture of Licensed Plumber Or Gas Fitter ❑ P,4umber 0//�0 Gas Fitter License umber Master Journeyman Location ' No. ZZ Date N0RTh TOWN OF NORTH ANDOVER f � 3?0�,(`•o •• MOIL 0 A Certificate of Occupancy $ sA�M�s ��' Building/Frame Permit Fee $ 122 e Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �?,527 'Check # `=� 16043 --Building Inspecto TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: � 60 SIGNATURE: Building Commissioner/I for o'Buildings Date SECTION 1- SITE INFORMATION 1.1g Property Address: 1.2 Assessors Map and Parcel Number: J JL/7l!/�•r�y�% le;7 R9 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �pe Zoning District Proposed Use Lot Aiea s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided C sV � // •✓ 1.7 Water. S .G.L.C.40. 54) 1.5. Flood Zone Information: Zone 1.8 Sewerage Disposal System: Outside Flood Zone Public Private ❑ Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 5TePftkj `53 SLjc j ZZ\./ y1) '57' b\3 d ht,�D�L6rL Name (Print) Address fore Service L��o Sighature Telephone 2.2 Owner of Record: Name Print Addrere�ss for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 9�/ A<e�� icensed Construction Supervisor: ✓ License Numbe Addr X11 G' �j �'J�.J� Expiration Da ignature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number t` Address Expiration Date Signature Telephone 89 M ic z O ' V V f\� O z M 90 O M r r zA MI 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 2506) 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 buildingpermit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 2 c�-® O I- 113 -S, :.© c o = 3 ��C� --- SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OI?FIC"LM[JNE 014L.Y. 1. Building (a) Building Permit Fee Multiplier 2 Electrical GOD (b) Estimated Total Cost of Construction 3 Plumbing e CI a Building Permit fee tel x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 pp © Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERSAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT SSci11 !z I, 5 ��W1JOr2-L-as Owner/Authorized Agent of subject property Hereby authorize aC iC_�s/..� r��.SC� to act on My behalf, in all matlers re tive t or orized by this building permit application. Signature of Owner �— �^ Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, o mpl of j AL / �� eo 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 bwner/Agent Date NO. OF STORIES SIZE / -• / jC�d F'c BASEMENT OR SLAB SIZE OF FLOOR TINIBERS ,� PL 2 ND 3RD SPAN Q6:� DIMENSIONS OF SILLS DIMENSIONS OF POSTS �/ �,• ,,� ,;C� DIAV_NSIONS OF GIRDERS _HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATE.RIAL. OF CHININEY 1S BUILDING ON SOLID OR FILLED LAND IS .BUILDING CONNECTED TO NATURAL GAS LINE D 4.. FORM U - LOT RELEASE FORM i� XI(Q �►�Qrf��� I (o ,,� , o � � _JC INSTRUCTIONS: This form is used to verify that all necessary approvals/pe mits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION***********************� APPLICANT ��)O/Mi�. L64 -1411 -ac -6(9y (y7_ -) 6`56 LOCATION: Assessor's Map Number /;:�' 7zS PARCEL SUBDIVISION LOT (S) STREET S '�> S(A L -LZ -y � ST. NUMBER �5.. ************************************OFFICIAL USE ONLY*********************************** I RECQMMENDATIONS OF TOWN AGENTS: RVATION ADMINISTRATOV DATE APPROVED 0— �9 DATE