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HomeMy WebLinkAboutMiscellaneous - 36 SAWYER ROAD 4/30/20180 0 w 71 Q 0 0 b 0 0 0 0 9652 Date .......... ... .. ... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ /r'll-t-2 ..... ........ �..c ...................... has permission to perform ...... ................. wiring in the building of ..................... A ........ ........................................... at .......... ................... North Andover, Mass. Fee ..... Lic. No. �/ ................ � E crRICAL I t'A L P E CT O;R Check 4 Commonwealth of Massachusetts Department of Fire Services r` BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Lv/ —e,--2— Occupancy and Fee Checked [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7//� / 0 City or Town of. NORTH ANDOVER 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) -34 Zp/ Owner or Tenant Telephone No. Owner's Address Is this this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service OP Amps /70 / aS/oVolts Overhead 21' Undgrd ❑ New Service Amps Number of Feeders and Ampacity Volts Overhead ❑ Undgrd ❑ Location and Nature of Proposed Electrical Work: r No. of Meters No. of Meters /.vent Comoletion ofthe following table may he waived by tho tncnertnr of No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets :2-- No. of Hot Tubs Generators KVA No. of Luminaires SwimmingAbove In- Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS Eo�.of Zones No. of Switches 11�Initiatin No. of Gas Burners No. of Detection and Devices No. of Ranges / No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers / Heat Pump Totals: Number ...­ Tons �� KW . ...................... No. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security No Systems:* f Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Q ,v — e e� v- Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ,rUD (When required by municipal policy.) Work to Start: / /D 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete.A� FIRM NAME: /(�d/� /�Aj?n1 , LIC. NO.: 14 Q/ Licensee: /f%'70�'NiAi t' Signature LIC. NO.: (Ifapplicable, eV�gr "exempt" in the license number line.) Bus. Tel. NO.• F > 9y%t,� Address: O %3dk goy l�.�N.yt✓� !►l d' OJ'JS�/ Alt. Tel. No.:4jE: 11F9 GW 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 a ent. Owner/Agent 7 Signature Telephone No. PERMIT FEE. $ 6he �- ze) - At� &,ot /1) '. 02,6 - 'o, / Y Ir i Date. �� �� a 0"O RT :1�o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 This certifies that .....�. �. �. ! .... �................... . has permission to perform ...'. plumbing in the buildings of ... :. . P. `/ .................... at .... l ...... s.`��. Y.i^ ...�� . t .. ; ... , North Andover, Mass. v � Fee. �%/.. ? ' . Lie. No.. �. ? ?. }. L .. .- �� "`�,�-� ....... PLUMBING INSPECTOR Check # G 86`/9 Ll N 1 a MASSACHUSETTS UN-IFORM APPLICATION FOR PERYRT TO D O PL•UTAOWG (Type or print) NORTHANDOVER, MASSACHUSETTS Building n Date 9- 1 Q Permit - Amount Tylye of Occupancy New � Renovation !. q Replacement Plans Submitted Yes No Check one: Certificate (Print•ortypa) 1. �+ 11 r'—j Corp.. Installing Company Name e rT R.1 Address a y Co VV\ +.r Partner. 1A A ©1-7Sra- Firm/co. 72 t" Q 1 <n I �� Va 19 - Name ofLiceused Plumber: Ch I� 1 S � I I Insurance Coverage: Indicate the insurance coverage by checking the opnate box: Liability insurance policy Other type of indemnity ,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 I hereby certify that all of the details and information I have sub best of myjmowledge and that all plumbing work and installati compliance with all pertinent provisions of the Massachusetts Title City/Town APPROVED (OMCH USE ONLY 1 Agent Q (or entered) in above application are.true and accurate to the :ormed under Permit Issued for this application will bo in robing Code and Chapter 142 ofthe General Laws - Type ofPlumbingLicense o3a33 License um er Master }/( Journeyman ❑ The Commonweizith of Massachusetts Depaitment o frndustrial Accidents Office of �Vestigations 60.0 MasAinvon Street JV ostOi2, M4 02111 �uww_rn�zs,�gov/dia . Workers' Compensation Insurance Affil-a•vit: builders/Contractors/Ulectrici �DDIicant -Tan s/Plwnbers n fnrm a $i nn Name (Business/Orb nization/Individud): Address: ' ' Ca U 11 �r •/ ' L h City/State/Zip:_ 1 6 ro Phone #: ,�01� (4TE 0 q3 Are you an employer? Check the appropriate box: 1 • [� I am a employer with 3 4. ❑ I am a geheral contractor and I employees (full and/or part-time,).* 2. ❑ • I am a have hired the sub -contractors sole proprietor or partner- ship and have no employees -listed on tbLe attachcd sheet I These sub -contractors have working in for meany capacity. workers' comp. insurance. [No workers' comp, insurance. 5. ❑ We are a corporation and its required.j 3 . ❑ r am a homeowner doing officers have exercised their • all work Myself [No workers' comp, right of exemption per MGL c. 152, §_I (4), and we have insurance required.] t no employees. [No workers' ndmp, insn=anc� re d Type of project (required): 6. ❑ New construction 7. n Remodeling 8. [] Demolition 9. [] Building addition 10.0 Elec ' al repairs or additions I LEflumbing repairs or additions 12.0 Roof repairs 7 quue ] 13.E] Other 'e,`-'„1: ".'"`.3=3CE^.t t ch. �.Trn SJOv,uF •'�°t QTSo ]YL O•Ut L:.0 s=6—___ bzTaw Bhavrin i I f Momeownem wno sucmit'ttiis affidavit indica h , a, e s :b r v,•ork'= com,-- sEes Policy c ting t_ey _ doing ail „.,:it and -ham joutsid8 contactors �iw^t au uit a ne +Contractors that cheer; this box m„--. atta -' w amdavit indicating such. u� an adturiouai sheet showing the name'of the sub -contractors and theirworlcers co 0 ' comp. P LicY information. .ram an employer that isproviding workers' compensation M&nrance for my employees Beloit/ is the poficy and job site. information„ fi=rauce Compiny �i Vr*I Policy # or self -ins. Z✓ic. M. W (_ -J- O ©O S y �} Expiration Date:`�4 rr�i 30<0 - M—.1, c Job Site Address: yq ( �� �± ' A\,A 0,--R f- City/State/Zip: M Attach a copy -of the workers' compensation policy declaration page (shovcrng the policy num ber•and capitation date). Failure to secure coverage as required under Section 25A ofMGL 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 Of up to X250:00 a da Mast the violator.Be advised that a copDER and a fine y of this statement may be forwarded OR Investigations of the �/( for insurance coverage verification to the. Office of I do hereby certify , yu" ana penalizes qt perjury thccr the information provided above is true and correct 6"?4 Official rose only. Do not write in this area to be completed by er'tp or fotnn official City or Town: P ermif-'r -ease # Issiig Authority (circle one): I. Board of Health 2. Building Department 3. City/Town 6. Other Contact Persurt: Clerk 4. EIectrical Inspector 5. Plumbing Inspector Phone'# Location "'G, No. X79 Date %4 ' c2 TOWN OF NORTH ANDOVER s i # Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18727 C� Buildinglni�pector ' TOWN OF NORTH ANDOVER L BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING ✓, g tog,--, 3 _ iT R BUILDING PERMIT NUMBER: DATE ISSUED: � /2 -tea SIGNATURE: Qn",� z�-,� Buildin ssione'r/I r of Buildin Date ar,4-11UP1 1- J11 E IN UKMA71U111 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3 � ` Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZOninR Distrid Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide red Provided ReqwrW Provided 1.7 Wator Supply UGI -C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record Name (Pdfitj Address for Service - 6kk 73 Signature 61 Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licea nstructi uperviso`r- Not Applicable ❑ 4z Licensed Construction S sor: ayll'`' License Number Ad V i_ 0 `�' �" `" �v Expire on ate Signature Telephone 3.2 R Home Improvement Contrac r Not Applicable ❑ Cl/ Company N e n Registration Number Add Expirati Signature Telephone 00 rn M 3 Z O v rn 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 all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 77777 Tfl Y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction qQ QO JJ 3 Plumbing Building Permit fee (a) X (b) p� Q, 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 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 permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1,04"�q"-46_ ,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 U)A-,s R Z Pri e Signature of Owne ent Date imm�" NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS Isr 2ND 3 RD 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 L E w o �-' U � �mo a � W a W a a O Fr y C Z W i Gi y O C, Z CG o w° cn O C or- .� 'r, c w° ate, r. U w a w W W pG UO'� w C7 Con C2w co W w c o z A(/I) e o 2 w O 0 z o O C m EQ L C ts Q N cc F� o� C1 0 �mo W y O m C O y C Z 2 w O 0 z o O C m EQ L C ts Q N cc F� o� C1 0 E L if N z CO) 0 N c 0 co IC co C C13 O co C 'c N W w 0 Z O g 0 zip co E C L O s Z d O y o C cm I C C V/�� /D -0 CD •� m m CO) CD CD CL ~ Z O� �3 .o O G3 ID O O cc 0 CL 2L �a eCv ci '0 C. OCO) C Z ai CL V ND m C . C CO2 C2 0 Y/ LLI U) 19 W C W N �mo y O m C O y C Z i Gi y O C, Z CLO O a O C •O. CL. ~ H m � m c •- t O AAA d C .E O � 13 O 0 C CL go .032 ca 06im E L if N z CO) 0 N c 0 co IC co C C13 O co C 'c N W w 0 Z O g 0 zip co E C L O s Z d O y o C cm I C C V/�� /D -0 CD •� m m CO) CD CD CL ~ Z O� �3 .o O G3 ID O O cc 0 CL 2L �a eCv ci '0 C. OCO) C Z ai CL V ND m C . C CO2 C2 0 Y/ LLI U) 19 W C W N a elC k S The Commonwealth of Massachusetts Department of Industrial Accidents Ofiice of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Athdavit I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity Please Print F --j I am an employer providing workers' compensation for my employees workina an this inh Qft �6 114 �yi°� Phan s: -c-& 7 Insurance. Co. %�'��� i� »lamCO Policy s 70 mar zatW City: Phone Insurance Co. PoHcv Failure to secure coverage as required under Section 25A or MM 152 can lead to the imposition Of criminal penalties of,a fine up to $1,500.00 anftr one yeas' Imprlsonrnent.as.raati.as.cM penatties.inlbe hm-CfA STOP WORK ORDERMd.a.tine Of (,S1Q0.0o)AJ* agaiost.ms. I understand that a copy of this statement may be forwarded to the office of Investigadom of the DIA for coverage verification. I db hereby cW*y6W the pa/r►9 and peneltdss� ofpedwyVthat the Imbrmeam provided above is true end cared. Signature date Print name /�1/`� ��� 9Y6 � �R Phone # %2i Official use only do not write In this area to be completed by city or town official' City or Town PWMMjcenslna []Check Y immediate response is required ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office Confect person: phone #. ❑ Health Department 0 Other 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 at: __ SSG4&that the debris resulting from this work shall be disposed of in a propi0y licensed solid waste disposal facility as defined by MGL 11,S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date CS # 022680 HIC# 103358 �-' (i Ill ; i A. J. Walsh & Sons 55 Pleasant Street North Andover, MA 01845 # of 978-688-6737 or 1-866-AJWALSH We hereby submit specifications and estimates for . _ r �., ,w �......... .. ...................... 44 .... ..... ......... .... . _ ...... .. _ .................. ........... __ _ .... ................ .................... ........ ......... _ We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: $ SOS 0 � with payments to be made as follows: Dollars Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate. All agreements contingent upon strikes, accidents, or delays i�"W�ZV�L beyond our control. Note — this proposal may be withdrawn by us if not ccepted within _ _ days. acaptante of Propogal The above prices, specifications and conditions are satisfactory and are Signature hereby accepted. You are authorized to do the work as specified. ! Payments will be made as outlined above. Date of Acceptance Signature u &-` NC3819 MADE IN USA