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HomeMy WebLinkAboutMiscellaneous - 7 COMMONWEALTH AVENUE 4/30/2018 / -7 COMMONWEALTH AVENUE 210/002.0-0011-0000.0 5_ The Commonwealth of Massachusetts (l:i icc Use Only Pewit No. Department of Public Safety Q = BOARD OF FIRE PREVENTIO9N REGULATIONS 527 CMR 12Occupancy b Fee Checked. 00 3/90 heave blank) 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 % — 30— S)7 City or Town of�,�Q �elJ�7dor�2 To the Inspector of Wires: The undersigned applies for a permit to perform th electrical work described below. Location (Street & Number) 06- / "� � Owner or Tenant 66c: 4- 0&;r Owner's Address 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 ❑ 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 y /--4, No, of Lighting Outlets No. of Hot Tubs No. of Transformers tal KVA No. of Lighting Fixtures Above In- No. Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No, of Air Cond, Total No. of Detection and tons Initiating Devices No. of Disposals No. of pumps Total Total Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 1:1 ❑Other Connection No. of Water Heaters KW No.nof Ballasts No. of LowWirVoltage ng No. Hydro Massage Tubs No. of Motors Total HP OTHER: d�YJ INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Lia ility Insurance Policy including Completed Operations Coverage or > substantial equivalent. YES[r NO ❑ .I have submitted valid proof of same to this office. YES or ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE OND ❑ OTHER ❑ (Please Specify) Expiration Date Estimated Value of Electrical Work S Work to Start —,31— Inspection Date Requested: Rough G,,/z! i 1/Final �i•L!r 4fz�� Signed under the penalties of perjury: FIRM NAME L 7/� /� / �� rF' L! /v LIC. NO. e oZ+ Jr2l Licensee S Signature LIC. NO. , jrt /,WL- Address � C ��� � Bus. Tel. No.Sl-k— 4�,P'4 71fs'fi Alt. Tel. No. 014NERIS INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial 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. PERMIT FEE S / ✓ (fit/ Signature of Owner or Agent i �- ' !2 1489 $ NORTH "O° TOWN OF NORTH ANDOVER 3? a..• - - L i p PERMIT FOR WIRING ,SSACMUSE� .Nr This certifies that ...................................-.-r.-....Q.:.-......... `.c................... Q 1 has permission to perform-,,... ................. ........... ................... j wiring in the building of at... .. '... ....... ,North Andover,Mass. F (5............ Lic.No ...�.P��............................. . . .................... i ELECTRI ALI�OR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Location 1) C-L2 tM w 0-J w eL� V 1 v--L No. ('00 Date 5 - a a , U.) NORT1y TOWN OF NORTH ANDOVER f �,r 3? � •• O 0 w 9 j • � , ,S a Certificate of Occupancy $ fs" E Building/Frame Permit Fee $ SACMUS ` Foundation Permit Fee $ Other Permit Fee $ .- TOTAL $ 12� Check # 2 Qq e 15 5 Si f Building Inspector t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1 APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Th>fs;Secf 41*r offf lase Oily B1ibDING PERMIT NUMBER: l DATE ISSUED: rn t� o0 �. SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION I Z 1.1 Property.Address: 1.2 Assessors Map and Parcel Number: O �r l ?-cfS Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District proposed Use Lot Areas Frontage(fl) 1.6 BUILDING SETBACKS ft Front Yard I Side Yard Rear Yard Required Provide Reqwred Provided Re red Provided 1.7 Water S 1.5. Flood Zone Inforoution: 1.8 Sewerage Disposal System: applyrivate C.40. S4) Zone Outside Flood Zone 0 Municipal 0�BOn Site Dir Public 0 � Private 0 � P poral System 2 J SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record CAMZAS� Na e(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 2(o -L Of -icen Const1ct rSupervisor. O U License Number tddress # Expiration Date ignature Telephone 2 Registered Home Improvement Contractor Not Applicable ❑ ompany Name Registration Number r ldress r Ekpiration Date z anature Telephone G) 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. Si ned affidavit Attached Yes....:..17 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building 0 Repair(;) 07 terations(s) ❑ Addition ❑ Accessory Bldg, ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: A G SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFXCISEfUNLl� r