HomeMy WebLinkAboutMiscellaneous - 747 GREAT POND ROAD 4/30/2018 (2)N
X949
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that.. P, . ...... ....... ......................
has permission to perform ............ o.&-- .......................................
A
wiring in the buildin of
................... P .......................................
at .'..y7 .. ... .. .................
......... ,North Andover, Mass.
..
A6 ....... Lic. No. ..........
ELECTRICAL INSPECTO
Check #
�r
>,..... C4&BF'Fii?716�`rI"ll@l ea th of lVi 's`sa�1c�'At setts ?fficial_? ILLSe, Oro.),
' Permit No.
Departmen t of Fit, —
?t'It R'
Occupancy and Fee Checked
EtC)AFiD OF FIRE PREVENT!ON REGULATIONS [Rei. l l!99] (leave blank)
FOR OPERMIT TO t?EIRF&�fi ELECTRICAL off
A!I work to he performed in accorclance with the; Massachusetts Electrical Code NEQ, 527 CMR 1200
(PLEASE PRINT IN 1ATK OP TYPE ALL INFORMATION) Date.
0411 o •TOW. 1l 0f. E ki p o U `,ef- To the Inspector of
B this application the undersigned gives notice of his or her into$tion to rfonn the e tru;al work described below.
Locaiion (Street d Number) ! �� j��Qj� V m /Lb
Owner or Tenant /-14?
Owner's Address
Telephone No. Y/
Is this permit in conjunction with a"u„q' ding permit? Yes No L!!T (Check Appropriate Box).
Purpose of Building_ 6:.s ( ex-er/f c e Utility Authorization No.3 yT % 1 y
Existing Servicer /� / A%olts Overhead ��Undgrd ❑ No. of Meters
New Service :006 Amps //�1%QVolts Overhead Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: e
Com lelion of the followin table ratan he waived by the Inspector of Id it es.
No. of Recessed Fixtures
No. of Ceil.-Sus Paddle Fs
p (Paddle)
No. of Total
Transformers KNIA
No. of Lighting_ Outlets
No. of Hot Tubs
Generators ICVA
No. of Lighting Fixtures
Above In-
Swimming Pool rnd. ❑ rnd. El
No.
o. o. mergency Lighting
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
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local EJCo n nnectionolo n❑ Other
Co
No. of Dryers
Heating Appliances
g PP KN
Security Systems:
No. of Devices or Equivalent
No. of Water RW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H dromassa ge Bathtubs
y g
No. of Motors Total HP
'Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
A 11gch additional detail ifdesir•ed, or as required br the Inspector of 1fires.
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. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 'ted (/ OS Inspections to be rcqucstcd in accordance with ivIEC Rule 10, and upon con-1pletion.
/ cer7if y, raider the Grins and penalties of perjury, that the infer atio��:y¢-�r t/ris application is true and complete.
F1R1Vl NAME: ar e � `�/ iris P1 LIC. NO.: `3F% %Z
Licensee: p 0,1& C Signature LIC. NOV
1
(// applicable, enter "esem Cin {�j� license number line}) i, ,e� us. Tel. No.: - o06 7
Address: �r�/ s°61�f/` S7 �`i %K�.S eiN`i) )',/ A of % Aai't. Tel. No.:
OWNERS INSURANCE WAIVER: I am aware that the Licens 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 agent.
Owner/Agent
Signature Telephone No. FEIl11I1T FEE
R
Location � C/'! cd Ad /'Cl
No. 36 Date
TOWN OF NORTH ANDOVER
EGD
9
" Certificate of Occupancy $
'Ss.KNusE` Building/Frame Permit Fee $ Llo
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
1 6 9 1 4 Building Inspector
TON" OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT EaAl& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
tt 4i
BUILDING PERMIT NUMBER: 3 6DATE ISSUED:
-03
SIGNATURE:
Building Commissioner/I for of BuildingsDate
SECTION 1- SITE INFORMATION
1.1 Property Address:
7 y 7 Cl- T_
1.2 Assessors Map and Parcel Number:
3 3 q-
Map Number Parcel Number" "
Q AA N> e,/ o e r f� f �
�tJJ 1"J .r Y V / l l
1.3 Zoning Information:
Zonin District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage(ft)
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
RegWred Provide Reqtiircd Provided
Recpjircd Provided
1.7 Water Supply M.GL.C.40.` 54) 1.5. Flood tune Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
liya. L -r -e r !1 NS oN7Y7 6�v �e
Name (Print) Address for Service:
Sig atu a Telephone
IM7 b S s
2.2 Owner of Record:
Name Print Address for Service:
Si at�re Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor -
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date _
3.2 Registered Home Improvement Contractor
4
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name: L -J a Lf Y —J-6
Location:
7 y? G ,r Fe
Ci A O Phone #
1 am a homeowner perfoftning all work myself
I am a sole proprietor and have no one worldng in any capacity,
1 am an employer providing workers' compensation for my employees working on this job.
