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Miscellaneous - 55 OAKES DRIVE 4/30/2018 (3)
/ 55 OAKES DRIVE 210/107.A-0142-0000.0 1 Ile r Date.... ' HORTI, °f "0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ♦ oma+ �_�?� SS�CHU Thiscertifies that ............................................................................................. has permission to perform ........?eO10-,�` 411 ce uf�e'69— n . ..................... r.................................... wiring in the building of........�.4.eri%q...... at..... ............k ............T....................... ._._North Andover,Mass. Fee...-S--57.!.-if. Lic.No. 34........ .P ..4"�/�!. .... •.Ay. ELECICALINSPE OR Check # TR 7343 Clmmonweahk of Momachu6ettd Official Use Only cc� ��77 Permit No. 7 3V3 al'artment o1.}ire Seruiced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrica*1ne 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF RtLIATION) Date:City or Town of: To tl�e0 jlt'eS: By this application the undersigned give noticee of his 9,r her intention to perform the electrical work described below. Location (Street&Number) �j�7 6)"ok At Owner or Tenant 1� I h 6/24 E Telephone No. Owner's Address D 0*11—'e Is this permit in conjunction with building permit? Yes ❑ No LZ (Check Appropriate Box) Purpose of Building j ►lei �e Utili Authorization No. Existing Service 160 Amps /V/ Volts Overhead Undgrd ❑ No.of Meters New Service C. 0 Amps I Z) / y Volts Overhead Undgrd ❑ No.of Meters ` Number of Feeders and Ampacity j Location and Nature of Proposed Electrical Work: S e&t& 04 q1M v Completion of the folloivin table may be waived by the.h7sector of 6Vires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators INA No. of Luminaires Swimming Pool Above ❑ In- ❑ o.o EmergencyLighting rad. rad. Battery Units 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 g Tons No. of Waste Disposers Heat Pump j.Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Co niei El Other Connectidoo n No. of Dryers Heating Appliances KW Security Systems:* Y 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 I'Vires. Estimated Value of Electrical Work: (When required by municipal policy.) 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 i urance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cover e is in force,and has exhibited proof of same to he per iit issuing office. CHECK ONE: INSURANCE VBOND ❑ OTHER [] (Specify I certify,under the pains and pet rl ies per./ury that the information on this application is true and complete FIRM NAME: �U�q �'% W LIC.NO.: 3 Licensee: � h,`PV, �J-b6� Signature LIC.NO.: l (If applicable, enter exemn t lic senumber lii Bus.Tel.No.: p J l Address: r �) /If Alt.Tel.No.: *Per M.G.L. c. 147,s.57-61,security wok 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 a e Owner/Agent Signature Telephone No. PERMIT FEE: S IUvvty Ur A.rv>JUVtK Commercial: Sewer Ejection Pump: $25.00 ELECTRICAL PERmmFEES a) including photovoltaic & Signs: $25.00 each ballast (Effective March 12, 2003) generating Equip Per KVA $1.00 Smoke & Heat Detectors & f . MYNIMITIPERIYIITkEES b) un-interruptible power systems, Initiating Devices: RS R'E TPAI $25.0'0 per KVA$1.00 in, :.:..,: L;<:::-:; ::<.;=- Residential: $1.00 each C;OMNIERCI4I=$5,00,0 c) batteries over 100 amp. hours,per Commercial: $60.00 up to 10 O SE CABLE. 0"NI cell $1.00 devices over 10 -$1.00 each )UTS.IDE OF BUILDING Heat Devices: $1.00 each Space Heaters: .r Conditioners: $40.00 each Heat Pumps: $40.00 each area heating$1.00 each arm Systems Security: (for fire Hydro-Massage Bathtubs/ Hot Sub-Panel: $25.00 stems see smoke/heat detectors) Tubs: $20.00 each Swimming Pools: sidential: $40.00 Lighting Fixtures $1.00 each Residential: )mmercial: up to 10 Devices Lighting Outlets: $1.00 each Above Ground: $25.00 0.^0 -dditiona1 devices over 10- Major Appliances: (not listed) 1ngrertr,.d: $50 00 .00 each $20 each Commercial Pool: $100.00 arnival Equipment: $50.00 each Motors: (per hp or fractional part Switches: $1.00 each piling Fans: $1.00 each thereof) $2.00 Temporary Service: )mmercial New Construction or Oil /Gas Burners: 1t:ust h.