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HomeMy WebLinkAboutMiscellaneous - 476 GREAT POND ROAD 4/30/2018 (7) 9 �y6.� DaP� 1 BUILDING FILE 1 Date 2-. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . `.0. . . . . . . . . . . . . . . . . . . has permission to perform . . � 4"Kb.67.>_.ftJ wiring in the building of . . . . . _. . . . . . . . . . . . . . . at . .7 . .4 X+ At . . . . . . . . . North Andover, Mass. Fee . ,ti �-. . . Lic. No. , �? .7 Iq. . . . . . . . ELECTRICAL INSPECTOR Check 11198 2 )q-r Commonwealth of Massachusetts Official Ilse Only Department of Fire Services Permit No. l ( C p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] ieaveblank 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 r work e her intention to perform the electrical scribed below. Location(Street&Number) y 76 (i�,,,+ �o y..►tl 0 - Owner or Tenant Flo N r -o; u 2 &e 1p-* Telephone No. y'7f,-lb49£4�-9V5_ Owner's Address SA-l+,-r J-3"b}- ,J o q "S- #N V e vc M 4 t Is this permit in conjunction with a building permit? Yes ❑ , No ❑ (Check Appropriate Purpose of Building Utility Authorization No. / 1 Existing Service_4D Amps 4 / -ZY0 Volts Overhead ❑ Undgrd©� No.of Meters l New Service Amps / Volts Overhead❑ Undgrd ❑ No.1ZY0 Meters Number of Feeders and Ampacity (� f�� 2(� G r-� (-- Location and Nature of Proposed Electrical Work: ¢rl Completion of the following table may be wai by the Inspector of Wires. of No.of Recessed Luminaires No.of Ceil: TranSusp.(Paddle)Fans s Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. E] 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 andInitiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Nber Tons KW No.of Self-Contained P Totals: ............... Detection/Alerting Devices No.of Dishwashers g S ace/Area Heating KW Local El Municipal El Other P Connection No.of Dryers Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage 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.) Work to Start: O V IZ- 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,tinder the pain penalties of perjury,that the information on this application is true and complete. FIRM NAME: - 0 1 LIC.NO.: -q-ZO?3 7 .�--. Licensee: �.q- _� G Signature _ LIC.NO.: �L �f (If applicable,enter "exempt"in the license number ine.) J f ., Bus.Tel.No.• 7�-t'a S-�{_e Address: °it7 t�y✓t c. 1'� `'`J"�- Alt.Tel.No.: -71'�S '%13 *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S icense: 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 agent. Owner/Agent [PERMIT FEE: $ Signature Telephone No. 'asset( ,[ aile6t-[ e-xnspeetiou z equixed'($5O.OQ)-( j h8pectoxs'cop=opts: (xnspeefoxs' ignatuXe� to iitiaTs) Pate MAL)�Ilsmctow, I?asse$�- wiled--j te�nnspectioxtxec nixed($ OAO)w[ Iuspecto�-s'commeJxfs; (JCrispectozs' zgxpt (re� initials) Date 3.TND.VP,GROMW WROC TION. passed--f I Failed--[ Ze-ansectto�xeuiret ($ DAQ)�[ Enspectoxs'coxamenfs: (lnspeefors'Signataxe-toHilals) ]ate assed—[ I Failed--[ e-nspectioxtxequixed($50A0) -[ tspeetoxs'commeits: (faspectoxs'siga ture-io initials) date ' NSPY,+CTXON•-OSIER. ' - pecfors'com.xnents: . • S , '06isp ecfoxn'ffli tature-no Ini fials) date ' 11OR TAG15 AM TO BE IMMED Q'UTAM XEFT ON SITE V TM AAP'XA TO BE INSPECTED Xg NOT The Commonwealth of Massachusetts Department of IndustrialAccidints Off lice of Investigations 600 Washington Street Boston,MA 02111 Uf www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): u—, Address: 47 k- City/State/Z' : w c Phone#: Are you ployer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 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. ❑Remodeling 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 10. lectrical repairs or additions required.] officers have exercised their 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#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie 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:. 