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HomeMy WebLinkAboutMiscellaneous - 71 WINTERGREEN DRIVE 4/30/2018 (2)_r 344 Date./ .". d. -.off.... NORTH TOWN OF NORTH ANDOVER py 4t'" ,s,•UOL PERMIT FOR GAS INSTALLATION 9 This certifies that .,.1.1-i �-6i . a. P-% .... P.. „ . has nermission for gas installation .... in the buildings of ... 5/'nl' f' ........................... at ..7% ... North Andover, Mass. Fee.?. Lic. No... ��.� .. ...... ....... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts City/Town of . System Pumping Record Form 4 M yV RECEIVED JUN IU5 `1012 I TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location:e4/ Rig onto o� S Left / Right rear of house, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town State 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes D- K10 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locationwere contents were disposed: Lowell Waste Water Zip Code State_ 1 L 0 Code Telephone Number `"T — 2. Quantity Pumped 0 e'S ptic Tank Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date -(y-('-) cep24 t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 N ASSACHUSETTS UNIFORM APPIIICATON FOR PERMIT TO DO GAS UTMG Type or print) NORTH ANDOVER, MASSACHUSETTS Date :Pee— (Q� -k9 joc D Building Locations Amount S �J Owner's Name hr New ❑ Renovation Replacement ❑ Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name TAC /{S cert% Corp. Address �� �M �2 ° ❑ Partner. Business Telephone 5o Name of Licensed Plumber or Gas Fitter WeI.JPjI ❑ Firm/Co. INSUR-ANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®, No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: [ am aware that the licensee does not have the Insurance coverage required by Chapter I421 of the Vlass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's ,Agent Owner ❑ ,Tent ❑ hereby certify that all of the details and information l have submitted (or entered) in above application are true anti accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Coded�h ter 1 - of the General Laws. By: Title CitviTown A-PPPOlv'EDio Fric;-usFt)NI,Y) Signature of Licensellumber Or Gas Fitter ❑ Plumber j..,?, CY%F Gas Fitter tcertse wumoe: ❑ Master �-1 Journeyman going (Print or type) Check one: Certificate Installing Company Name TAC /{S cert% Corp. Address �� �M �2 ° ❑ Partner. Business Telephone 5o Name of Licensed Plumber or Gas Fitter WeI.JPjI ❑ Firm/Co. INSUR-ANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®, No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: [ am aware that the licensee does not have the Insurance coverage required by Chapter I421 of the Vlass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's ,Agent Owner ❑ ,Tent ❑ hereby certify that all of the details and information l have submitted (or entered) in above application are true anti accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Coded�h ter 1 - of the General Laws. By: Title CitviTown A-PPPOlv'EDio Fric;-usFt)NI,Y) Signature of Licensellumber Or Gas Fitter ❑ Plumber j..,?, CY%F Gas Fitter tcertse wumoe: ❑ Master �-1 Journeyman THEC 9W0NWE4LTHOFMASS4CFIUSE77S Office Use only DEPARTMENTOFPUBLICS4FETY Permit No. BOARD OFFIREPREVENTIONRWUL4TIONS527CMR12.00 --- Occupancy & Fees Checked OAPPUCATIONFORPERWTOPEUORMELECTRICAL 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) Dat 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/ 1,0J i`an �' -&sA) (��� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes o (Check Appropriate Box) Purpose of Building %— AA M / %, � Utility Authorization No. Existing Service2Q_ Amps % ZU/ -Lyovolts Overhead E3 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 o9 ` /,>cao's No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundg1:1round El No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners ALARMS No. of Zones of Detection and N° 2662 Date f..u............................ itiating Devices of Sounding Devices of Self Contained It NoRTH-tection/Sounding Devices a;•'.;�``-°- o TOWN OF NORTH ANDOVER at Municipal Other F p Connections _ PERMIT FOR WIRING t - This certifies that .'