-ave Utility A.utho,-iz:,l'i(in .terations: Residential $20.00 each Residential$25.00 00.00 per 1,000 Sq. Ft. of Commercial $20.00 each Commercial $100.00 )nstruction Space Office Furnishings: per circujt $10 Transformers: i )mmercial Service Change/ (Relocatable Partitions/Cubicles) a) capacitors, Per KVA $1.00 pair: Outlets & Fixture: $1.00 each b) ducts, conduit &conductors rst hae Utility:authorization Number Ovens Built in/Counter Top Units: (Associated w/Padmount Transformers) $25 00 (first 100 amperes or fraction, one $10.00 each c) each manhole$10.00 .ter) Panel Change/Circuit Breaker: d) each handhold $5.00 each additional 100 amperes Residential: $20.00 e) per KVA $1.00 ipacity or fraction. $30.00 Commercial: $25.00 0 primary feeders, $25.00 each(over each additional meter$25.00 Phone Jacks: See ' 600 volts, non-utility owned) )mrnercial Temporary Service: data/telecommunications g) vaults and equip. $25.00 each 00.00 Ranges $15.00 each Washers: $15.00 each 3st have Utility Authorization Nnn,i)er Receptacle Outlets: $1.00 each Waste Disposals: $5.00 each )mmercial Repair and/or Recessed Fixtures: $1.00 each Fater Heaters: $30.00 each aintenance Permit: (Blanket Re-inspection Fee: $25.00 ' 7-mit)up to 2 Electricians$150.00 "For il,Ii!�]��^������, �� r pair of Electricians over 2 $50.00 Repair to Service Residential: $20.00 1�ar e Commercial rta/Teleccmmunication: � � sidential: $1.00 per port Residential New Construction Ste NVII.-hig hIti Et'cit. It1 rmmercial: $30.00 up to 10 (Dwelling): $220.00 (with service up to 200 amps) Pt vices over 10-$1.00 each ., „-. � Must have Utility Aiithorizafior, \umber paiiI I.KeIYl3ed 5� (375) 623-r.r.)()6 shwashers &Disposals: p (Office Hours S ant Io 10 and) for services over 200 amps see below Each 'yers: $15.00 Each a) for each 100 amps capacity or fraction add $20.00 nerenc Li (Battery Units i, i],S���L4Eif?. Sgt skt'.ttl ,'; g y Lighting g (B �' ) b) each additional meter$10.00 .00 each unit c) each additional panel/sub panel I RO G1-1 edeas or Sub-feeders: $25.00 1. F+I.NAL ch 100 amp capacity of fraction :reof Residential Additions/Alterations: I TREN"I,.�:1 O <3. � sidential: $5.00 each $220.00 maximum mmercial: $15.00 each Residential Service Change or ADDITIONAL s/Oil Burners: Underground Service: fl`SPEC TIO c *S25.00 (if sidential: $20.00 each $40.00 illus,have Utiliiy:'.r,t.i,ori`iatinri €'�unil,er applicable) mmercial $20.00 each a) one meter, up to 100 amp capacity $40.00 (revised 07/05) b) each additional 100 amp capacity or fraction $20.00 Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( C),527 CMR 12.00 ' (PLEASE PRINT IN INK OR TYPE ALL INFO ATION) Date: — City or Town of: To the Inspector of Wires: By this application.the undersigned gives not ce of his other int— intention to perform the electrical.work described below. Location(Street&Number) Tele hone No. � Owner or Tenant �. p Owner's Address Is this permit in coni tion with a building permit? Yes ❑ No Q__�_Check Appropriate Box) Purpose of Buildings {/G �s�fy�/�y_ 9G Utility Authorization No. Existing Service Amps. /:/,(,f Volts Overhead-Ea"_—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: 1 1-A 15" 6_)4542 _ 4axyv A 2my-0 Completion o the oll.ouing table may be waived by the Inspector of Wires. No.of Total No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans. Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool rnd.Above ❑ n- o.omergencyigl rn ❑ Batten Units �i No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.9hones No.of Switches No.of Gas Burners o.oetectton an. Initiating Devic No.of Ranges. No.of Air Cond. To al No..of Alerting D ices No.of Waste Dis secs Heat Pump I.Number T ns KW No.of Self-Con ined Totals: Detection/AleiiIng Devices: No.of Dishwers Space/Area Heating W Local ElM nne ciion ElOther No.of Dryers Heating Applian s KW Security S stems: No.of-Devices or Equivalent No.of Water KW No.oT 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. 