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HomeMy WebLinkAboutMiscellaneous - 36 BAY STATE ROAD 4/30/2018Date .l.?-/,qV ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 3 "US ES Thiscertifies that ... ............................................................... haspermission to perform ........ ..... .. ... .. ... .............................................. wiringin the building of ........ ... ....................... ............................................... at . ....... �. ........................ . North Andover, Mass. ic Fe6.,.Z -------- ic. NoA1k'.9-q-- ..................... LECTRICAL INSPECTOR Check # 5444 NORTH 0 0 A SS This certifies that .......::7 has permission to Date ....=,..:. ...... A TOWN OF NORTH ANDOVER PERMIT FOR WIRING ..................... ....................... ......... wiring in the building of ....7:1. I...............................1!.............................. at . k. ... ........................... . North Andover, Mass. Fee....... Lic. No .............. ..................... 6"\_ELECTRICAL INSPECTOR 1-11UL'r. it 5445 TBE COMMONWEALTH OFMAMCHII Office Use only DF.PAl�71'YIDYfOFPUBIICSAFEfYy���� Permit No. RD BOAOFFMPREVEWHON 527CNR120 Occupancy & Fees Checked APPLICATTONFOR PERMIT TO PERF RMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA HUTS ELECTRICAL CODE, 527 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) /O Owner or Tenant 7 k _T O L 7 go Owner's Address 7,!v Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. X30 /? j Existing Service� Amps volts Overhead1:1 Underground � No. of Meters � New Service Amps /ZD�� olts Overhead ffUnderground No. of Meters Number of Feeders and Ampacity 3 Z o d Location and Nature of Proposed Electrical Work �r-�.Oz/yv J* -ti _, ,t�,•,�Lc cz,, o No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above[71 Below Generators KVA roundground No. of Receptacle Outlets r No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW El Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydra Massage Tubs No. of Motors Total HP OTHER• Ito& subntiedvalidptodofsatnelofto m YES � I drd&'g die MURANCE & BOND OTHER WodctoSm `` -Of-/ MVectionD&RegtjmW Stgledur R3ral6esofp#rf IMMNAME alar YES E] NO E] IfFuhawdrekedM,plmindrMthetypeofoa uWby Roor�dValteofF7et�ricalWodc$ IioaimNa Licer>s�e.,�-ry.,,�. scene--��.._--� f�/(z 3 9 /fBuSb=TdNa f 7k ,?o Y Ad m �/5 � u �7, - � .zi /' >-v � % Arc I�] Na � -1 7? / 9..� OWNER'S1NSURANCEWAAUR IamawaedutheLigedot'strothavethem utameamageoritsatsulde9im"alentasmgnf dbyMassadus tsGaalLaws and drat my sigma cn dlis pa= 4Vbcmm yaws this ra W'mnat (Please check one) Owner a Agent Telephone No. PERMIT FEE S- tgna ure ot Owner or gen Date ..... r7....." ....... . Of WORTH 02 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,SSACHUS This certifies that-. :h.- .t �,! .. 1 �f? ....... has permission for gas installation`s'.,.-:. -. -� � �:'....... ` in the buildings of .............................. at .��'.. -�` ` ::.. , North Andover, Mass. Fee. .` .. Lic. No.�'�/ ?,-t_, ........ . '6AS INSPECTOR Check 5023 1 ti MASSACHUSF IS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations GI:Y YJ[J✓�(a �„ d f��-SJ Owner's Name PERNIIT TO DO GAS FITTING Date a — (- -0 5 - New ❑ Renovation Replacement ❑ Plans Submitted ❑ Permit # �6 0, -3 Amount $ go (Print or type) Name Address UA -2� v -, ioury s unVIN `0 Name of Licensed Plumber or Gas Fitter VY) CAL— Check Check one: Certificate Installing Company ❑ Corp. ❑ Partner. afl//Co. INSURANCE COVERAGF. Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®/ No ❑ If you have checked yes, please indicat the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity ❑ Bond Owner's Insurance Waiver: I 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. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and intormatton 1 have submtttea (or enterea) to aoove appucauon are true anu 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 Massac�iusetts State Gas Code and Cha�ter 142 of the General Laws. A By: Title City/ Town APPROVED (OFFICE USE ONLY) Sign atureilf"I`censed Plumber Or Gas Fitter © Plumber 1� 13 l ❑ Gas Fitter License um er ® Master ❑ Journeyman x wrA a a O x F z z o H w 8 HO °N a oHx z w N -t -t °° �aa °a 1-4 1Ho a 0 SUB -BASEM ENT B A S E M ENT O 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type) Name Address UA -2� v -, ioury s unVIN `0 Name of Licensed Plumber or Gas Fitter VY) CAL— Check Check one: Certificate Installing Company ❑ Corp. ❑ Partner. afl//Co. INSURANCE COVERAGF. Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®/ No ❑ If you have checked yes, please indicat the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity ❑ Bond Owner's Insurance Waiver: I 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. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and intormatton 1 have submtttea (or enterea) to aoove appucauon are true anu 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 Massac�iusetts State Gas Code and Cha�ter 142 of the General Laws. A By: Title City/ Town APPROVED (OFFICE USE ONLY) Sign atureilf"I`censed Plumber Or Gas Fitter © Plumber 1� 13 l ❑ Gas Fitter License um er ® Master ❑ Journeyman Location 3 6 Z3,4 Y S (.A YQd y r� No. �' � Date �_ ,kaRT" TOWN OF NORTH ANDOVER O'tt.o ,,ti0 9 Certificate of Occupancy $ �ss^C USE<Building/Frame Permit Fee $ a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ o? D Check # 173u3 ✓ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 3 � _... .. .. .S3 xx:x i- axxx•S x.. " ��a.. � � � '� � '4 BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: JW C- 62AA-,,- - Buildin Commission /I or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: .36 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 110� —Zes. Zonis I3istnct Proposed Use 1.4 Property Dimensions: 690© 7< Lot Areas Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reguired Provide Regpired Provided Required Provided f 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yea No 2.1 Owner of Record Name (Print) Address for Servi GG Signature Telephone 2.2 0Wner of Record: Name Print Address for Service: nature -Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone 14 Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor a Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone Ma M Z O lIi 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 buildin permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Descri tion 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: /C-, �' FA y Cq . SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ' 0FFI4QIAI:USE;Ul�TI Y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1 , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED 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 Signature of Owner/Agent Date NO. OF STORIES 1,42 SIZE 110 BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DWENSIONS OF SILLS DEvIENSIONS OF POSTS DIMENSIONS OF GIRDERS I IT IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover Building Department - 27 Charles Street ` �o �w North Andover, MA. 01845 �RgsR�u,as� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax HOMEOWNER LICENSE EXEMPTION Please print DALE JOB LOCATION Number j6treet Address "HOMEOWNER J ,.L�/99 /6 / / �$ 699= Name Home Phone PRESENT MAILING ADDRESS W, City Town State Map / lof Work Phone I L�lI'Y�J Zip Code The current exemption for "homeowners" 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 one home 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 SIGNATU APPROVAL OF BUILDING 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) Sig ature 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 m The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 workers' Compensation Insurance Affidavit Name JL Please Print Name: WA I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity F7I am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address City: Phone #: Insurance. Co. Policv # Company name: 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 -well -as -cMil,penafties in the formnfa_STOP WORK ORDERand_a.fine of.($1.00..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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature. Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department 0 Other 0 EN04scs 2 i� 0� 2 C' O CD Z O N a� .y Ca L.. CL Co c O CD Q cc Osr CO) O V CO) c O cc A M COD0 O w CD CL V) C CD o, c O C ea � o a- d ca wL•+ G CD Z ts m CL CO) C LU N uj W W LO ujW N o U a W a w a � A a c o w o c4 v x U � w A. o a C w w c ac' � w ¢ 7 a° � w w x G w' cn X o U) 2 C' O CD Z O N a� .y Ca L.. CL Co c O CD Q cc Osr CO) O V CO) c O cc A M COD0 O w CD CL V) C CD o, c O C ea � o a- d ca wL•+ G CD Z ts m CL CO) C LU N uj W W LO ujW N � NORTM ,SSACMUS� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ,� .. ��./�-t„ . , , , . .................. has permission to perform .... P.' ............ plumbing in the buildings of . at ..3G..1. "Vx S -.A-1, r. . Fee 2J.,.'-... Lic. No../.,)?. Y. . Check # > 2 6179 ..................... VLb-. rth Andover, Mass. ..... `-...y... ....... . PLUMBING INSPECTOR MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building New 1:1 Renovation El i OwnerYName Type of Occupancy Replacement FIXTURES TION FOR PERMIT TO DO PLUMBIr Date — /-5—• O'/ Permit #-- Amount Plans Submitted YesNo ❑ (Print or type) Ch ck one: Installing Company Name_ �/ S �f C6D�/�j �Certificate n ;�� Corp. Address ld G i�%G�'/i% f�Uc�iU/C/36j�D �1j� %%% % t❑1 Partner. Business Telephone Finn/Co.J Name of Licensed Plumber: OAV,17-714TJ h M S Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy m Other type of indemnity BondEl ❑ 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 signature Owner E Agent ri 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 insta�ist iA�alumbing ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu Code and Chapter 142 of the General Laws. d By ig re okxmnsecr JrIUMDer Title 'Type of Plumbing License Cit (Town Y cense um er Master 0 Journeyman ❑ APPROVED loF�tce USE oNt.r.