HomeMy WebLinkAboutMiscellaneous - 56 HUCKLEBERRY LANE 4/30/2018 ' 56 HUCKLEBERRY LANE
210/065.0-0211-0000-0 .
1,
3 Date.. .'?.... .-').
... .. .... ... .....
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SS us
s.
This certifies that .... ...................................................................
has permission to perform ........ ..... ..... ...................................
. ........ ....
wiring in the building of............
at.��.... A., —,;.e......... .North Andover,Mass.
-C-11 i�l ..........
Lic.No. ............. .....J.................... .....
Fee................... (I....................
--EL-EcTR16AL INSPECTOR
Check
Y �
Commonwealth of Massachusetts Official Use only
Department of Fire Services Permit No._= 413
Occupancy and Fee Checked?�—
BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/991 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 2.00
(PLEASE PRINT IN INK ORT�A INF RMATION) Date-
City or Town of: , To the Inspect r ofWires:
By this application the undersigned gives no ' of bis o her i tention to per rm the electrical work described below.
Location(Street&Number)
Owner or Tenant Telephone No. – C
Owner's Address C
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps i 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: Installation of Security system
Completion o the followin 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 Above o.❑ In- o Emergency Lighting
rnd. rnd. 0 Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
io Detection and
No.of Switches No. of Gas Burners o. Initiatina Devices
r No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons g
No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.o Water KW No.o No.of Data Wiring:
Heaters Si ns Ballasts No.of Devices or Equivalent
Telecommunications Wirinle
No.Hydromassage Bathtubs No.of Motors Total HP TeNo.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector oj'Wires.
/1 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.
y CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: lllaRInspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, under the ain and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: Sec=-ity LIC.NO.:
Licensee: John S. Bassett Signature LIC.NO.: 1533C
(Ifapplicable,enter"exempt"in the license number line) Bus.Tel.No.: 603 594 5928
Address: Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Li , see 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 ent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $J5
AV IIIIW
101 HIGH STREET, PO BOX 40, NORWICH, CT 06360 FOUNDED 1840
WMW
INSURANCE COMPANIES
(860)887-3553 — TOLL FREE 1-800-962-0800/1-800-243-4080 — FAX(860)886-8270/(860)887-2898
www.nlcinsurance.com
October 31, 2014
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured: Nhon Vuong
Property Address: 56 Huckleberry Lane
Company Policy Number: H5209672
Date of Loss: 10/22/14
Claim Number: C43764
Claim has been made involving loss, damage, or destruction of the above
captioned property, which may either exceed $1,000.00 or cause Massachusetts
General Laws, Chapter 143, Section 6, to be applicable. If any notice under
Massachusetts General Laws, Chapter 139, Sec 3B is appropriate, please direct
it to the attention of the writer and include reference to the captioned insured,
location, policy number, date of loss, and claim number.
On this date, copies of this notice have been sent by first class mail to the
municipal officials named above at the address shown.
Sincerely,
(Fama"m-'- ,.//Yl
Barbara Garofalo
Property Adjuster
Date. .!. . .
TOWN OF NORTH ANDOVER
3:
c
•� �
° PERMIT FOR PLUMBING
s � � •'a
;,SSACHus�
This certifies that . ' `. . ... ..... . . . . . . . . . . . . . .has permission to perform . . . . . . .
plumbing in the buildings of .'r-
at . `S�<.'. . . . . . :��''t��'.!`?!.�"'�`.''�., North Andover, Mass.
�ry i r
Lie. No.. . . . . . . <
Fee,_:,... . . . . . �,�. ... . , .-�. ;�.,.�..� . . . . . . .
�PLUMBIN,Q N CTOR
Check #
5103
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS / c
AleL/4E_ J � DateBuilding Location r y Owners Name '' � ,e Permit# G
h Amount � '
Type of Occupancy �
NewEll Renovation ❑ Replacement Plans Submitted Yes No
FIXTURES
d
H
a
v� a s O U a
O W F W x w CA CnZ
U Z
Pq
z A W A x a
3 A AO A
�asv�c
�S1�gr FLOOR
lv>Hlvr /
i ry�1��
M FLOOR
M l'1J(M
FLOOR
5MFLOOR
6M FLOM
7M FLOOR
8M 1'1_.l M
(Print or type) A/JP Yl + �jVU Check one:
Certificate
Installing Company Name O �rp. 72
Address u)e
Partner.
