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HomeMy WebLinkAboutMiscellaneous - 96 MABLIN AVENUE 4/30/2018N oV 2319 Date..... ........................ (10-1- (�l TOWN OF NORTH ANDOVER PERMIT FOR WIRING .... .......... .... ....................... This certifies that ..................... ... . U 4 h,As permission to perform—.4 " 4 . 7�71 ..... . ................................................................... wiring in the building of ....P..:..r........( ................ ......../ I/I/v- lql).P- at ..9 41M ....... � ........................... . North Andover, Mass. Fee,.5� ..... '.. Lic. No . ............ . ....... ........... (�r .............. ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer AE60MM0NWF.4L7710FM4SS4ChVSE77S Office Use only DEPARTM0VT0FPVBLICS4FM Permit No. BOARD OFFTREPREV© ONRECMTIOAS527CMR12:QD Occupancy &Fees Checked U4VPPUCATIONFOR PATO PERFORMELEOWCAL 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 The undersigned applies for a permit to perform the elcal Location (Street & Numb ) ITAt Owner or Tenant ✓� / Owner's Address Is this permit in conjunction with a building permit: Purpose of Building 000 � Existing Service Amps�Volts New Service Amps�Volts 14umber of Feeders and Ampacity work described below. Yes I VI No Overhead a Overhead To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. Underground ED No. of Meters Underground M No. of Meters Location and Nature of Proposed Electrical Work % (If Mo. of Lighting OutletsNo. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground gronrid No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total " Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local 17-1 Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Si s Bailasis No. Hydro Massage Tubs No. of Motors Total HP ln%==Come PtasuantlhD& p nasofMwmdudlsGatealLaws IhmeaamtLiabtldylns==Pdrym&&gCagift C ,wa==rns male YES M NO 14 Ilzwsubrnimadvatidp=faf=neiotheOffix YES rJ NO r7 IfywhmeduiWYES,pleasecdc*thetMxofmeaWbydwdmgthe ,Wcbcx INSURANCE a BOND OTHER Speffy) �W�Wties*ow E Vahte xdWaic $ WaklD&Efft Ir�csiwDee9eRegtre*d+ Rough Final � y �'- S P 12 C S 1C L& C M i Q ( 0� FIRMNAME ' ^ LioaseNa Lioaesar_ �� SP•+ � U=seNo A I 50 BtsirmTd.Na 8 TI -1054 H=13 AM AkTeLNo. (� � )vs (0a 1___ OWNER'SINSURANCEWAIVER;tamawuethattbeLioasedoes�thenuanta wmaWa7lsWArtW4uvdia>tasmgtmadbyMassadxse C,ataaiLaws andthatmysigiWern$tspear>$.apQ&Mm waimsthis ra*mwnt (Please check one) Owner Agent Q Telephone No. PERMIT FEE $ Location ql MAMIL-1 No. Date 3 F Oi�«•o TOWN OF NORTH ANDOVER :•,�O � .. n y Certificate of Occupancy $ ssACNUSEt� Building/Frame Permit Fee $ Foundation Permit Fe $ Other Permit Fee {Poo $ ..- TOTAL $� Check # 13 Building Inspector • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BU WELDING PERMIT NUMBER: DATE ISSUED: e 6,*�� SIGNATURE: on& Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION I . 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Am�- Map NumberF Parcel u ber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dis; d Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided ReqWred Provided 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 ❑ Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name P nt) Address for Service : rg ature Telephone 2.2 Owner of Record: i Name Print Address for Service: 11 Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 r7 Company Name Registration Numbef �{ � app 1 O !`. Address Expiration Date {BUILDING DEPARTM Signature Telephone 1 AQ 111 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 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: >11a SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beUFFiCIA Completed by permit a licant , USE 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize 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 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 Signature of Owner/A ent Date m MOM NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2ND 3 RD 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*****'"k**************** APPLICANT V LOCATION: Assessor's Map Number SUBDIVISION STREET 0(!1 OFFICIAL USE ONLY PHONE4,&9E N(I PARCEL"" LOT (S) 8 ST. NUMBER REC MENDAT N OF TOWN AGENTS: 1,5_">"0? 'I' 4P0 / 114 47} -DIcle- CONSERVATION ADMINISTRATOR DATE APPROVEDi5'J 00 DATE REJECTED COMMENTS �^ TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm DATE 'w-o3��?�o�= O -• y O Q y � m n m C7 O H C! a !7 T Ow ' my T 9 a O_rn W v-01 �O m O N �mm9Am O �. _ 7 O y n O O m Cto Cr1 a ,� ^" O O y C^n cc ��o: •�: l 1 a� �_ CO O � O y � 01 y Z y a d C c CL ,J y m n•� C :� y m C H� ® =0 :a 1 •� CD n m d wC'J: � o0 CD 0 �o •o c : m CD W: •% y CD d mow: 5: d to O m cn rD n C/) 07?i c 7� o p? 0 y ?� 0 ?? cn o Ct1 n �n w 7� o oCc C � n a- j. o aCa r o a o C cn cn �^ c In 0 0 x V � O 'O CD O n Z CSD O y p ar U) Q y m m nv m = O � O m CD CD m %< CD O O C p m CD � w _9 C CD y G.� y .o COCD I S- CD C C") o, o CD O CD 'w-o3��?�o�= O -• y O Q y � m n m C7 O H C! a !7 T Ow ' my T 9 a O_rn W v-01 �O m O N �mm9Am O �. _ 7 O y n O O m Cto Cr1 a ,� ^" O O y C^n cc ��o: •�: l 1 a� �_ CO O � O y � 01 y Z y a d C c CL ,J y m n•� C :� y m C H� ® =0 :a 1 •� CD n m d wC'J: � o0 CD 0 �o •o c : m CD W: •% y CD d mow: 5: d to O m cn rD n C/) 07?i c 7� o p? 0 G1 c>ncn z ?� 0 ?? cn o Ct1 n �n w 7� o oCc r La ?? z w n a- j. o aCa r o a o C cn cn �^ c In 0 0 x V 0 z Q 0 c ORI moo? C:) cp U) LLJ :mQQV z o U 0 a t� z a W W� LLA VV/ C� a �y W E"+ N M N ORI moo? C:) cp U) LLJ :mQQV JAMES A. TRUDEAU Adjustment Service, Inc. P.O. Box 208 Templeton, MA 01468 Phone: 978-939-2255 Fax: 978-939-4234 Notice of Casualty Loss to Building Under Massachusetts General Laws, Chapter 139, Section 3B March 27, 2003 Building Inspector 27 Charles Street MAR 2 8 2003 North Andover, MA 01845 Board of Health 27 Charles Street North Andover, MA 01845 Fire Department 124 Main Street North Andover, MA 01845 INSURED: Parrino, Vincent ADDRESS: 96 Mablin Ave., North Andover, MA 01845 LOCATION OF LOSS: 96 Mabline Ave., North Andover, MA 01845 COMPANY: ' . National. Grange Mutual POLICY#: 52K20555 CLAIM #: 03-02030 DATE OF LOSS: 02/24/2003 TYPE OF LOSS: Ice & Snow Dear Sir or Madam: P.O. Box 291 Douglas, MA 01516 Phone: 508-476-1888 Fax: 508-476-1133 A claim has been made involving loss, damage, or destruction of the above -captioned property which may either exceed $1,000.00, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,. please bring it to our attention, and include a reference of the captioned insured: Location, policy number, and/or date of loss. Sincerely, James A. Trudeau Adjustment Service, Inc. James A Trudeau