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HomeMy WebLinkAboutMiscellaneous - 75 CARTER FIELD ROAD 4/30/2018PW imum6J sir Date.4 ................................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................................. ........................ has permission to perform ........ ......... wiring in the building of ..... at ............... ............................ North Andover, Mass. Fee S.�. ........... Lic. Noo.1 �?� - .............. 1 ... r ...................... 'ELECTRICAL INSPECTOR Check # lol 9 4850 TIM C0AD10AT9TALXH0FA1t4S&4CHUSE77S Office Use only DEPA)UA1ENT'OFPUBIwIt S4= Permit No. Yl� ,g BOAROOFFIREPREVIPMON[(,WWJLAHONS527CM]2.M CRI/ Occupancy & Fees Checked APPLICATIONFOR PERMIT T PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH HE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1 ®3 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) �'� G,4 r,—(67o, R Owner or Tenant 4-A L 1(�— t �( ! 7V 67 Owner's Address 1-965 Vl( C. LO vt-4 1' l t A- 0. Is this permit in conjunction with a building permit: Yes ©"No (Check Appropriate Box) Purpose of Building (,(> AJ Utility Authorization No. _ Existing Service AmpsVolts Overhead M Underground No. of Meters New Service Amps 1Q / Z c(pVolts Overhead MUnderground ©/ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t 4,is v �1 kcok) S� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above M Below Generators KVA round ground F1 J 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 Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- hrutrartoeCovetage. PutstaarrttothetaofMassadn>�ttsGa�ertlLaws �i IbaNeaamartLiabl7IIyhmanc-Pohyi hxkgCor-vk!E CovetageoritsalstaiUegtuvalat YES NO IbavesubmadvalidproofofsamerotheOffice. YES Equuhavedred edYES pleaseinc?ic&theMmofcovtgeby ,l Ms 101,10M. .4. OWNER'S INSURANCE WAIVER; I am aware that the Iiomse do andbratrrysignaturecnthispeon¢applialtiottwmm stinsreq *myi1 (Please check one) Owner I Agent Signature ot Uwner or Agent ftwespeffy) Evirafioul),&� RooFslim VahieoffleclricalWotk$ Fmal GG S LiarseNo. Al - -LioateN0 �'O — BummTel.No. - Qy Alt Tel. No. ivettieiitru�oecovaage�ilssubs�tt>tialegtrivalentasiegt�rtadbyMass7cin>setts Cknerallaws FMI u� Telephone No. PERMIT FEE $! The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # 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 # T 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.afine up to $1,500.00 and/or one years' impdsonment.as welLas_chdi.penatties}nlbeljxn dASTOP.WORK ORDFRand_afore.of_($11t0.OD)-ajdayagaitW me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pains and penalties of perjury that the fnf0rma60n provided above is true and correct Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensinn. Building Dept Check if immediate response is required .0 Licensing Board E] Selectman's Office Contact person: Phone #. ij Health Department ------ -- E3 -----Other _ --- Location P / -er r/ vl- No. 3,S-0 Date -Jo —O 3 NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # L 169'11 f Building Inspector 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -t S' CA DW F(#0 P -Q • 492- 2 We A NAV N, Map Number Parcel Number T—A 1.3 Zoning Information: 1.4 Property Dimensions: &,z ctp. S#A) /R "P 5 # + ftizo roan �f Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS M Front Yard Side Yard Rear Yard Required Provide Reqdred Provided Required Provided 2v YO zo 3o za 300 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone lnfornution: 1.8 Sewerage Disposal System: Public Private 0 Zone Outside Flood Zone � Municipal pi On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record (TS' 41 C U, 92). ti . A A&*2 ,N► Name (Print) Address for Service Si re Telephone 2.2 Owner of Record: z Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1 Licensed Construction Supervisor: W y% l License Number Address c ✓ 6 j 1/ a ,? � 3j Expiration Date Si re Telephone 3.2 Registered Ho provement Contractor Not Applicable 11 Company We Registration Number Address Expiration Date Signature Telephone LJ ION /F1 R z M go O ic r M r r Z 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. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check atl applicable New Construction >' Existing Building ❑ Repair(s)0 T terations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ - Specify Brief Description of Proposed Work: 541t� P&A.0 -5&R SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bypermit a licant i Q CIAL r USFr gzg. 1. Building g y0� ` (a) Building Permit Fee Multiplier 2 Electrical(b) 12)20 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 dO Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN _ OWNERS AGENT OR CONTRACTOR APP IES FOR BUILDING PERMIT I, ID I , as Owner/Authorized Agent of subject property Hereby authorize 2), to act on My be t; in matters relativ work authorized by this building permit application. J S' e o weer Date J CTION 7b OWNER/AUTHORIZED AGEU DECLARATION 11 z 4,,,D. Zv, as Owner/Authorized Agent of subject property Hereby declare that the statements and info ation on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name ----; zf&� —. 'e e S' e of Owner/Ant Date NO. OF STORIES ZSIZE Jet BASEMENT OR SLAB S SIZE OF FLOOR TINIBERS iST 2 No 3 RD SPAN . DIMENSIONS OF SILLS P % DRAENSIONS OF POSTS DIN ENSIONS OF GIRDERS Jv HEIGHT OF FOUNDATION THICKNESS !d SIZE OF FOOTING X 4 MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND sea IS BUELDING CONNECTED TO NATURAL GAS LINE N(, FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that allnecessary 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. �ilir■ralili■iia!■liflrl i -earl. ■.ri■i'!■iirii■ ■■!■■llralr■.ii■ii■■!■■■l■i■lilt■• APPLICANT L L C PHONE 97F -'KF 7' Z ASSESSORS MAP NUMBER .62 LOT NUMBER Z -F 13 g SUBDIVISION CA R.1$R f It IRDS - LOT NUMBER ®P WS?kC8 STREET CA R-Tg�, F 19 LD RGA STREET NUMBER �■■!•s■=■rr!■ass.iasirrrlir■tilt■ri.■■•lrlaalalerrsrrl■i!■riiii/s!■■■a■■s■i■■lr■ OFFICIAL, USE ONLY �irr.rr■r■ ■ r■.rr--■rr■!!■aarrrarraaaaar■r■rrr■■■r�llraaaau■■i■a■■■■■■■■■■i■s■■ RECO ATI F TOWN AGENTS �■■r.■. ■■. ■ie■■ ■ -.aisles■■■■ Y■r■!■■■■■i■�.■iriarrlrr!lrsilsriir■slsslla■■ DATE APPROVED CANS NATION TRATOR DATE REJECTED CONIMENTS i - n s PLANNER CON ENTS DATE APPROVED /I DATE REJECTED DATE APPROVED FOOD INSPECTOR -HEALTH DATE REJECTED DATE APPROVED 1 zJ a SEPTIC INSPECTOR - HEALTH DATE REJECTED CON54ENTS PUBLIC WORKS - SEWER / WATER 111,111 CONRVIENTS RECEIVED BY BUILDING INSPECTOR DATE BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 055417 Birthdate: 04105/19,60 Expires: 04/05%2004 Tr. no: 21586 Restricted: 00 THOMAS D ZAHORUIKO 185 HICKORY HILL RD N ANDOVER, MA 01845 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print zb'll I am a homeowner pe V/ al7'YJ ng all work myself. I am a sole proprietor and have no one working in any capacity 179-i�J1 Z61 33_ EDI am an employer providing workers' compensation for my employees working on this job. Company name.- city: ame: City. Phone #: Insurance. Co. Policy # Company name: Address Insurance Co. Policy # Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the imposition of criminal penalties o(a fine up to $1,500.00 and/or one years' imprisonment as_Yze11_as_CMI inshelnrm_ofa_STOP O WORK RDF.Rand a hne_d_($1D0M)aAay.agai )store. 1 understand that a copy of this statement may beJ drded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the pas and peva f perjury that the information provided above is true and correct. Signature Date /1 Print name Pbone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check d immediate response is required ri Licensing Board O Selectman's Office Contact person: Phone #: Ej Health Department O Other W� p R . 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TOWN OF NORTH ANDOVER •X PERMIT FOR GAS INSTALLATION 1 SUCMUSESSy. This certifies that .. l9.���-�. <<....�.?.!�. ��............. has permission for gas installation .... J?�� - in the buildings of ....!t %? A . . � .......................... at .. C.. r°`� ......... , North Andover, Mass. Fee.. �.... Lic. No........... ....�' �:... . G,. . AS INSPECTOR Check # 4583 f MASSACHUSEM UNIFORMAPPUCATON FOR PERNIlT TO DO GAS FTrrING (Typeor print) Date NORTH ANDOVER, MASSACHUSETTS +� \ Building Locations / Owner's Name New 1 [/r Renovation ❑ Replacement ❑ t! Permit # Amount $ C�,n� � �,r^•�t) Plans Submitted (Print Name Addre Check one: Certificate Installing Company ❑ Corp. 6/Partner. Business Telephone L44.�j - %'(OU 11Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE 4unecx one I have a current liability Insurance policy or it's substantial equivalent. YesET No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity . 13 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. Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and instal compliance with all pertinent provisions of the Massachuset By: Title City/Town APPROVED (OFFICE USE ONLY) SignAure of ❑ Plumber Check one: IJ Ow/r ❑ Agent ❑ j/ orIde ed) in above application are true and accurate to the ornder Permit Issued for this application will be in Cd Chapter 142 of the General Laws. Fitter H' -Master ❑ Journeyman Plumber Or Gas Fitter License lNumoer x w x 9 x U �:) Cn Cn U z G w d a z zF 0.x.Wao ax Ww w C40'w �srG 0 w C7w z O o° O w WF ° wF Fx P.U � Oa x A c7 aD A a H Oo SUB -BASEMENT B A S E M ENT 1ST. FLOOR 2ND. F L O O R 3 R D. F L O O R 4 T H. F L O O R STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print Name Addre Check one: Certificate Installing Company ❑ Corp. 6/Partner. Business Telephone L44.�j - %'(OU 11Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE 4unecx one I have a current liability Insurance policy or it's substantial equivalent. YesET No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity . 13 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. Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and instal compliance with all pertinent provisions of the Massachuset By: Title City/Town APPROVED (OFFICE USE ONLY) SignAure of ❑ Plumber Check one: IJ Ow/r ❑ Agent ❑ j/ orIde ed) in above application are true and accurate to the ornder Permit Issued for this application will be in Cd Chapter 142 of the General Laws. Fitter H' -Master ❑ Journeyman Plumber Or Gas Fitter License lNumoer Date... ............ ° TOWN OF NORTH ANDOVER A s• PERMIT FOR GAS INSTALLATION �S^CRUSE a This certifies that has permission for gas -installation �. ��G p/I'G.,✓ in the -buildings of at a4ze� r=!�carfh Andover, Mass. Fee Lic. No. �f • . ............................ . _ GASINSPECTOR Cheek # 4587 MASSACHUSETTS UNI pRMAPPLICATON FOR P.ERNIIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 11�13�0 Building Locations ----.Z5 Cartpr F;o,a n, Tara L i h De e1 m Owner's Name New Renovation Replacement Permit # Z Amount S 50.00 Plans Submitted ❑ x W C.#) &dw � �' x ..ru a de to Pl b r Un 1 w w m w x H m a a w N r e iz ° �w w st b 3 � � o ° �' a �, 'x SUB -BASEMENT w a zU 9 ° BASEMENT q 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 3TH. FLOOR (Print or type) Name Eastern Pro ane Gas Check one: Certificate Installin 131 Water St. gCompany Address � Danvers MA 01923 Cork. Business Telephone 1 800 322 6628 ❑ Partner. Name of Licensed Plumber ❑ Firm/Co. or Gas Fitter R; l � u.. , , _ .. INSURANCE COVERAGE I have a current liability Insurance policy or it's substantial equivalent. Check e- Ifyou have checked ,es Please indicate the Yes Liability insurance policy ❑ type coverage by checking the appropriate box. Other type ofindemn' No[] qty ❑ Bond ❑ Owner's Insurance W aiver I am aware that the licensee dMass.General Lawand that m si does not have the Insurance coverage Y Signature on thisrequired by Chapter 142 of the permit application waives this requirement. Signature of Owner or Owner's Agent Check one. I hereby certify that all of the details and in Owner ❑ Agent ❑ best of m g Plumbing I have submitted (orto enter) in above appliption a�,e Y kn°wled a and that all lambing work and installations compliance with all pertinent provisions of the Massachusetts Stat Performed under Permit Issued for this application will wiwiand ll be in the Code and Qhapter 142 ofty)e General I-aws. w,n ❑Signature of Licensed Plumber Or Gas fitter Plumber O'Gas Fitter LIcense um er OVED (OFFICE USE ONLY) ❑ o ter LP 1018 ❑Jst yman a NO RT1q O 2 ,SSACHUS� Date. 8 0(0 1 O� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .., ".1)4urPP�" . ; has permission to perform . /'�Cl ' P Gmp/ �LS� Q� plumbing in the buildin s of./Q.PA..�-.`P`.y�?..-`/`�.�.'..... at. eA ........ ��j.. , North AT01over, Mass. 4 i Fee. �. . Lie. No. PLUMBING INPO.R .( Check # 6155 5 MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUS`E/TTS 164 Building Loca oif `qA4 ! Q APPLICATION FOR PERMIT TO DO PLUMBIP Date C 6 )wners Name ���/ ,LCA Permit ( Amount J� of Occupancy �� 6 � � Z ��� `j_YccS OIL New 10 Renovation Replacement Plans Submitted Yes No ❑ FIXTURES (Print or type) Installing Company Name Address Name of Licensed Plumber: Insurance Coverage: Indicate Liability insurance policy r -ance coverage by checking t Other type of indemnity r Check ono:• Certificate � - o17P. Partner. Firm/Co. to box: Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner E Agent 0 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massac is to P bin g C did ter 142 of the General Laws. 71 BY ig ure of i7censeaum er Type of Plumbing License Title CJ 114 City/Town icense MumDer Master ❑ Journeyman APPROVED (OFFICE USE ONLY