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HomeMy WebLinkAboutMiscellaneous - 34 PRESCOTT STREET 4/30/2018 (3)gV 3/.056 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING �` �✓� This certifies that ...:....:......................... : �?-���-'' ............................... has permission to perform ............................................................................ wiring in the,building of ....... .................................................. �J at .. -rN... Via' -' G.... !'�--��....................... . North Andover, Mass. Fee. ...'h..... Lic. Nc&.M':�Zr........... ............................................. !' ELECTRICAL INSPECTOR Check # V l WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �y Official Use Onlyy� �I Permit No. 36L [ & VB CO3b1 to ALgM01FWASSACVVSETZ Department o Tub& Sae D . f Safety Occupancy &Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Al work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1 :00 (Please Print in ink or type all Information) Date To the I or of Wires: Town of North Andover The undersigned applies for a permit itt to perform the electricalcawork described below. Location (Street & Number 1 a e CS [ /:C5de Owner or Tenant (!T 1Q A U e l Owner's Is this permit in conjunction with a building permit Yesk No p (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service % M Amps 2QZ2 40 Voits Overheadk Undgmd p No. of Meters New Service Amps Voits J Overhead p Undgmd 0 No. of Meters Number of Feeders and Ampacity ilcke/i / n 1 e �9Q&� Location and Nature of Proposed Electrical Work INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES - NO = have submitted valid proof of same to the Office YES - NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND - OTHER - (Please Specify) (Expiration Date) I J Estimated Value of Electrical Work$ ll/ C '09W'09WWork to Start Inspection Date Resquested Roug Final FIRM N Signed uunndEer the Penalties of perjury: LIC. NO. r Licensee Signatu LIC. NO. LO`Q�6/ Bus. Tel No. Address 111P_ Alt Tel. No. OWNER'S INSURANCEWAIVER: I am aware that fhe Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMIT FEE $ � (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA I Above p In p No. of Lighting Fixtures S Swimming Pool gmd 0 gmd p Generators KVA No. of Emergency Lighting ,o. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices Nod of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices p Municipal p Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wirin .j No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES - NO = have submitted valid proof of same to the Office YES - NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND - OTHER - (Please Specify) (Expiration Date) I J Estimated Value of Electrical Work$ ll/ C '09W'09WWork to Start Inspection Date Resquested Roug Final FIRM N Signed uunndEer the Penalties of perjury: LIC. NO. r Licensee Signatu LIC. NO. LO`Q�6/ Bus. Tel No. Address 111P_ Alt Tel. No. OWNER'S INSURANCEWAIVER: I am aware that fhe Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMIT FEE $ � (Signature of Owner or Agent) Date...`' 3..0-/ No- 4-40 4.0 RT :�tia TOWN OF NORTH ANDOVER it •.r ..,. '. °� ° PERMIT FOR PLUMBING s i 4 v C�\_r— _Y. ) f This certifies that . �-:........ .....�_, ............. . 1' has permission to perform • • • • • • • • • • • • lumbing in_ the buildings of .. - : ....... y ,North Andover, Mass. atm./... f Fee. 'V?....�. Lic. No .......... ..... .. '? ...... G" PLUMBINGI.NPE&CTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FO PERMIT TO DO PLUMBING (Type or print) �•/ NORTH ANDOVER, MASSACHUSETTS /� C-1— DateBuilding Locatio�S( Owners Name 2 ( 4/ ' 7 Permit # 4/ �i'�o ,tel Amount rib y New Renovation �Replacement El Plans Submitted Yes No (Print or type) Installing Company Name C1{L �� / ' f ri AddressC� "' A �� 3�//W AUZ�/l pS� Check one: Corp. _ Partner. . Firm/Co. Name of Licensed Plumber. AInsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0---, Other type of indemnity 0--- - Bond ❑ Certificate Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance h Signature Owner Agent I hereby certify that all of the details and information I h ubmitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ' talla ons performed under it ed for this application will be in compliance with all pertinent provisions of the Mas achu tate Plumb' d C ter 1 2 of the General Laws. By: i ot Lice-asea FlutpUer Type of Plumbing License Title ` O City/Town icense Mumber Master ourneyman ❑ APPROVED (OFFICE USE ONLY i •N c • N • • .A � (Print or type) Installing Company Name C1{L �� / ' f ri AddressC� "' A �� 3�//W