REJECTED COMMENTS %oat TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FO D INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SE IC INSPECTOR -HEALTH DATE APPROVED l OZ DATE REJECTED COMMENTS \ %ed Sti� (J t­e,�- -,P+�-o j^ I_r(}A� PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9\97 Im ,TE C BRT If7J E.I>.I OVMQAT►oN t��,,� w E!, ViRONEERS,��. ALFRED A. $HABOO, P.E. �N I V O'RTN A NAarR , P.O. Box 516,160 Pleasant Street, North Andover, MA 01P45 9 .1508) 683-3893 Scq/�; �": yon �✓ /8, 1992 2o L„4T N -�hTi c • 90 t N G8'-09 1-09'' W S'&'L L !'VA rJ �44 �w 0 yl cb Ca-krivy TAA -r -H l 'O Ps &I -S SHwv N CO ATLY W !U .-rA,,Tf166 Z^ NING I&Y- LAws �►�wpN Q FO VL 5, l./S& (3F' TC T.J�-IJ-�LDIN� rho-- PdGTdk- ONLY, �R 11i F D��"'E'RMINATl01J DF �u►uQ CoWPcaN►+zY ORNo►J Lou+rc�M�'C'r wHEN 'C0uG1-ZUCTe-t> . S, NO 'STI;�E'zz T' Z 1 0. 1± �% z ,. J W Z oil 1 0 ^� .. .. s ; • 2G.ed � r � N o — N � 6` m 2o L„4T N -�hTi c • 90 t N G8'-09 1-09'' W S'&'L L !'VA rJ �44 �w 0 yl cb Ca-krivy TAA -r -H l 'O Ps &I -S SHwv N CO ATLY W !U .-rA,,Tf166 Z^ NING I&Y- LAws �►�wpN Q FO VL 5, l./S& (3F' TC T.J�-IJ-�LDIN� rho-- PdGTdk- ONLY, �R 11i F D��"'E'RMINATl01J DF �u►uQ CoWPcaN►+zY ORNo►J Lou+rc�M�'C'r wHEN 'C0uG1-ZUCTe-t> . S, NO 'STI;�E'zz T' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: STI �=_P �"YV fCJ FAL 2 Location: J 3 'S L-1 L L'L- U' ' " - 5 7 City NPADi /_VJ0011fRI J-14" Phone # Ci-9+CO ? 76<56 I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. ('mmnanv name= Address G> Zx Company name: I --- Address City Phone #: Insurance Co. Policy # 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_weelLas-ciOI..penaltiesinlheinrmd-a STOP WORK ORDERmd_afire._cf.131.00-00)-riay.againstme I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ti I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signe Print 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 0 Licensing Board p Selectman's Office Contact person: Phone #: ❑ Health Department 0 Other A; z7zl - - , c4r"",7 "o') `� � ,����y� ��-`',� ;oma ,� �fs��► 7��� 145�7a'--t, o elw- �/�Sv Tri/ , o e- /, � � t -zo ex- 0 e- /a i 9A- gZ,00, yi i I'd 8800-2E*1-£09 eSb=OT ZO SO ^oN J Z'd 8800-26b-609 44TWS-2jea '0 eSb:Oi 20 SO ^oN Zd Wd2G:90 Z00Z S0~ -^-N ZOEV699209: 'ON XUA 831S3HDNUW XUWAd00: W08-1 4 Id Wd£b :90 Z00Z SO Z0£b699£09 : 'ON XUJ 83iS9HONUW 'XIUWAd00: WOaJ 0 z 0 1 x O O; °E v P4 U 24 z "a o p O C -cz G U W O p.' p G a o �¢ W p -C, C a O a z p ro G z W a w w G 7 b V)V) o O N c :cam o ` H cc, c V C.) = o ' V1 o EaQ A co CL .- H E c 0 CD c� CM CL E o o N � L C ftwa: m H C m c O N to O v, cc 0 :� vmo Oy m = om o> aCz �o : m o� m (� c� w mo o ' Z O ev 01, w os a Q i` m c O = m CLcoo CD 3 N z W �rL.+�t �+ y.. 'rCD m .yCD cm O C3 -0 o-O� c g N CL m' o = tyv a CD O t M� 0 0 N 0 co .E Q L CLQ .0 C O Q Q _m CL CO) O Q V CO2 C O O .0 C. 0 i Ns F -Z. 'T It Ns I 0 N*P o a LI R%, n, 7k a LI R%, 8 n 1"176010 N DEPARTMENT OFPUBLICS4FUT �k-93RBOARD OF MEPREVENWONRECUL4T101�SS27CVfR IZ:00 Perntit No.