.� -: ?'' �. ............................................................................... / has permission to perform....:.......................................................................... wiring in the building of ... .,j............................................................. .. at�/Z ¢ civ. !— .............. .:�r.�- .........................(:. �,..........�.`.�..... North Andover, Mass. Fee .............. Lic. No"'G ...................... - .. ..... l�/I ELECTRICAL INSPECTOR Check # / v YES ©/ NO M ; thetMxcfwaagebydnkingthe Expiration Date d Vaht dUecftral Wads $ 7rao"'OG Final WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Lm13 % Sd / �6L l amrssTel. Na 9 �k dd _ Q y C S%f7�c� 7— Gtt4��ro, cY � I/ Q iL IE AI<TeLNa 9,71- OWNER'S INSURANCEWAIVER;Iamawxethatt rLiaedoeslnott lbe im=cmeaWtztls atec>i diatastegmWby aEeosCalaalLaws a nddAmywarnthispeMitE Iwdi%tSftrC4i inat (Please check one) Owner Agent ❑ Telephone No. PERMIT FEE $ Location _/� �,f -,�-�.%t-cam,�s� _.I/)/,- No. 2No. I/ Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ J �� Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # ;J 9-1; l q � i 3 1 7 Building Inspe r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING :.. ..- cx It BUILDING PERMIT NUMBER:�® DATE ISSUED: — o / A - Craoo,04�t to /aW SIGNATURE: /9,& Buildrng Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 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 Required— Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal Syst.MX Public ❑ Private ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name PP 'nt) Address for Service Signatur Telephone 2.2 Owner of Record: 7 ,ik4" / * e --e/, z � , Na,me P t Address for Service: / P 7.f-)0 ��� /J— 7o Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (rLG.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 ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other L❑. Specify,/- %-..,si ` l ✓o Brief Description of Proposed Work: v/ �o,.s7i���` Z- /'uC/rns b9J<,.s�f f t 11w �� s• 16.tc SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant rte.,,Y,. OFFICIAL.IISE fQ1!TL.Y 1. Building 3 O 0 Q (a) Building Permit Fee Multiplier o 2 Electrical� o. o Z (b) Estimated Total Cost of Construction j7cko 3 Plumbin Building Permit fee (a) X (b) 3Q2 4 Mechanical HVAC r — 5 Fire Protection 2-0 Q 6 Total 1+2+3+4+5 3 Z U d 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 I, 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMMERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 j NORTF Towyn of North Andover '`" %.76 Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 :978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE z Z JOB LOCATION T/ �y' "'�4 �P e✓ Number Street Address "HOMEOWNER v� �� d� �4��, 0 F�i If -70 Name Home Phone PRESENT MAILING ADDRESS -71 1�r� Town State �Oy/ O Z Of Map / lot 9 7?,) Aos = 0 3rd Work Phone Zip Code The current exemption for "homeowners" was extended to include owner-0coupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a panel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requireme C HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL FORM U - LOT RELEASE FORM INSTFUC T IONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS Si=CTION***** APPL!CANT �"� C S4"t, LOCATION: Assessor's N12p dumber /- o y SUEDIVISION STREET �;/�i�/.�P.✓ �l, �� PHONE 1 V -/S"7 a PARCEL ('7 L O/ LOT (S) ST. NUINIEER 7/ RECOMMENDATIONS OF TOWN AGENTS: , r/-,,V/,SY 3,45 F- rn £ /1) -r CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS FOOD INSP CTOR-HEALTH DATE APPROVED DATE REJECTED PTI I PECTOR-HEALTH DATE APPROVED _ a� DATE REJECTED COMMENTS T`� �L PUELIC WORKS - SEWERMIA T ER CONNECTIONS DRIVEWAY PERMIT FIRE DEPAR T NIENT rtECEivED EY EUILDING ii (SPEC T OR DAT Revised S,-' im I 3 0 A-V e " 24'6 C3 F1 FE] 0 3 C/) ;W --i pooc 0 rr X'a X x FAX: S - PAGE � e i, �,..,G`.