AUZ�/l pS� Check one: Corp. _ Partner. . Firm/Co. Name of Licensed Plumber. AInsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0---, Other type of indemnity 0--- - Bond ❑ Certificate Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance h Signature Owner Agent I hereby certify that all of the details and information I h ubmitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and ' talla ons performed under it ed for this application will be in compliance with all pertinent provisions of the Mas achu tate Plumb' d C ter 1 2 of the General Laws. By: i ot Lice-asea FlutpUer Type of Plumbing License Title ` O City/Town icense Mumber Master ourneyman ❑ APPROVED (OFFICE USE ONLY Location " No. %_ Dated �ol TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # $ / `-/ 911 _ If L,/ Building Inspector , A, TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7M�77— 77— BUILDING PERMIT NUMBER: - DATE ISSUED: SIGNATURE: Building Commissionevl2axatro,r.of Buildings Date SECTION 1- SITE INFORMATION t 1.1 Property Address: done SCUT% / s/ 1.2 Assessors Map and Parcel Number: -y / Map Number Parcel lumber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUII.DING SETBACKS ft Front Yard Side Yard Rear Yard Required . Provide Required Provided Re 'red Provided 1 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 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Roles` .� -4- arx L (, r#aaL 3 `i /°Pasco l/ �,'/� Name (Print) - Address for Service S 2 62630 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constrpction Supervisor: Q j License Number Addr D OV ? �' --4' Expirat on Date Signatifre Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ f t�y� t7 5' Company Name Registration Number Ex ration ate Address Signature Telephone o t C 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 building permit. —Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) lte Arations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition c• ❑ Other ❑ Specify Brief Description of Proposed Work: tvQCQ�rhe� 5 t.yt/2`%� (r%✓tf S SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a_p licant�,-�� a Q�$ xUSEIQNhy 1. Building (a) Building Permit Fee Multiplier 2 Electrical ,f/1S�o —t (b) Estimated Total Cost of Construction n 3 Plumbing ql Building Permit fee (a) x (b) `7 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 behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, M ICA oicl 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 P e Si ature of Owner/A en Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1ST2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A 143 K Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax. (978) 688-9542 DEBRIS DISPOSAL FORM y-.•�' a o 0 L ti M �a9.o �p're° r•P4°i'tg In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit-# the debris resulting from the work shall.be disposed of in a properly licensed solid. waste disposal facility as defined by MGL c11, s150* a. The debris will be disposed of in /at: Facility location Signature ofA,pplicant Dae NOTE.- A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. . +a ! ✓ �anz�nai arefrz/W of - A&W -1/111111A BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 061988 Birthdate: 09/01/1964 Expires: 09/01/2001 Tr. no: 3686 Restricted To: 00 MICHAEL W DELANEY 203 EAST ST METHUEN, MA 01844 Administrator r' � U�e+ riosamanruavll� nf..�firsxz��rw�/fa HOME IMPROVEMENT CONTRACTOR _= Registration: 104625 Expiration: 7/14/02 _ Type: 08A DELANEY CONSTRUCTION Michael Delaney 203 EAST ST. ADMINISTRATOR I METHOEH MA 01844 Name: W Location: Ci AP -7 /V H Phone �� �� I3 � S `z. (-7 am a homeowner performing all work myself. F -1I 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 V Company name:%� z �%���/��-�� e per, c, Address 113 City:5/-W1 F 1, ru 6T D 302'2 Phone t4 7,� b S Insurance Co. Za^ i2 ] / S u ~ �� l� Policy # C -19 y 7 � 0 ©`^- 0,3 ComDanv 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 penalties in the form of a STOP WORK ORDER and a fine of ($100.00) 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. /do herby certifyyr6�he painog penaltjg3�Y perjury that the information provided above is true and correct. _ / ,-�,V 0 Print name PW 1-C te;c )get Phone #-97k M )7 S Z Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Cf) m Cl) 0 m LTJ CA C � CA coC') Z y oo-v CL C2 d =• CO) CD � O � o v CD o cr CD CD o D W -M 3. C CD y CD Q o CO) CO CD S v y o 'O Z CD a O CD 3 0 44 CD C y 0 0m _S EL O m CA OSmn m C) H n C C7 1'1'1 Z ?-C N O of .mi m H T =r a .. a m CD .-P m y G y N m _ ® fm �� O ii 00 p N C2 W -CO CL O am :111""v" ! 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