�+� Occupancy & Fees Checked APPUCATION FOR PEMff TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAcif iSSTS ELECTRICAL CODE, S 27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -33 Sc, / )� i! J t Owner or Tenant i t -e �+ Owner's Address 3 S 1 1 vq v J ' -- Is this permit in conjunction with a building permit: Yes [D"No a (Check Appropriate Box) Purpose of Building Utili ktyAuthorization No. Existing Service .1 Amps 0`10 Volts Overhead � Underground ED 4 No. of Meters New Service Amps �� Volts Overhead r --J Underground l:3 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tuba No. of Transformers Total KVA No. of Lighting Fixtures tlj Swimrning Pool AboveBelow ground I--] ground Generators KVA 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 Detection and Initiating Devices No. of Sounding Devices No. of Self Contained No. of Zones No. of Ranges No. of Air Coad. Total Tons No. of Disposals No. of Heat Total Total Pumps Tons KW No. of Dishwashers Space Area Heating KW Detection/Sounding Devices Local Municipal Connections Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHE ListranoeCa�aags R��attothetagliat�oQvi�seltsCBlaalLaws Iha�eaanatLialtyh>aratoePt�fig'icitdngCrn>pi�eCaa itsscb�tiialagt YES [EfNO Ihmstlbmk1edva1idpo0f0's3re1Dl ZOffM YES U NO IfyauhmcdwdWYES pk=i �dhetMrof=cWby'dzdcinglle NA AI`KE rM BOND [] OHiER M ft=Spe* Eitim*dV"o UwhA Wrak S WorkbSlat InspecdonDaft.0- led Rao Fiat >/ �7 Signedunda�iePf3alfie3afpajW LioaseNa I7 �(�(�? fy FIRMNAME Goasee�'� ;! C Bas¢rssTd.Na � i "'Li AkTeLNa 3� ,.�Y� ; OWNER'S1N5URANCEWAIV ;I.anm=hettleLioase fl�ei at�aem or9ss>i a�livalatascogtaedbyiviassadttaeltsGenaalIsws a odthatmysig�rn4fspemdappilcMm%wim sdnsm*imm f. (Please check one) Owner 1:1 Agent Telephone No. PERMIT FEE $ __ 59U9 Date.................................. 01 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING mv y .......... 44'e-. This certifies that .... I ........ "s.e .............................. has permission to perform .......J.64S .... NO4i!w2 ........... wiring in the building of ..... '17 1- � ... Af6I ... 7 ....x ........4#219.Rez ................... at ............... 3- ....3......... ....... North Andover, Mass. /IV "4111-9 Fee.....................-. Lic. No. ............. .................... EL crRicAL INSPECTOR Check # + DEPARTMENTOFPUBLIMFETY BOA IRDOFFIREPREVF.M70NREGUL4770AN527CNR 12:00 Permit No. Occupancy & Fees Checked APPLICATION FOR PERMITTO PERFORMaECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12.00Dat (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) g Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) .3 Owner or Tenant � �'k t, -e i n +9` 2 C-6 Owner's Address Is this permit in conjunction /with a�� building permit: Purpose of Building Fes?J( h Existing Service--1�Amps ` ° �C Volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work r341 Yes ®i No (Check Appropriate Box) Utility Authorization No. Overhead a Underground Overhead Underground Q No. of Meters No. of Meters No. of Lighting Outlets No. of Hat Tubs No, of Transformers Total TVA No. of Lighting Fixtures 1 Swimming Pool Above 1:1Below Generators KVA and grotmd No. of Receptacle Outlets No. of Oil Burners No. or 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 Irtitiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local a Municipal Connections Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP lnstrarwer bHage. PusuatlDIhemquie tgllSoOviasodmse t Gene lL3WsQ $S eC�Wdl�t YES [E NO Ihateaa=tLiabt&dyhmanePbbWi dLKEgC roM 'H