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HomeMy WebLinkAboutMiscellaneous - 11 BINGHAM WAY 4/30/2018 w 1 li 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IM ORTANT:Applicant must complete all items on this page J LOCATION (A-_7,. '� ► ig 1, 1 -� IA R PROPERTY OWNER N�v� not ©vstN d` � Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement - Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE P �_rz 0-F S�t�S rERFORMED: � S w v I� S Identifica 'on Please T e or Print Clearly) OWNER: Name: a• 9ti� ��� aySIN �� it Phone: Address: Y% CONTRACTOR Name: rn 04hD S C,NST ICC Phone: 1.78 `f Address: 161 (Vr�A Jl Supervisor's Construction License: 7 5� 19 Exp. Date-:_ "� 1 Z Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone:9n (P92-3732 Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 11,54 V2 FEE: $ 2- Z R- Check No.:��cf�" Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to theuaran and g t1'.f signature of Agent/Owner _ Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans Location r No. lk Date r D i NORTIy TOWN OF NORTH ANDOVER F R 9 ` Certificate of Occupancy $ . o49 Building/Frame Permit Fee $ n r sACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #A t. 226 Bu 19i-ng Inspector TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS RUG-07-2009(FRI) 08; 23 Office (FHX)9785350943 P. 0021002 PROJECT MANUAL 196026 ASPHALT SHINGLE REPLACEMENT @ BINGHAM WAY: 667-2 NORTH ANDOVER, MASSACHUSETTS was chusetts Department Of -Housing and Community i0ovelopment NORTH ANDOVER HOUSING AUTHORITY ONE MORKESKI MEADOWS �.. NORTH ANDOVER, MA 01845 Phone:978.682.3932 FAX: 978.682.0815 Joanne Comerford, Executive Director SPECIFICATIONS PREPARED BY.- DEPARTMENT Y;DEPARTMENT OF HOUSING&COMMUNITY DEVELOPMENT ARCHITEcruRAL/ENGINEERING SERVICES UNIT 100 CAMBRIDGE STREET,SurrE 300 BOSTON,MA 02114 TELEPHONE: 617.573.1168 FAX: 617,573.1335 July,2009 t t tzzs Lom►nonwealdh of1if=achMSettc �`�. D��e�p_f'industrial Accidents ii.. Dolce of Inresd adions 600 Trashing tun Street Boston MA 02111 c� , A www-mas gavldiaVorcersCompensation fnsirance.A�davrtRMers.Iicant information . tr acorsMectriciate/PiQmbe Piease Print LeQibf rs NaMe(Business/Oigmniza6on/IndividuW); 1�1 �p i jJ S L N S 7 CJ ` /'Co & ki,1 �1 toN L tr L Address: Ci / ` /7..ig: b t-9,Z Z phone 226 zt cis X73 Are y�o etauployert CScetrk.the$PProPriate-box: I.K m a mnPlo c,with=— 4. F1 I azo a en Type of proitxt( uE ernployees(full and/or ,� ;� ersl contsactar and I P time)• iisve hired the m d>-eontmct= aw construction 6• ❑'N . 2•�]T tam.a mole.proprietor:or Pffi'mer- Iiste:d on the attached sheet ? 7• []RernodeiM ship and have no employers , Tfz-se s g working for me in M6-contractors have any capacity workers;' comp.ie. 8 Q Demolition' required.] do s come• iasraasscx We are $ ��osafi 9. [l Building addition 3.�1 am a homeowner doing all work ri�� have exercised their. 10.[]EEe-h-ical repairs or additions �ceTseI£ of exemption per MOL I LC Plumbing requi[No-work='carrtp, C L5'2, §1(4)7'.and•we have no oof ins sus o adaitions ngntred.]1 .employe•:s jNo wore 12. *Amy eppiicarR that oheeics iw,' mus COMP• n umnc;e required.] r Homeowners who atao fill out the section blow Showing theirworkact'bompeh oi' Submit this affr&wh indicating 6roY zm an P Cy inform �Caatraoton that eF+eck tins box rematetae&ed sa rt}dctiaarJ Sheetsho end then hoe outside contraetozs must K'+�!Z t:he name of the Sub- Submit a new affidavit imiioctiag Suah.' I e:ra=a io er - ttnactocs and Ehair work=, � 3' iha7 csi+nv o• � ...n� trti►re.ere.i~„ c...r,��zs��r+zsurance or •. >n.�errnatecer_ J �'en�l0ve�; �.elncy.�.�t Insurance COitr .E p7. y�IaC site Name: Pormy#or Self-Ens. Lic.