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HomeMy WebLinkAboutMiscellaneous - 92 FRENCH FARM ROAD 4/30/20180 US Date ..... Z. ......... Z .......... .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING 11 This certifies that ............... ............ ............................. has permission to perform ........ 5'nccar.i —1<e..... l f"f ' ...... wiring in the building of .......... CkLe."e,0(z .......................................... at ..... 1.4 ... ............ . North Andover, Mass. Fee.. 4 Lic. No. ................ IC L INSPE R Check # 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time ofongoing construction activity, and may be -deemed -by the Jnspector_of Wires abandoned.and.invalidaf_he--. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or theinstallinlentity stated on the permit application. - ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012. ule 8 — Permit/Date Closed: 4,,7 •---1�, I**mote: Reapply for new 0 Permit Extension Act — Permit/Date Closed: Official Use Only Commancv¢aUh o� /i'�asaachusel�; Permit No. _ �(,JePFrEmertt o�J'�r¢ �eruice3 Ccc aancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/071 (leave blank) APPLICATION FOR -PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CM 12.00 (PLEASE PRINT IN INK OR TYPEALL EVFORMMTION) Date: -T „? City or Town of. _ A) nn 1n4 (1 �70� P �-- 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) Owner or Tenant Owner's Address Telephone No. Ts this hermit in conjunction with a building permit'( 'Yes ❑ - r`lo (Check Appropriate Box) Purpose of Buildin Existing Service Amps / Volts New Service Amps / _ olts Number of Feeders and Ampacity Location and Nature of�Proposed Electrical Worla Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters F^l It� Or 1.lre �ctS 1'n „rtr,o rnllnwino tnhlP may be waived by the Inspector of Wires. No. of Recessed Luminaires --- NQ. of Ceil: Susp. (Paddle) Fans o. o otal 'Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators iCVA No. of Luminaires - Above n -o. Swimming Pool grad ❑ grad. EJ o mergency ig ing Battery Units _ No. of•Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices eat Pump I Number 11 ons Wo. o elf- ontained No. of Waste Disposers Totals: Detectioa/Alerting Devices No.'of Dishwashers Space/Area Heating KW Municipal her Local [I pa_ Heating AppIiancesy Security System :* Device rvalent No. of Dryers No. of ]\o. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent elecommunications �Minng: No. Hydromassage Bathtubs No. of Motors Total HP :No. of Devices or Equivalent ()THE • I - n ­."­­/ • d by Hi Irmermr of tires. QQ41 AttaCn aamnonah ueiuu yucou �,+. 01 W • may•-•• -- -� ••-----.------ -+ Estimated Value of Electrical rk: (When required by municipal policy.) Work to Start:_ ' Inspectio a 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 0 BOND ❑ OTHER ❑ (Specify:) 1 certify, under the pains and penalties of perjury,, that the information on this application is true and complete. FIRM NAME: k,�> St? u r S� f'L �s LIC. NO.: Licensee: M(af l� �r �tirJhLl Signature LIC - NO.: SC• (1f applicable, enter "exempt ' in the lhcen umber line.) , Bus. Tel. No.: O.3 4 � Address: I S, �. L I n T t1� Y. 1-� \ t S 1J l 1 O 3 L% L.j_• Alt Tel. No.: "Per M.G.L. c. 147, s. 57-b1, 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 ae.ent. Owlier/Agent, PERMIIT FEE: S Signature Teli p.ione No: ^V f v Department of P blit Safety One Ashburton Place, P.m 1301 `= Boston, Ma 02108-1618 License: S - License Number: SS CO 000953 BR()['FJY SR I 1 I',M )RSE ST XOR'AFOOD, NIA 0,11162 Expires: 02.07120 i Restricted To: 00 Tr, no: -11.7.0 Keep top for receipt and change of address notification. 111 h:IORSE ST NCR;^1000. (,IA 021062mDIG SAFE CALL CENTER: (888) 314-7233 - - •- - ---- -• -• - -- - - - ---- --- comissioner—� _..__..--.--.------- --_ Fold, Thon Onlad, Along All Perloradom CDIVIMO(VWEALTH OF MASS ACHU8ETTS::.::":•:.: BOARD --'-':; .. FA _ ;rA_REGtSTERED SYSTEM CaNTRACTOR::;'.; s%-IS$UESTHEAB&ELICENSETO_;.` TYPE SECLIRIT'f'.. S.SRVI"CES, .INC - ?*4.ARK A.: BROPFIY..... i. d-�4.10 ._U.NaVERS -CIIY: AVE i- ; r; N. _`; ;4tEST4JQ017 ,.MA•, 0209,0.-211,:;{•: 849174 f.: "_ _.' ;45 C 07./31/13 �::.`::•.•.849374,, r.•... . v .Fold. iron Oa,arh Alang Ap Per!oratlor>r .