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HomeMy WebLinkAboutMiscellaneous - 64 COLGATE DRIVE 4/30/2018 / 64 COLLATE DRIVE 210/081.0-0023-0000.0 I Date....���.'. '.©.�.. NORTH °f<t``° '•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACNUS� \T�� = -�. This certifies that ............. ................ ..... �..... �-?-..................... has permission to perform .........d©r-7.. S E.Y. tom............................ wiring in the building of............!' ..L. ..C<.a;l..&!e ................................ R at....� /)�........................ .North Andover,Mass. Fee. •?� Lic.No. : ,4...............,1� �e►�r.'-ttS ELECTRICAL INSPECTOR 4 Check # let 6971 Permit No. lag l Department of Fire Services O BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05cy and Fee Checked ] (leave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD All\vork to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PL EASE PRINTININK OR 10 - AL.L INF RMATION) Date:— 2 --- ---_ City or Town of: To the Inspector of� fires.• By this application the undersigned gives notice of his o her intention to perform the electrical work described below. Location (Street &Number) 16LIT.e Owner ot-'Tenant KileAomT'elepltone leo. ___ Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No FLX (Check Appropriate Box)_ Purpose of Building Unlit Authorization No. -- - Existing Service 160 Amps /_ZtWolts Overhead Undgrd ❑ No. of Meters New Service 20V_ Amps r J ! (/ Volts Overhead KUnd",rd ❑ No. ol'Meters -- Number of Feeders and Ampacity - Location and Nature of Proposed Electric..^.l Work: Completion of the folio-,vino table may be ivaived by the Inspector of YYires No.of --_- Total - FNo-01 . of ecessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA 1 I ,! No. of Luminaire Outlets No.of Hot Tubs Generators KVA j AboveIn- o. o mergency ,iI`-gff)Dn No. of Luminaires Swimming Pool El ❑ 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 j) 'a ' u Imti tm Devices No. of Ranges No.of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self-Contained _ _ Totals: ��� . Detection/Alertin Devices �I No. of Dishwashers Space/Area S HeatingKW Local Municipal _-__.__-_.j p _ ❑ Connection ❑ Other (I No. of Dryers Heating Appliances KW Security Systems: No.of Devices orXguivalent Na of Water KW No.of No. of Data Wiring: j I - Ile aters Signs — Ballasts No.of Devices or!E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices orIEquivalent OTHER: �— Attach additional detail if desired, or as required by the Inspector of Wire"'.. 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 insurance including"completed operation"coverage or its substantial equivalent. Th(- undersigned heundersigned certifies that such cove5aeis in force, and has exhibited proof of same to the permit issuin off ce. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) 29u / S Iz 3i I certify, tinder thepaaiin-s-and pend lties-of peijt that e information on this application is trite and niplete. �9 FIRM NAME: jolu �/e thlc Cv — LIC.NO.: 3 Licensee: ST6104,e411 -4(-)10A Signature LIC.NO.: (Jfapplicable, enter "exempt"int a license numb lune.) t Bus.Tel. =_ Address: 6h i l 1:n /:•C ko d&c A Alt.Tel.No.: 'Security System Contractor License riquired for this work-, if applicable, enter the license number here: 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 vent. Owner/Agent PERMIT FES: $ s' v Signature Telephone No. •s L ♦ y 4 GJt Location -0 �vL� ,g 6, '. 3. a Na �� Date ,.ORTp TOWN OF NORTH ANDOVER + • , Certificate of Occupancy $ �s CNU5 Eta' Building/Frame Permit Fee $ l- 1� Foundation Permit Fee $ -' Other Permit Fee $ / TOTAL $ Check # '' Building Inspector pORTN 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION + 9SSNCHUS�� Permit NO: Date Received: ' Date Issued: 0, P O IMPORTANT: Applicant must complete all items on this page LOCATION 7 CO,/ PROPERTY OWNER 134 Pn//. c o y Print MAP NO.: PARCEL: iZ 3 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building One family 11 Addition ❑Two or more family ❑ Industrial Iteration No. of units: Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED , Lim-ft,4 4 L moi°,b Z��z.v T Identification Please Type or Print Clearly) OWNER: Name: ,8 d R /G%�' GOA'/V� Phone: Address: l�� ©� -� r-E ep ' CONTRACTOR Name: /1/ o )F ,Aiy L • 91, 4P Phone: 7 0/2 3 y r n� Address: U'����r"' -� /D /*,�D I/�`I? ..