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pa' s andpenalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: . Licensee: . Signature L LIC.NO.: - _'yam (If applicable, r exem "in the is nse nun}Gerliae.) Bus.Tel.No.• P1�'7 Address: Alt.Tel.No.: OWNER' IN WAIVER: I am aware that-the Li ensee 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. r Date......... ,-,....'dam • NORT1{ °f�"":•'"° TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �SS�cHusE� This certifies that ............ ��-' ' ....................... ......................... .. ...�..0. ......................... . . .. .. ....... .. ........... has permission to performQ..... wiring in the building of.h.�,�i......P /L/w"..................................... �at............S S.......................v...._5.......... .................. ,North Andover,Mass. ©ofJ Ree... / .......... Lic.No I4.1.Z..gS.S'.............../ ..../.......!y-�! E��EcrmcAL YNSPECfOR / l 'E Check V F j.� Commonwealth of Massachusetts Official Use U�sefO/nly " r ermit No. Lam(/ Department of Fire Services Occupancy and Fee Checked 8, T {a BOARD OF FIRE PREVENTION REGULATION [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code P C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO ATION) Date: � City or Town 0f: "0— To the Inspector of Wires: By this application the undersigned gives not ce of his or her intention to perform the electrical work described below. Location(Street&Number) Z9 Owner or Tenant l Telephone No. � � Owner's Address Is this permit in conjt ion with a building permit? Yes E:1 No (Check Appropriate Box) Purpose of Euildingt {/G �s /k tfTIbJG Utility Authorization No. Existing Service Amps 2!ZQ / /(e Volts OverheadrE�' _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 the fbliou4ng table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency ig in rnd. rn Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devic No.of Ranges No.of Air Cond. Tons No.of Alerting D ices No.of Waste Dis sers Heat Pump Number T ns KW No.of Self-Con fined t f Totals: Detection/Ale!fing Devices No.of Dishw ers S ace/Area Heatin W Local ❑ M icipal [I Other P g nnection No.of Dryers Heating Applian s 1{�y Security S stems: rY 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 Hi�E Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) ` (Expiration Date) 1, Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: tls Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pa' s and penalties of perjury,that the information on this application is true and complete. FIRM NAME: , LIC.NO.: Licensee: Signature LIC.NO.: '!J (If applicable, r exemtV- "in the ic!eensseee nun )per Iiae.) Bus.Tel.No.: Address: - !r���, -/E 5l C�l�, � Alt.Tel.No.: OWNER' IN WAIVER: I am aware that- e Li ensee 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. Location 15 S .11;>. No. 1, 3 Date NOR,N , TOWN OF NORTH ANDOVER Of " O • ti0 F 9 Certificate of Occupancy $ �'�s'••°•E�� Building/Frame Permit Fee $ s�cMus " Foundation Permit Fee $ Other Permit Fee $ _ ` TOTAL $ Check # r - / /Av/p 14 V v r Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER Cf DATE ISSUED: ic SIGNATURE: Building Commissioneffl for Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: CST) Map Number Parcel Number 1.3 Zoning Information: 1.4 Property ensions: Zoning District Proposed.Use Lot Areas Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name Address for Service Signature Telephone 2.2 O r of Record: Na Address for Service: Z rn Signature Telephone SECTION 3-CONWRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Z_ Licensed Construction Supervisor: /f License Number Address Expiration Date Signature Telephone { 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name �...-1•� � �����`�� � �/� ��� f�� Registration Number I••. Address 7— 'tet✓r ]"— Q� Z07CD O Z Expiration Date ^ Si nature T e hone 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 buildi rmit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: !� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 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 / OTO I 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 authorizto act on My be t, all matters relWye to\4rk autho 'ze by this building permit application. v� 7=-l YP Si nature of 6w,,&_ Date SECTI 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare tb statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Pri m Si ature of Own ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 No 3 RD SPAN t DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ���aaoac�ivaelta i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 025991 Birthdate: 02/07/1941 Expires:02/07/2002 Tr.no: 14925 Restricted To: 00 LOUIS GRANDE 11 DEBORAH DR READING, MA 01867 Administrator = HONE IMPROVEMENT CONTRACTOR Registration: 109565 Uapiration; 9/21/00 Type' Individual E UFUCA+, f LOUIS GRANDE � &OPIS GRANDE i 1 DEBORAH DR ADMINISTRATOR READING MA 01867 E 7 ' -� L, y / \ U 12 ' � '� J O • - The Commonwealth of Massachusetts ........... Department of Industrial Accidents - Office 011nivestfoo foes 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: ,,v citycJ�=/ t/l_ /�f-f/'—c��^ Z phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one working in anv ca slily �//%%%%% % %%%%//%%/%��%%%/%/%%%//%%%/%/%%%%/%%%%//%/%/%%%%///%//%%%/%//%%/%%%//, '%l////%��%%�%%%%�%%%/%���%%��%/%%%�%%i I am an employer providin workers' co ensation for m g . ..............:..n?P .:..:;; Y employees workwg on this jab. cpm an name:: address. .; . .. ... ''<'<: S. ' insurance:co. 1fE olicv# ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: - al coninany name. address_ .............:. nlititie#• illB11 ranee ohcv#..... ....::....:....::..:..: .../1..... moi. a:;>;•:: l v n me. address. phone# aii4nra . e- ..< nee co.;:<;>:?;:; `:<> '>><'�»»?« ;'fir«:>r > i ?< ''<> ><� _�>�>�><`�> ............ FaIlnre to secm•e coverage u required under Section 25A of MGL 152 can lead to the int lion of criminal pos pw�lties of a fine np to S1,500.00 and/or one years'imprisonment as weIl as dvIl penalda in the form of a STOP WORK ORDER and a 8ne of 5100.Ofi a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verlBcatlon. I do hereby certify r the pains and penalties of perjury that the information provided above is true and correct Signature Date '-��'�� Print name ® <<avGe Phone# o fficial do not write in this area to be completed by city or town official city permit/license# ❑Building Department ediate response is required ❑Licensing Board ❑Selectmen's Office ❑Health Department phone#; ❑Other Unwed 9/95 PJA) NORTH Town of Andover No. `' 70 369 Ao dover, Mass., COC MIC MEWICK �^ ADRATED Cl S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System O BUILDING INSPECTOR ;i�A Y a o!THIS CERTIFIES THAT.......... ... ................................................................................................................................ Foundation has permission to erect.../ PI.h �r�! �.. buildings on.......�� ..... /Q. .. ........�� . ........... Rough to be occupied as..............a..04 . .. .............................. ..................................... 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. M Ito '7 IQ /Z .*#y PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Jam° Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR * Rough .................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove 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. Date. No . 5 G NpRT: p TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING y a o a ,SSACMUSE� This certifies that ". . . . . . ... . . ./. . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . !. . . ` tel'` ` plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No.. . .!": �. C.. . . . . . . . . . .. . . . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer k I MASSACHUSETTS-UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) �19 Mass. Date-Z— 19� Permit# J G 6 Building Locatlon s1_2 � I Owner' Name � y: -pe of Occupy"n" cy �// J✓� New Q Renovation O Replacement ©� Plans Submitted: Yes O No ❑ FIXTURES Z y Q Z Y y y y y O Z 47 1 O7 J Z_ N < cc Z Q) X = X. N — LL Z ` d F- F- U V y it m y y W } < f- y CC ? C Q d7 Z cc a X O LL W O O ¢ < cc < W Z J W �- t• W y a J y C Z J — C G a 4 cc W LL Y W tL Z X F Y 4. O y Z Z W � O U X > N O y Z O O < F- < < x N N Q < O < J ,i < it O < H a J C VS C CJ = F y LL o A d T1 , 101 CmO sue—BSMT, BASEMENT 4 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name -7 — tic Check one: Certificate Address Z-EeIJporation /tr ' Q Partnership Business Telephone 06W& ❑ FmVCo. Name of Licensed Plumber '�- INSURANCE COVERAGE: I have a current liab�ilitY-insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked Vis, please indicate the type coverage by checking the appropriate box A 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 by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ &gnature of Owner or Owner s Agent I hereby certify that;all of the details and info.-mation I have submitted (or entered)in above application are true and accurate to the best of my knowledge and,that all plumbing work anC installations performed under the permit msjed for this application will be in compliance with all "nent provisions of the Massachusetts date Plumbing Code and apter 142 of the General Laws Ev &gnatur cf used Plumber Title Tyne o` Ucense V;' .ter L / 24- 76 Date..`.. ........tJ.......... 4 NORTH °t<�``°:•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 3 CHUS This certifies that has permission to perform.r1?` . .':ti��.`... ...................................... wiring in the building of r ... ........................... ................................................ ate.... ....................:`Z-9..... ...................................... ,North Andover,Mass. Fee s.... �.......... Lic.No c�c. \ �. ........................... G -ELECTRICAL INSPECTOR Check # ;,()f WHITE: Applicant CANARY: Building Dept. PINK:Treasurer o��U.�o _-.P The Commonwealth of Massachusetts P. it No. Department of Public Sa Occupancy Checked ).. f� 3/90 (kwe bt.n4) BOARD OF FIRE PREVEN710N REGULAnONSS 527 CMR 12:W APPLICATION toFOR meP( accordance PERFORM ELECTRICAL WORK AJI work e Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR j ALL INFORtiATION) Date T7- a 1 — City or Town Of /l/ n�,oJ•l/- To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street b Number) YS' OA Ke S t`r J e. 0-ner or'Tenant SA, "�,, 0 11,t}� 1 0 ier's Address � Is this permit in conjunction with a building permit: Yes Fj No ❑ (Check Appropriate Box) Purse of Building Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No_ of deter; hew c"er ice Amps / Volts Overhead ❑ •Undgrd ❑ No. of yeto-s N—b---r of Feeders and Ampacity r Location and Nature of Proposed Electrical Work T (ao f, �,. �z 0-1,1— No. of Lighting Outlets No. of Hot Tubs No. of Transfomers Total u KVA = No. of Lighting Fixtures Above In- Z Swimming Pool grnd. ❑ grnd, ❑ Generators KVA ,No. of Receptacle Outlets (jF No. of Oil Burners No. of Emergency Lighting Battery Units f S No. of Outlets • No. of Cas Burners FIRE ALARMS No. of Zones m1Voof Ranges Total No. of Detection and z . No. of Air Cond. tons Initiating Devices W No. of Disposals No. of Heat Total Total J Pumvs Tons KW No..of Sounding Devices C: No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No_ of DryersHeating Devices KW Local❑ Municipal ❑Other to Connection LL No. of Water Heaters KW No, of No. o Low Voltage E SiSns Ballasts Wiring o No. Hydro Massage Tubs f No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant-to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or is substantial equivalent. YES8 NO [JI have submitted valid proof of same to this office. YESk NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 0 BOND ❑ OTHER [ (Please Specify) Estimated Value of Electrical Work $ Expiration Date) Work to Start Inspection Date Requested: Rough 8 Final Signed under the penalties of perjury: FIR'l NA.'W LIC. H,'). Licensee L 10u� tt�C �.