%/i..• I•onurrr•iunerlir �!. rA:.�rr'/rru.-!ia ` DEPARTMENT OF PUBLIC SAFETY Number. SS CO OWS53 —m��ri�•y Expires: 02:07-1"201-1 Tr. no: 117.0 �1je S -License: ADT SECURITY SERVICE NIARK A r3ROPHY SR Restricted To: 00 Tr, no: -11.7.0 Keep top for receipt and change of address notification. 111 h:IORSE ST NCR;^1000. (,IA 021062mDIG SAFE CALL CENTER: (888) 314-7233 - - •- - ---- -• -• - -- - - - ---- --- comissioner—� _..__..--.--.------- --_ Fold, Thon Onlad, Along All Perloradom CDIVIMO(VWEALTH OF MASS ACHU8ETTS::.::":•:.: BOARD --'-':; .. FA _ ;rA_REGtSTERED SYSTEM CaNTRACTOR::;'.; s%-IS$UESTHEAB&ELICENSETO_;.` TYPE SECLIRIT'f'.. S.SRVI"CES, .INC - ?*4.ARK A.: BROPFIY..... i. d-�4.10 ._U.NaVERS -CIIY: AVE i- ; r; N. _`; ;4tEST4JQ017 ,.MA•, 0209,0.-211,:;{•: 849174 f.: "_ _.' ;45 C 07./31/13 �::.`::•.•.849374,, r.•... . v .Fold. iron Oa,arh Alang Ap Per!oratlor>r r No a D c f� Date �.... . TOWN OF NORTH ANDOVER ...,.'. 0 PERMIT FOR PLUMBING This certifies that -Ili .....-A. .1 " j, has permission to perform .. . � ....�................. . plumbi g in the -buildings of.�"..G. ............. . i { MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE / d- PERMIT # JOBSITE ADDRESS OWNER'S NAME ' POWNER ADDRESS TEL[ TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: ®! RENOVATION: [— REPLACEMENT: PLANS SUBMITTED: YES ® N0[] FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB_I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM GREASEDEDICATED FM-F=FMFM M-I®Fm--MFM-FM-F®fMFM-K-�iMF � M��FW-FW-FW- WM11 1�iFW-MWWl- DEDICATED WATER RECYCLE SYSTEM [0— W— FW -FW -FW -FW -F- -F-F-F-F-F- MF MOM IMM MF DRINKING FOUNTAIN FM-F=-[M-FM-FM-[P-W-FM-FM-F-M-F=-FM-FM--FM-FM-P=w F= - FLOOR/ AREA DRAIN F F�-F�--�lF�l(�IF�-fl -Fl --F l�f�lF�Ir�Fi INTERCEPTOR (INTE KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirementsof MGL Ch. 142. YES ( 'NO ©1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 OTHER TYPE OF INDEMNITY Ej BOND M OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 01 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME c? w- (✓� �'� ( LICENSE # SIGNATURE MP M JP n CORPORATION • # •_ i PARTNERSHIP 0# LLC COMPANY NAME -!ADDRESS CITY mac" I ( =STATE ZIP P� TEL FAX itCELL I� EMAIL 0 o o Z V1 ❑ ci LU n u.i w }N %i, 41- t✓ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UV-. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly a ,rte` s Name (Business/Organization/Individual): 1 J J't-' G Address: `I City/State/Zip: v w -P rl f� �%'Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with LP 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No wokers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10 E1 Electrical repairs or additions 11.lumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. Tam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I' L', o. C' 9 Policy # or Self -ins. Lie. #: f Expiration Date: /' d %— /) lob Site Address: T b L 6 � r`7 � � City/State/Zip: A 4, do– t -__ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine )f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certifyAinder the pains and penalties of perjury that the information provided above is trice and correct. ?hone #: G1 7 !. f �d 5020 0 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # d 1-Y --�,). � Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: CONTROL #H355871 5p IMPORTANT If this license is lost or destroyed, notify your Board at the: + Division of Professional Licensure, 1000 Washington St., 1 Suite 710, Boston, MA 02118-6100. If your name or address shown is changed, notify your board Of correct name or address to insure proper mailing of next i Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws 5 as amended. It is a personal privilege,' and must not be loaned ? or assigned to any other person. Keep this license on your Person or. posted as required by law. CONTROL# H338693 IF;9POR r ANT , If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, -1000 Washington St., Suite 710, Boston, MA 62118-6100. t If your name or address shown is changed, notify your board Q of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege, and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. CONTROL# H355872 IMPORTANT If this license is lost or destroyed, notify Board at the: Division of Professional Licensure, 100 Washington St., Suite 710, Boston, fVtA 02118-6100. If your name or address shown is changed, notify your board of correct name or address to, insure ro er 1 Renewal Application. Always refer top yp mailing of nexour license number t i This license is subject to the provisionsof the General Laws as amended. It is a personal privilege, and must not be loaned ` Person or or assigned to any other person. Keep this license on your Posted as required by law. %! r' i /r f COMMONWEALTH OF MASSACHUSETTS PLUMBEF S AND GASFITTERS LICENSED A:. A JOU--f, PLUMBER ; ISSUES THE ABOVE LICENSE TO: I JOHN P TURC'1 i 1O P-RINCESS AVE -i • i CHELMSFORD MA 01824-00:00— ..17168 1824-0000 `17168 0'_:/01/14 147656 ! . OelI tf=ZNtlg+ -Ky@ ►�i � I i COMMONWEAL i H OF MASSACHUSETTS =i ` Ie o 1••c .t � PLUMBERS AND GASFITTERS :RRGISTERED AS A PLUMBING CORP L) I ISSUES THE ABOVE LICENSE TO: JOHN. P TURCO i I TURCO PLB `>I HTG INC M 8677 11\\ice` 10 PRINCESS AVE U) CHELMSFORDl MA 01824= Date /.?. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. ��.'P Q !? / , ..L �. .............. . has permission to perform. wiring in the building of �� .. ! ... .................. . at ......�1.�..fT O �..?. ��...�`� '' c, . , North Andover, Mass. 75 Fee./ ....... Lic. No16.5. 7.7... !11,6 .................... ... ELECTRICAL INSPECTOR Check # ` "i♦!I 12 \. Commonwealth of Nassachusetts Official Use Only Department of Fire Services Permit No. //// Z.. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrical Code(MEC), 5Xo- City CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 l a- y or Town of: Avor.lk ,JLj f jL To the Inspector of Wires: By this application the undersigned gives notice of leis or her intention to perform the electrical work described below. Location (Street &r Number) q �— K Owner or Tenant L pr t c-, I kc,, c,J Telephone No. Owner's Address _<)4,'-M P_ Is this permit in conjunctiqp with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building_ g z,�Je Utility Authorization No. Existing Service d-00 Amps 11-0 UVolts Overhead ❑ Undgrd New Service Amps I Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity LocationandNature of Proposed Electrical Work: 1, j�1f /v ec j &J t rte lit . .L. Iii .. - 1 1 _ 1 J— 11 1 { nil L4—/7 . C, d- 1-1/ , , No. of Meters No. of Meters Compledon ofthe followink table may be waived bn the Lrsmdor of Wires. No. of Recessed Luminaires I No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires!� Swimming Pool Above ❑ In- ❑ ntd. grnd. o. o EmergencyLighting Battery 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 I nitiating Devices No. of Ranges No. of Air Cond, Total Tons No. of Alerting Devices g No. of Waste Disposers P Heat Pump Number Totals: _.. ..........._..__._............._...._ Tons 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 ystems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: Attach additional detail ij"desired, or as required by the .hrspector of Wires. Estimated Value of Ejlectrical Work:(When (When required by municipal policy.) Work to Start: a 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. CHECI{ ONE: INSURANCE Fr BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjurit, titat the information on this appti s true and cotapleteYY. FIRM NAME: T ' Lt c*t(!C L t_ U //V/7 LIG NO.: 1)16 j Licensee: (..fcrh.Y>f� r7 SIL �`. GCS %G Signature LIC. NO.: 40— (If applicable, enter "erenrpt " in the license number line.) Bus. Tel. No.: 53`j/ Address: t QC '7/►ty�/ !/[ �t�Jr ( ���L!!Z� YYi� �t I Alt. Tel. No.:IPt *Security System Contractor License required for this work; if applicable, enter the license number here: 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 agcn Own nt PERMIT FEE: $ ? �ev Signaturetura 'Telephone No. 77te Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 1 Congress Street; Suite 100 Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansPlumbers i11....ne. i%r4itf' 1 .noiIhil Name (Business/Organization/individual): wireworks,LLC Address•21 R Olympia Avenue „.Woburn, MA 01801 Phone 09 227 6918 Are you an employer? Check the appropriate box: i. [✓ I am a employer with .___ 4. ❑ I am a general contractor and I �q employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- These sub -contractors have ship and have no employees employees and have workers' working for me in any capacity_ comp. insurance.: [No workers' comp. insurance 5. [] We area corporation and its required.] 3. El am a homeowner doing all work officers have exercised their eight of exemption per MGL myself. [No workers' comp. m insurance required.] t c. 152, § l (4), and we have no employees. [No workers' coma. insurance required.] T�rpe of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [] Demolition 9. Building addition I f.+.® Electrical repairs or addition; 1 i.❑ Plumbing repairs or addition I:''..[Q Roof repairs 13.❑ Other "Any applicant that checks box #I must also fill out the section below showing their workers' compensation police information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must :submit a new affidavit indicating such. lContractors that cheek this box must attached an additional sheet showing the name of the sub -contractors and stage whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my emPlayees:.gelow is the policy and job site information. Insurance Company Name:Travelers Policy # or Self -ins. Lic. #:UB -2B920884 Expiration Date- 312512013 Job Site Address: - 902 >fn� � % A G(efg-D City/State/Zip: /moi Y ihv�:bv ,,v,� 6��`Y` Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fi of up to $250.00 a day against the violator. Be advised that a copy of this statement may tic: forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' under the ns and enalties o er'u that the in ormadon provideaP above is true and correct S i ature: jDau-0 Phone 039 227 6918 _ Official use only. Do not write in this area, to be completed by city or town offieial City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 'ER FLECTRICIAF WIREWORKS LL:' LEONARD SILVAGGIO 21 R OLYMPIA AVE WOBURN MA 01801-6.07 10574 A 07/31/13 15777 OF ELECTRICIANS AS A REG JOURNEYMAN ELECTRICIAN! LEONARD SILVAGGIO 5 ANDREWS CIR 4AKEFIELD MA 01880-5140 :250 E 07/31/13 815341 Location 9a FRe��c FgR"P i2ol too. 17J Date /Oa TOWN OF NORTH ANDOVER w « Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee ckcK $ TOTAL Check #'-� �.Od Building Inspector t� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: /a SIGNATURE: G Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address4 C-P� "67 I kx. 1.2 Assessors Map and Parcel Number: C -5,S7 1-7�-- Map Number Parcel Number - 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.I.-C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT boff Record 2.1�Owner Itflklll 1��V '0/ d , Nam rmt) % Address for Service: Signature Teleph-olfe- 2.2 Owner of Record: Name ,Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number ' Address Expiration Date Signature Telephone M z Q C R C 2 R C MalT 3 C 49 n r r SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(ol) Workers Compensation Insurance affidavit must be completed and submitted with tiers 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 ❑ Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ I Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SRC:TTON A - FCTYMATV" 9"nNC'rUTrn'rTn1V i...c....-. Item Estimated Cost (Dollar) to be OFFICIAL -USE ONLY Com leted by permit applicant licant -. 1. - 1. Buildin g D0 dD (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number ..VVT1nN 7. nWNnm ATT'rr r-mnir'/ TiAv m a "1VXr LL' 1P.lJ TVI1G1\ OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT aOwnerAA rized 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 11 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 Yrrnt Name of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DM ENSIONS OF POSTS DIMENSIONS OF GIRDERS HE, OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE • 1 �.)cl to � • FORM U - LOT RELEASE FORM b I' 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*********************** APPLICANT ZORI &&h17A) PHONE coil ��? -`IbQ-�4'S51 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) �Jr STREET � H�I%VST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECQMMENDATIONS OF TOWN -AGENTS: // NSERVATION ADMIN COMMENTS —e —yw TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS MATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED__ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm E • Town of North Andover Building Department 27 Charles Street North Andover, MA. 0184,5 D. Robert Nicetta Building Commissioner .