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HomeMy WebLinkAboutMiscellaneous - 43 MILL ROAD 4/30/2018 (2) 1 43 MILL ROAD 210/107.0-0109-0000.0 / I 9054 Date 'S. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SSACHUSEt This certifies that . . L-t �' �' . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .V. 4 t'-.v,-.•. . . . . . . . . plumbing in the buildings of . . YYI.►-2Y . . . . . . . . . . . at . . .L4 �! k . . . . . . . . . , North Andover, Mass. Fee.Lit•.00. .Lic. No.. . . .. . . . . . . . t/.Q �t n(° PLUMBING INSPECTOR Check # � i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: MA. Date: a 0 /( g� Permit# Building Location:V3 / M—C� Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential v New:(] Alteration:❑ Renovation:21 Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED LU H z SYSTEMS z z WULn W z fn 9z Ln Ln y Z d W Z ~ Y 5 N J U W () C C z o: z z Q C Q m h CQ' [n ~ W Q H Ln O z h N y W W >- tY Y C F- LL � w p w Z w Z u ° LL 2 -2 Q Q Q = 2 2 y w C CY V �' vai O ~ V j Q o 3 a Y Z y F w cti di O W w _ to w Q y a m m o o LL s � g s N � � � -SUB BSMT. ¢ 3 BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4'FLOOR 5T"FLOOR e FLOOR 7T"FLOOR e FLOOR Installing Company Name: b ��� �, heck One Only; Certificate# . lP 12,(.r (1 Address: J � El Corporation � Town: State: BusinessTel:66 3��a`79�9Fax: ElPartnership ❑Firm/Company Name of Licensed Plumber: FINSURANC_ COVERAGE: nt liarinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.942 Yes ❑ No❑ hecked Yes,please indicate the.type of coverage by checking the appropriate box below.iability 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 Massachusetts General Laws,and that mysignature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's A ent ®wrier El E] 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate tc the best of my Knowledge and that f t plumbing�:�erk and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapte 42 of the General Laws. By Type of License: Titre ,_ berS' nature of Licensed Plumber L1u -ity/Town aster APPROVED OFFICE USE ONLY) ❑Journeyman License Number: /Z—Pg COWONWEf rffl OF MASSACHUSETTS RVE ONO CONTROL# G 0 2 2 7 5 0 LICENSED AS A JOURNEYMAN P^LOM B IMPORTANT - ISSUES THE ABOVE LICENSE TO: If this license is lost or destroyed, notify your Board at the: NORMAND P BERUBE Division of Professional Licensure, 1000 Washington St'., 7th Floor,Boston,MA 02118. != 12 LINCOLN ROAD If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next NEWTON NH 03858-3103 Renewal Application. Always refer to your license number. �t This license is subject to the provisions of the General Laws22340 05/01/12 790363. as amended.It is a personal privilege,and must not be loaned t or assigned to any other person. Keep this license on your l person or posted as required by law. CONTIVi®N-"WLAETH 0FMASSA hiUS TTS _ __ !MB E �►' �►� iTy'T�'�t�S LICE ` NSE _ ASA ASTER PLU UMBER R ISSUES THE ABOVE LICENSE TO: NORMAND P BERUBE 12 LINCOLN RD NEWTON NH 03858-310 + CONTROL# G022749 ' 11588 05/01/12 790 IMPORTANT If this license is lost or destroyed, notify our Board at t 7th Floor,Boston,MA 02118. Division of Professional Licensure, 1000 Washington St., r '4i - - - -- — I If your name or address shown is changed, notifyt of correct name or address to insure proper mailing of next aE ! + Renewal Applicltion. Always refer to your license number. 1 This license is subject to the provisions of the General Laws t as amended.it is a personal privilege,and must not be loaned ((! or assigned to any other person. Keep this license on your i person or posted as required by law. I31 i V4ORTH ® Of . No. 1l5 ` 6 r�- OO "LA K E o over, Mass., • • � 1 COCHiC HE WICK �. BOARD OF HEALTH MIT T Food/Kitchen - PER Septic System +' BUILDING INSPECTOR THIS CERTIFIES THAT.................. .G..�,.� ......... ....... ... .' .............. ................ ................................ .......................... Foundation has permission to erect............. building s on ........qf3. !��•�••..... Ro . ............ to be Occupied asKL '�' p . ..... ! '� ".................:. .��,,, D ...... -I..../J.... himney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in a Fi this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 'LUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final c,vof�44— 1e/j ` . PERMIT EXPIRES IN b MO S ELECTRICAL INSPECTOR aa� UNLESS CONSTRUCTIO ST '0� ........................ ...... ....... .................................................................... Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final er— ���� 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. /-�=s2 '- XaORTIy - Of �`- Adove 0 o , dower, Mass., 8�LA • I COCMICME WICK 0 FATED p?���� BOARD OF HEALTH PERMIT T D Food/Kitchen ' ^"j�! r% Septic System�P,1'7 r�`l ..