6'Lf Policy#or Self-ins.Lic.#: o Pt-U_ 7 Q c, �piration Date: Job Site Address: 17Lo d- 4- tvly �� City/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 of the DIA for insurance coverage verification. I do hereby certify u er the pains and p alties of perjury that the information provided above is true and correct. Signature: Date: - lD V Z Z 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#: i 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." r Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications licati ons' man given p p pp y g n 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 burn 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 at 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 WWWMass,goV1dia Date. . .. .. . .. .... . c NORTH pf „ao ,°,ti0 3� TOWN OF NORTH ANDOVER p 9 ' PERMIT FOR GAS INSTALLATION s a �9SSACH U5ESt . This certifies that . .'".- -'e ��. . . . . . . . . . . . . . . . . . . . . . . . . .a. . . . . . . . . has permission for gas installation q,. in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .: � . .. . . . . . .. . .. North Andover, Mass. Ole �•� Fee' . . . . . Lic. No.. . . . . . . . . . i GAS IN Pil TOR Check# ��4 4760 MASSACHUSETTS UNIFORM APPLICATON FOR PFR/NM TO DO GAS FITTING (Type or print) Date NORTH AND,0VE�R¢MASSACHUSETTS (l !610 Building Locations - T d`� � Permit# Amount$ , EiJ�t/fI�� We%/?LJ ?O/Z— Owner's Nam New❑ Renovation ❑ Replacement © Plans Submitted ❑ wu =� F O z O F W w d z 1-4 a x wx H O x 3 A c7 8 a° > a H O SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR t (Print or type) Check one: Certificate Installing Company Name 7-, W14 L L O Y14�✓ !�� Corp Address /0 ,0- Q o X 5'7,?, ❑ Partner. 144 Business Telephone 97 6 b'S"' 150`I' ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 7�l/vr/ os W4 My eq eJ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesE] No❑ If you have checked M,please indicate the type coverage by checking the appropriate box Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required b ter 142 of the � re9 Y Chapter Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner —1 Agent ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State GasCodean Chapter 142 of the General Laws. F-t Z�c� By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber ;t Y f 33 City/Town ❑ Gas Fitter License Number ❑ Master ,APPROVED(OFFICE USE ONLY) ® Journeyman 1 Date. . .. . Gy . . "ORT„ TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACHUS� This certifies that . . . . . . . . . . .:�"`":'. . . . . . . . . . . . . . . . . . . . . . . . . has permissi on to perform--.., plumbing in,the bdildings o . . . . . . . . . . . . . . . . . . . . at. . .�' . . . . -! `f�. . . . . . . ., North Andover, Mass. Fee . .'. . .Li c. Noy . . . . . . . . . . . . ( � PLUMB' �iNSPECTOR Check # `' Y' VV 6u51 c MASSACHUSETTS UNIFORM APPLICATIO- FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANID R7MASSACHUSETTS -1 1 V—), i Date Building Location W�16r in, PO'ay') Owners Name Ne11j&,,t5eA-Permit#��: Amount ' Type of Occupancy Q AJ R 1 i'n.1 New � Renovation Replacement .�C Plans Submitted Yes No FIXTURES D v4 ARF HIM 2��Ds=1t 4II iWW 7.lH)`1�D�t type) Check one: Certif cate �r't or' . A N1 t H Installing Company Name L T � Ps L o'� � � 0 Corp. P'Address t`0 - 0?(, 5 7 D Partner. t AW 2 .UCC' tM A Ol t{ Z usiness Te ep one cj 7 51-150 '-f D Furn/Co. Name of Licensed Plumber: 7 A/0 Al 0,S .Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D Bond El II surance 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 D Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P rbing Code and Chapter 142 of the General Laws. By: Signa ure Of icense um r Type of Plumbing License Title A 11 03 City/Town License i um er Master D Journeyman APPROVED(OFFICE USE ONLY Location 4&, No. Date Z kORTN TOWN OF NORTH ANDOVER c? .•_, o� Certificate of Occupancy $ + + Building/Frame Permit Fee $ • o a f Foundation Permit Fee $ JAcHus P� ther Permit Fee b��c, $ SEC; ED Sewer Connection Fee $ nn Water Connection Fee $ � V . o11, T(gTAL N�• Building Inspector Div. Public Works PER'ltIT N,O. g 2S APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE — JONE SUB DIV. LOT NO. I ,,LOCATION y� PURPOSE OF BUILDING �WNER'S NAME v `' NO. OF STORIES 0 SIZE= 1. _ 1- t�/o►C. IJC V-6WNER'S ADDRESS ( BASEMENT OR SLAB �ULLp ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 7 3RD UILDER'S NAME / SPAN DISTANCE TO NEAREST BUIL NG 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 YL. I)'c-'VL :� C� /� � �,p � LAND COST SEE BOTH SIDES _ vLv IS I� C• ST. BLDG. COST dp0 PAGE 1 FILL OUT SECTIONS 1 - 3 1-`}I'-►-� R cf� EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 121�1.t. \ 1 JG« c� EST. BLDG. COST PER ROOM 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 V D/ATE FI 7 Z�? ` BOARD OF HEALTH SIGNA RE OF OWER AUTHORI D AGENT y FTFL.# s137FEE �---- �✓CONTR.TEL# � _� - ONTR.LIC.# PLANNING BOARD PERMIT GRANTED AB ,9 9161 BOARD OF SELECTMEN i 1 BUILDING INSPECTOR BUILDING RECORD Y 1 1, `OCCUPANCY 12 , SINGLE FAMILY -1 STORIES 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 1 ' 2 FOUNDATION 8 INTERIOR FINISH \ 1 1 , CONCRETE B 1 2 13 � CONCRETE BL K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 '/2 '/l FIN. ATTIC AREA _ N_O 8 M-T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARMU'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME, BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME ' i CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE ADEQUATE NONE 5 ROOF 10 PLUMBING GAB; HIP BATH )3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 1 1 ✓ i 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING f MONTH OFFICES OF: . mom 'sTown Of 120 Main Street APPEALS NORTH ANDOVER R North An(lover. Cil 111 a� C;IN ; • - ;:, ' s�cHun� MiISS;WIIIISCtIS U 184., HEALL-'1tVI\1 IOIV DIVISION OF ((i 17)lith-477 i HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIREC'1'011 In accordance with the provisior)s of MGL c 40, S 54, a condition o r Number t;Q� Building Permit disposed of in a properly liccnsc(i solid waste is that edisposal fadebris cility from work shall be 150A Y by MGL c 111, S The debris will be disposed of in: (Location of Facility) oU2�YT t �-�. L4't4c gnature of Pct A licant ` Z' Date NOTE: Demolition permit from the 'Town of North Andover must be obtained for this project through the Office of the Building Inspector. ti NORTIy own o 6 �L ndover NO. 425 ;... � ,.;r " n A � VEWAY �T PERMIT : OF _ er Mass , SC�1' I S 199Kr C MAn A0Pte\ BOARD OF HEALTH PERMIT, THIS CERTIFIES THAT...... ILD . WftA ....I "%f Or �It f3(4aQ�£�- f......................... .. .......................... T 6reh /� /� BUILDING INSPECTOR .. .. buildin s onRough has permission to~ ... .............. g ••• •• 9 • T ` •�• ;' •Ib Q/V / "7� !�"M� �` `�}� � Chimney to be occupied as� ..N. ..!!:"'.l.l�...........11.�. N�. �r!$l.!��aA*..1.b�.......P.. Final provided that son epting this per 't s Il' ever respect conform t e s of the applic 'on o file in � " PLUMBING INSPECTOR this office,and t t son; y-t a�si h Inspec o to on aas-tru ion��. Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 0N" . Rough weak Q� Die' UNL,,E``SS�1 CONSTRUCTION STAR S service Final --� .............................................. �" t �tL 1��F►�* � r ���N � BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector