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HomeMy WebLinkAboutMiscellaneous - 89 JOHNSON STREET 4/30/2018Date .... / -7 - / Q ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..................... 4 ........ N..7 . . ................. ................................ has permission to perform ,S ,5,e .................. wiring in the building of ............ .................................................. at ................ ..... ...... . ..... North Andover, Mass. Fee .... !Y'>..' ... Lic. No . .... :...a.l�.............. ........... Check # 13 2 13,- / 73 9249 C�ommonwaaC� o� �a9dacic�a�l 20,Darfmvnf 01 _.j•ira sarvicaJ BOARD OF FIRE PREVENTION REGULATIONS UIV - Official Use Only Permit No. Occupancy and Fee Checked _ (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: OL -11 -lb City or Town of: /0 To the inspector of Gr/ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with aVilding permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. -A,),3,�>, Yes ❑ No (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ NG. of Meters No. of Meters Completion of the following table may be waived b the Inspector 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 SwimmingPool Above In- arnd.nd. i o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners _ FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. InIn Detection and itiatin Devices No. of Ranges Na. of Air Cond. Total No. of Alerting Devices No. of Waste Disposers Heat Pump Number__ _ Tons K_ _W _ o. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other Connection No. of Dryers Heating Appliances KW. Security Systems:* No. of Devices or Equivalent No. of WaterKW No. of No. of Data Wiring: Heaters Sins Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wirin": No. of Devices or Equivaent OTHER: 1O 7,?•�do2 S %o/�y Attach additional detailuif desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: if ��/ �� `�y (When required by mnicipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVE GE: 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 [X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that -tthe �information. on this application is true and complete. FIRM NAME: ( ��' c� �', ((f (wi S e � U i Gam' LTC. NO.: Licensee: L./,%/,'A/' T/4//c` Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number lin Bus. Tel. No.:�—� Address: 1 r inT�m 2_/%s �)ff !23Q5�i— Alt. Tel. No.: *Per M.G.L. c. I47, s. 57-61, security work requires Department of -Public Safety "S" License: Lic. 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 .r` Signature Telephone No. PERMIT FEE: $ T,�— FXe &12n�� ? Department of P b[Ic..SafetY -� One'Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: Certificate of Clearance Number: SS CC 002577 Expires: 12/23/2011 Restricted To: 00 WILLIAM M TAYLOR JR 18 CLINTON DR HOLLIS, NH 03049 ,-CAI G 35M-10/09.10162009LICENSEFORMI -_ DEPARTMENT OF PUBLIC SAFETY z Certificate of Clearance t- Number: SS CC 002577 Expires: 12/23/2011 Tr. no: 1420.0 S -License: ADT SECURITY SERVICES ✓VILLiAM M TAYLOR JR18 c G, �OCLISTON DR NH 03049 Commissioner Tr. no: 1420.0 Keep top for receipt and change of address notification. r .> N r �I C) -0 --J CD r' C C) r — -- a Z C) D JS 0 z O. • m n ;0 =-- x MZ rn nl _( 7- "'( y 0 G) b C t m c M ' r cn u C) LL O z o _m T , L m S o z m D LA' Ln m C� � . p (� Ln O L n I i7 a: p C:: C, T Z (� in C. I L-) J I1 (n Location ` A 0 p SOJj No. 4. 16 Date ti MORT►, TOWN OF NORTH ANDOVER i 1 OG Certificate of Occupancy $ '� s'••E<�' Building/Frame Permit Fee $ 6 Q AC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $J Check # d . S Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 777-7ffgY BUILDING PERMIT NUMBER: © ( DATE ISSUED: a C �4 Ak C SIGNATURE: Building ComnWsionefflnspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 6900 69 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 R red Provided ReWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIUVAUTHORIZED AGENT 2.1 Owner of Record Aovw NamePrint) Address for Service: Signature Telephone 2.2 Owner �offRecord: �C f�Y`/,!)&� op L � Name, Print Addres for Service: 'a Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: A42� Not Applicable ❑ T,i&nqn Consiruction Supervisor: License Number J� AddressWow T ciG (E��` pi tion Date tg re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name x Registration Number '1%0U^71 Adddress r ' Expiration Date t n re Tele hone Ma M X ic z T N O z M 90 on M r zAA Y T 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 all applicable) New Construction ❑ 1 Existing Building ❑ I Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: I SF,CTTON 6 - RSTiMATFD CONSTRITCTION COCTC I Item Estimated Cost (Dollar) to be Completed by permit applicant OFTICIAI USE ONL-y :'y ' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction pCel 3 Plumbing Building Permit fee (e) X tel 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number M54L1IVA is VWf4EX AU IHUHILAIION 1'0 BE UOYLPLETED WHEN I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ! as Owner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date to act on 1, 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 of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMMERS OT 2 ND 3 RD SPAN DIN ENSIONS OF SILLS DIN ENSIONS OF POSTS DLIV ENSIONS 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 • Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, North Andover, Mass. 01845 I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below described: Owner's Name......... ............................ ........................................................................................................................................... Job Address ......... " .. .� ...1...... -W .........................city..../r ..X........................ State. �y ................... . SPECIFICATIONS ,..�....... .................. ............. ��, ;�,,- ........ ............... , -"�.r. . r .......... ... .......61 ....... .. .7 .. ... � ..... .. . .... ....... .. ......... � "` ................. / ..�...... �...Z.G .................................................. ............................................................................ .......................,........................................ ............ ............. ................ . ................ .-.....��c`.... ,,�.�!�... .................. .................................................. - z .....,r�.:................................................................................................................................................ y .........:.................... �:A.............................................................................. Materials and labor to cost $ .�L� ,��tt.� .......................... Payable n ................................and balance in............ .....�. monthly installments of $ .........................................each, payable on . .....................................day of each and every month thereafter until paid in full (..............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation. ` IN WITNESS WHEREOF, the parties have hereunto signed their names this .............Zf, )......... day of.... Ni�+1fG.�.....T Accepted: Signed.......... .................................................. Owner (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Per.... ........... ..... ...... .. .. . . Representative Signed...................................................................................... Owner Signed...................................................................................... ✓ire iJn�n,»tn�ttixcrt'Ci[ of �:U(.aa:uzcflre6e./.ta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR j Number: CS 034049 Birthdate: 12/08/1923 Expires: 12/08/2005 Tr. no: 12443 Restricted: 00 MARIO T CASTRICONE 31 COURT ST N ANDOVER, MA 01845 Administrator �° �r ✓ire �o�trinraittaea�l a`✓l•U[�c�c�a6n,�,ta I t;Y Board of Building Regulations and Standards 1, h HOME IMPROVEMENT CONTRACTOR Registration: 1103317 Expiration: 7/7/2004 Type: DBA CASTRICONE ROOFING & SIDIN Aano Castricone 31 Court St. N. Andover, `MA 01843 �" Location: a& ('==MUM 0f ` C'"= @9a7ment of I�dvstriata[cta�ants 050 of -IMwevatim 600 WWfmtstoa S"W {Boston, NA 02111 Work=- CompenwAua Itst mote AffArdt of Telephone O I sm a hotneowner perfaam s all work myself: i W. sole proprietor and have no one worldn in my capacity D I air, an employer providing worloers' compensation for my employees Working on this job Company Name: .0a -A _.. Address: City: Invarance ComPMY. Telephone M: ,a= Z7,P` V.2 Policy #:._ 1�L 15� 6 A 91 q U 1 am (ctrde one) sole proprietor. genetal contractor or homeowner and have hirea'he crmtmetcrs l *tt below who 64'6 e follaaririg workers' compensation Policies: r Company Name: Address: City: Telephone #: Insurance company: Coatpsny Name: Policy #: Address: - Chy: inns er. Company: Telephone #: Policy #: Attach additional abeet if necessary Fahurs to secure coverage as required under Sectior. 25A of MGL 15B cat: lead to the tmFosWcu of LTiminal penalties of a fine up to 51,500.:10 au&or out years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a ftme of 5100.00 a da, against me. I undersm id that a copy of this statement may be forwarded to the Office of Investigations of the DTA for coverage verification. I do hereby certify under the pains and penyufes' of perjury that rhe inforntarton above is true and rorrect Otrida! 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