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HomeMy WebLinkAboutMiscellaneous - 85 SUTTON HILL ROAD 4/30/2018 (2)I Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ..................................,....................................................................... has permissiomto � perform...........GSC!!�L......�` ....................................................... .,�.-�..-�.......�.......... wiring in the building of ................................ S .................................................... at ............'&Z:...................n... I North Andover, Mass. 2S� X96 /71- Fee ............................. Lic. No.................. ...........................3!...............:... ............ Check # ELECTRICAL INSPE bR / (f1mmomveaR o f Mamachaieffi Official Use Only cc�� c7 Permit No. 1,5233 e(JeParimerct o� }ire �eruiced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 71 —%S — /J City or Town of: V�/,,JA ludeyelL To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) g,1- &) // u,J Owner or Tenant J 'vn PYA NN o S Telephone No. L/`) 9./1 ?/,� t Owner's Address 1'7 o b l- I I p k o,Llen- Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service CLO C Amps /'2p / 2Yi' Volts Overhead ® Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Z Location and Nature of Proposed Electrical Work: W i rl _ 2 A -L , S Y S`T e4c) k t,.}h Jisl4j epine E PLV G r -c. i L - S,l%+ I- ,; -f-""t e1' Nc'w Completion of the following table may be waived by the Insoector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Lj Swimming Pool Above ❑In- ❑ rnd. grud. No. of Emergency Lighting Batteg 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 g No. of Alerting Devices No. of Waste Disposers Heat Pum Totals . Number .... ..... Tons I ................. KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring• No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: LIC. NO.: Licensee: _Ch a^( es, �- a Signature c� ac LIC. NO.: (If applicable, enter "e m-p_t"� m� r�he 1' ense n tuber line. Bus. Tel. No - Address: 2�r �`�c�'�//"�'�- ; '•�� ��%�3 Alt. Tel. lTo.: J *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety"S" License: Li,,,: No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 PERMIT FEE: $ Signature Telephone No. 11 r . J k Location 0 S ' No. Date TOWN OF NORTH ANDOVER • L .. 9 o ; ; Certificate of Occupancy $ yeaJAC '"•°'s��� Mus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5 WO 166-0 5o Building Inspector 1 UwN UY NUK"IR ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING nuo 1iC BUELDING PERMIT NUMBER: / © DATE ISSUED: C SIGNATURE: Building Commissioner/Inspector tdbuildings Date SECTION 1- SITE INFORMATION LI Property Address: �l 1.2 Assessors Map and Parcel Number: i Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: A&5 31 m ep u Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Provided b 3o ',� 2v35 p 1 30 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes i�0 2.1 Owner of Record Name (Print) Address for Service: �WL L "– CMA t Si re U Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ —+y Licensed Construction Supervisor: License Number Address ( g" L 68 LL 7 j, f l f ® v1 �T r (� Expiration Date Signature �� lw" Telephone A.2 R istered Home Itfrovement Contractor Not Applicable ❑ jCompany Name Registration Number Address Expiration Date Signature Telephone T M Z O I 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 Descrition of Proposed Work check an a liable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: oil C-7� 1 +1 -1 �a $1 C., SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant " OFFICIAL USE-t3i:Y' - 1. Building Z u APO (a) Building Permit Fee Multiplier 2 Electrical dd. (b) Estimated Total Cost of Construction o2 S 0 0 3 Plumbing 5f� Building Permit fee (a) X (b) o� SD 4 Mechanical HVAC 5 Fire Protection 6 Total= 1+2+3+4+5 -' Z d C7 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize i U V1 �1— Y r 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, 6(f P as-Qwmr/Authorized Agent of subject property Herebv dell are that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief V Pri am /� co' Z 19 Si a e of Own 1 ent Date T OF STORIE5 SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 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 FORM U - LOT RELEASE FORM INSTRUCTIONS: 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 SECTION 1 APPLICANT Gr -- i PHONE7 F7 p LOCATION: Assessor's Map Number l PARCEL SUBDIVISION LOT (S) STREET S Po 0.P 1 I ST. NUMBER **************************OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS t1 TOWN PLANNER DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMME DATE APPROVED DATE REJECTED— UA I EJECTED UAI t AF'F'HOVED DATE REJECTED _A41r C -r -(j 1 �ice'! aw �h PUBLIC WORKS - SEWER/WATER CONNECTIONS PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING Revised 9\97 jm TE 50770N HILL- X A"6MY C'E.CT/FY TO TyE T/TLE /.r/SU.PO.PANO rO 7i/6 ZW -Vo ' 71147 7Wd - AWY444/.v6 /J LOCATED OA/ rs/E tor.45 s snirv,q vo 7WAr/m6ws cO,dFaelw IY/T// 7AWC70WAI ANdCveiZ ZONllld .CE6!