#: Expiration Datc; Job Site AddrasS; Attach a copy of the workers' coot �d3'� e1Zrp. Nmskiiots policy dtx Failure to �' �tafioo page(Showing the pa['Ecy aumher and e Secure coverage as required under section 25A of h4(}L c. I52 lead to the' xpir ion dat-4 . fine up to$1,5DQ.00 and/or one-yew imprisonm Po on of criarinal of up to S25D.00 a �;as well tis civil penatfim in the farm of a penalties of a Investigations day agaEnstthe violator. Be advised filet a e of this MP WORK ORDER and a fine gations of the DIA'for insurance Coverage op statement may be forwarded csage verin-L•stiMe to the Ofnce of I do hereby cerfify under pains and peri`' arPerlcuy that the information ' . Si provided abpw is trae and eorretx Phone#: $ C a � y Dai: 3 0 Official use only. Lao not write fa this area,m be contptetMr ajo,or town ofd City or Town: ity(circle fssu,ag Auffioc' Pertait/L:icease# one): 1. Board 0""=t f Hesit.6 Z 13olldiug DeParfinent 3.C' 1T 6 Other 4 O"w"IClerlt 4 Electrical Inspector S. Plumbic b Irespector Contact Persatz: Phone#: i Oil h�llildi..lot- 017strti ett�. Cicsns °n 11` . h1tiptrl�-S;lli�t' e,. Restricts e: CS SUperyis ou.r.rpd S ; BRl a to, 00 ,5g'4 °r License 14dar c/s AN Dso/� NH 03051 Expiration: T 912812010 = 29S8 J 1 AUG-07-2009(FRI) 08; 23 Office (FRX)9785350943 P. 001/002 MCNews details job display bgp://www.edcirws-ronYisp/PriiIJob.jsp'IcW-10 I l298&.pub1id=C kF`rt^' PAI 0062900132 BID STAGE:BIDDING Alteration BINGHAM WAY ELDERLY HOUSING 5&7-2 RESHINGLING Project No.196026 LOCATION:North Andover,MA(Essex Co.) ESTIMATED AMOUWP$107,800 U� COMTRACTYNG METHOD:Competitive Public Skis V BIDS DUE:July 23,2009 at 2:00 PM(To Owner) OWNER:1Vprth,Hncl;:uar i!ou�If1Q�:Ci'LQt:ti:`� I Morkeski Mdws,North Andover,MA 01845 (978)682-3992 FAX*(978)791-1142 DIVISION: "t"C,�� Div?shingles,shingles roof ties&roof coverings,thermal&moisture \ r ou protection Spec Cond.DCAM Certification is required. CONTACT;Joanne Comerford with owner, (978)682-3932,FAX (978)682-0815,jwmerford@northandoverha.com Ph=Owner Industry Type..RieLid.iz21r1 Industry Sub Type: anar nmjits First Reported June 29,2009 Last Published Jun 29 2009 OCOPYRIGHT 2009,CONSTRUCTION QATA COMPANY,ALL RIGHTS RESERVED. This material may not be published,broadcast,rawrhten or distributed, i II aa�o`1 I 1 toff 7/20/2009 7;39 AN V •• YJ yyYY6 .!!. C VL J A � CERTIFICATE OF LIABILITY INSURANCE '.'E" MMI) Pltowctn CLIFFORD R LARSON INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIDp 1343 MASSACtiiJSETTS AbENUE ONLY AND CONFERS NO RMHTS UPON THE CERTIPICAT6 ARLINGTON,MA 04476x101 MOLDER. TMS CERTIFICATE DOES NOf AMEND, EJCTEND OR ALTER THE OVERAGE AFFORDED it THE FOLICIES BELOW. (781)848-92� wliulreD MEADOWS CONSTRUCTION CO LLC INSURERS AFFORDING COVERAGE MAIC N 166 MIDDLE ROAD RA: RTY ALG SYFIELD MA 01922 WRW t 0: INSURER c INsurWRO: COVERAGES ' F- MAYTHS PO'CIES OF IN SUpANOR CE LISTED BELOW HAVE BEEN 18OVED TO THE INSUR60 NAMEO ABOVE FOR THE POLICY PERIOD INDICATED•Nffr�Nl1'H$TANDING PEREQUIREMENT. UNNTHE NS RAMC`,CAFFFORDI EO OF rniE POLICIES BESRACT CR�BEOHEREIN 8 SUJUEC E yy r TO WN3 EACIIS CERTIFICATE CONDITIONS CEO OR POLICIES.AG&k(ATE L�NIT$SHOWN MAY 14AVE SEEN REDUCED By PAID GLANS, CH POLICY RDIw6ER Y EYPIRATI 6L?RERAt W1883TY � T m' LNDii _ COMMBRCMI.GENERAL LIAGILITIF W"00311 m I i CWMG MADE 11 OCCUR PREMISES MEo Ow y Lee S PERGORAL s ADV KA RV t CENL A—MATELorrAPPLIEB PER NERAL AGtiitE(�TE i POLICY PRO- LOC PRODMTy•efmfipP &ECT AGG t ANTOMOCILE LL*JKJTY AMY AUTO ALL AUTOS Ed °'431P LIMIT i SCMEOULEDAUTOS OWIL INJURY f NIREDAV►OS NON-OYftV AUTOS 800'Lr INJURY TV wadwo f �Lafd°nyE i GARAGE LI/1B W YY ARy AUTO OPLLY-EA A mENT i OTHER THOW EAACC S AU FO ONLY: AGG i PJfCESt1UMBRELLA LyaluTy OGcuR FIC MMS 1AM Efa1 OccuNaENCE t AGGWgGATE i OEDIKTMW t RETENTMu f i A YIOANERt COWOSATM WC2-31S-352o33O38 AMDLyIIpLOYEltB'LIA91Lm —9/1—2t2008 9/12/2009 TATu ANY FR0VPVOAlPAWfKQGXECVTIVE N R OFFlfXNA In Nm)Ek0.ueWy Y E.4 EACMAccwENT E 1D0000 OFFI eRM M NII) Psd"EeAAt10fl0Agi° ,,,,, E-LDISEASE•EAEMPLO f 100000 OTRER E.LDIgEASE.FOLKYINdR $ 5000 -. DESCRVTbN OF OPERATION!I LOOATIOMI VEIACLEG IEXLtVS10�ALTOep GT ENDORSELMNT IIPECMI pZ;M NE' . The workers'compensation p011Cy provides emrage only for the state of MA as noted in Sedon 3A of the poliCy. 7NORH CANCEL 51WULDANYOFTLIEA20WMCMMpgyO�XCARCEILEDI1PVMTREEVpjkKn N VERHOUSINGAUTHORITYDA'f7N�1ioF.TYestuiw►19uMV--EAIDEAVORM*AIL T LTiyMEAD�W3 "Un"TOTNECBtTISICATFNpL•BER�pTOTRELS11%evrFAumToucsos ALL WTW VER MA 01845 #wow NO OKIGATION OR LWJPL"r OF ANY KOO UPON nm R m AaeRTs OR REPREa^iYTATA1Ei. AUMpr/up RE►REAeNTATW ENlritlge "F U ACORD 25(2609/01) d CCRT SIO.. Sf31e84, CLlert(.=i 3.1s74-u Ana.eraaAla st31/a°f°e, dJ19>M,Y609ACORD CORPORATION. Allriphts reserVed. 11:11 AN TL 3 of� i OWNER-CONTRACTOR AGREEMENT COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT This agreement made the 7th day of August of 2009 by and between North Andover Housing Authority hereinafter called the"Owner°,and Meadows Construction Company,LLC hereinafter called the"Contractor. Witnesseth,that the Owner and the Contractor,for the consideration hereinunder named,agree as follows: Article 1.Scope of Work: The Contractor shall perform all Work required by the Contract Documents for Asphalt Shingle Replacement @ Bingham Way prepared by the Department of Housing and Community Development acting as and referred to in the Contract Documents as the"Architect". ARTICLE 2.TIME OF COMPLETION: The Contractor shall commence work under this Contract on the date specified in the written"Notice to Proceed"and.shall bring the Work to Substantial Completion within 90 calendar days of said date. Damages for delays in the performance of the Work shall be in accordance with Article 9 of the General Conditions of the Contract. ARTICLE 3.CONTRACT Sum: The Owner shall pay the Contractor,in current funds, for the performance of the Work subject to additions and deductions by Change Order,of the Contract Sum of: ONE HUNDRED THIRTEEN THOUSAND TWENTY dollars $113,020 CONTRACT SUM IN WORDS CONTRACT SUM IN NUMBERS ARTICLE 4.TME CONTRACT DOCUMENTS: The following,together with this Agreement,form the Contract and all are as fully a part of the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents, Contract Forms, Conditions of the Contract, and Specifications as enumerated in the Table of Contents,the drawings as enumerated in the List of Contract Drawings, DHCD publication known as the Construction Handbook, and all Modifications issued after execution of the Contract. Terms used In this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions. ARTICLE 5.ALTERNATES: The following Alternates have been accepted and their costs are included in the Contract Sum stated in Article 3 of this Agreement: Aitemate No(s): 1 and 2 ARTICLE 6. REAP CERTIFICATION: Pursuant to M.G.L. c.62(c)§49(a), the individual signing this Contract on behalf of the Contractor, hereby certifies, under the penalties of perjury, that to the best of their knowledge and belief the Contractor has complied with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support. ARTICLE 7. WORKER DOCUMENTATION CERTIFICATION: In accordance with Executive Order 481 the undersigned further certifies under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the performance of this contract; that pursuant to federal requirements, the Contractor shall verify the immigration status of all workers assigned to such contractor without engaging in unlawful discrimination; and that it shah not knowingly or recklessly alter, falsify, or accept altered or falsified documents from any such worker(s). The Contractor understands and agrees that breach of any of these terms during the contract period may be regarded as a material breach, subjecting the Contractor to sanctions, Including but limited to monetary penalties, withholding of payments, contract suspension or termination. DHCD 4/2007 Owner Contractor Agreement c.149 S25k-100k 1 of 2 RUG-07-2009(FRI) 08: 25 Office (FRk)9785350943 P. 001/001 • �.v•• v• Yr!