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HomeMy WebLinkAboutMiscellaneous - 796 WINTER STREET 4/30/2018✓:� // r Date ... 9. .......... .. / ....... y TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..-Z�P/ . ..... ....... ... ;0 has permission to perform ..... . .............. .. ......... ... wiring in the building of .... . �e��trj ...... ........................................ t , 7;�� L-.-j1,i4 �(/ Sr . ............... at.............. ............................................. ............... Z&orth Andover, ;,I_ Fee ...,3 . �.... Lic. No ........ ............... .. .. .... ....... I ELECTRICAL IN Pr .... Check # �131:; x 5 Lj 3 6 ?wS e&har ?2ul5XZ?W 057 X BOARD OF FIRE PREVENTION REGUL APPLICATION FOR PERMIT TO PE All work to be performed in accordance wiOthe Masa (Please Print in ink or type all information) Town of RM ELECTRICAL WORK Electrical Code 527 C R 12:00 Date d / To the IrApector.9f wriires: The undersigned applies for a permit to perform the electrical work described below. /� / ',� / a Location (Street & Number Z 7 L0 lOV // / 5%� S Owner or Tenant Owner's Address e Is this permit in conjunction with a building permit Yes// No 0 (Check Appropriate Box) .! Purpose of Building ,//I/ G L /i 0 WLR L //, /.V G Utility Authorization No. Existing ServiceD /) Amps '236 VoitS New Service Amps Vofts I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead #I," Undgmd 0 Overhead 0 Undgrnd 0 No. of Meters No. of Meters No. of Lighting Outlets Official Use Only L,577S Permit No. J�V No. of Lighting Fixtures Above 0 Swimming Pool gmd 0 527 CMR 12:00 Occupancy & Fee^eckedr RM ELECTRICAL WORK Electrical Code 527 C R 12:00 Date d / To the IrApector.9f wriires: The undersigned applies for a permit to perform the electrical work described below. /� / ',� / a Location (Street & Number Z 7 L0 lOV // / 5%� S Owner or Tenant Owner's Address e Is this permit in conjunction with a building permit Yes// No 0 (Check Appropriate Box) .! Purpose of Building ,//I/ G L /i 0 WLR L //, /.V G Utility Authorization No. Existing ServiceD /) Amps '236 VoitS New Service Amps Vofts I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead #I," Undgmd 0 Overhead 0 Undgrnd 0 No. of Meters No. of Meters No. of Lighting Outlets No. of Hot fuse Total No. of Transformers KVA No. of Lighting Fixtures Above 0 Swimming Pool gmd 0 In 0 gmd 0 Generators KVA No. of ReceptaclesNo. Outlets No. of Oil Burners of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Sounding Devices NoJ of Self Contained Detection/Sounding Devices 0 Municipal 0 Other Local Connection • No. of Ranges 5)e / s Al r!, Total No of Air Cond Tons No. of Cliposal Heat Total Total No. Pumps Tons KW No. of Dishwashers ( Space/Area Heating KW No. of Dyers Heating Devices KW No. of Water Heaters KW No. of Signs No. of Bailases Low Voltage Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) Estimated Value of E e rical W k$ 3 -!5-,0 ® O (Expiration Date) Work to Start 0 Inspection Date Resquested Rough Final Signed under the na ' frjury: r FIRM NAME T /y V 67 / %_ d Iv L' C % LIC. NO. Licensee �1 Signature LIC. NO. ` Bus. Tel No. O ® 2 2 d Y Address Att Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial 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 $ �/ (Signature of Owner or Agent) . Name: Location: City Phone 71 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 Cifir' Phone #: Insurance Co. Policy # Company name: Address City Phone #: f Insurance Co Policy # Failure 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.Cd and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information 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 E] Building Dept ❑Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. .- ........ � .. ...... ...... . . has permission to perform ..... :.. ........................ . "plumbing in the buildings of .:'................... . Fat ....... ".......... North Andover, Mass. Fee �Lic. No...f..=.% //`/-.... ........ PLUMBIdI, SPECTOR Check 5916 MASSACHUSETTS UNIFORM. (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 776 oe OAnersl� New ri Renovation Er of CATION FOR PERMIT TO DO PLUMBING Date 2 - Z17 - c> y Permit # Amount Replacement Plans Submitted Yes No ❑ (Print or type) Check one: Certificate Installing Company Name ITCorp. Address �� SF�`G-CY �o a p : ciE� ro... Partner. Business Telephone 78/ - 899 - cs39-z- rl Firm/Co. Name of Licensed Plumber: O -C s✓ ue r J -r. ,Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 13 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 IOwner 0 Agent El 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 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� By Signa ure o iceZ nseu r um er Type of Plumbing License Title wee63 City/Town License NumDer Master IT Journeyman ❑ APPROVED (OFFICE USE ONLY i ilk --�----------------------■ (Print or type) Check one: Certificate Installing Company Name ITCorp. Address �� SF�`G-CY �o a p : ciE� ro... Partner. Business Telephone 78/ - 899 - cs39-z- rl Firm/Co. Name of Licensed Plumber: O -C s✓ ue r J -r. ,Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 13 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 IOwner 0 Agent El 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 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� By Signa ure o iceZ nseu r um er Type of Plumbing License Title wee63 City/Town License NumDer Master IT Journeyman ❑ APPROVED (OFFICE USE ONLY Location 7/01 No.414 Date t �y NORTq TOWN OF NORTH ANDOVER O F A 9 } �o ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # L1 176,79 —Building Inspe6tor v SIGNATURE: Building Commissioner/12ECEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1.2 Assessors Map and Parcel Map Number Number: Parcel Number I1/ & A TN A /yy D (l e e 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Signature Telephone Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Public ❑ Private ❑ Zane Flood Zane Information: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ MU M z z M 90 0 Mn ic e M aaas z^ !� SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �I?A /� L� 7 9�, Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 (2S o69o?a Licensed Construction Supervisor: License Number I / / �/7 v !! Address 7 ol EG L J — G �%� y�T� Signa a Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ /I1 y7U Company Name K e L'4 6 /y � Registration Number Address[ 410 O C i ' Aa""G'oS-6 Expiration Date St nature Telephone MU M z z M 90 0 Mn ic e M aaas z^ !� SECTION 4 - WORKERS COMPENSATION (NLG.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 check applicable) New Construction ❑ Existing Building UK Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: PEfoLAcC OAAltil✓Ts . G0aAl7- eieS "'ULDI/VG SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OICfA,ISE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (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 -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, /- 9,4 AIC/ 6 / -?,4 KG— as Owner/Authorized Agent of subject property Hereby authorize �>n �Q iQ / (� `' /4 /3 /4/ 6--r to act on My be f, in all matters re at to wor uthorized by this building permit application. Signature of Owner Date S�ECTIOONN 7b OWNER/A ORIUD AGENT DECLARATION 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 —X-ZI Al 0 s /st K C Print e SignatureofOwner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS 1 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE fie toomvnw�uuea�i o�✓�aadczc�iudelt4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR s Number: CS 009070 Birthdate: 07/10/1938 p s r� Expires`: 07/10/2005 Tr. no: 13730 Restricted:. 00 FRANCIS A DRAKE g 34 FARRWOOD DRQ ANDOVER, MA 01810 Administrator i✓ize L� oorvrreaiuuea,� o�✓v(,cWOacituGn,�6 i Board of Building Regulations and Standards .sem HOME IMPROVEMENT CONTRACTOR Registration :_111470 ,,i ion 12/29/2004 Type Puvate Corporation 14 DRAKE CABINET &'REMODWNG FUNK DRAKE (REAR) 401 LOWELL 5T�� I LEXINGTON, MA 02420 � qw pt v ®� '•. a C � O N vO t� '•C7 .n c cCl C13 m c �► A Cc _o E� CD � a CE m E 5 z ,. .� m O ' O O w m CCL-_ �mm C y N ID r)Cm , .m Zia .