Co' lila♦embn&dmtbdprodbfSOMIDtheOiT= YES r" 1 NO � IfycuhaeedredWYES,pfea9ein&*IheiyMcf=eaWbydtadargthe apprcpri*bcPL L ---J [N5(JRANCE BOND ExpiladcnD* F0rgkdVahredE1mftxd Wodc S WaictDSlath>Spec tD*Re Wrged Ragh FTnal SigtTedunda�iePtrraltesefpetjtay �W�, L,.7 �l (4' 1 FIRMNAME ! // 910 G ' l Ierlo / 7 j' %�' LioaM `` Sigt>ahlte "— W 1A BLairmTd.N . AltTdNTa OWNER'SINSURANCEWANER;IamawarethattheI�oemdmn t �re�rranecD► arAss>bstaMialegTdvaiatasroylmadby�GerraalIaws andthattrrysigtral cont kpan*appbmb—Mv,Wmd>isre#m=t. (Please check one) Owner Agent El Telephone No. PERMIT FEE t Location 33 �� t l.c�d� No. 452, ` Date - i Z Loy— Nom,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ CHU '�s'•E<� Building/Frame Permit Fee $ JACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ UC) __-- Check # CA 04 18381 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: .7 v SIGNATURE: Building Commission tdr of Buildings Date - SECTION 1- SITE` INFORMATION _ 1.1 Property Address: • L 1.2. Assessors Map and Parcel Number: . a Map Number Parcel Number /�� '/7�����r /�� • 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts & 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Rcqaired Provide ReqWred Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 34 I.S. blood Zone Information: 1.8 SeT'"W Disposal System Public ❑ Private ZOOe Outside Flood Zone Municipal ❑ On Site Disposal System - SECTION 2 - PROPERTY OWNERSE[MAUTHORIZED AGENT '"� i`t� Ct; Y ; 2,10 2.1 Owner of Record kk 2 % Name (Print) Address for Service lJ 7 Signature ; Telephone 2.2 Owner of Record: IName Print Address for Service: p 76562 X -vol"�� SignaVe Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ [,Company Name Registration Number ;Address Expiration Date Signature___ __ Telephone SECTION 4 - WORKERS COMPENSATION (NVLG.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 .......0 No....... SECTION 5 Description of Proposed Workcheck a9 ■ ble New Construction Of Existing Building ❑ Repair(s) ❑ 7 t'erations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SF.f'TinN 6 - F.CTIMATWD VnNCTP1TrT1rniv me rc Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant 1. Building GD (a) Building Permit Fee Multi lien 2 Electrical &V to (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 oma r.Tr�av n_ �at�wrnr � irmrt�r.irs ....�.��. Check Number .— — — 1.1..,...- — ... OL• a. WIVKrLL' I ML W nMA OWNERS AGENT lO'RR CONTRACTOR APPLIES FOR BUILDING PERMIT n e.� I, as Owner/Au thorized Agent of subject property, Hereby authorize to act on Ctlehalf,in f rs relative to work authorized by this building permit applica Signature of Owner �J Date l� SECTION 7b OWNER /A UTHORIZED AGENT DECLARATION I, AL1 i� as Owner/Authorized Agent of subject r property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge t and belief Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRvIBERS I ST2• 3RDI SPAN DIMENSIONS OF SILLS D VMNSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATU1tAL GAS LINE A i ...c UJ /Ylassacnusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ,•` Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Jf 4' City/State/Zipy�yA/G/,,P .cr &;'f/ Phone #:_IT Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employee's (full and/or part-time).