(9-78) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE G' O JOB LOCATION - 0 �O: �t/v 11Y4 z FIE Number Street Address Map / lot "HOMEOWNER &Y /�1�5 clo J Name Home Phone .S AiY Work Phone 'RESENT MAILING ADDRESS 9A /�elvc_ I/,, / fjxm , &0'Awly?,�� City Town State Zip Code The current exemption for "homeowners" was extended to indude owner -occupied dwellings of two units or less and to allow such homeowners to engage an indivi W for hire who does not possess a license,, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) .DEFINITION OF HOMEWC+WNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ;- cessoiy to such use and/or farm structures. A person who omstruc s more *mn one home in a two-year period shall not be bonsidered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, bylaws, rules and regulations, The undersigned "homeowner" certifies Drat he/she understands the Town d No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and req r ents- HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 111 .x. ___ GAGE INSPECTI _JN PLN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY, LAWRENCE MA. 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOK:.MICHAEL * LORI CALLAHAN DEED REF: .5 168/2 19 LOCATION: 92 FRENCH FARM ROAD PLAN REF: 8926 CITY,STATE: NORTH ANDOVER, MA SCALE: I "=GO' DATE: 10/29/0 1 JOB #: 201.05(53G 145' FKENCH FARM ROAD CERTIFIED TO:. PENTUCKET BANK Flood hazard zone has been determined by scale and is not necessarily accurate. Until definitive plans are issued by HUD and/or a vertical control survey is performed, precise elevations cannot be determined. NOTE: This mortgage Inspection was prepared:':;: - - A-14 specificcaly 1br morigage purpose only and is not to be relied upon as a land or property �,✓{ line survey, used for recording, preparing dead 11 JOHN descriptions, or construction. No corners were location J• set. Building and offsets are appr•oximately located on ground and :� i - RUSSELL o areshown specifically for zoning determination > ;; 38717only and are not to be used to establish property lines. The netters shown hereon are based on ,t client -furnished inforination and may be subject to further Out -sales, takings, easements andrighls 3U of way, and other -matters of record and preserptive ly,., or other rights. Northern Associates, Inc. assumes no responsibility herein to land owner or occupant, O accepts no responsibility for damages resulting from said reliance by anyone other than the said mortgagee and its assigns in connection with its proposed mortgage financing to said mortgagor. l C) PO N-) This mortgage inspection was prepared in accordance with the Technical Standards for dtortgage Loan Inspections as adopted by the Massachusetts Board of Registration of Prnjttssional Engineers and Land Surveyors 250 CXR 605. 1 further state that in my professional opinion that the structures shown conform with the local zoning horizontal d i,inerlsional setback requirements at the time of construction or are exempt under previsions of X.C.L. CH. 40-A Sec. 7. O 1.Property/Ilouse is rmt in Flood Hazard. = 2. Property/House is in a Flood Hazard Area. M 3. Infor•malion is insufficent to determine Flood Hazard. Flood Hazard determined from latest Federal Flood Insurance Rate Map Panel Date Zone �n 0 t � � + G � �; f � V l yX6 pd St iJ � •a U) m m m cn 0 m CD C:L C2 Cr CO CD E CO) "o CD CD 71 2ul!j CO) d O CO) Cl) O CO2 d n CD O rf CD y� CD Co) 0 0 CD CD I� O —• y O C7 W no5m C/2 Oxon m C7 CD 0 CLC.) fl1 Z ? = CA O � , = � O CL 0 y T =r CD n ev O y CD O Co CO p —1 N O m : CDCD S > > 0 o 0 p0 ZS O I-► O y C2 :� W �• _=Co ;O M C N r, •� a o.�c ate^.: O C4: 4416 m cn CD0 CD CZE ^ C C' cJ m -- � N cn c_ H J O CA J V ? N OW :n d f0/� 1 •�= m O O h �. so z l y z wCD • .. co '-� cn r: S O Co z O ON 09 F3 d n 4 o rn "� P w ;o 0rb a�n -x w cn ?. g A Cil r �7] con � w ;v DOQ r �( n? w n Or"T � T rt •0 �C.i - �.r/y rA I'd cn C N p- x nCA O E M 1 3 No • : Date ..... .11 .. �.. a TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................)........................... has permission to perform ...... Q ......................... wiring in the building of ....... rr :.....:� :...