• tc ec� Signature C'aq Vag AAddress �' _ L//IC, N0. k$� t Cst ABus. Tel. No. b G '4- 7� Alt. Tel. No. 0 PER'S INSURA'CE WAIVER: I am aware that the Licensee does not have the insurance coverage or its s::5- stantial equivalent as required by Massachusetts General-17--w-1, and that my signature on this pe^it appiicaticn waives this requirement. o-•ner Agent (?lease c`.eck or.ej r � JOSEPH TATONE & ASSOCIATES , LLC ARCHITECTURE PLANNING INTERIOR DESIGN June 8, 2007 Mr. Matt Thomas Thomas Carpentry 5 Willow Street North Reading, MA 01864 RE: Garage Beam - Graef Residence, 55 Oakes Drive, North Andover, MA Dear Mr. Thomas, I have observed the completed installation of the 2-span continuous (2) 1 3/a" x 11 7/8" LVL garage door header beam for the above named project. The installation is in conformance with the recommendations of the manufacturer (Boise Cascade) regarding bearing lengths and nailing of the LVL plies. I take no exception to the installation. Respectfully, >ke � ,.. N0:91"SO�' Joseph Tatone AIA ►Rvr 178 Park Street Suite 102 Row North Reading , Massachusetts 01864 voice (978) 276- 1960 fax (978) 276- 1961 email : jtatone@jta-architects.com opo��t Page# of pages �Ci(ivy c? CC� v p ki Proposal Submitted To: / Job Name Job# '7" Address Job Location �S dam'4r 4�r /� , Date Date of Plans C cC /Va Phone# ` g / 2 Fax# Architect We hereby submit specifications and estimates for: -!e Y�`'�1 ..e . ......... C _e--..... ~ fPJ�loV? NCc/S y^ N ^. J-G m t vP � .c_Q..... ll� ��.n h......... ..... .... _. ... ..............._ ........... ._ 7p7roposehereby to furnish material and labor—complete in accordance with the above specifications for the sum of: �, O G Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. 01cceptance of Propont The above prices,specifications and conditions are satisfactory and are Signature �� hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined abo/e. Date of will S/G Signature NC3819 _ :, BUILDING PERMIT of 00RoT" qti t1 4 . ...ab�6 0 TOWN OF NORTH ANDOVER 0 L - Z. APPLICATION FOR PLAN EXAMINATION Permit NO: kpr r Date Received °gwreo Date Issued: �2 l0 �SSACHUS IMPORTANT:Applicant must complete all items on this page LOCATION or,+ .s .5 4,, -- PROPERTYOWNER Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes p !Machine Shop Village yes ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repairreplacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer J ,J DESCRIPT ON OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: S eh 4-e Phone: Q'7k Y06 llgC Address: CONTRACTOR Name: Rvr 7�- Phone: 17';19' 9'8'6 F1,4/416/ Address: Supervisor's Construction License: 16 1 3 7 Exp. Date:_ !i s 12� 12- Home zHome Improvement License: S^S" 7 Exp. Date: Zo 1 j r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 4,1 G</-c FEE: $ Check No.: 00 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ���Signature of contractor rZQ q Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ,❑ Notified for pickup - Date ._........__...................................................--._.._........................................................._..........._............___._......................................................_...------..............................................................---..........._................_...............................-----.....---............................ .......... Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Location No. zz Date �d NORTH TOWN OF NORTH ANDOVER O F S ` Certificate of Occupancy $ Building/Frame Permit Fee $ s^GNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ti Check # 22520 Building Inspector i NORTH own of over dover, Mass., C OC m C:MEWICK f S RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 7 BUILDING INSPECTOR THIS CERTIFIES THAT / 1...<..<.1/.......... r ........................... ............. Foundation jhas permission to erect........................................ buildings on ... �....... ,� � .. .................................... Rough 1..'wl ..i ! y to be occupied as...................... 1 . .......t7... /... Q.