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HomeMy WebLinkAboutMiscellaneous - 45 SAWYER ROAD 4/30/2018 45 SAWYER ROAD 210/032.0-0036-0000.0 Date . toTOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . .�.�. . . . .-� .�/ .�1'X� . . . . . . . . . . . . . . . . . has permission to perform . wiring in the building of . . . �Ow71�. . . . . . . . . . . . . . . . . . . . . . . at . . WY 2.. . . . . . . . . ,NrlCAL h Andover, Mays. Fee . $�. . Lic. No. � ?..4.7.. �. . . . . . . . �.5!�!. ELECT INSPECTOR" Check# 1 'i 046 7 Commonwealth of Massachusetts Oficial Use Only Department of Fire Services Permit No. f Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank 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: Al 11 f 7" ,?V 2 012 City or Town of: NORTH ANDOVER To the nspector of W re By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 95- _5.#W!Le P &Q, Owner or Tenant lI le * AeC/IN BROW Telephone Noa?gS_?31 Owner's Address GU /' Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. !3502119�s - Existing Service 6o Amps /o70 IcQVO Volts Overhead Undgrd❑ No.of Meters New Service 1_06 Amps IdO ldfQ Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: CJ#1j6e �Ey(ffT l* gvel'hod Sew%(P TO • NP kl aVPPkeR ) /60 A M10 SP/` V, W 30C^ /6a�ha.l✓ /SA L ViI&V Completion of the following table may be waived by the Inspector of Wires. l of No.of Recessed Luminaires No.of Ceil: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 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 ger 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: _ ACh,(We olaleT Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: O (When required by municipal policy.) Work to Start: o in to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE V GE: 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 Rd'BOND ❑ OTHER ❑ (Specify:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . . t°An/ �12G7`/laG4 G LIC.NO.: j Licensee: ,9, 11 V I✓ ,f t; df4-xl Signature A LIC.NO.: S,4M-e (If applicable,enter "exempt"in the license number line) Bus.Tel.No.• C�f36 Address: </ a( le MP /��e✓ �����y Alt.Tel.No.: 744Wr/k9 *Per M.G.L c. 147,s.51-61;security work req'aires 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 agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. .- • �.1-r�1Ui.....�•i.'4•(�j(�•[y-:{(�f��■77��(''-�►►'e{'��•f�J.-efdll��-/��Q'ffw PQQ{�,Q�(T�/'p�'Q'�] .`�.1���`UJ+..+S�J.`f ����o . • � .*�..u.tlL✓...•..-*.LIJ..W...-.•{�.L Yw-.\!,].Lr••..� ' ' .. r ' +•� Z •• . �'asse�•-, _ �i'aj�e�.�C � �euzs�ee�Zoz�xe�uix'et�($�'4AD)�( � �ns,�lectpxs'�camme�ats: (�nspee axsti zgaaEnxe� to rzfiaXs) Pate 011, �'asser�•-- raiSet �� e xus ect o�xet txixe ( 0.00) j . i�ts,�ecto 'cams>zexifs: . ( ns ec#oxs',zgna tze- hdflals) Pate [wectoxs'calmnentsr (.tnspectoxs�,�zgnat-sue•-�o?uifia�s) ]ale , ' Yaupaci--fi eanspeet£onxequire ( O.OD) j aectoxs'eo�n�.epfs: - (1-48Pectoxs'$zgnatun-io�hluaTs) )late . d.•--� �' �'azter��� �- 'ate�nsp ection xer�uix'et�($�D.O D)•-[ � 3Ciox�g C0hme7 lts. 5 QE.s�lecLars,Minat[xre-no1initials) date ' fl 7f'�,GNS t��t 'ff'd?RTi`�tifT,fi'fib�1�7T r' 9l :iFcTe�17,�Trir+`'fit +.AZ?VA.` '4��+ P +CTE�3Tq- oT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV. 600 Washington Street Boston,AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information an Please Print Leizibly Name (Business/Organization/Individual):. 04 0 N X AIV ;5l eC t4-A r Address: oR a J /U e y , City/State/Zip: N6AUeN NQSY o Phone#: ,fGff yJ/ /Yak Are you an employer?Check the appropriate box: Type of project(required): l.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.[ 1 am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ uilding addition [No workers' comp.insurance 5. El We are a corporation and its q ] re uired. officers have exercised their 10.aElectrical repairs or additions 3.❑ ram a homeowner doing all work right of exemption per MGL l l.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 1311 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site nformation. nsurance Company Name: 'olicy,#or Self-ins.Lie.#: Expiration Date: ob Site Address: City/State/Zip: kttacg a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cerp under the pains andpenalties ofperjury that the information provided above is true and correct. i nature: Date: a o2 hone#: S(13 q3- 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#: rl Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants " Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE evised 5-26-OS Fax#617-727-7749 Z www,mass,gov/dia PEWMIT NO. . APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. v PAGE 1 MAP i4O.0,7 L LOT NO. 3� 2 RECORD OF OWNERSHIP (DATE BOOK '.PAGE ZONE SUB DIV. LOT NO. LOCATION ! D PURPOSE OF BUILDING OWNER'S NAME � C T7//S/may®-P/�� NO. OF STORIES 'l SIZE�I —V OWNER'S ADDRESS �//' t''�L//j�G�i/i'�Zy�� BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �LG /l��`/L O�� / SPAN --- DISTANCE TO NEAREST BUILDING s•' DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION s—L -e LAND COST SEE BOTH SIDES /f /�\ tJJ CGJJ/� EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 3//,g- ` O BUILDING INSP[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT � 1>-r SL�9/ FEE OWNER TEL.# r PERMIT GRANTED C� CONTR.TEL.# CONTR.LIC.# T/ H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ Si ORI ES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B 1 2 13 , CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAII UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 14 1/1 1/1 FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY, ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR DEI-I POOR _ AQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ -TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 6 COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL LM 2nd _ ELECTRIC 1st 13rd NO HEATING NORTH Town of dover 0 to ;.: ur:lY QIN 1 dower, Mass. s-�/ _19? COCHICHEWICK AoRATEo P'PC 5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT............................... . ... ................ . ...........�... ...... . 71 ............................................. Foundation has permission to erect........ ... buildings on ............. 5 W ....�. Rough to be occupied as............ `��. ., �.,�! ..... . .. Chimney ........................................ ............... . ................................... . .. 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 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough ......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required ccupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det.