�1.. ......................... . r /" ;� ` r ` r I ...; North Andover, Mass. FeeF.Y. ............ Lic. No-4-14?2 ............................................................ jf ELECTRICAL INSPECTOR )o8/ /98 09:30 15.04 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Onty z„ ,t T, he ()! Permit No. _ 3t;MrtMrnt taf VuhUr _54aft:tq Occupancy & Fee Checked G BOARD OF r'iRE PREVENTION REGULATIONS 527 C ;1R12.00 390 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 / 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate ,ijry or Town of NORTH ANDOVER To the Inspe r of Wires: The udersigned applies for a permit to performelec:ricai work scribed below. Location (Street & Number) Owner or Tenant Owner's Address v/s'e Is this permit in ccnluncnon with a/building permit: Yes _ No (Check Appropriate Box) Purccse of Suildinc S( ti S/t / t `Sr Utility Authorization No. LIJ Existing Service Amps /Vcits Overhead _ UncgrnC ! No. of Meters Ne,.v Semite Amos Valts Cverneae - Uncgrna I_ No. of Meters Number of Feecers ant ,imcactty Lccat:cn ar.c `nature of ?rcccsec Eiectr:cai .11crx �S,pl �Re �C�U `e 0 .No. at '_:gn:ing Cutlets No. =1 'Hot -%=s ! No. of 'ranstormers Tatar KVA alai Above— :n - No. at L:g-ung = ><tures Swimming ?apt grna. — grnc. _ I Generators KVA I No. at Emergency Ugnting No. at tecec:ac:e Cutlets No. et Cil 'turners i Battery Units No. of Swncn Cutlets i No. cr Gas Su-mers I FIRE ALARMS No. of Zanes No. of Cetecncin arta Total No. ct Ranges g � No. _ f " Air Ccr.a. ;Ens Initiating Cavices No. ct Souncing Cevices No. at Seit Containea No. of Oiscosais No.ar Heat Tatar Total Put -_s :ons K'.V No. at C• snwasners - ScacerArea Hearing '� oetec::cnrScunatng cevices Municia-at _ Cennec :on _Other Na. of Criers Heaanc Cev:ces KWLec3t No. :t No. at Low voltage No of Water heaters KW i Signs Satlasts Wirinc I No. Hvcro Massace Tins i No. at !.Motors Total HP OTHER. SURANCE CCVE=AGE. ?_rsuant :o the recuirements of,- Mas sacs ;enerai Laws i ave a current Liabtiity Insurance Pcucy inducinga Cm^: un a Oceraes Coverage or as substantial eeuivatent. YE _ NO _ I nave suomiree van cot of same to :he Office. YES NO _ �If ^ave aae//c// a YES. tease inatcate :he type at -overage cy cnecxing :he aocr nate aoz_ _ _ `,/ ' 6• ,S / INSURANCE _ BCNO _ OTHER _ (P!ease aver fy) JJJ CCCC !! J �— ( oarra/non Gate%r�J Esumatec Value of Electrical Worx 5 werx :o Star, lnscec::on Cate Aacuestec: Rougn Final w ! «( WW 1 * . Signea uncer :rte Penaities uuj�;/ j '�` �' 3 FIRM NAME �'v �/ / ` UC. NO. ,Lds�r"— Ucenses nature �-U7C. NO. i Bus. Tei. No. ZSi ACCress `� h Alt. Tel. No. OWNERS INSURANCE WAIVER: I am a re that the Licensee apes r.at nave the insurance coverage or its substantial eeuivatent as re- euirea ov •Massacnusetts General Laws. ana :hat my signature an :n:s cermit abbitcation waives this reeuirement. Cwner gen \ (Please cnecx crier d eiecr.one No. PERMIT FEE S iSigr.ature or Cwner ar .tgenrt Date.......... No -:'� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ' .... .......... has permission to perform ...- .......... ...................... plumbing in the buildings of ........................... . at . , ..... ' ..................... North Andover, Mass. Fee.'........ Lic. No.. ... .................. PLUMBING INSPECTOR t' i/ / -' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date r— Z nes Nae Permit cBuilding Locan t�'wC, n Amount , d�+ Type of Occupancy New Renovation Replacement ri Plans Submitted YesNo a Pll� (Print or type) L Check one: Certificate Installing Company Name ` E rO4 a y t T'1�1 �.. i,14 Corp. Address '17 y `� Partner. Business Telephone Q ]� Y>$ f 2 3> �Firm/Co. Name of Licensed Plumber: _ Insurance Coverage: Indicate the Liability insurance policy Er insurance coverage by cbkfcki Other type of indemnity the appropriate box Bond 11 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 I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and ins llation erfon compliance with all pertinent provisions of the Massachu etts*� ft t City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License Co S License Numoer Master Agent in above application are true and accurate to the r Permit Issued for this application will be in and Chapter 142 of the General Laws. 1301/ Journeyman ❑