The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 35 HOLLOW TREE LANE 4/30/2018 (2)9513 f jaw Date........ 7n. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........Da <!1.. .... �T' 71 t.111 :.................................. has permission to perform ............11/.1�T.................................... wiring in the building of. {./��!iy..�ir� ��!�,�� ..... .................. �j�k.C.�o.c�✓...7 '...... �'�......._...... ,North Andover, Mass. at ..... i Lic. No. `�....., Fee - ft4w......� z . ..�!i.�1.. .;...:.....�- ELECTRICAL{#NSP+i* Check # v l� - �• �•_•� lrbn.uu We b in accordance -with the provisions of M.G.L. c. 143, § 3L, the f permit application form to provide notice of installation of wiringshall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the otification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be-deemed_by-the-Inspector_of_Wires abandoned-and_invalid-ifhe—_.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for c("`Nott f work shall be permitted for reasonable cause. A permit shall be teApinated upon the written request of either the owner or -the instale�atated on the permit application. S The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beynning on August 1008 and extending -through August 15, 2012. 8 — Permit/Date Closed: ❑ Permit Extension Act — Permit/Date Closed: *** Note: Reapply for new Official Use Only cc��rr�� cc77 Permit No. �C.JaParfn�nt o�.}irw �atvicQ9 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 (M C), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ?/ 3 f/e City or Town of: 42;2 A4aX4,2e To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 35— 110e ed&j me6 LN. Owner or Tenant IVU6 6Q T Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building I Utility Authorization No. Existing Service Amps / Volts Overhead ❑ ' Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:/7'r/�� , �.yTl�/, ,Q/.t-twle ,Qft✓t Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires /0 No. of CeiL-Susp. (Paddle) Fans o. n Transformers ota KVA No. of Luminaire Outlets b No. of Hot Tubs Generators KVA 111 No. of Luminaires Swimming Pool Above ❑n- rnd. rad. [Ell o Emergency Lighting Battery Units No. of Receptacle Outlets ` y No. of OD Burners FIRE ALARMS No. of Zones No. of Switches / Z No. of Gas Burners o. ostingDetection an Initiating Devices No. of RangesNo. of Air Cond. Tons Total No. of Alerting Devices No. of Waste Dis sers p° eat Pump Totals: um, er ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers % SpacelArea Heating KW Local ❑ Muntcun1ctpaction ElOther onne No. of Dryers Heating Appliances . KW S stems:* ecuriNo. of bevies or Equivalent No. o atero. KW o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or Equivalent iring: OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /'b Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: RAGE: 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 [4 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: DM I D F LE'GT PO CAL C,oi-rraAc-TINU 4-1-C _ LIC. NO.: I y 1(031q Licensee: D A k11 0 RA 6 4 4 P, Signature ' y��— LIC. NO.: (llapplicable, enter "exempt" in the license number line.) �' r —Bus. Tel. No.: `118' 662 Address: R'7 gen-mawT STIy , oRTH 41490\197P,►M,Q �I��S AIL Tel. No.:211-3-7S-573-1 '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: $ Date..7�/. �. . �'<� �� •otic TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING sSACMU5. i This certifies that . 6,1� /`........ • ... . has permission to perform ... PC. K. U4-. ................ plumbing in the buildings of . %2 �. c1.¢..."5t� .................. at. r. (-%.t .6 C...�........ C North Andover, Mass. Fee.//.??��-.. Lic. No. /. 'Gl.. ...... ...t.. . . .......... PLUMBING INSPECTOR Check K,R 8360 MASSACHUSETTS UNIFORM APPLICATION FOR PERNUT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 3S eZl w 22re ZAN e Owners Name S %Uel v Permit # rr Amount Type ofoccupancy New [3 Renovation Replacement ® Plans Submitted Yes No TiTVTTTI2F.0 (Print- or type) Check e: Installing Company Name /XA ung>> fl,.AA4 de.4 a 4_47-b_ orP- LjPartner UFirm/Co- Certificate Name of Licensed Plumber: 4,1AIV -Te- Insurance T _Insurance Coverage: Indicate the type of insurance coverage by ch6cking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 0 Agent I hereby certify that all ofthe 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 State Plumbing Code anChapter 144 of the General Laws. By: ignaxure of Uicensedum er Type of Plumbing License Title I -A a 9 City/Town rcense Nuum e"6 r'-- Master Journeyman APPROVED (OFFICE USE ONLY i .,I •l nvzziI -.