� ...................................................................... Chimney e provided that the person accepting this p it 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 Final PERMIT EXPIRES 'IN 6 MONTHS UNLESS CONSTRUCTIO TARTS ELECTRICAL INSPECTOR Rough :... Service BUILD G INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove 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 Qet. i �•s_. Nl:issachusems - D(: artmcnt of Public l B(1-ard of Buildiif-Rei-ulations and Standards+ F Construction Suparvisor License License: CS 101367 — — — R69tricted to: 00 MATTHEW THOMAS 5 WILLOW ST NORTH READING, MA 01864 Expiration: '2/15/2012 ("nnmis tier Tr#: 1013671 .aolbalslunupv O WCONIGV321 Hl80N ~ 1S MOI�IM 5 vi! OHl M3HIiVV kUl49 lV0 SyWOHl 1 Ienpinipuj -adlll '•., 1 9££482 #Jl t lOZ/U5 :uogemdxg 65L55 L uopei;sl6aa q Nolo INOO1N3W3A021dW13WOH T s aspuul pubs ol)bp 2;)U:tplpl!na 3o pauoa U� Jvarrre�aru�uoril a�� I T North Reading, Ma (978)886 8444 Thomas Carpentry as represented by Matt Thomas, will provide the following services for the Graef residence at 52 Oakes st North Andover, Ma. - Remove and dispose of old siding and under paper - Install new Tyvek house wrap and membranes where required - Replace garage door trim with PVC - Either replace trim or skin with aluminum anodized white (rakes and facia) - Install new Andersen 400 series windows in pace of originals - Install new elliptical window over door - Install new French door in rear - Install bow window in front - Install new natural pine trim inside - Install new Hardie brand fiber cement siding pre finished textured beaded - Install new vinyl brick on front lower in place of"shakes" - No treatment to porch window area, due to future project - Install shudders on front windows color TBD - Clean site and dispose of all waste in dumpster on site Start date approx April 5 2010 Payment schedule: - Deposit of$12500 due on April 5 2010 upon signing of contract - 2nd payment of$10000 due approx when old siding removed and walls prepared for new - 3rd payment of$10000 due approx when all windows installed and interior trim on - 41b and final payment of$9500 when job complete and Graef family is satisfied Any extras will be discussed when and if they arise I commit to perform the above work in a timely and professional manner: Matt Thomas ti�i/� � �f0 I commit to pay for4ab e o i performed timely and professionally: Martin Graef 41 S t t." The Commonwealth of Massachusetts Department of Industrial Accidents Office of Lnvestigations 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): M q 1-7` e 4.9, Address: ;1 Lv ;/�� S'-f City/State/Zip: /(��� /�ir•� �� `�(a 0(kG61Phone#: ?9- F,?6 --9*4;,C/ Are you an employer?Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2•LJ 1 am a sole proprietor or partner- listed on the attached sheet # 7. L"J modeling shipand have no employees mployees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. o workers' comp. insurance 5. 9. Building addition � p. ❑ We are a corporation and its required.] officers have exercised their 10.7 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[I 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' comp,insurance required.] 13.0 Other Any applicant that checrW box must also fill out the section below b-—in -'*.eirwor-^s'com,.a,s—ni^^Policy: ,r 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 s thepolicy information, lihp c1'and�ob site 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). 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 of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: --- Date.: Phone#: E only. Do not write in this area, to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.PIumbing Inspector son: Phone#: 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 15.2, §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 pernait 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 Revised 5-26-05 Fax#617-72.7-7749 www.mass.gov/dia