�i�s��{�++ f j• S"'lJ,��`I° i''- ;^,�>!"Jam,. BUII;DING INSPECTOR THIS CERTIFIES THAT.......... ......... . ....Q... ..'��r............................. ..................... ...................... i"""' """"" Foundation has permission to erect.. ......... buildings on ........q3. r..0 .............. Ro to be occupied as Kv ..... .......... } .1�. r` IV► himney provided that the person accepting this permd shall in every respect conform to the terms of the application on file in o Fi i this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of , Buildings in the Town of North Andover. ;--PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough , c.���,�✓2� ��/i�f PERMIT E 'IRES 1N b MO Final S a�• ELECTRICAL INSPECTOR ,INLESS CONSTRUC II® , S�' .................................................................... Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove 444 'rAilo No Lathing or Dry Wall To BeDone FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. t. Smoke De SEE REVERSE SIDE �-�=sZ _ t„r NORTH Town of No. 905- to L O . dover, Mass., COCHICHEWICK �.9 �DRATED I"?C. S U BOARD OF HEALTH Food/Kitchen PER .MIT T Septic System �`G.r /ro , 9 e'— BUILDING INSPECTOR THIS CERTIFIES THAT�.............. ..�.............................................................................. ._� F 'on ;. d i✓ has permission to erect...... i r'r buildings ons to be Occupied asp ©�� G ®n s c..0 / T r� ....................... p @......................................... �'� Fe(!�(�!1.y ✓L!�?>s� .......... `� '....."may "Chimne y provided that the person accepting this permit shall in every respect conform to the`terms of the application on file in -"`°._ this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of F ' Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ough Ca 7-,;0-F-(/ PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR s� Rough. ........................� '..... ;,; a�.� . z...,,, , ..�t,................................ Service 0 f BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove [Final ough No Lathing or Dry Wall To Be ,Done Until Inspected and Approved by the Building Inspector. FIRE.DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. o1 .L - �W v' NORTH own of over No- go i1 — t q o o , dover, Mass., COCMICKEWICK �0OAT ED U BOARD OF HEALTH Food/Kitchen PER ..MIT T Septic System ,�j THIS CERTIFIES THAT.........�� BUILDING INSPECTOR�f ! `� � r ............................................................................ ................................................... Fou n ��' ,✓ / x.� has permission to erect..... buildings on .. a t ........ :........!'..............-..........►.................................. .R gh " o be occupied as........... f.�y,'Os.>i „G:fLt��....�✓jft,;/ dA'�.+s� ...... '�'�% ` ✓'�S 4 Chimne y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in F71>%._ this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICALvsPECTOR Rough. ................... :r:* Service aJILDING 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 Until Inspected and Approved by the Building Inspector. FIRE-DEPARTMENT Burner Street No. IL SEE REVERSE SIDE:] Smoke Det. o1�.L 102 16 DateI ..... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING S4c. qC US This certifies that ....... ....... ....... . ..... ........ ....... has permission to perform ......... .................... wiring in the building of..........M .... .. ... . ............................ at....�19A&4 ...............6.......................... North Andover,Mass. o Fee.-SP=..... Lic.No.�23.... . ........... L luc,..L IN P AM LECr CAL N PECI Check , 3- 7D/ Q\ Commonwealth of Massachusetts Official Use Only • Permit No. r0 2 « u. Department of Fire Services Occupancy and Fee Checked 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),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 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) l43 hot Owner or Tenant v Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building mj,L �-=A Utility Authorization No. Existing Service !,()Q) Amps Volts Overhead Undgrd ❑ No.of Meters 1 New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector o Wires. �) No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- No.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 'LZ No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:" No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: ( Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lec icaI Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COV 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the ns a penal ies of perj ry,that the informatio on this application is true and complete. FIRM NAM F LIC.NO.: 23 3lT Licensee: Signature LIC.NO.: _ /� (If applicable,e ter "ex pt"inf li a z� r line us.Tel.No. Address: t��Plt � ��( (��(� Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security men 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 Owner/Agent Signature Telephone No. PERMIT FEE: $ ` The Commonwealth of Massachusetts �. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1 11 e Address: 41� ke P►P // 6�d - City/State/Zip: JVP_ fel ),MooPhone Are Y.04an employer?Check the appropriate box: Type of project(required): 1.P I am a employer with D 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors , 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I ? L( temodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: • Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). h 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 est ations of the DIA for insurance coverage verification. I do herebycern r the pa ins and penalties of perjury that the information provided ab ve i true and correct. Signature: Date: / Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6elina5 5hdural �nqineerinq LLC Phone 978.465.6436 Daniel L. Gelinas, P.E. Fax 978.465.5160 579A North End Blvd. Salisbury, MA 01952-1738 email danlgelinas@comcast.net August 8, 2011 M. D. Kober 54 Rabbit Road Salisbury, MA 01952 Subject: Structural Observations, revised framing, site 43 Mill Road, North Andover MA 01945 Dear Ms. Kober: Per the request of Brian Kennedy,this letter indicates the recent framing modifications satisfy the intent of the Gelinas structural drawings and the IRC 2009 as amended by the Massachusetts Residential Code 8t' Edition Previously noted on July 11,roof framing changes where discussed and agreed upon with the Framer and Brian Kennedy. Point of emphasis Drawing SG2.1 Rev indicates these changes, basically: 1. valley beam removed 2. beam B31 three 1 3/4 x 9 1/4LVL's used with new bearing wall/check wall above to carry existing rafters over framing this area 3. bring other rafters framing parallel to B31 along until B31 4. old valley beam essentially becomes valley blocking and/or over framing tails 5. Remainder of framing observed to dates meets the intent of the SG design drawings Please call with any questions, cell 978.360.2562 DANIEL, L. it k GELINA m Very Truly Yours, " s rUr-i U0.33994r,,�#L "N �. ter, ,ww Daniel L. Gelinas, P.E G Letter 8-9-1 Ldoc 1� Date.... ....... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING C �,SSACHUSE� This certifies that ....... .......... ... ..... �'h........... has permission to perform . C. .... .. wiring in the building of. l�!:Z .. f�. !.......................... at. .....�l.. [.-..... ............................... ,North Andover,Mass. r-� Fee_ . ......... Lic.No; 3 � +. ............................... . _ LEGMCAL INSPECTOR Check # �S � ` 5 412 7'R'COMH0NWEALTHOFMASSACHUSETTS Office Use only / DEPAR71l1IIVT0FPUX1CS4FM Permit No. .�^ ��— BOARDOFFIREPREVEMONREGUL4HONS'Wa R12.M ;� ; �JM Occupancy&Fees CheckedAPPLICATIONFOR PERMITTO PERF,OELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACW,SSTS 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 wordescribed below. Location(Street&Number) H3 Mid R i 1 Owner or Tenant r =e. i Owner's Address Is this permit in conjunction with a buildin permit: Yes[::] No (Check Appropriate Box) ) Purpose of Building (e`5 j 4 62 Utility Authorization No/7�7 Existing Service k 0 0� Amps Volts Overhead O Underground No.of Meters New Service 2= AmpsI?x) /ZWO Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1• dy I CQ_ Q.l No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 13 gro—'i No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices _ No.of Dryers Heating Devices KW Local Municipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• 1W[ar=Covelage.Rnlant1otheteWmTter&dW1 sGerr dlLaws IhaveaatnadLiab>7ityh>su relblicyinchrlmgCcTmpleeComaageorils&tAnaleWvalart YES NO T,hawa n wdvaaliidproofofsametDdrOffca YES Ea ffyvuhare YES,plea9ei dc*tlrmmofwwrdgeby chedangthe 11����..111 INSURANCE BOND 0 MH R E3 (Please spacfy) WodUDStatt (1 qkqectimDaleRequesbd Ro# E=aWdVakcofE1achxalWdk$ ^ (7 SignedurderTrPbtak� Futa1 sofpajt�ty� ✓ \ _ FiRMNAME C. L � 3 LffwNo. Z s lS L ' I licensee �.3J�eS V (flVlC SiRe LioffWNo Bus�Tel.No. hy3 , SZ—6 Wo _ Q ViAo d c°4�G w��til ,�V A-�-�. I Alt TelNo. 663 '94—hof OWNER'SINSURANCEWAIVER;IamawarethattheL=wdoesnothavedrmmanceeovaagLorgSakstamalequiNa astegtmedbyMassaci�GenalLaws andthatmysig rmmcn thispmn tappkabonwaivesthismw*mnatt (Please check one) Owner M Agent Telephone No. PERMIT FEE$ signature of Owner or Agent Dldllflmlate..... . ........................ AL TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4AT.0 �,SSACNUS This certifies t hat .. .... .......z...... .................................. has permission to perform ...... ....................................... wiring in the building of... ......... ................................. at... ........................... . North dove Mass. Fe ... ........ . ...... e..,/.. ..:...... Lic. ... .. .. ..... ........... LEETRICAL INSPECTOR Check it 5531 I/ Commonwealth of Massachusetts Official Use Only Permit No. n` Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIO/ S [Rev. 11/99] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code Dn7liz 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATI N) Date: City or Town of: Q To the Inspector of Wires: By this application the undersigned gives notice of his o4h4 ention to perform the electrical work described below. Location(Street&Number) Owner or Tenant 6 e4 Telephone Nof Owner's Address Is this permit in conjun tion with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building � 1 C C Ze Utility Authorization No. + Existing Service e ,�4L 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: Completion of thejbllow4ng table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool rnd.Above ElIn- rnd. o.o Emergency Lighting Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Heating Appliances Security Systems: No.of Dryers g pp Kms' No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent t No.Hydromassage Bathtubs No.of Motors ` Total HP - Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail ifdesired,or as required by the Inspector of Wires. t� 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 covera is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURAI BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: /0-1 (When required by municipal policy.) Work to Start: V'151;�00 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pai s and penalties/of perjury,that the information on this application is true and complete. FIRM NAME: l/ CL LIC.NO.: Licensee: Signature LIC.NO.: (7f applicable,e r `•ezem t"in the license number line.) Bus.Tel.No.; Address:_ `/'� 3'% /fi4 L ,c� Alt.Tel.No.: OWNER I URANCE WAI R: II am aware t at censee 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 PERMIT FEE: S Signature Telephone No. 1, Location LaR l� No. Date 1G/3 a-a .rte gORTq TOWN OF NORTH ANDOVER •v f F - 9 Certificate of Occupancy $ vs CHU5 Eta' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t> r 5 J �j Building I sn pector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REpPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. s�� DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: c)? Map Number Parcel Number V y,� 1.3 Zoning Information: 1.4 Property Dimensions: -ZoningDistrict Proposed Use Lal Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red equl Provide RegWred Provided —Required Provided 1.7 Water S M.G.L.C.40. 54 1.5. Flood Zone Information: 1.8 uPP1S' ) Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record Q )1arl' Name(Print) Address for Service: Signature Telephone Rv 2.2 Owner of Record: (9 Name Print Address for Service: P, I z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone r, 3.2 Registered Home Improvement Contractor Not Applicable 0 AV 4 Company �5° - ame / c Registration Number V42 >�� .�� OUB' � �' _�+� ��'-( � �ddtess J � �j (, ` 7 616 V-D 61 t� Expiration Date Signature Telephone i SECTION 4-WORKERS COMPENSATION(M.G.I. 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. G Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition ❑ I , Accessory Bldg. ❑ Demolition ❑ Ofer ❑ Specify Brief Description of Proposed Work: e qiL o r- l-' Ke < /'ri6 l?da� i j SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be �CIA ��� N zx .::>, Completed b rmit a licant _ >F 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 / O 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 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, AJx,-la ho e)C ,as Owner/Authorized Agent of subject v property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge J and belief S P rf;y .4 R-h a qe>-1 Prii4CZame /(// 0 Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3KD 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 IBPROUEflEKi C4NiRACiOR - pe: Private.Corporatio i • t .r , i <..Bay-Statt,•Roo jj Inc Se n Wow ;keno p 7' ST. neemsaro0 BfADIN6 _ . E flA- 018b4 r •.r s r� 4 'E ENT CONTRACTOR 2­. ration O3/3112T}42 ' `� — ,..3�PPrieate,Carporatia Se ner �nNisraAro�4, READING MA. 01864 ..1 t. 9 Town of North Andovero4 t►ORTh , ti D `'6 oL Building Department o 27 Charles Street * ` North Andover, Massachusetts 01845 (978) 688-9545 Fax(978) 688-9542 �' `°`"''�• �` I DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# SIM the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Signature of Applicant a Date NOTE: A demolitionP ermit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.