-.�---....--�-...-----� i `o 8 I .-.-.-..-�--�----..-----. Now 0 No ON MEMO 0 00000 is (Print- or type) Check e: Installing Company Name /XA ung>> fl,.AA4 de.4 a 4_47-b_ orP- LjPartner UFirm/Co- Certificate Name of Licensed Plumber: 4,1AIV -Te- Insurance T _Insurance Coverage: Indicate the type of insurance coverage by ch6cking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 0 Agent I hereby certify that all ofthe 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 State Plumbing Code anChapter 144 of the General Laws. By: ignaxure of Uicensedum er Type of Plumbing License Title I -A a 9 City/Town rcense Nuum e"6 r'-- Master Journeyman APPROVED (OFFICE USE ONLY 'a .� The C'ommonwealt-h of A, Department oflradustziaj_4ccidents Office of Aivestigadons 600 Washin- n Street ry• Boston, I1 L4 0211. 4rmv-Mas&gov1dia Workers' Compensation Insurance AfFida.•nft: Builders/Contractors/.C"lectriciaus/Plumbers An licant Information - p/ Please Print Le�ibiy Naane (Business/Ora niza ion/Individual): Address: ' f City/State/Zip:�{%.ePhone #: n employer:, Check the appropriate box: a employer with �-- 4. ❑ I am agegeral contractor loyees (full and/or part time).* sole and I have hired the sub -contractors a proprietor or partner- Iisted on the attached sheetand have no employees These sub} contractors have ing forme in any capacity, Le workerscomp, insurance. orkers' comp, in urance 5. ❑ We are a corporation and its red ] �� a homeowner doing workrighfofeg�piion officershave exercised their all lf [No workers' comp. per MGL c.152,§I(4), and we have no ance required.] t employees_ [No workers' •e a�S' comp. incl,•ancerequired-] = 1.=2C�::t tIL°t che--UO bbox.#' •m.—,.L aISO flu om, f c Homeowners % hgo Beed—_- belowhL^"�^� oI""5 T -i o'CZXerS' Co Type of project (required): 6. ❑ Neu, construction 7. a Remodeling 8. ❑ Demolition 9. ❑ Bmldmg addition 10.0 Electrical repairs or additions .1 L0'Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other O SUCmIt tills afildavn lndlcatin they .I 1 ... r•..-•�-..... r�:::.y Z..u.W. =-a -- *Contractors e1 z �o g aL ,,ck and then hireoutside contractors r/ilia-t submit a new affidavit indicating such. +Coatlacgrs fhzt checl; is ue+ al• o z a hed as additional sheet showing the name of the sub -contractors and theirworkers' comp• poiwy information ram an employer that is providing workers' campensauan insurance for my employees Below is the policy and job site information. Insurance Compiny Policy # or Self -ins. Lic. #: `' Expiration Date._�yne ad / / Job Site Address: 3Sho�o Gy T e City/State/Zip: .& Attach a copy -of the workers' compensafion poficy declaration page (sho�v5rtg the poiiey 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 penalSes of perjure th'xr the information. provided above'is true and correct 1' �A —Cry' 9— Official use only. Do not write' in this area, to be completed by city or toren officwl City or Town: hsili - Authority (circle one): X. Board of Health 2. Building Department 6. Other Contact Person: PermitUcense # 3. City/T()" Clerk 4. EIectrical Inspector S. PIumbing inspector Phone'#: Information an. d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every peon in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as "an individual, partnership, •associattion, corporation or other legal entity, or any two or more- of oreof the foregoing engaged in a joint enterprise, and including tyle legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association ox- other legal entity, employing employees. However the owner of a dwelling house having not more than three ap'artmL euts`and who resides therein, or the occupant of the dwelling house 'of anofhei- who employs persons to do mainte;:a=ce, construction or repair work on such dwelling house or on the grounds or building appurt=.ant 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 