HomeMy WebLinkAboutMiscellaneous - 7 VILLAGE WAY 4/30/2018Date.�.'. t::�.-..0.-..��....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
'This certifies that ... f P...'. `.. A..J........ w.:P''1.....................................
has permission to perform(— ` S ..... ..
....................................................................
wiring in the building of ... L. f.5?
at .......... v.4.�L �. �.......(..�!.A.`�......................... . North Andover, Mass.
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Fee ... 3....... Lic. No.�' `�'.3Q..................... `..........�.A!u....
ELECTRICAL NSPEc-m
Check # �R 4-
3 j
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HT C0HV0NWEALTH0FARSSACflUSE77S
DEPAY1A&— 'OFPURIICSAFMY
BOAROOFFIREPREVEMONREMUTA770NS527CMRI2-00
Office Use fl��
Permit No. �]J
Occupancy & Fres Checked
APPLICA.TIONFOR PERMIT TO PE'RFORU 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) .7 1 A o,/Al d0 I Jav
Owner or Tenant JQ
Owner's Address `7 1 /,".
Is this permit in conjunction with a building permit: Yes M No r7 (Check Appropriate Box)
Purpose of Building /.�d1t1_1 Utility Authorization No.
Existing Service Amps�Volts Overhead Underground No. of Meters
New Service Amps / Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work e '
No. of Lighting Outlets
Total
No. of Lighting Fixtures
FIRE ALARMS No. of Zones,
No. of Receptacle Outlets
Tons
No. of Switch Outlets/,
No. of Ranges
Total
Vo. of Disposals
No. of Detection and
To. of Dishwashers
Tons
'o. of Dryers
Initiating Devices
o. of Water Heaters
,). Hydro Massage Tubs
KW
KW
No. of Sounding Devices
HER -
4
mceCA c� Paist lD 1rieq;1 miff$oflv.
acurtatLiabAtyk u<*Pb&,yirrk)
subrniled valid proof of same io the off m
irrgthe _ _ box
RANGE BOND
No. of Hot Tubs
Swimming Pool Above
No. of Oil Burners
No. of Gas Burners
No. of Transformers
Below Generators
round
No. ofEmergency Lighting Battery
Total
KVA
KVA
No. of Air Cond.
Total
FIRE ALARMS No. of Zones,
Tons
No. of Heat
Total
Total
No. of Detection and
Pumps
Tons
KW
Initiating Devices
Space Area Heating
KW
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Heating Devices
KW
LocalMunicipal Other
O
Connections
No. of
No. of
Signs
Bailasis
No. of Motors
Total HP
raa wati is -. V r...
• I•• t° ::c- ::a y � � � r
Estimated ValmdElm" Work $
to Start liqxrtionDaleRegiested Rots F�
i underTrIftrolties ofpCOT-.
NAME LicffwNo.
LmwNo ?�
BusmessTel No.
At Tel No
R'S INSURANCE WAIVER; I am aware that the Lim does nothave theirmuance coverage orits str)xlantul egtuvalaft as regtmed byNlassac mez General laws
my signature on this peurvt application waives this regmen-ent
check one) Owner ® Agent
Telephone No. PERINJIT FEE_ _
$
Signature of Owner or Agent
Name
Location:
The Commonwealth of Massachusetts
Department of Indusfial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
City Phone #
QI am a homeowner performing all work myself.
E5(1 I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for n -y employees working on this job
Comaanv name:
Address
City: Phone #
Insurance. Co. Policy #
Company name:
Address
City: Phone #
Faiture 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' imprisonment_as_weJt_as_chni penalties in-the_fam Ufa-STDP VA)RK ORDER, -w a..fim�f ($1DO oD� arlay against -m,- t
understand that a copy of this statement may be forwarded to the Office of Investigations estigations of the DIA for coverage verification.
1 do hereby certffy unler the pains and penalties ofpedury that the information provided above is true and correct.
Signature
i3/s
Print namee�1�%f/V Pbone.# k1 --�
Official use only do not write in this area to be completed by city or town offidar
City or Town Permit/Licensing
D Building Dept
E]Check if immediate response is required E] Licensing Board
E] Selectman's Office
Contact person: Phone # E] Health Department
F, Other
F. COMMONWEALTH OF MASSACHUSETTS
kDIVISIONOF PROFESSIONALf I
-OF ELECTRICIANS
AS A REG JOURNEYMAN ELECTRICIAN i
ISSUES THIS LICENSE TO ', y
HERMAN 'H- WEN
,38 QUARRY STREET, i
i ,QUINCY MA 02169-4123
39383 E 07/31/04 372705
e
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ift
Location ZJ*-'4`-�
No, Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 3 / 3,;--
t%( ' trr)
n
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Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
�RENOVATE,
x4..