� O I J L/S Supervisor's Construction License: 0 ��/V/ Exp. Date: Home Improvement License: / 3/ q5:0 Exp. Date: J4A�p ARCHITECUENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERM T.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ '2 ioO x10.00=FEE:$ Check No.: Receipt No.: Page 1 of 4 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ 1 Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to prod ect �I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signatur f gent/Owner i Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY { INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ []Water Shed Special Permit + ❑ Site Plan Special Permit � COMMENTS El Other I I I M t DATE REJECTED DATE APPROVED CONSERVATION i ❑ ❑ 1I COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.'..2006 I Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Building Setback (ft.) C Front Yard Side Yardir Yard 0 Re uired Provided Required Provides RequiRred Provided s e vation Decision: Comments r Water&Sewer connection signature&date Temp Dumpster on site ye no_ Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: NOTES and DATA— For de artment use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 t NORFOLK AND DEDHAM MUTUAL FIRE INSURANCE COMPANY SMALL CONTRACTORS POLICY RENEWAL CERTIFICATE P0iiCY # R0412920 Named BLAD, NORMAN Agent INTERNET INSURANCE AGENCY, INC Insured 40 FERNVIEW AVE #10 Phone (978) 685-7690 N ANDOVER MA 01845 Agent # 20155 FORM OF BUSINESS: .......... .............................. . ........ ....................... ............. a a ....... ..... I-'- Policy Period: ONE YEAR from 02/04/06 to 02/04/07 This declarations page together with the policy jacket, the policy form and any endorsements, completes this policy. Coverage begins at12:01 A.M. Standard Time at the covered premises. ............. ...... ............ ......... .... .... ... ........... .... ......... r% : . ......... ....... .... 7 1 ......... .......... . .. .............. Basic Annual Endorsements State Taxes Total Annual Add'I/Return Prarnhim Priarnhim nr Fee.% Prpmhmm Prpmotirn $957 $957 2 Bid 11-ocaflon Address if Different L' Mortgagee Information Business Description CARPENTRY "A I I I 1 7 1 I Premmum POLICY DEDUCTIBLE $250 BUSINESS PERSONAL PROPERTY Limit $10,000 Included TOTAL PREMIUM PER BU I LDING $957.00 ...........- ........... 7 1 EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE THE FOLLOWING COVERAGES REDUCES THE AMOUNT OF INSURANCE WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH-D.4 OF THE BUSINESS LIABILITY COVERAGE FORM. . ...... .. ....... LIAB & MED EXP (OCCURRENCE/GEN AGG/PROD COMP OPS AGG) MEDICAL EXPENSES $300/ $ew $600 Included DAMAGE TO PREMISES RENTED TO YOU $5 Inc 1 uded $50 Inc I uded .............. .. .......... .. ........ ........... ......... .. ............... Premeu I Premium ... ...... SEE ATTACHED PAGE .......................................... .............. .... ...... ....... DAT9, A X.P.M. . ............ . ........ . ... ...... ............. ..... ..... .. .. ..... .... .. .. ...... ...... .............. ...... .. .... . .. ........... ............ . . ...... ........... BOP-2 (REV.04/05) Type of Payment DIRECT BILL 10 PAY - - - - - NOR'TH Tovm . o _: Andover O No. 719 dover, Mass., T c LAKE co H11 � �d ORATED P'P�` `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.........6-bl............ke-to-1- a4. . ...... ......... ......... .................. ................................. Foundation has permission to erect........................................ buildings on ....�...�....�.