co 3unpliance 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.perfonnaom of public work um -el 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 numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) ivith.no employees other than the members or partners,. are not required to carry workers' comp ensation it urance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insure coverage. .Aho'be stu-e to sign and date the affidavit The affidavit should C re uue c that ,. S: t -- r c rzia t' or li q .ng auest d; n at a epari W crit. or • b t' d to the city or �.o n•Ti tl'i&� the cuuucauuu for thepe r W4e c l�.e. re F,WA D Industrial. Accidents. Should you. have any questions regardLg the ha;'r or, if you are r: u.ired to obtain a worlkers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. Cita or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided '& space at the bottom of the aff davit for you to fill out in the event the Office of lnvestigations has to contact you regarding the applicant Please be sure to fill in the permit/lic--me number which will be•used.as a reference number. In addition; an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under `.`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 per=mits or licenses. A new affidavit must be filled 'out each . year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to bum 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 Deparimeat'.s address, telephone.and,f mnumber._.. The Commonwealh of Massachusei-ts. Departineat of Industrial Accidents 'O1-01of Inre&tiUvafio•IIs ' 600 Washina-tan Street Boston, MA 02111 Tel. # 617-727-4900 ext 40..6 or 1-9 77-K&SSAFE _ Fax # 6.17-7- 7-7749 Revised 5-26-05 ' vmm mass._gov/dia LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 —352-2858 cell: 978-502-5921 July 16, 2010 Mr. Stephen Nugent 35 Hollow Tree Lane North Andover, Ma 01845 RE: Nugent Residence, 35 hollow Tree Lane, North Andover, Ma. 01845 Dear Mr. Nugent As you requested I visited the site to review the installation of the Engineered Materials consisting of LVL Beams utilized in the framing of the above project. These Beams are shown on plans prepared by Steve Foster Dated 112-4-09 with the framing sheets certified by me 12-16-09. Based on the above site visit and based on what I could visibly see I can certify that to the best of my knowledge the of LVL Beam members utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the Massachusetts State Building Code for 1&2 Family Residences. This certification assumes that all other framing requirements of the drawings and code, including but not limited to materials, nailing schedules, blocking, connections and other details were properly complied with by the licensed construction supervisor responsible for the project. Should you have any questions please do not hesitate to call. Yours truly, XL'� awrence H. Ogden P.E. Structural 27765 N OF Mgsso 9 IAWR CE G NAR LD �n "� ��bf zoo n 7765 EHG��`c Date ... 71 ........... ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. M..e..e ........am ............ ..... ....... has per4nission to perform ..... ...... Z�- iv,.e . A/9! ............................ wiringin the building of ..... . ... ..... ......... ................... orNorthAn 6 r,Mass. �11 2,42�1 Fee .... (A .......Lic. No�k4% ............ �. . x 4.....�....... ............. ELECTRICAL INSPECTOR Check # 5329 Official Use Only, Permit No. THE COMMONWEALTH OF MA S5ACHUSETTS (� J✓✓ r Department of Public Sofe5 {) t +4 f~ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & F#Che,kd4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordan2with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of The undersigned applies for a permit to perform the electrical wofk described below. / Location (Street & Number 35 /'70&0\7;;�41 LA.Ne Date / '/P - 04 - To the Inspector of Wires: Owner or Tenant a tt� (/C/l/ /!/v� i01' T Owner's Address S-A mc Is this permit in conjunction with a building permit Yes j/ No • (Check Appropriate Box) Purpose of Building '.!