Com
aanv name:
Address
QW. . PFtorte.
Insurance Co. Policv #
Company name:
Address: .
Wit:`. Phorlo'#k'
Failure to secure{
coverage as required under Section 25A or MGt.152 can lead to -the irtpos d . ofa�finet � � S'1.50
and/or one years' irnprisorrnent tetetLas�anl peaatties iolheiam�t�$7DP Tine�f ($1!]A QD)�stagFa nom.
understand that a copy of this statement may forwarded to the office of investigations of the DIA for ¢overage verification.
I civ hereby c&W under the pains and penalties ofpoWwy Nest Me'o famefti provi&ad above is tragi and cors ct
Signature l% l l' a l 0.3
Print name Pine JOR
Official use only do not write in this area to be completed by city or town df Lf
s
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
Jt,q"&-eM evT, SAle
(Location of Facility)
N/�
Signature of Permit Applicant
o3
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
• ~ `
Town of North Andover
Building Department '^'• °`
gATo Pp,•(
27 Charles Street "SSA�H�SE
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE 1-6 3
JOB LOCATION -? 7 -7 6 r e aT Paiv�
Number Street (Address Q h Section of Tc
"HOMEOWNER '7q7 7 tT Y eaT f a^t D
Number [� Home Phone Work Pho
PRESENT MAILING ADDRESS ? 7 7 &_Y 610 -T 1 4 A"IS k D ,
N- �4pj>ever MA
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of 1 or 2 units 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 parcel of land on which he/she resides or intends to reside, on which of two
there is, or is intended to be, a one family dwelling, attached or detached structures
accessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 108.3.5.1)
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 requirements.
p�
-.-A-
HOMEOWNER'S SIGNATURE w i� --! --
APPROVAL OF BUILDING OFFICIAL.
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
Revised 4.30.03
Home owner Exemptions Form
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Date. //..
HORTM TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
This certifies that ... I..�-. 'r. .....
has permission to perform .....P. �' .. ...................... .
plumbing in the buildings of .. 12 .�. - .
at . %. .? . �f?r �� ............ North Andover, Mass.
Fee. �� �, .' .. Lic. No. ` >.� ? ... ......%`
ALU, M8ING INSPE TOR
Check # el Z
5038
MASSACHUSETTS UNIFORM- APPLICATION FOR P=R ET Ta, DO �tE;' 'G
(PfPub or TM)
TSL , Mass. Date U 2L'cl Permit #
Building Location Owner's Nam &
J)--A-Z�
,�
Type of Occupancy �� SS +� t'I r1 i _
New ❑ Renovation 11 Replacement a? Plans S ibr-#i'ted: Yes ❑ No ❑
FIXTURES . Ll----�
Installing. Company Name 20jMe-r i.�-SPWMA-TAei7 Check one: Certificate
Address�� 1� Ct: /-}Chi /nen) /�) ❑ Corporation
li) E % N4 u Fn) pi l ( y 1 �fVL,/ ❑ Partnership
Business Telephone _ K'If j_ X177 ! 9-A'"/Co.
Name of Licensed Plumber _ ' f e3 T- mm e4 I-K'oc"
INSURANCE COVERAGE:
I have a current I�'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes E' No ❑
If you have checked ves. please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy kd" 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:
Cinnaturw of (iumur n. A..,.e.•.. e......6
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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' gode and Cbapter of the eral Laws.
Title
re of Ucensed Plumber
City/Town Type of License: Master % Journeyman ❑
APPROVEDO IC US ONL License Number 13 3-;
Y
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MO.
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MEMNON
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Installing. Company Name 20jMe-r i.�-SPWMA-TAei7 Check one: Certificate
Address�� 1� Ct: /-}Chi /nen) /�) ❑ Corporation
li) E % N4 u Fn) pi l ( y 1 �fVL,/ ❑ Partnership
Business Telephone _ K'If j_ X177 ! 9-A'"/Co.
Name of Licensed Plumber _ ' f e3 T- mm e4 I-K'oc"
INSURANCE COVERAGE:
I have a current I�'ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes E' No ❑
If you have checked ves. please
/indicate the type coverage by checking the appropriate box.
A liability insurance policy kd" 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:
Cinnaturw of (iumur n. A..,.e.•.. e......6
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 ormed under the permit issu for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plum ' gode and Cbapter of the eral Laws.
Title
re of Ucensed Plumber
City/Town Type of License: Master % Journeyman ❑
APPROVEDO IC US ONL License Number 13 3-;
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Location
No. Date
h o�
"0" TOWN OF NORTH ANDOVER
r`
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
N' Q 106952o/97 15:12 25.40 PAID
Div. Public Works
"
Certificate of Occupancy
$
Building/Frame Permit
a
Fee
$
y's 04 " Eta
s�cMus
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
N' Q 106952o/97 15:12 25.40 PAID
Div. Public Works
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