= ca a N O O O w U Nm� CCC U) ;Z:s� cm U) cm -a c CL c m o� C3 o cm C3 0 CL c ID C .0 m C CD N N m.Sl— m = r=... occ go c c E�ormsCM C3 CD N o O� p C S m * *- CLO.. CIM a T M y co .y L CLO ca ev CL CO2 V CO) O R .0 cc CLC40) D u o °q U w ° ° w" Q W ° rz ° w" �i o a w" W W cn o cn v ° cn pt v ®� '•. a C � O N vO t� '•C7 .n c cCl C13 m c �► A Cc _o E� CD � a CE m E 5 z ,. .� m O ' O O w m CCL-_ �mm C y N ID r)Cm , .m Zia .= ca a N O O O w U Nm� CCC U) ;Z:s� cm U) cm -a c CL c m o� C3 o cm C3 0 CL c ID C .0 m C CD N N m.Sl— m = r=... occ go c c E�ormsCM C3 CD N o O� p C S m * *- CLO.. CIM a T M y co .y L CLO ca ev CL CO2 V CO) O R .0 cc CLC40) D 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 t disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: /90 s ED (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of /nvestdgatdons Boston, Mass. 02111 Workers' Compensation :Insurance Affidavit Name Please Print Name: Location: Citv 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 n iy employees ung on, this job. Company name. Address CW. Phone<#. Insurance•• Co. Policy # W 7sy9A3/9eq3 _ anwe to secure coverage as required: under Section 254 or MGL 152 cwlead to the *r.*=ifion of airro pwMMje.;.: of arfirT and/or one years' imprisoxr�ent�o41 �1he�iarmaieejl, understand that a copy of this statement may 61; o yarded to the ©trice of Investigations of the b A for cok"age vetil ion. do herbyc a, Wy underhe paries and penaltfr PfredwyRist Me ir>rw»iatiar provided abovee►t e.anat comer Print name /- AK4 /V 14 / S Official use only do not write in this ansa tv be comply by city or town oftiiciar City or Town -p4j—a aS-6 3,%� "l N°- , Date...... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... f �J �' /� / ?` C f/l ! < 4..` ........... ................ has permission to perform ................� .'�pf.''.. � . � �f �T � wiring in the building of �A) .....L � " o �?� Z.!4. f ::e ............................... , North Andover, Mass. Fee.3S/. 0.0... Lic. No. 1 s„ . ��° .... f ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Bob Si gong NORTHSIDE Electrical Contracting L.L.C. 38C Tremont Street phone: 781-662-7554 Melrose, MA 02176 fax: 781-662-6824 �.\ office U" oni�r ?he Commonwealth of Massachusetts flJq, Crrwit b. Department of Public Safety occumnc> % fee owcked BOARD OF FIRE PREVENTION AEGULAnONS S27 CMR 1200 3/90 (tfa,K blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AA mock io be oerlortned In accordance with the Mawchusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN Ili& OR TYPE ALL INFORlSA1iom Date ?—E-0 I Town of Natick, Mass. To the Inspector of Wires: The undersigned applies for a permit / o perform the electrical work described below. Location (Street 6 Numbers lVA I 14141 Owner or Tenant C .rte. Owner's Address % 7 1,1 1/ 11 Yk 11.✓ ' J —r Is this permit in conjunction with a building permit: Yes 13No❑ (Check Appropriate Box) Purpose of Building lhSIJIV rC1 X.A Utility Authorization NO. cc Existing Service Z�Amps / Zo 1 2_02� Volts Overhead [Undgrd ❑ No. of Meters I New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and I Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers ToVA No. of Lighting Fixtures Swimmin Pool Above In- g grnd. ❑ grnd. ❑ Generators INA No. of Receptacle Outlets No. of Oil Burners No. of Unitsncy Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Disposals No. of Hpu=s TIons To KW NDetectiof on/SoundingeDevices Local ❑ Municipal ❑Other Connection No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters kW No. of o. o s Ballasts Low Voltage Wirin No. Hydro Massage -Tubs No. of Motors T)tal HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO 0 I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER El (Please Specify) piration ate Estimated Value of Electrical Work $ Work to Start Inspection Date Required: Rough Final Signed under the penalties of perjury: j /11 n FIRM NAME .�l/a �S�/C��i S ���YI C 1 [ 1) Aly -10 LIC. N0. LicenseSignatureJ 3 • ✓ I Z7 ` Bus. Tel. No. C a ? --7 -5 Address JMj' 6 Alt. Tel. No-. 791 ` 4g3 1/90 OWNER'S INSURANCE WAIVER: I am aware that the License 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 � � 0