/GAT.bt1S ,fW,5- R0/.W %d7A4C rf OZ47,W Sr -PESTS f LOT Li.✓ES. I FaeT.s�ct CE.�T/FY TiS�iOT TAY/.3' OA✓EGL/.V6 /SNOT L0G4rE0 Al r.YE FEOE.P G FZeVW0 XWZ4.e0 .4A'4.4, �Syewn! oN Feu rY P-�.vc� '*'zsoctig �M�� 1,-A-1:1-1) sTe,01KE / E. ITf//.S oL.�N Fo,P BOavoey x-rE,P�i PL O T PL.4.t� O,P.9N�iV FO.P o•ves� iti.�o.P.ss- �1E.P.P/�1.9Gt' E,vGiA/EE.Pi�v6 ,SE.Pf�/lES �i.eezoeos. 6G �-4•P.(� ,ST.rEET 1-�'ra�+/o A.f/OOi/E.� A'1AS.S.4G,f///SETTS O/8/O 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (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 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name P{ ase Print Name: conpc- h o41 Location- �� l r 'f'��^> i l� Pit E I i+ City .7 �� :� �� f , ( 4 7 Phone # I J� F] I am a homeowner performing ail work myself. I am a sole proprietor and have no one working in any capacity. ® I am an employer providing workers' compensation for rry employees working on this job Company name: r6G a °L lam© Yi r u ci + 110 Address Phone#: `1 ✓ Insurance. Co. I Y I. Poli # Companv name:yojt", '� , \,V, Address City: Phone#. Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the irnposiition of airninal penalties d:a fine up and/or one years' imprisonment_ as_wvlLas_c� p malbesin-theimmn-faBTOP]Ill9RKDRDER.,and_afma-c( ]11. M)-ato mw-$1,51.op understand that a copy of this statement may be forwarded to the office of Investigations of the DW coverage verification. 1 . I do hereby ceriVy unPerthe pins and vena/ties Ofnerfum that Me infarmabon arovided ahnve k thiEf arra fmwrm-1 e Print Official use only do not write in this area to be completed by city or town official' E ��v-�y�-`,6 eel y City or Town Permil/Lic ening Building: Dept pchecck Y immediate response is reguked .p licensing Board Q Selectman's Office Contact person: phone # E:] Health Department n Other `J/t 0 �j �ize 'COOmYlit0421I{ o��/UGad6�CYut6P,�I6 + BOARD OF BUILDING REGULATION$-. License: CONSTRUCTION SUPERVISOR ' Number GS 002176 j Birthdate 03/28/1.941 Bxpiires 03%28/2004 Tr. no: 9968 s Restricted -00' JOHN J BURKE 71 SUTTON HILL RDS N ANDOVER, MA '01849' Administrator C/) m m m Cl) 0 CO) .p CD Cl)Z CD O 06r CZ nco .0 0 OIc p CL cr 03 CD O O GO CD y CD O d O y •O n O y d C) CDO rF CD a y CD CO) O CCD O CD O -• ca cr y dorm "o ti mm n y C7 cl.C) m Z - .== N � O� d .�► m y T comm G y Vl � N O ?m m S > > m N O U2 O O :O c A = y O _ MM� >�c l/•�, i0 OCA (� 0 CD . O r CL �dy _ v C, A/ O to ? y m O CD c m� toFw : + I-► C O Ocil O OCD0 Z N IA j CD . co a3 =CD N O C•! C W =� G n� C _ C7: s o �q cn �1 cn .� 0. cd G ?f 7 w gj O z w c� "xi O Cil n GODGOD 7d � ro O � �7 �) n � O ►n O C) 2 Cl) cn r9 y � O a O o x O C CD Date/, ,-)-. tri- (,. ). 04 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 This certifies that .. 5. y. f. .... .�.!. ................ . has permission to perform (=J .................. plumbing in the buildings of ..6'1'. .. C ................... at. }...S. . �. lc /�' .. (. (............ . North Andover, Mass. Fee A0. ..... Lic. No. .. ...... f.. . J PLUMBING INSPECTOR Check # 5757 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location IrtaA 11/LL %f%wners Name /1'%� 0/Y/ FLL Permit # 7 Amount Type of Occupancy New ri Renovation 1_J Replacement Plans Submitted Yes ❑ No ❑ (Print or type) Check one: Certificate Installing Company Name �/�G UF_ TT/' ��� - yT�/ ❑ Corp. Address 1/l /7 hf c %% /1W GLS19 Partner. Business Telephone Firm/Co. Name of Licensed Plumber: oew"'—g-O -'�/_'= /*, -C/ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LLQ' Other type of indemnity ❑ 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 ❑ 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 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 Signature or LIcenseaum er Type of Plumbing License Title � s—� City/Town 1cense um jL er Master El Journeyman rjj - _ APPROVED (OFFICE USE ONLY Lam MM NMI (Print or type) Check one: Certificate Installing Company Name �/�G UF_ TT/' ��� - yT�/ ❑ Corp. Address 1/l /7 hf c %% /1W GLS19 Partner. Business Telephone Firm/Co. Name of Licensed Plumber: oew"'—g-O -'�/_'= /*, -C/ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LLQ' Other type of indemnity ❑ 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 ❑ 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 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 Signature or LIcenseaum er Type of Plumbing License Title � s—� City/Town 1cense um jL er Master El Journeyman rjj - _ APPROVED (OFFICE USE ONLY Lam