Business Te ep at Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate thety insurance coverage by checking the approp ' ox:
Liability insurance policy Other type of indemnity Bond ❑
Insurance 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 ❑ 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 Massachusett ate =m �Cod nd Chapter 142 of the General Laws.
By Signature o icense u er
Title
Type of Plumbing License
!v 0
City/Town cense um er Master Journeyman ❑
APPROVED(OFFICE USE ONLY
3456 -) Date../.// Q�
NOR7M
°f,•``° '•�"° TOWN OF NORTH ANDOVER
A _ ' PERMIT FOR WIRING
SACNUSEt
This certifies that .../..(.`r!j .....�J'`Ul�' '��"
.............................................
has permission to perform .....
.............. .........................................................
wiring in the b ilding of........ ...:.y( .................................................
at.............................:. .. ............... .... orth Andover, �s .
Fet/5:,v(>... Lic.Nol.�.�..�............
ELECPRICALI ECTOR
Check # 31A
Official Use Only
Permit No.
Occupancy&Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date I - 2 S v
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform theerival work described below./
Location(Street&Number ,t U L iC yt��
2
Owner or Tenant T u wl L 4/ ,� o
Owner's Address
Is this permit in conjunction�wiiith a buildpermit Yes b� No ❑ (Check Appropriate Box)
U
Purpose of Building 'G—e Gr`tel r, lity Authorization No.
Existing Service 2%Oy Amps -1 G 6 Vats Overhead ❑ Undgmd GI; No.of Meters
New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters
Number of Feeders and Ampacity
i Location and Nature of Proposed Electrical Work
Total
No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA
Above ❑ In ❑
No.of Lighting Fixtures d Swimming Pool grnd ❑ grnd ❑ Generators KVA
t No.of Emergency Lighting
No.of Receptacles Outlets �o No.of Oil Burners Battery Units
No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
Heat Total Total
No,of Di sal No. Pumps Tons KW No.of Sounding Devices
No./of Self Contained
No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices
❑ Municipal ❑ Other
No.of Dryers Heating Devices KW Local Connection
No.of No.of Low Voltage
No.of Water Heaters KW Signs Bailases Wiring
No.Hydro Massage Tuds No.of Motors Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES ANO =
have submitted valid proof of same to the Office YESC0 = If you have checked YES pleaW indicoe the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify) F &:,1 O Q
(Expiration Date)
Estimated Value of Electrical Works _
Work to Start . /'d3—O ca Inspection Date Resquested ��� a Rough Final
Signed underthe Penalties of perjury:
FIRM NAME LIC.NO. 9 G
Licensee Signature LIC.NO. O`
Address 0" 0/ice /1t�1� /4a �C Ur�fil Alt Tel.No.`�l�z/ �Bus.Tel 7�_��/
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not havethe insurance coverage or its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) //)//�
Telephone No. PERMITTEE $ 7�v✓
(Signature of Owner or Agent)
� . . .� . ��"
N° Date..� ..... ..................
t HOR71y, �
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING a
,SSACMUs� 4
This certifies that ......... ...:. '-
.......... ...............-'�.•`'1�;�.......................
has permission to perform ........ .:. .- ,-�-.................u-.... .....---....�
0
wiring in the building of
at.... ....... K: -, ' G t . / 't--...... ,North Andover,Mass
i
Fee_.2...- '�..... Lc.No...y�.::. ...............................................................
ELECTRICAL INSPECTOR
03/02/98 10:00 25.00 RAID
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
�`�� 1
E The Comrnorrwealtl� �� ��----
- f=1 - f Massachusetts Off1c9 U59 Only
Department of Public Safety Permit No.
,1
" " BOARD OF FIRE PREVENTION REGULATIONS 5
27 CMR 12:00Occupancy h Fee Checked_________^
/7 3190 (leave blank)
APPLICATION FOR PERMIT TO PFRFORELECTRICAL
"work to tH peanrmed in t cc3rdenp with the Ma'11RcnUlert7 El�ctricy Cede.X27 CMR WORK
(PLEASE. i'fatNT IN INK OR TfPE ALL INFORMATION
n p Q
City or To. of /J/.�/PT/ Date
-The underrioned applies for a permit to perform the electrical work described below.
To the inspector of Wires:
Location (':",heat & Number)
Owner or 7eoant
—IL jyl EIVT
Cwner's Addie. __�_0Q-- f RK _s%. �01 T t /(,/0,
Is !his permit it conjunction with a buitdin I�1
9 Permit yes ❑ no ,�Y �"�".-----
(Ch�;k Appropriat9 Sox)
Purpose of Buildln .P..C `-;K�'4_
—Utility Authorizatior• No.