/We1/I �°��}i Utility Authorization No. Existing Service Amps Voits New Service Amps Voits Number of Feeders and Amoaclty Overhead • Undgmd • No. of Meters Overhead • Undgrnd • No. of Meters Location a d Nature of Proposed Electrical Work�SePA G Dt,e,n'Je an ac A M T S,014 Xes P INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includimpleted Operations Coverage or its substantial equivalentYES NO = have submitted valid proof of same to the Office ES NO = If you havoc �jecked YES please indicate the type o coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) Or/ /-I/ d-, (Expiration Date) Estimated Value- f Electrical Work$ Work to StartT jai " 0'% Inspection Date Res nested_ Signed under the Penalties of perjury: •''77)� /� FIRM NAME j/A ✓� � / ' 1 Qe , Ci �9 —0 LIC. NO. LIC. NO. Bus. Tel No.—.7 S" 53gl— Tcp Address Alt Tel. No. i3 - sqa- -c $Iva a OWNER'S INSURANCE WAIVER: I am aware that the 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 $ 45, " (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above In No. of Lighting Fixtures Swimming Pool gmd gmd Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of twitch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ran es No of Air Cond Tons Initiating Devices .'I_ Heat Total Total No. of L'V osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal • Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP / /, / �7 /p INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includimpleted Operations Coverage or its substantial equivalentYES NO = have submitted valid proof of same to the Office ES NO = If you havoc �jecked YES please indicate the type o coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) Or/ /-I/ d-, (Expiration Date) Estimated Value- f Electrical Work$ Work to StartT jai " 0'% Inspection Date Res nested_ Signed under the Penalties of perjury: •''77)� /� FIRM NAME j/A ✓� � / ' 1 Qe , Ci �9 —0 LIC. NO. LIC. NO. Bus. Tel No.—.7 S" 53gl— Tcp Address Alt Tel. No. i3 - sqa- -c $Iva a OWNER'S INSURANCE WAIVER: I am aware that the 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 $ 45, " (Signature of Owner or Agent) Y Location 35- r L-A Nc No. &p_3,.3 Date -7' TOWN OF NORTH ANDOVER /.--- . Certificate of Occupancy $ Building/Frame Permit Fee $ SgCHU`+ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # % g y WA16�11111111111 130 , 17462 AV/p Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIRENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING fiAT IIlIC tai` BUILDING PERMIT NUMBER: DATE ISSUED:6233 SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 17 SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: s.= Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone Outside Flood Zone ❑ - Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSIIIPtAUTHORIZED AGENT rl 2.1 Owner of Record Name (P, t) ,/ 1 Address for Service 41 Signature Telephone 2.1 Owner of Record: 'name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature � Telephone Not Applicable `❑ �j,y _ License Number ,/, Expiration Oate 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1346 77 Coritgnany Name // , /�✓s z/- V c�� ' ��/'�� Registration Number `1 Address Expirati n Date St nature Telephone 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 afl in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check ell applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: jet o, ID -etc I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I I result .;i Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction �— d i 3 Plumbing Building Permit fee (a) x (b) 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, �.,. j� 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. 7ZXZ-4 � Signature of Owner Date SECTION 7b/ OWNER/AUTHORIZED AGENT DECLARATION I, 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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3Ku 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 c� f i(qqA/a7 rrvpv�aaa TWOMEY & LEGARE CONTRACTING Professional Building / Remodeling P.O. Box 366 Shaun Twomey No. Andover, MR 01845 Doug Legare 978-685-7447 978-556-1547 NAME OF OWNER ADDRESS OF JOB ��✓ �- / ` �-� ' �� s TEL. 64f / DATE: —( t Z-00 T We hereby submit estimates for: (4 -CAA Y-4— 4- 2-') - 2-.) CCXJ .,Y,S i¢ ✓} j- Mss G- t� `7� I c Lr s .4`>. J We Propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars($ Payment to be made as follows: Authorized Signature NOTE:This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Signature " Date of Acceptance: /?"y' Signature. �f 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) Sign. ture of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: / �✓.ei✓14 �-� r-L45e� �✓� c°i ✓7 Address .1f67/1 Citv: ��yJ /K�Phone #: Insurance. Co. Policv # 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..penalties lnshe fnrm icfa_STOP WORK ORDERand_a fine of.