•Wl�flLr V!Y TO THE AWARDING AUTHORITY A. The undersigned proposes to furnish all labor and materials required for replacing Asphalt Shingles for the NORTH ANDOVER HOUSING AUTHORITY In North Andover Massachusetts in accordance with Contract Documents prepared by Department of Housing&Community Development For the contract price specified below,subject to additions and deductions according to the terms of the specifications E. This bid includes addenda numbered C. The proposed contract prlce is: NioJI u •4V Dollars $ 1 3 Bid Amount in Words B vont In Numbers For Alternate No. 1 Add$ �_ Subtract$ No. 2 $ ` ti Each Alternate shalt be listed separately D. The undersigned agrees that,if selected as general contractor, he will within five days,Saturdays,Sundays, and legal holidays excluded,after presentation thereof by the awarding authority,execute a eontract.in accordance with the'terms of this bid and fufrilsh a'performance bond and also a labor and materials or Payment bond,each of a surety company qualified to do business under the laws of the Commonwealth and satisfactory to the awarding authority and each In the sum of the contract price,the,premiums for which are to be paid by ft-general contractor and are included In the contract price. The undersigned hereby certifies that he is able to furnish labor that can work in harmony with all other elements of labor employed or to be employed on the work;that all employees to be employed at the worksite will have successfully completed a course In construction safety and health approved by the United States Occupational Safety and Health Administration that is at least 10 hours in duration at the time the employee begins work and who shall furnish documentation of successful completion of said course with the first certified payroll report for each employee;.and that he will comply fully with all laws and regulations applicable to awards made subject to section 44A. The undersigned further certifies under the penalties of perjury that this bid is in all respects bona fide,fair made without collusion or fraud with any other person. As used in this s "person"s and m subsection the word erso can natural P n shall person, Joint P ,)c t venture,partnership,corporation or other business or legal entity. The undersigned further certifies under penalty of perjury that the said undersigned is not presently debarred from doing public construction work in the Commonwealth under the provisions of section twenty-nine F of Chapter twenty-nine, or any other applicable debarment provisions of any other chapter of the General Laws or any rule or regulation promulgated thereunder. "' ?1&X, t� Name of General Bidder Signature 12" BY: Date: Signature 8,Title of Personid ,� ��� Business Addn:9s r ' city aadState) Nate: if the bidder Is a Corporation,Indicate state of Incorporation under Signature,and affix corporate awl;if a partnership,91v8 full.nam"and residential addresses of partners If different from business addresses. N Andover Bingham Form for General Bid 00.41.13 1 of 1 RUG-07-2009(FRI) 08:30 Office (FRX)9785350943 P. 001/001 Bingham Way North Andover, Ma, General Conditions 1...... ea $ 7,000.00 Price/sq $335.07 Roofing T-Lifetime 226 sq $ 325.00 $ 73,450.00 Hip and ridge 25 bndl $ 35.00 $ 875.00 Starter 18 bndt $ 25.00_ $ _400.00 _ --- �— Ice and water 20 roll $ 50.00 $ 1,000.00 Capper Step Flash 475 ft $ 5.50 $ 2,612.5_0 _ Paint Rakes, Fascias and soffit 1890 ft $ 4.25 $ 8,032.50 Totals $ 93,370.00 Alternate#1 New Gutters 1110 ft $ 16-00 $ 17,760.00 Alternate#2 Alum -- wrap fascia, rake and vinyl soffit 1890 sq $ 5.00 $ 9,450.00 ARTICLE 8.VALIDATION: This Contract will not be valid until signed by the Director of the Massachusetts Department of Housing and Community Development. In Witness Whereof,the Parties Hereto Have Caused This Instrument to be Executed Under Seal. CONTRACTOR AWARDING AUTHORITY Meadowsb Construction Company,LLC North Andover Housing Authority Name of Contractor Name of Housing Authority 166 Middle Road One Morke*i Meadows,North Andover,MA 01846 Street Address Byfield,MA 01922 C' State Zip Signature and eal By _ Chairman S natur id a Title Witness 1 � Attest: ' If a Corporation,attach 7notarized copy of the If signed someone other than sing Authority Corporate Vote authorizing signatory to sign Board member,attach a copy of Certified Board Vote Contract. authorizing the signatory to sign Contract. DEPARTMENT OF HOUSING&COMMUNITY DEVELOPMENT In accordance with M.G.I. c.1218, and Revisions thereto. Undersecretary Date DHCD 4(2007 Owner Contractor Agreement c.149$25k-100k 2 of 2 V40RTH Town of 4 Andover / O No. 0 . 8� - i o ;yAKE dover, Mass., C0CH1C1' EWICK 7,9 ADRATED PPS` `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR ��. .. THIS CERTIFIES THAT..p .�........ ...... .. �. ......... ... ..... ....................... Foundation has permission to erect...................................Ouildin son .( (�.--L....... .1./ ...�,,. . . ................� !� Rough t0 b8 OCCUpled as }. .. . . . '........ ..... ... .. .... .......... Chimney provided that the person accep ing this permit shall in every ect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 135 , PERMIT: EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU AR Rough Service TOR Final .......... ... .......:...::.... BUILDING INSPEC Occupancy-Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter Location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit iv,dez- ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses )d Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit j Addition Or Decks i ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) j ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report Ll Engineering Affidavits for Engineered products i NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application I Doc: Doc.Building Permit Revised 2008 I No 2874 Date....:'2......................... NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACHUS� This certifies that has permission to perform '.:. - `' .................. .......................................................... wiring in the building of.................. ....................:.C.::.:... ' �................. t ..................................................... � -.. ... .North Andover,Mass. ee: .✓...... Lic.No�" ............................................................... z ELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer THE09MM0NWE4LTH0FMM4CffR1SEM Office Use only/ DEPARTAMATOFPUBLICSAFETY Pemtit No. �d`7 el BOAMOFMEPRU M ONMGMT10AN527CMR12-M Occupancy&Fees Checked 10PPLICATIONFORPERAffATOO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date�_���_ Town of North Andover To the Inspector of Wires: j I The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) comm. BJt%J 3%4( i.1AM C%Z(A. . Owner or Tenant A 14,001 F.Q *kOV 5 i s1Cn AtJ"r-�kOr l7Y Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service II O� o _ Amps IC /� Volts Overhead 0 Underground No.of Meters 1 New Service 2a�0 Amps IVO I.Fgb Volts Overhead [aUnderground No.of Meters l Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work QA5e_t_-1T_l__, FL — 1a�*10tcaP�U R�i-ra>, -+ __taew 5TcNI-ce No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets 1 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 1 No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and IV Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices o.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of n Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER =4 11KIkk, VOR tAA*101t;APPt7) L3AICt" , Zt.15TA1\ *lE,W, '200A 100 A PA4ek- :5 htstttanoeCo Ptasuatrt9�thetagtmenats�GataalLaws IhaNeaaxmtLiabiidyhst==PbbLYmdu&gCanP6e Covw,WaAssksbrtWe ivaffft YES NO Ihateahnnadvabdprcdofsametothe011m YES -NO 1f} .4eofwvw,wbydakingtc by ng CEEBOND o OUIER o ) >� ElpirdonD* E0tnaledVahtedE1ec tical Wodc$ WakIDSW 7. S O ► hWxCfionD*RaWeWd RM0 _7 - (-- 01 Fatal %A SigrodunderTIPtrt ho FIRM NAME 9ZA 'rcLE C T e t C LiarseNa t S o_S3 A Li== ZNEW SAC¢A Sigt&ue J LiMnseNo 3 l;.o0 5 4ET BusirmTel.Na 1.03 fm3S 3 al z ddres,L 6 3 SE.REf1t NttL L1J41f`1 t >.JN o3G7L- Al<TdNa 6a3 770 31 0 OWNER'SINKRANCEWANER;-lamawatedAlheLioa�se tx�$teimlratoeoot a�ss> Ic�alec�tivalartastegtmadbyMa�sadt sGa>aalUm "dvtmysigtt maitispemz$ waitesttusrtw,anent (Please check one) Owner M Agent Telephone No. PERMIT FEE$ r-,2S