Existing Service _
-An�p'g---/�_—___Volts Overhead 1] Undgrd ❑
New Service No. of Meters
Cvr>rhFad ❑ Und rd ❑
Number of Feeders and Ampacity (1 g No. of Meters_
Location and Nat-,,e of Proposed Electrical
No, of iighting Outlets —.
Na- of Het Tubs INo. of Transformers TOTAL
No. of Ughtln Fixtures Above In rr ��" KVA
Swimminq Pool , ornd.C�gmd l_1 Generators
fJq. of Receptacle Outlets -- No. of Emergency Lighting KVA
No._af CII_Surners
No. of Switch Outlets - Battery Units r
No. of Gas Burners FIRE ALARMS —�— t
No. of Ranges ---_—�—� TO A7A7 L No. of Zones
_ No. of Air Conditioners TO
No. of Detection and
HEAT `- Initiating Devices
No, of Dlsoosals TOTAL— TOTAL tlo. of Sounding Devices
No. of Pumps- TONS KW "
No. of Sett Contained
No. of Dishwashers Detection/Sounding Devices
_ Soace/Area HeatinaKW No. of Dryers � —
__ Heatin DrviCe4 KW Local ❑ hlunicipal ((--��
--�"---" Connection I_ J Other
No, of Water H9ato— KW Na. of No, of
Si ns Ballasts Low Voltage
-- Wirin N-
- /
OTHER:No. of Hydro Massage Tubs No. of Motors-.�..Total /
-- .—�HP
INSURANCE
I havCOVERAGE: Pursuant to the requirements of Massachusetts General Laws
e a current Uability Insurance Policy Including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I heave submitted
valid proof of same to this office. YES ❑ NO C7
If you have checked YES, please indicate the type of(."average by checking the 9 appropriate box.
INSURANCE ❑T BOND ❑ 0, MER U (Please Spe•:ify)
Estimated Value of Electrical Work S� (Expiration Date)
Work to Start
Signed under the penalties o� a gu '— Inspection 0001 : lctuested: Rough_
P n ry: Final
f'ln"A NAME
Lir a ree LIC. NO. r G
Signature
Address - 0• ' D l _/1� _✓% r L. �?L�C,�� '� X—LIC. NO. l r
•�: f�/t Nlr°J'T. / /b= f�' Q!� !� Bus. tel. No.if'Q3
O"✓NEB's INSURANCE WAIVER: I am aware that the Licensery clues not have iha insurance coverage or its suit. Telal.
M, -chuserts General Laws, and that my signature on this ar,pPr-atlon waivns this requirement. Alt Tet. No
owner Agent equivalent as required by
_ 9 (Pleas9 check one)
(Signature of Owner or Anann Pte __ ...
Location -6-6, ` f V C � �J`� pe,�- (N-
No. Date _1_ -C—
NORTq TOWN OF NORTH ANDOVER
Of�"aO ,a,grC
� 9
Certificate of Occupancy $
+s'• HU E<t' Building/Frame Permit Fee $ ��
CMus
s�
rr Foundation Permit Fee $
Other Permit Fee $ 3C
t TOTAL $ S
Check # 0 ✓ r
15 '179 Building Inspector
e
TO" OF NORTH ANDOVER
BUILDING DEPARTMENT
kPPLICATION TO CONSTRUCr.REPALR,:RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY.DWELLING
3UILDING PERMIT NUMBER: DATE ISSUED: _
SIGNATURE: /U
Building Cclmmissionerflrjs edor of Buildings Date
ECTION. 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
ate
C
( I Map Number Parcel Number
1.3 Zoning Information: 1.4 Property D mertsionsr
' Lot Area;S Fronii#.:
�otiin�Distri4t. U
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide ReqWio Proviied RNOTed Provided
1.7 Water Supply M.G.LC.40. 34) 1.5. Floud zwe Information: .. 1.8 Scwerige Disposal System
?ublic 0 1.Private 0 Zow Outside Flood Zone 0 Municipal 0 On Site Disposal System t2 or
SECTION 2-PROPERTY OWNERSHIPAUTHORIZED A.GEN..T
2.1 Owner of Record
C5
i [Jame(Print) Address for Service .
Signature Telephone
2.2 Owner of Record:
C
Name Print Address for Service:
A
Signature Tele hone.