� .:l�'....�i�j........ ....... Rough to be occupied as........ Q I� Chimney P � ................S .f *... . i►.. Q. ..................................... provided that the arson acce tin this'pe' shal�in eve respect conform to the ms of the application on file in P P P g P r. P PP 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION K144" TS Rough . .. ........... Service PECTOR Final Occupancy Permit Rewired 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. "INThe Commonwealth of Massachusetts c Department of Industrial:lecidents Office of Investigations 600 Washington Street N Boston ,VM 02111 www.mass.gov/dia Workers' Compensation Insurance ,affidavit: Builders/Contractors/Electricians/Plumbers kppI licant Information Please Print Legibly Name (l�usincssiOreaniiationilntlivi�lualY. '/ Y D r] ,®y1 �j� M• ��/'1r�/ ,address: ��D / ��N 10 'PI4,1 044AI- 7_/0 _ City;State/Zip: ", Ivpd Afej114.4,O/ Phone 6K 461,2,4 3 Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am (full and/or part-time).* have hired the sub-contractors a employer with d. ElI am a general contractor and 1 6. ❑ New construction -ml I am a sole proprietor or partner- listed on the attached sheet.' F1 Remodeling ship and have no employees These sub-contractors have 3. E] Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] exemption right of er ti1GL I I.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work g P P myself.[No workers' comp. c. 152, §1(4),and we have no 12.[rRoof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] k.\ny applicant that checks box(t I must also fill out the section below showing their workers'compensation policy information. y Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating:;uch. Contractors that check this box most attached an additional:,beet slowing the name of the sub-contractors and their workers*comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_-_—_ - --------_._-- -- --- Policy 't or Self-ins. Lie. !I: —_—__ _ 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!,IGL c. 153 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP Nk ORK ORDER and a tine 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 DLA for insurance coverage verification. I do hereby certify un r he pains anal penalties ol'perjury that the information provided above is/rile and correct tiin;tture: nate: �Yjiciul use only. IDo nut write in this urea, to be�wnipleted hr cilp or town g1ficial. I City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Cleric 4. Electrical Inspector 3. plumbing Inspector 6.Other 1 Contact Peron: Phone ro ® l Page# of_ pages Norman L Blad Construction 40 Fernview Ave. #10, N. Andover Tel: (978)687-6263 Lic#016141 - MA Reg# 131950 Proposal Submitted To: , Job Name Job# Address / Job Location Date �f �z Date of Plans • O (� Phone# Fax# Architect �..., We hereby submit s ecificat' ns and estimates tor.. __ _- ._.. _.. P J Altl r _ t We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ Dollar with payments to be made as follows: 07 _ ♦.'�� Any alterationonly or on deviation from above specifications involving extra charge o will be Respectfully executed onl u written order,and will became an extra char a 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 it not accepted within -30 day 0.cceptance of i3lropool The above prices,specifications and conditions are satisfactory and are Signature � 1 hereby accepted.You are authorized to do the work as specified, Payments will be made as outl d above. Date of Acceptance G1?1 Signature NC3819 MADE IN USA I I BOARD OF BUILDING/REGULATIONS Wq OR License: CONSTRUCTION SUPERVISOR 4 Number: CS 016141 Birthdate: 03/15/1947 `- Expires: 03/15/2008 Tr.no: 20180 I Restricted: 00 } NORMAN L BLAD 40 FERNVIEW AVE#10 N ANDOVER, MA 01845 Commissioner i I Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131950 Expiration: 10/13/2006 Type: Individual i NORMAN L.BLAD NORMAN BLAD 40 FERNVIEW AVE #10 N.ANDOVER,MA 01845 Administrator 4 li I I I x a T II