�,�'t,. m m U) 0 m y Cl) n Z CO) d O �• r ? o CO) o v CD CDCL O c=r % 0 CD O CD C CD CO) Cv y O COD B v CA O '0 z CDCDo CD C C ? O of S O S• y O Q VJ » n m n y C7 dm n m Z =r= C4 CL = m CD -4 O m y G y o mo= OO CEO. L7 :N td � py � CL tG O ? ? �o CD : 1 C G CO CD O y C, d y ' H 0. dQ cclS a N O .� O m dy• �N CD _ O !9 O . CD 0: ,3 � O CD s �CD, .� CO2: CD �CD:�: h C �S. v z I . . r Ol 0 C/) O a 0 0 O G, M w p z m p n o m r o w G m r c, 0 p O O x x O 0 9 V) Office Use Only �( 3,�J� ( 1 014t Cfomm naitalth of fuzarlptftsPermit No. pC drV) lepurtmjent of Ilublic —Aatfav Occupancy &Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 30 (leave blank) �jCQ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 52LM__� R 12:00 q� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datel Qxi or Town of NORTH ANDOVER To the Inspector ires: The udersigned applies for a permit to perfgrm the electrical work described below. -V Location (Street & Number) Owner or Tenant Owner's Address A) Is this permit in conjunction with a building permit: Yes _ No Ell (Check Appropriate Box) Puroose of Buildina Utility Authorization No r-; Existing Service Amps _J Volts Overhead '' Undgrnd F7, New Service Amps Veits Overhead '_ Uncgrno _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Werk No. of Meters No. of Meters H No. of Transformers total No. of Lgnung Outlets i No. c. Hot :uds KVA No. of Lighting Fixtures 9 9 Abover- Sw mm)ng Pool ;rno. _ in - ' crud. — Generators KVA No. of Emergency Lighting No. of Receotacie Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Surners FIRE ALARMS No. of Zones No. of Detection and —otai No. of Ranges c..^. I No. of Air Cc. tons Initiating Devices No. of Sounding Devices No. of Disposals Heat ,eta) Total N° °i Pumcs :ons KW of Seif Contained No. of Dishwashers iNo. ScaceiArea Heating KW DetecnoniSouneing Devices — Murncioal - Other Local '- Connecron No. of Dryers Heating Devices KW No. of No. of ( Law Vcitace No. of Water Heaters KW I, Signs ?a lasts Wihnc _ No. Hvero Massace Tubs No. of Motors Tota) HP OTHER' a— . d INSURANCE COVERAGE: f Pursuant to the reeutrements of ,assacnusens general Laws lent. YES _ NO I have a current Liabiiity insurance Policy inciucmg Come:etee Operations Coverage or its substantial equiva have suom)tted valid proof of same to the Office. YES Z NO _ If you have checked YES. please indicate the type of coverage by checking the aoproor)ate pox. INSURANCE - BCND - OTHER = _ (Please Scec:f'+) (Expiration Date) Estimated Value of Electrical Work S Work to Start insoecaon Date Recuestec: Rough Final Signeo under the Penalties of perjury: , a `j36 s— FIRM NAME C /v, ms. %Signa,;:: a NO. Licensee ii .M JQ—C 19�r��X Address i t91� �.4.cJ /4Ls� sift/L /j2 .��f Q 3fAlt. Tel. N.. 0212 — OWNER'S INSURANCE WAIVER: I am aware that the Licensee goes not have the insurance coverage or its substantiai eeuivalent as re. otured by Massachusetts General Laws. and that my signature on :.^.)s permit aopimat)on waives this reeu)rement. Owner Agent ,Please check one) PERMIT FEES V `� ,eteonone No. (Signature of Owner or Agent) x 5=n= Date...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....:.:..:...,. ^.<..�.,..a ........ has permission to perform ......:: ,.! {...1.1..........4 .............r ......+.:.:.:,..f .}....... 11 wiring in the building of........�,:.......:........t.....;, .<.t...«......R............... att ' ...!. tt �+.s...<: Vit!i'x�................. .North Andover, Mass. ......:....... :..............� ..... . Fe .,.1),..!3.x.. Lic. ELECTRICAL INSPECTOR 4 f 06/6/95 11:09 30.00 PAID WRITE: Applicant CANARY: Building Dept. 1, PINK: Treasurer GOLD: File