HomeMy WebLinkAboutMiscellaneous - 42 VEST WAY 4/30/2018Date .......
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that e,0AVQ 57Ke,-- �LE�rn��- �E✓Z�/tom
...................................... ......... ...................
has permission to perform................................... /
............................................
wiring in the building of ...................... ..............................................
at ..........................7 ......ui!! jLECM�AL
... , North Andover, Mass.
pb
33" /d 77i
Fee..................... Lic. No............. ..................INSPECTOA�
Check # J' V'z 7
7621
Commoglry l>`papf:Ma$skh_ usetts O iciialWUse ()Illy
-'Department of Fire Service'
�'.
Occupancy—and Fee Checked
1. BOARD OF FIRE. PREVENTIOWREGULATIO.NS [Rev, I'I/)9
hgp ,Us, ve blank
,. ] tic:i 1
APPLICATION:. FOR.PERMIT.TO PERFORIIA .EL.ECTRICAL WORK
AIG_wtwk to -hr )xrfi rmcd in ac. ordatimmit4 sic Mpscarinpirns.lJectricrl_CAnlc O
'1, 537 tvl It(PLE.4SG t'RiNT IN INh.OR' TTPEALL: fNFORhf4:TfQN) Urate:�
y City..o.r Town of IANOOOUL� To the h peetor a/ 64'irc•.ti:
Li this application thcundcnik*ncd..�i��cs noticc,.�f his:or.her inlention.to r�rtiinn the electrical work described below.
I�l►cation (Street-Se:N linher)
Owner or.Tenant ►
' 1C% q• �P l4 t,>: F Telclihonc No.
Owner's Address .S C
1s this permit in:conjunction with ua.uilding pertnit't;?::. Ves' No ❑ (Cheek Appropriate Box)
Purpose. of Building, Utility Authorisation No.
Existing;ServiceAmps. / Volts Oyerhiad ❑• ; .: Undgrd Q' No. or Meters
New Service. Amps / Vo1Ls Overhead ❑ Undgrd Q No. or Me(ers
Number of Feeders.. Inpntcih
bwation and,Nature of ftppclsed.Electricul•VKnrk:
go r_> (,, yt i(f ck_rI C -%TS, �-
! �/�lUrr/C CG�3rrN E T L/ V'l
. Cnlnnkvinll c!/•d►c• fi►llrnlduic lclh/c Item hc• ntiilt•c/ hr rbc• /uxcavvc» • „!l t'ir. �
No: of. Recessed Fixtu.res•• '
No::of.Ccih,Susp (Paddle) Fans
No -of' Total
Traniformers kVA
Nci. of.LightingOutlets
No, of.Hot:Tuhs..
Generators kVA
No. of 15igltting Fixtures S
-Above- n.
S.wimniiug I'c►o1; ►rnd: ❑ urnd. �'1F1kE:'ALAR.M7SNo_
o s► . n►erge.eicy ,ig ► ing
Bath Units
No. or Receptacle Outlets' 'L
No. of OR Burners;
orLa►nes
..t
No., of Switches
No: of,Gas.Burners ' `:`
o: of etec ion':u►
:
Initiatin Devices
No. of.Ranges
Tothl.
Tolls'
No. ofAlerting Devices
No. of Waste Disposers `
Heat umpTNkiimber
Totals:
```
; .ons : -
KW
No::of Selt-Contained
Detection/Alertin Devices
No. of Dishwashers'
SpucllArea H:catin�� KW ' ;a;.o::
Municipal: ,� Other
Connection
No: of Dryers
Heatint;:Appliences ' KW::. '..
Security Systems: '.
No.:of Devices or Equivalent
kW
Heaters.
o,..o
-Signs, Ballasts:.
Data hNirin ►�
No: ►f IN vices or^ Equivalent
No. Hydrontassage Bathtubs
No. of Motors - Total HP .
ec
eiNn f Dc ices or wif
gu* valent
OTH ER:
anar.N aM�lilinnn/ rk9»!l !f Ji:�irYl, ur ».c n quir,r/ hr /hr /xyt /ur a/ I I 'in :r
INSURANCE COVERAGE:.Unless-waived by lhcpwncr; no pcimit:for.ihc performancefcicGricai wort: may issue unless
the license: provides proof of.l.iability:,initii7once iiiel iding `complat6d oper.ition" coverage ur ils substanlial cqui.valcnl. •Ill e
undersigned u rtifics;that- covc:rab�c: is::in-forcc; pnd:Wti:.gxhibitcd pnxif of snmc..to the permit issuing utlicc.
C'HEC'K ONE: ;INSURANCE' BOND.❑ OTHER.❑`: (Spc.c:il`y
j/,.. iGspiniuun[)ulrl `
Estimated'V.aluc of ElectricalMork: S C = v� (Whe n n yuircd by municipal policy.)
Work to Start: Inspedions.to b.e requested:in ac. prdance-with MEC Rule 10, and upon completion.
/ cerlif, u/lcler the pains ruldpenallias uf-p-r u/7�,a/!i// the ulfnr»lalion: /cit )Iris n/►/o/i�lioN',is rrtre rt!►d run►/!/rtc:
FIRM NAME.; S�r.r✓ t'�1��il�,�o\. ��Ul��� ��`�. LIC. NO.:
• Licensee: � ��Ga �p->�� ':Signature •• LIC. NO.: t{1�A
(//up/rlirrthlr, lIcr "sac lyL c!"in/Lc�l�lt%�sc olio r-litc1 1 C� Bus. Tel. No.: �3 2`19 19 >/
Address: � � -gyp rJ`Z� - C�^ atL Td. Ntl.: 7� i ��'5
OWNER'S INSa1RANCG'�YAIVER: t am awtare.Ihal: the LicunsecAws.nul have the liability.insut-.Ince: coverage uurnualy
ruquired by law., By my signature bclow,,l.hun;4ywaivc:this: ruquircmcnt' I am. the (check one) ❑ owner ❑ owner's a;cnl.
Owner/A�rcn t
Sigilauue Teleplinne No. PERMIT FEE: $
A4
A.
Location<
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
s;K,o' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
$
Check #
16464
wilding Inspector �%
;. TON" OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT EEM RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
AM-._ .a.
BUILDING PERMIT NUMBER: DATE ISSUED: /
SIGNATURE:
Building Commissioner/1for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
V�� UDC
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Pr osed Use
1.4 Property Dimensions:
Lot Areas Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
ReqWred Provide ReqWred Provided
Re(Itfired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. blood Zone information:
Public ❑ Private ❑ 1Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSEM/AUTHORIZED AGENT
2.1 Owner f Record
.JIFF
Name (Print) Address for Service:
Signature Telephone
2.2 Owner of Record:
Name 'Print Address for Service:
Si nature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
pRegistered Ho a Improvement Con for
3A
Y VldCK4e- .TA'LJ D%A- 014&04
Not Applicable ❑
Company Name
683
Registration/' Number
Add ss
Expiration Date
Si nature ------ Telephone
SECTION 4 - WORKERS COMPENSATION (M G.L. C 152 § 25c(6) 1.
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this all
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Descri tion of Proposed Work check au licable
New Construction '❑ Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify `�.,, V\ '
t
Briefescription of Proposed Work:
w� t— ':�;l 0, 'N
I SR.CTTON 6 - F,STIMATF.D CONSTRIICTION COSTS i
Item
Estimated Cost (Dollar) to be��
Signature of Own er/A ent
g
NO. OF STORIES
Completed b permit applicant
BASEMENT OR SLAB
t3
1. Building
PLD
2 3
(a) Building Permit Fee
DIMENSIONS OF SILLS
Multi lier
2 Electrical
(b) Estimated Total Cost of
THICKNESS
SIZE OF FOOTING
X
Construction
3 Plumbing
Building Permit fee.(s) x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
"37> 7
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
SEC79ON 7b OWNER/AUTHORIZED AGENT DECLARATION
I, V1 k" rl, 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
an elief
k � L 441-)
Pn t Name
1 "1 0
Signature of Own er/A ent
Date
NO. OF STORIES
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMis, 1
PLD
2 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
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✓tae �oo�vrrearuuea o� /G%aaoac�u�arlta
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 12231.8
Expiration: 8/16/2004
,=Type: `'DBA
BETTER HOME S'WINDOW 9 SIDI
M CHAEL LAW
18 BATES RD
HAVERHILL, MA 01832
�.AdmioistrRtnr
Y
It
License or registration valid for individul use only
before the expiration date, If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not valid without sienature
Date................
NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... ..........................
has permission to
wiring in the building of ....................................................................................
...............
at ... 47.9 ........ ...... 4�k .......................... .North Andover, Mass.
Fee -k..- Lic. N61 ... A..."
............. ..................
ELECTRICALINSPECTOR
Check # /0
4553
The Commonwealth of Massachusetts
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office use only
Permit No. ��y
Occupancy 8 f=ee Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date JJ)/JS It 0.3
To the Inspector of Wires:
The undersigned applies for a permit to,perform the electrical work described below.
Location (Street & Number) Ial If k5l, IAJ14
Owner or Tenant J FFF 6 AAJ
Owner's Address 64A4 E -
Is this permit in conjunction with a building permit:
Purpose of Building 0I/VOG4
Existing Service Amps _
New Service Amps _
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
Volts
Volts
No ❑ (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
L'£, 1 -OA VW Y 4- St
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Compperations Coverage or its substantial equivalent.
I have submitted valid proof of same to this office. YES NO ❑.
If you have cher ed YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $
Work to Start �A)�ti�i %l < y3
Signed under the penalties of perjury:
FIRM Nf
Licensee
Address
'ell,5
(E piration Date)
OWNER'S INSURANCE WAIVER: I am aware that the licensee
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) &I -
Telephone No.
(Signature of Owner or Agent)
PERMIT FEE $ -� 0
Total
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
No. of Lighting Fixtures
Swimming Pool grade Eland ❑
Generators KVA
No.of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Bat
Battery Units
No. of Switch Outlets
No. of Gas burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond. tons
Initiating Devices
Heat Total Total
No. of Disposals
No. of pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Municipal
Local ❑ Connection ❑ Other
No. of Dryers
Heating Devices KW
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Compperations Coverage or its substantial equivalent.
I have submitted valid proof of same to this office. YES NO ❑.
If you have cher ed YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $
Work to Start �A)�ti�i %l < y3
Signed under the penalties of perjury:
FIRM Nf
Licensee
Address
'ell,5
(E piration Date)
OWNER'S INSURANCE WAIVER: I am aware that the licensee
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) &I -
Telephone No.
(Signature of Owner or Agent)
PERMIT FEE $ -� 0