SECTION 3-CONSTRUCTION SERVICES
' 3.1 Licensed ons on Supervisor: Not Applicable 0 o
j k u C
�,.distruction Supervisor:
�— License Number
Address (�
Expiration Date
ignature ne
Egg3.2 ftegistered Home mprovement Contractor Not Applicable 0
49ompany Name
�— Registration Number 11r
ddr s
L
Expiration Date
Signature__ Telephone
i
ffN 4-WORKERS CUNTPENSATIOIv(1►2G.I�C 152 § 25c(6)
Compensation Insurance afidavit must be completed and submitted with ihis•1:4) Ation. Failute to provide this affidavitwill result
ial of the issuance of the buildin rmit.fidavit Attached Yes......,❑ .ppo.......0.
N (TOYS b6cri ttoii.ofpro ose8 Wolk;'check all 9 hcable, .
New Construction 0 Existing Building 0 Repaix(s) 0 Alterations(s) ❑ Addition ❑
Accessory Bldg. 0 Demolition ❑ Other 0 Specify
Brief Description of Proposed Work:
4
i
SECTION 6 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be
m leted by rmit a licant
1. Building
(a) Building Pennif P&
Muitt her
2 Electrical (b) Estnnate I Total,Cost of
`Construction
4 Mecharu
3 echa i .. Building Permit fee.t,}.x(b)
cal,.HVAC.
� 5 Fire lrotrxtion r—
s3.
6 Total 1+2+3+4+5) Check N?htibe'
S ON 7a 0WINER;0kT OWNER; ORIZATION TO BE COMPLETED WIIEN
W S A NT U C LIES FOR BUILDING PERMIT
I' as r/A ed Agent of subject property
Hereby authorize « wt v 7o act on
My behalf,in all matters relative to work authorized by this building permit application.
Si nature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I'Iroperty as Owner/Authorized Agent of subject p
Hereby declare that the statements and information on the foregoing application are true,and:accurate.,to the best of my knowledge
and belief
Print Name
Si iature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
i; SIZE OF FLOOR TDABERS 1 2 3kw
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIfv1ENSIONS 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
NpRT1y
ETD
® of
.. ,. ; over
No. 2 X _ :
i �
CN
�A CoCIC LA dover, Mass., I l -a 6 •o700
DRATED PI�C
S H E
BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
J
BUILDING INSPECTOR
THIS CERTIFIES THAT....... ..A .................h.4......�.a..A..N........................ ........................................... Foundation
.+ 11 ( (�
has permission to-ereet....1'.�^. (S buildings on .. J10 VL.......4.�4,..!U .�!.�' ^ &, Rough
................. ............ ................
to be occupied as 3 /1t� ��iv ..Z Ar ............................................................. 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 I 'spection, Alteration and Construction of
Buildings in the Town of North Andover. �a Ia S3, .� PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR
C Rough
.. ...... ........ .........................I........... Service
BUILDING INSPECTOR
Fina_1
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.
i
SEE REVERSE SIDE Smoke Det.
t
t✓fze t�omvnzoozureai o �/�aaaaclzuaet7a
BOARD OF BUILD I G REGULATIONS
;License: CONSTRUCTION SUPERVISOR
Number: CS 023365
Birthdate: 12/04/1957
Expires: 12/0M2001 Tr.no: 13683 i
j Restricted To;- OQ
DAVID REITANO.
56 PLEASANT STREET-
METHUEN, MA 01844 Administrator
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/�•.A� ove7 M.�, /y1�d- �o �07 �q��� ,C�ce 3� W 0
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111 vit
Workers'Compensation Insurance Affi
Please Print
Name:
Location: C Z
( c
Ci \� UvC Phone
am a homeowner performing all work myself.
01 am a sole proprietor and have no one working in any capacity
am an employer providing7eompensation for my loyees vyOrking onthis job.
Com an name: 1\ a
Address
Ci : G Phone*_15..d��2 '�-
Insurance Co. L Jc.,- -_.r Poli # (Q
Company name:
Address
City: Phone#:
Insurance Co. Policy#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00
and/or one years'' prisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I
understand t a c y of this statement m orwarded to the Office of Investigations of the DIA for coverage verification.
I do herby ertify and the ai and p n erg that the information provided above is true and correct.
Signat Date
Print name Phone# /
Official use only do not write in this area to be completed by city or town official' ❑ Building Dept
❑Check if immediate response is required Building Dept ❑ Licensing Board
❑ Selectman's Office
Contact person: Phone#: ❑ Health Department
❑ Other
FORM WORKMAN'S COMPENSATION
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A.
Th 74,ris will be disposed of in:
e
(Lo of F ility)
ignature of ermit Applicant
- 0
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector