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Home My WebLink AboutMiscellaneous - 41 LYMAN ROAD 4/30/2018 0 LYMAN ROAD 21010100:0 Date.. ........ NORTH 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SS This certifies that ....................... has permission to perform wiring in the building of........t�....... ..... ...................... at Z....... ... ........ f ... North Andover,Mass. Fee\��. ................ L ....... ic.No . .... .IU... ........... .......... CTO CA. N-1 R Check # 4e 4/ - 8725 ' I Commonwealth of Massachusetts Official Use Only Permit No. 97: Department of Fire Services Occupancy and Fee Checked g� BOARD OF FIRE PREVENTION REGULATIONS [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), 27 C/ R 12.00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7�d/Q 9 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inte tion to perform the electrical work described below. Location(Street&Number) I Owner or Tenant Telephone No. 9 role Owner's Address e Is this permit in conjunction with a bu' ing permit? Yes ❑ No (Check Appropriate Box) Purpose of Building ,,�t..�4 Utility Authorization No. 4Y'Off' 70 Existing Service_160 Amps 1,-2Qya Volts Overhead Undgrd❑ No.of Meters New Service C?OQ Amps Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followingtable may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Bo. Units f No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons No.o Self-Contained No.of Waste Disposers Totals: Detection/AlertingDevices • Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection El other Heating Appliances KW Security Systems: No.of Dryers No.of Devices or Equivalent No.of Water KW o.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or E uivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. . Estimated Value of Electrical Work: (When required by municipal policy.) j 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 cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Rr BOND ❑ OTHER ❑ (Specify:) I certify,under the pais nd penalties of erjury, t the information on this application is true and complete. FIRM NAME: ev .v v LIC.NO.: ,3 Licensee: glignature LIC.NO.:�!!/�33� (If applicable,enter" empt"in the 'ce e n ber line.) s.Tel.No.:7��•7�7�' � 1 -9 Address:. .4/ wasp D i D Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security w requires Department of Public Safety"S"License: Lie.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 PERMIT FEE.- Signature Telephone No. Location VZ Gl1;,7/1 -7 Jw No. Date NORT►1 TOWN OF NORTH ANDOVER • : , Certificate of Occupancy $ Building/Frame Permit Fee $ ` ) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ( y r � 191 '13 tlBuilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEyMjyOLISH AjONE OR TWO FAMILY DWELLING ly{� HS �o$1 �'¢':h'� � .f-"'•"�aaat#x.._`E'<.. WELDING PERMIT NUMBER: DATE ISSUED: �-02-a 3 X la SIGNATURE: ic Building Commissioner/I Aor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: k_ ,Povfg. I fl 945 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re 'red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 -lone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record :3aSViA ?. Ivo. Name(PZit�) Address for Service � Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ' D Licensed Construction Supervisor: O License Number mn Address D icExpiration Date Signature Telephone r' 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r Z Expiration Date G) Signature Telephone Y� 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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) V Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIALUSE O!1LY Completed by permit applicant r 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) I/4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 000 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 behalfmatg relative to w ��ork authorized by this building permit application. �/ 0 Signature oC4wner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I ,as Owner/Authorized Agent of subject g J 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/A I ent Date ' NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TTIVIBERS 1ST2 ND 3 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 ' FORM U - LOT RELEASE FORM 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE LOCATION: Assessor's Map Number--//a-. PARCEL_ SUBDIVISION LOT(S) STREET �G'ST. NUMBER *** ***** *** ►** ******OFFICIAL USE RE C MENDATIONS O OWN AGENTS: CONSERVATION AD (NIST TOR DATE APPROVED Q Q DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS- SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9W jm • Joseph Y. Savoie Rc Sandra r-ol-1-s tin S.-vein BUYER: 7 4. I O t500�t po S \4II , 0 op # �' �� • 80.0 ?ft Fonds Federal Credit Union �m� MORTGAGE INSPECTION PLAN . , . I�'° 7E. ,--�,..P '" '- _............. ...,....• -- ,..,.,rno.. ,., cc-rnirr ocNl4aauc�m /�11'7� Ir f7 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: e � 1_eP (Location of Facility) t Signature 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 t%ORT{t q SLED 1. Town of North Andover Building Department '<e 27 Charles Street 4SSacHuD,:sEt North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print.[ DATE I I2°� O JOB LOCATION 41 I , Nkht-A -P— Number Street esAddress �t Section of Town "HOMEOWNER 9_ `S 1�5/�-4-5 �� I��f +q —6125 Number (jHome Phone Work Phone PRESENT MAILING ADDRESS 1 LJµAt4 R klk, 0113A1 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six 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 109.1.1) 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit.(Section 109.1.1) 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 requiremegts. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. NQrc � M Town of Andover No. t6 79 Olj� COC dover, Mass. S' 3 ORATED p` 10 C:) 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �0l M BUILDING INSPECTOR THIS CERTIFIES THAT........ .................eja�V.0.1t............................................................................ Foundation has permission to erect..#4P J� buildings on ....�..(......L.y...01.^Q MOt Rough to be occupied as..O `.0 � Chimney o wr c ................................................................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatin to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. '` ha ` so .� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations 'Voids this Permit. ( Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION RT TAS ELECTRICAL INSPECTORRough ............ ....... .. .. ................................ Service 100 BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building. GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough . Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 4t 40 A I'll 2C Su c.. 114 1- ' I � f O ' t to €' = loo it , r, T 8 10 6o 1-t t rh.->e — _ l Fo ` 1 Zx E)OLb le t 40 Zk t® ✓o e3 f Y,°-r 5� � C t � � n TAIL I I� E7x/ / %:_ L 4