Corti feted b rmit a licant *, -4c I. Building --M (a) Building Permit Fee (J Multiplier 2 Electrical W.V (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) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT q f A U A frASC0 I, lP M V 1 as Owner/Authorized Agent of subject property Hereby authorize ! �r Y`r- ' � 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, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR,SLAB SIZE OF FLOOR TIIvMERS I sT2ND 3 PLD SPAN DIMENSIONS OF Sl1,LS DD,4ENSIONS OF POSTS DD,4ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL,GAS LINE 511b10- FORM 11b10- FORM - U - LOT RELEASE FORM if INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ............................ ............................................... APPLICANT �R, f V,+AI1JUc� A - CAfrrt%CC) PHONE 9 - (o9/"s�}� .—b ASSESSORS MAP NUMBER LOT NUMBER G/� - 4 Slr SUBDIVISION LOT NUMBER STREET + CO MPX-1-) PJ &, Aoc STREET NUMBER ........................... OFFICIAL...E................................a US ONLY .■■..........NONE■.■...................■t■t■..■.■..............■A■f.■..■.■■■ RECOMMENDATIONS OF TOWN AGENTS ...... .............. .................................................... < i DATE APPROVED O b CONSERVATION ADMINIS OR DATE REJECTED colvwrrls ( w eve 0�,^ /60 — nasal a.l Feu 2.x� s`�s DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD IN C- OR-HEALTH DATE REJECTED DATE APPROVED SEPTIC O - DATE REJECTED COMMENTS PUBLIC WORKS—SEWER/'WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Profeselonai Land Sunreyors&CMI Engineers MaRrAG ZSPECTION ESSEX SURVEY SERVICE 1958• 6 P= OF LAND OSBORN PALMER 1911 • 70 PLX LM ZD IN BRADFORD d WEED 1885' 72 h• �1af1 aVF MASS. � 47 I I 1 OwElc/��1 I hog•� , ` I I 4b Z rra NOUCE:THE UNDEnSIONEO WILL NOT BE RESPOHSIRLE IF THIS PLAIT IS USED FOR ANYTI1100 OTHER THAN MWITUA0E 11URPPSr5:NP1 fIIR Ap01T10115,FENCES. PLAMIXCS.001111DANIES•SPECIAL PERMITS OR VARIANPES. stopper R Mello, A Registered Lend r Do by Certify That The,Above Mor �e y i j on plot Tan Was Prepared For Am' ��;�'( �+dI/nNt 1kc, in Com etion With A II) 1 b And Is of Intended Or Represen Property Line Survey. No s t. It t Be Used For Establishing Fence, Hedge Or Building Lines.' No Respons ty [s Here i To The Leel Owner Or Occupant. This Plan Shall Not Be Accepted For R ding. tion Of a Strictures As Shown Hereon This Plan Has Been Prepared For :e lianoe With The Local Applicable CowftywacinB purposes Only For 1 A By-Laws I Effect When Constructed, Above Party And Is Not To Be Usi ii spect To rizontal Dimensional _ For Boundary Measureo ants. W to Or pter 481 Of 1987. Subject Property Is Located In i ?ogle On A Federal Insur 7a�,I�s ration Deeipdted Flood � .10 Hazard Aske Per_!!ep O� I q q I 31317 C'0 Datexi baa 3 ISTEP•,p� JWe y ?cel .'Nski 2273 FG 3/4 104 LOWELL STREET PEMODY,MASS.01000 9 1 I� 1 , 96866LZTBLT 6028T TOOZ.ZT'AO� i 4T0/ZTO'd tV0# fi Elizabeth D. Weber My Commission Expires:February 26 , 2004 . I i I NOK T►y 0 0Andover 0 I.- 21M. 00 No. �j / * - h �• -a/�-A m a R o LA E dover, Mass., COCHICHEWICK V ADRATED APS\ 5 '9S BOARD OF HEALTH PERMI T T D Food/Kitchen Septic System M A� v / CA r r 4 y BUILDING INSPECTOR THISCERTIFIES THAT..... ..,../....... ............................................................ .................................................... ........................ Foundation has permission to erect...A......Q. v' ....... buildings on Commov � � �..u.�. Rough to be occupied as....corvo I.J.......P 9 Q.I......�.�.....r r► .r r Chimney ......... .... ..... .......... ........................................... provided that the person accepting this ermit shall in eve res ect conform t the terms of the application on file in P P g P every P PP Final this office, and to the provisions of the Codes and y-Laws relating to th 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 PERMIT EXPIRES IN 6 MONTHS Final o o M vvELECTRICAL INSPECTOR P" jW* r#r%t L%A*gJNLESS CONSTRU O S ART Rough .. ...... ................... ........t&0"9'0t.......................................................... Service Z M BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Prentises -- 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.