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Home My WebLink AboutMiscellaneous - 68 Martin Avenue e,pr £3 � c�ac�� aa sada Date.... ........e 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SAC US This certifies that ..... .... ................ ...........�L..................................................... .. has permission to perform....... ..................................... wiring in the building of........ ............................ t..... .............. .North Andover,Mass. Lic.NO.A.�4-. ....... .................................................. --_ELECTRICAL INSPECTOR Check # 433 TLIECOA MONWE4LTHOEMASS4CHUSETTS Office Use only DEP.47UA1E11V1'0FPUX1CSAFETY Permit No. -1,33 a' BOARDOFFMPREVFV770NREGUTA77ONS527CM 12W ��— Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Ave Owner or Tenant Owner's Address r ve— Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground M No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures /� n„"„ Swimming Pool Above Below Generators KVA `(' Kms((G� ground round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and _J Pumps Tons KW Initiating Devices Nd..of Dishwashers Space Area'Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections ED No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs . No.of Motors Total HP OTHER kWrM eCorerago RZMtlDtberagtritenlm&ofMmada>MGenaalI-aws Maw aamatIiab&ykwa=Pbkyim1xlmgCon Covwdg�adssu alegnvalerlt YES NO 11"abrMadvalgiptoofof'sarnetothe011ioe YES IfyouhawdpclodYES,pl mm&&thetypeofcoverag�by Icu box F*afiMDPk F:�rlatedvahreofF7aeWolk$ w0doostrtt ]iiSpectiorrDa�l2e�,es�a Final signedurxlAr ofpajtuy J p EIRMNAME '-�I ^C� UO=No [icc e� ,1'�CG t } (,c�a� sigr ue ` Btl CUMNOO 0 3� —0q24V�-- At TeL No SIM ERS INSURANCE WAIVER;Iamaware thatthe Lmwdoesnothavethe irarrarrE�mvaageoritssutsmtialegwvalentasraluaadbyMa%aclatmCler laws M that mysignature onthispermit application waives this leq ikrr>`nt Please check one) Owner ® Agent Telephone No. PERMIT FEE$ SignaLure ot Uwner or Agent Location 18 �1� '� Y No. 3 9 G Date 1 - 8- 03 NORTh TOWN OF NORTH ANDOVER O f • s Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 1�CHusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 O Check # ` C113 16100 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING x.,+ �.. ie BUILDING PERMIT NUMBER: DATE ISSUED: X 00 SIGNATURE: c .� Buildin Commissioner/inspector of Buildings Date z SECTION 1-SITE INFORMATION O LI Property Address: 1.2 Assessors Map and Parcel Number: 000 i3-90 Map Number Parcel Number W 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required F7Provided v l /5-_ 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSIUVAUTHORIZED AGENT rn 2.1 Owner of Record \ Name(Print) Address for Service 7 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O 1 Z 07,�,Y7 License Number mn Address 6(/ �f ` -71-31 1 Expiration Date 1 ic St natu Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Addr ss r Z Expiration Date /� Si ature Telephone V f ; 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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑, Other ❑ Specify Brief Description of Proposed Work: 02 / X30 r PV-&Ah� Sld �4 G x I —L over�.g�� ea � SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be = OFFICIAL>ETSE ONLY Completed by permit applicant 1. Building 3 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) O _ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 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 authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 3.1( eVq,0t4,/ ��S L L� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief t • Prt t N Simature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS 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 t E i A _. s At r JA 5Li I,C_(L 23 SE`: j Ik 2 — -_ ((i 4 t Q r er( VVI �T iIt 14 L f / TV Z w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name 1;��\��I✓� i�t/� CSN�-1 ► Location: -1 - ��' J Vq LJ City N- 0-N Phone # 7� _ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City Phone#: Insurance.Co. Policv# 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'imprisomnent_asyell_as_chdLpenaltiesin-theimm Afa_STOP WORK ORDPRand..a fine of.(,SillOM)-ajJayagainst.me 1 understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. A I do hereby cetunthe pains and penalties of p at the information provided above is true and coned Signature �.-� � � Date Print name CI-13 Phone# 3 -? ?� 1 Official use only do not write in this area to be completed by city or town officiar City or Town Permit/Licensing. Building Dept []Check ff immediate response is required 0 licensing Board E] Selectman's Office Contact person: Phone#: E] Health Department Ei Other �� ✓fe �ommz�nus�z�ll. a`�l�<��/u.�.,tta - Board of Building Regulations and Standards License or registration valid for individuI use only - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 106275 Board of Building Regulations and Standards Expiration: 7/22/2004 One Ashburton Place Rm 1301 Type: Individual Boston,Ma.02108 WILLIAM A CONATON William Conaton 121 LOWELL RD. ��y WINDHAM,NH 03087 Administrator Not valid without signature '� ` ✓lt•P tJb?7L93L4�'L(.(1P.il(.11L O�i/GC�EClaf..Lia'. X11 a BOARD OF BUILDING REGULATIONSi License: CONSTRUCTION SUPERVISOR Number. CS. 049000 Birthdate: 07/3111963 }}; Expires.07/3112004 Tr.no: 27123 Restricted: 60 WILLIAM A CONATON 121 LOWELL RD WINDHAM, NH 03087 Administrator t NORTH Tovm ofEAndover O c to No. .3 __ . 0� t- C L A dover, Mass.,/—L— o? 3 DRA'rED S u G _` H 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........I�./. ,�1..........A'A.f s.. ............ ..................................................... BUILDING INSPECTOR � 4j Foundation has permission to erect.... .. ............. buildings on .......6... .......,('/,�!4.�7"..N.....�v Rough ' c/ �! OVC�A 0. ~ I, 0 to be occupied as.'5...�.............................A .....q'../ ...... ............ .... ........, r &V VIS *4* 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 I730 ction, Alteration and Construction of Buildings in the Town of North Andover. A/SG 107 ,_ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 4 C 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.