(.$10o..00)aday against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. , Print a' Official use only do not write in this area to be completed by city or town official' # zo� kls- icy 2 City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate msponse is required ❑ Licensing Board ❑ Selectman's Office Contact person. Phone #: ❑ Health Department ❑ Other D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax Please print. DATE JOB LOCATION Number "HOMEOWNER Name PRESENT MAILING ADDRESS Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 City Town HOMEOWNER LICENSE EXEMPTION Street Address Home Phone State Map / lot Work. Phone The current exemption for "homedwners" was extended to include owner -occupied 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 Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended 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 onehome in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC Zip Code 0 0 z ri 9 P�J W am . � w .�o �•O C C y o CJC.2 c ' c O m �Ea` 0 ' o c. Yau f0.1 O mm O m y 0 U3 c O C • O O •O ID O ` 3 v, ID oc t o CM c c � 'o • o m coa d' Z o c O c C Q O m C •p = m � CL— N ti +r CC_ m w=Wc Z W E o-0 �m cO CD CJ C* a m� �� a F- 2 $CL NIP 2 M IN cc 3� oL O C' �a c O .O co CD Z s CLC40 C C C c y LU W W oC W U) o a a x 0a v � w Z A w Z � a ►~ w `�hh U) � cc w [GAJ] CR ° cn L cn W am . � w .�o �•O C C y o CJC.2 c ' c O m �Ea` 0 ' o c. Yau f0.1 O mm O m y 0 U3 c O C • O O •O ID O ` 3 v, ID oc t o CM c c � 'o • o m coa d' Z o c O c C Q O m C •p = m � CL— N ti +r CC_ m w=Wc Z W E o-0 �m cO CD CJ C* a m� �� a F- 2 $CL NIP 2 M IN cc 3� oL O C' �a c O .O co CD Z s CLC40 C C C c y LU W W oC W U) Date ....... ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........j. ... &/,-Q Qlbc 7— .......................................................................... has permission to perform ...... aAW?IX- Vj "e /'V ... ........ i ......... e ...................... ................. wiring in the building of 0 (;-Z-Al'-r— at ......................................................... . North Andover, Mass. Fee .... Lic. Nd!Yk..314 .............. 1�� ....... * ..... .... ....... ELECTRICAL i NSP . ECMR .0 ..... ...... Check #3 7322 Commonwealth of Massachusetts Official Use only ` I�fk; Permit No, 7 Department of Fire Services • • Occupancy and Fee Checked F, BOARD OF FIRE PREVENTION REGULATIOhf8 (R,ev. 1 1/99)'' leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAIJWQRK All work lobe performed In secordanee with the Massachusells Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: y / % _0•7 City or Town of: &LY-2?z AQTo flee hisserrnr of W;res: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 5— aZUlj ? e6i5- ZA� Owner or Tenant ,J ne ICltJGFiy7 Telephone No, Owner's Address Is this permit in conjunction, with a building permit? Yes ❑i— No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps I Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and AmpacJty Location and Nature of Proposed Electrical Work: �(�t.� /vim (7C�� rntnnietinn of the /allow nv loh/e muv be wuived bit rhe ln.w cloy of Wires. No. of Recessed Flrtures No, of Cell.•SP� (Paddle) Fans •us r ° I utansformers KVA Transformers No, br Lighting Outlets No. or Hot Tubs Geaeratom KVA Nu.'or Lighting Fixtures ove n•17o. Swimming Pool rnd, ❑ rnd, ❑ of Ernargency Lighting Buttery Units No. of Receptacle Outlets � No,.oGpil,Burners FIRE ALARMS No, of Zones No, of Switches as-5 No, of Gas and o, o et ng D evvices Initiating D No. of Ranges No, of Air Cond, Total Tons No. of Alerting Devices No, of Waste Disposers eat Pump Totals: Number Tons o' o e - untn ne Detection/Alerfln2 Devices of Dishwashers Space/Area Heating I(W Municipal❑etherNo. Local ❑Connectiun No, of Dryers ry Heating Appliances KW Security ysevice No. of Devices or Equivalent No. o oter Kyy Heaters o. o o. o Signs Ballasts Wiring: No. of Devlccs or G uivalenr No, Hydromassage Bathtubs No. o(Motors Total HP or n cut ons tang: I ( eviees or E ulvolent OTHER: Attach adatttanat detail V dcjirea, or a7 r;9uirsa by uto nuy—or yr -"- 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 coYera is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) r rel, (Expirro(ion Date) Estimated Value of Electrical Work: �� ' (When required by municipal policy.) Work to Start: � 11T-0 7 Inspections to be regyested in accordance with MEC Rule 10, and upon completion. I cernfy, under the pains and penalties of perjury, that the information on thi app 'on is true and eomplere. FIRM NAME: ,0400 cr/ LIC. NO.r IW` 3'4 Licensee: 41V 1C,1 /%gcy6,¢�_ Signature LIC. NO.: (IJ applicuble, enter " e.rempt " In the license number line _ Bus. Tel. No,:277 682- z�Z Address: -5-& LT$6444zb ST' 441a4C5l `�6 Alt, Tel, No,:91r 3`r r L7 3Y OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not llove the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement, I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: ,S Si;nature Telephone No, I i Date.�.. 'N ORTN TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4L This certifies that . ......................................................................... has permission to perform wiring in the building of ........... ................. at ............ ..................... North Andover, Mass. Fee ... 97$ ..... Lic. No.............. 4 ........ ELECTRIiCAL INSPECTOR Check # "o 7441 Commonwealth of Massachusetts Official Use Only Permit No.• a Department of Fire Services '} BOARD OF FIRE PREVENTIONREGULATIONS, Occupancy and Fee Checked [Rev, 11/99) ,cave blunk APPLICATION FOR PERMIT TO PERFORM ELECTRICAhf WORK All work to be performed in accordance with the Mussachuselts Electrical Code (MCC), 527 CMR 12,00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D ate: — —cU- 7 City or Tom of: To 1hr In:;norfnr nT rfiil-es: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)�'�Lo�� Owner or Tenant [' �jy�Telephone No. Owner's Address Is this permit in conjunction with a building permit? YesIoEr No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Atnpacity Location and Nature of Proposed Electrical Work; we 17— ti/«jam,(, 4C OAVIX& �yc7i.n Coln IcN v r/ie allowing 1nhlu niuv be vruive' d br the hi.t )eNur Of Wi/ r.r. JofPnngCs essed Fixtures o. 0 Total /D No. of Cell.-Susp. (Paddle) Fans / Transformers kVA ,t ting Outlets No, of Hot Tubs Generators KVA ting FixturesnNo,ofAIrCond, ming Pool ave n- ❑ o. o Emergency ig tine end. rnd. Bnttery Units ptacle Outlets LQII•Burners FIRE ALARMS No. of Zones ches f Cas'Burners o, o etection an Initiatin Devices ges Total Tons No. of Alerting Devices No, of Waste Disposers est ump , Um bee ons o, o e - untamed l Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Headng KW Local ❑ Municipal - Connection unicipalConnection ❑ Other No. of Dryers Heating Appliances KW Security Systems: No, of Devices or E uivalent o. o eat XW o. 0 0• o Data Wiring: Renters Signs Ballasts No. of Devices or E uivolent . FNo. Hydroruassage Bathtubs No. of Motors Total HP a ecommun cationsit ng; No.ofDevicesorE uivnlenr THER: allach additional derail tf desired,or ar required by rhe lnrpecror o/Wiiel. LNSURANCE 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 ❑ OTHER ❑ (Specify:) '`i4 (Expiration Date) Estimated Value of Electrical Work: OD (When required by municipal policy.) Work to Start:k4L�� ' inspections to be requested in accordance with MEC Rule 10, and upon completion. I cernfy, under the pains and penalties of perjury, that the Information on this applic n FIRM NAME: on is lrrre and comp/ere �(// O 6 LIC. NO.., Licensee: Signature (I% applicable, enter-'e.renipt"in the license number line, LIC. NO.: Address:_ j j� �$C.gc�Ij s�–. !,Q lD Bus. Tel, No.:`1" 7Q 692 - �o�Z OWNER'S INS RANGE WAIVER: l ant aware that the Licensee does not have the liability nlsu ance coverage no ally 3� required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner Owner/Agent Sik ❑owner's agent. gnature Telephone No. PERMIT FEE: S a