::3
BUILDING PERMIT NUMBER: `La DATE ISSUED:
92�v
SIGNATURE:
Building Commissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
A2 Az
Map Number Par Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (so Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Re uired
Provided
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 0
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSIiIP/AUTHORIZED AGENT
2.1 Owner of Record
�e a a
Name (Print) Address for Service
n
Signature - Telephone
S
2.2.Owner of Record'
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Con t ction Supervisor:Al
License Number
n
A 01
Address
(�
lz i o
V 1►L� 0,-7-(6l
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
l Lo -
2
ompany Name
Registration Number
YL Gp2
Address
o � O
y&&.C��
Expiration Date
Signdture Telephone ly
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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 (checkall abnlicabte )
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
s J .-J r -10--1 1 _ / — / _ Or
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
OFFICIAL iiSE OI.Y" ag ,q, 4
Completed by Ermit applicant
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
�,4J
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
D
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
MAI 1 - G as Owner/A�thorized Agent bject property
Hereby authorize A/- �QG,I1��Y1 to act on
My behalf, i all matt rs elative to ork authorized by this building permit application/
103
Sionature o Owmer Date
SECTION p7b OWNER/AUTHORIZED AGENT DECLARATION
er/f,D°t/[ IAs 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
/.ler Ta Vl Vtl�_
Print Name
l//
IL ✓„z„a o1-�� e
Si nature Sf e ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 ST2ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAI.OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
9
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BOARD OF BUILDING REGULATIONS M
j; License: CONSTRUCTION SUPERVISOR
Number CS' 078682
{
t Birthdate. 01/21/1957
Expires: 01/21/2005 Tr: no; 21086
{ Restricted: 00.x'
j HERMAN WEN
j 38 QUARRY STREET,' ( ...�,
QUINCY, MA 02169' Administrator
�UCOMMONWEALTH OF MASSACHUSETTS
J
jr OF ELECTRICIANS,
AS A REG4-JOURNEYMAN ELECTRICIAN!'
ISSUES THIS LICENSE TO
` t to •'iF
HERMAN ,H.. WEN
. 38 QUAFZRI( STREET'
Ju"' I
'� " QUYNCY MA '02169=4123"
3938.3 E., 6731/04 ° ..
� - 372705
Fold, Then Det&ch Along All Perforations
a I
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!3,ard,*Of iuilding Regulations and Standards'
HOME IMPR&EMElSlt- 6N-rkACt6R
Regi-stratici-w. 13-4292,
piration.
',4 10/2'3/03 -t
V '-Df3A*
'4�
DF -
HARMAN "W. -'EN :'
38 QUARK St -
QUINCY',MA0216 . q
Administrator
I II'Zqlmi
le # of _
Proposal Submitted To: Job Name Job #
Address fl Job Location
' Date Date of Plans
a , >'
Phone # Fax # Architect
We hereby submit specifications and estimates for: ........... ____._ ... .. .............. ................. ... _........ . ....._...._
! , y r
....___,,..___...._._ „f. _� _
t � ,
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We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of:
$ �A-- Dollars
with payments to be made as follows:
• An alteration or deviation from above specifications involving extra costs will be
Any p g 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.
Occeptance of Propool
The above prices, specifications and conditions are satisfactory and are Signature M61mm—
hereby accepted. You are authorized to do the work as specified. g
Payments will be made as outlined above.
Date of Acceptance Signature T ' - f
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Imo' NC3819 MADE IN USA
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N° 1;,455
Ir
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that //Sl? !. 114 4. f... l��..�.............. .
has permission to perform ............................
plumbing in the buildings of . C. //< .......................
at .....-7V.: C. .5' .. L<. �4 .Y....: , North Andover, Mass.
Fee. a2. Lic. No.. ?.31. L. .......
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
),I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or`Ty� )
—IPermit# K Mass. Date v fir%
' Building Location—, Ow is Name �
Type of Occupancy Residential
11
New ❑ Renovation ❑ R acement N Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg, &Plg. CO. Inc. Check one: Certificate
Address Pl@sant Street [a Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone --78.1 $ - 7 7 7 ( 1-1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No El
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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 ❑
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 the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Oapter 142 of the General Laws.
By_ _
Signature of Lice ed lumber
City/Town _ Type of License. Master ( Journeyman ❑
_
APPROVED (OFFICE SE ONLY) License Number 8322
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SUB—BSMT.
BASEMENT
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1ST FLOOR
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2ND FLOOR
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3RD FLOOR
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4TH FLOOR
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Installing Company Name Heritage Htg, &Plg. CO. Inc. Check one: Certificate
Address Pl@sant Street [a Corporation 714
Stoneham, Ma 02180 ❑ Partnership
Business Telephone --78.1 $ - 7 7 7 ( 1-1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ® No El
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy IN 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 ❑
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 the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Oapter 142 of the General Laws.
By_ _
Signature of Lice ed lumber
City/Town _ Type of License. Master ( Journeyman ❑
_
APPROVED (OFFICE SE ONLY) License Number 8322
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