* 2. �am have hired the sub -contractors a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' *A- comp. insurance required.] 414r -.50139.3 Type of project (required): 6. ,❑ New construction ?• Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other --�-rr••--•. ----• �••��� ....n n a .,..a, a,ov .,l1 vut ine section oeiow showmg their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and them hire outside contractors must submit a new affidavit indicating such. tContractors that check this boa must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing 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: City/State/Zip: Attach 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 c. 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided abope is true and correct '3 r Oficial use only. Do not write in this area, to be completed by city or town oj, j'tciaL City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers on in theto service of another under any cone workers' compensation for trair ct�of hiie� Pursuant to this statute, an employee is defined as "...every P. express or implied, oral or written." or An employer is defined as "an individual, partnership, association, corporation tiondrother a deceaseentitd oemerr an ytw or the re of the foregoing engaged m a Joint enterprise, and including the legs representatives receiver or trustee of ab individual, partnership association or other legal entity, employing employees. However the owner of a dwelling house having not more than s to do apartments n enconstru construction resides r wok on such occupant dwelling house dwelling house of another who employs person or on the goods or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to Your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number((ss along h with no employeeir s other than the of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) required to carry workers' compensation insurance. If an LLC or LLP does have members or partners, are not employees, a policy is required. Be advised that this affidavit mayobsisub ratted to d date �eDepartment ,o�fe��davitlshould Accidents for confirmation of insurance coverage. Also be sere gra be returned to the city or town that the applicationuestions re a permit or ding the law or f yoe is u re reequired,not the to obtain awk�'t o Industrial Accidents. Should you have any q regarding compensation policy, please call the Department at the number listed below. Self-insured companies should enter thea self-insurance license number on the appropriate line. City or Town Officials Please be sure that the- affidavit is complete and printed legibly. The Department has provided a space at the bottom , of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicanter. in addition, an applicant Please be sure to fill in the permit/license numb ti ns m any iv n year, a reference need only submit one affidavit indicating current that must submit multiple permit/license app Y policy information (if necessary) and oder "Job Site Address" the applicant should write "all locations in (city or town);" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each owner or citizen is obtaining a license or permit not related to any business or commercial venture year. Where a home (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should You have any questions, please do not hesitate to give us a call. The Department's address; telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia 0 t o m c � o T C: - C -3 V .Q O.0 LO W — O o m 0: D CL EC a�; GOP• Q, � ' C � N � �w :WIN �L� U) o Z' 3 C O ... a �z� y y C C S= W _O y O O0 cp AV o.w . vim ac 1p:V: :zs O os y y Z o lV C O C Hy o.= T , C,* co s LU Go 06M wZ 0 LU m v C o Q h C> m� ®� z W JS k- $ C.=o m 9 T ar L Z CL ® y I CD cm go � 0 � — ECDCD m� as CD ® L Cc 0 cm< caC — cc C.) as c CD CL V � ■— ■— ca 0 U) W w w U) o a w° a4 U w a a°' w a w U W a � A o -0 o m c � o T C: - C -3 V .Q O.0 LO W — O o m 0: D CL EC a�; GOP• Q, � ' C � N � �w :WIN �L� U) o Z' 3 C O ... a �z� y y C C S= W _O y O O0 cp AV o.w . vim ac 1p:V: :zs O os y y Z o lV C O C Hy o.= T , C,* co s LU Go 06M wZ 0 LU m v C o Q h C> m� ®� z W JS k- $ C.=o m 9 T ar L Z CL ® y I CD cm go � 0 � — ECDCD m� as CD ® L Cc 0 cm< caC — cc C.) as c CD CL V � ■— ■— ca 0 U) W w w U) _ocati'uni� No. !�/4 ? Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ " Other Permit Fee $ � Sewer;Connection Fee $ 94Nater Connection Fee $ TOTAL $ C'/ 4 /J U . 77 Building Inspector Div. Public Works Location No. Ald! Date -,/ g,�-- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Q • O 0 Building/Frame Permit Fee $ Foundation Permit Fee $ $ ther Permit Fee �q41 /6 -Connection Fee Olio eater Connection Fee rC% TOTAL $ �+ ���• 0-0 Building Inspector J'j Div. Public Works PER:l1IT 1vO=� _ APPLICATION FOR PERMIT TL'�BUILD —NORTH ANDOVER, MASS. � J3 )p J AGLr 1 MAP +40. %�� L LOOT NO y�` j� I 2 RECORD OF OWNERSHIP JDATE BOOK PAGE ! ZONE SUB DIV. LOT O. hat%T-f' -�jh�l Cv'j--r Z7w C- LOCATIOr _ �^ yju' J` `oil PURPOSE OF BUILDING OWNER'S NA h-'f'ih _ j- --j-,meg r J NO. OF STORIES SIZE 'B'i G3 OWNER'S ADDRESS 3 G 'GI`�I�C. BASEMENT OR SLAB l�idST�J/ ARCHITECT'S NAME ,2' ^ ^ BUILDER'S NAME:fin J�� J�(d�P�4.�� i � C SIZE OF FLOOR TIMBERS ® 2ND 3RD SPAN / -7 DISTANCE TO NEAREST BUILDING LIQ DIMENSIONS OF SILLS DISTANCE FROM STREET '• "" POSTS � j DISTANCE FROM LOT LINES - SIDES C REAR C/ / "" "' GIRDERS / O .e AREA OF LOT / G 09 X FRONTAGE /J�© HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ,v=:ei SIZE OF FOOTING X IS BUILDING ADDITION /V Q MATERIAL OF CHIMNEY ' IS BUILDING ALTERATION /y IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE�J IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY JY`.� V IS BUILDING CONNECTED TO TOWN SEWER Jy 6 IS BUILDING CONNECTED TO NATURAL GAS LINE �y L INSTRUCTIONS{ SEE BOTH SIDES R4-�iyC�.�yY�.}�t�^/� ulltS kJgr, 0 111sr�iL7 Shi Z i PAGE 1 FILL OUT SECTIONS 1 - 3 AFRAME PERMIT $� 0 0 PAGE 2 FILL OUT SECTIONS i - 12 Mg ELECTRIC METEPS IQJST BE ON OUTSIDE OF BUILDING A ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS f. PLANS MUST BE FILED AID APPROVED BY DING I CTOR gJ DATE FILED // / f- 511 SIGNATURE OF OWNER OR FEE 7-4 U 62 tO / Vtd ay. v3 PERMIT GRANTED OWNER TEL. N CONTR. TEL. # 6 6 3 f 0- T t s 1 CONTR. UC. #_ An2E;/ 2 OU AUG 28n I.,. L- - "UILIE I' 04 �iil8� a �3 3 PROPERTY INFORMATION LAND COST EST. BLDG. C08T' & /`j 00 EBT. BLDG. COST PER SQ. FT: J� EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4. APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN / � 4 BUILDrNQ INSPECTOR 1 OCCUPANCY SINGLE FAMILY Si OkIES _ MULTI. FAMILY OFFICES BATH 13 FIX.) APARTMENTS MANSARD _ CONSTRUCTION 2 FOUNDATION SHED S INTERIOR FINISH CONCRETE TIMBER BMS. & COLS. 3 1 2 I_ CONCRETE BL'K. _ PINE BRICK OR STONE KITCHEN SINK HARDWD SLATE AIR CONDITIONING NO PLUMBING PIERS PLASTER RADIANT H'T'G STALL SHOWER DRY VJAII ROLL ROOFING I UNFIN. 3 BASEMENT GAS OIL ELECTRIC AREA FULL TILE FLOOR FIN. B'M'TAREA '/. 1/2 1/. _ FIN. ATTIC AREA NO BMT _ FIRE PLACES HEAD ROOM _ MODERN KITCHEN 4 WALLS I g FLOORS CLAPBOARDS I B 1 ��- 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH I `I 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. ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK .ON MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME {+tiJY CONN. OR CINDER BLK. ._2 TiV1i31 }9 3W STONE ON MASONRY WIRING �--�—�^�.--� €T 5 ROOF II 10 PLUMBING GABLE GAMBREL FLAT je>6 HIP i l HEATING BATH 13 FIX.) WOOD JOIST MANSARD PIPELESS FURNACE TOILET RM. (2 FIX.) SHED FORCED HOT AIR FURN. WATER CLOSET TIMBER BMS. & COLS. ASPHALT SHINGLES STEAM LAVATORY _ WOOD SHINGES HOT W'T'R OR VAPOR KITCHEN SINK WOOD RAFTERS SLATE AIR CONDITIONING NO PLUMBING TAR & GRAVEL RADIANT H'T'G STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES _ GAS OIL ELECTRIC TILE FLOOR NO HEATING TILE DADO 4 ; 6 FRAMING i l 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 GAS OIL ELECTRIC B'M'T 2nd 1st 13rd \ NO HEATING c SRT I R 1 E.I>, 1-OUNiagT►oN t'"�A N ENVIRONEERS. -,: . IN I Cr tTM AH7>*44R, /44A ALFRED A. $HABOO, P.E. P.O. Box 516,160 Pleasant Street, North Andover, MA 0145 • .(508) 683 -3893 5"CALE: -�: yo, ✓ is, 1992 e1A ! 21a. �,_2a �-o -r L•4 3 a 31. I do FA I CV �° .L c£RT{FY `J #"-Y -r r. .Q O1` 1 vaitTli NAaU is.¢, /'1A A10604 m '�u�t.T • O� C•6lG.T'� Nowa Q D-r&'RAMINATioN OF ;�—ZONINC 1Coufroitorry OR NoweAlJvair-A ti'e _ �n%NEu �o1Js'rf�uGTE-D - 90 # 1 , NG8'-091-08" W S'&LL!'VA tj 1� Z ..% _ o � J W L 1 {v 0 A Pi W s ; � 2G .•o 1 � y trri Z fi � N o i — 4 N (� m 21a. �,_2a �-o -r L•4 3 a 31. I do FA I CV �° .L c£RT{FY `J #"-Y -r r. .Q O1` 1 vaitTli NAaU is.¢, /'1A A10604 m '�u�t.T • O� C•6lG.T'� Nowa Q D-r&'RAMINATioN OF ;�—ZONINC 1Coufroitorry OR NoweAlJvair-A ti'e _ �n%NEu �o1Js'rf�uGTE-D - 90 # 1 , NG8'-091-08" W S'&LL!'VA tj k FORM U - LOT RELEASE FORM O' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law,-' regulations or requirements. ****************Applicant fills out this section*****************• cti.�ilP �.lf C �;✓ :� �� c APPLICANT: Z-1 R 1FW1 Phone 68-2-133 LOCATION: Assessor's Map Number /0 7 Parcel ' Subdivision Fog m //44 v Lot (s) _ Street U LC I UA/. i St. Numbet ************************Official Use Only************************ RECOMMIENDATIO OF TOWN AGENTS : Date Approved C� Y - Conservation OF Date Rejected Comments o y Toc7fi PlaErier Comments A= Health Agent Comments Date Approved��- Date Rejected Date Approved 91171 9,a Date Rejected Public Works - sewer/water connections V! driveway permiti- ✓ ��l?�ra lu Fire Department �,.f,. i - ZO/ _Received by Building Inspector G 2 81992 f P � r Date dt* Z0 0 to w U, N tu V) 0 T 0 LU IU q— U) U.1 w z 0 Ili III WF (D I - 111 -J 10 -- -j n -A Cc C-) U-1 T- LU U) cr -) C3 LLI (y �t J: n. U) 0 LL fr. 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