HomeMy WebLinkAboutMiscellaneous - 99 MARIAN DRIVE 4/30/2018 (2)Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................7- .......................................................................... has permission to perform ...... C 47H ...... .............. wiring in the building of .......... mc.1.41n,664 ....................................... at ........ � ..... ....................... 1,71 North Andover, Mass. Fee .3/�:0 . .... Lic. No. ................ 3 -& tR Check # x , �'i 32 (.Official Q V Official Use Only ommontuea Lor aa9ac a '7 Permit No. 1 � 3 L... _ e(JePartmed o�.}ire Jeruices Occupancy 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 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IINFORMATION) Date: 11-13-09 City or Town of: A, Of iI &�hbd t°k-,, 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) 9q Owner or Tenant .&tn &ti Owner's Address S� �► Is this'permit in conjunction with a building 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. Yes ❑ No [� (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ undgrd ❑ No. of meters S7 el Completion of the followine table mov be ivoived by the Inspeclor of 111'h -es. 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 -N—o.of No. of Luminaires Above Ei In- Swimming Pool rnd. grnd. E] Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners (FIRE ALARMS No. of Zones Detection and No. of Switches No. of Gas Burners nitiating Devices In No. of Ranges . No. of Air Cond. TotalTons No. of Alerting Devices Heat Pum P Number Tons ICW No. of Self -Contained Disposers. No. of Waste Dis P Total ............. Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Munical E] Local [-1Conne tion Other No. of Dryers ry Heating Appliances KW Security Systems: No. of Devices or uiyalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent INo. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent IOTHEl2: l 0-7 Attach od,.itional detail if desired, or os n quired 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 X BOND ❑ OTHER ❑ (Specify:) I certify, under the paints turd penalties of perjur-v, that the information on this application is true and complete. !� FIRM NAME: �D% �5 fur / _ L: C. Licensee: -�QJ� si—( Signatures-�)1 ��_ LIC. NO.:�I_� (lfnp;�licnb(e, enter "exenf i the lirele � ��ber line. /S Ivl� G Bus. Te). No. _�13.���� Address: _Y. C� T r �J IY-/q Alt. Tel. No.: . *Per M.G.L. c. 147, s. 67-61, securi.y work requires Department of Public Safety "S" License: Lic. No. SSCC. 00 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) ❑ o veer ❑ owner's .,cert. Owner/Agent Signature Telephone No. PF'Rmi,r FEF: S 014 t-lvta4jallc�� Department of F`i6blic Safety One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: Certifin, te of Clearance Number: SS CC 001975 Expires: 10/09/2011 Restricted To: 00 KENNY WONG 18 CLINTON DR HOLLIS, NH 03049 S-CA1 C, 40M-OFV0B-DBSLIFORMCA108212008 DEPARTMENT OF � LJBLIC SAFETY Certificate of Clearance Number: SS CC 001975 Expires: 10/09/2011 Tr. no: 558.0 S -License: ADT SECURITY KENNY WONG 18 CLINTON DR HOLLIS, NH 03049 .. j, -7-7- COI6jJjc)j,1'ff;:ALTH 0-F k1i A S A C H L) t L E CUIA 'S REGISTERED SY EIA TECHNICiAN KENNY Q 22 FIELDSTONE DRIVE BURLINGTON MA 01803-142-13 Tr. no: 558.0 Keep,top for receipt and change of address notification. 4 14 ro DIG SAFE CALL CENTER: (888) 344-7233 F: 4 Date. Ik . � TOWN OF NORTH AN PERMIT FOR PLU NG R This certifies that. f ... ..°. ....... . has permission to perform ... .� ..... .... !`. N.l ............... plumbing in %the buildings of ... �� ��z.. ` ` `" . c�' ........... at .../.r :` ....!� l ...... ,North Andover, Mass. Fee.. 4.... Lic. No..�'/ -��/� ....... . PLUMBING INSPECTOR Check # 7896 � 'a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location P%A �'%pn ��OwnDate ers NameeM t Type of Occupancy Amount ,?o �- New Lj Renovation U Replacement ' T{ YV1rTTD z'c- Plans Submitted Yes. ElNo ❑ (Print or type) Installing. Company Name_`j'�' Address 'ePq "54_ m yam - Check one: .Certificate Partner. Firm/Co. Name of Licensed Plumber: e4e- Ve— InsuranceCoveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver. I, the undersigned, have been made aware that the license three insurance e of this application does not have any one of the above Signature Owner ❑ I hereby certify that all of the details and information I have s mitted best of my knowledge and that all plumbing work and ins�a)lns je compliance with all pertinent provisions of the Massa llSEt Qr P IBy: Mtle 1APPROVED (OFFICE USE ONLY Agent ❑ entered) in above application are true and accurate to the under Permit Issued for this application will be in g Code and Chapter 142 of the General Laws. Type f lumbing License rcense um er Master FT ---journeyman ❑ Location No. � Date oRTh TOWN OF NORTH ANDOVER F • , ; Certificate of Occupancy $ ) s+st cNu Building/Frame /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1,5ZI 18180 Building Inspector 9 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �` ",q�` t'�",¢ye "} BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: �a— 1.2 Assessors Map and Parcel Number: w Pet? Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dish c—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.10 r of Record ,wn y� l C-UO4e \A Name (Prin) Address for Service Signatur Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ d 441 154%P i Licensed Construction Supervisor: © J4� License Number ��o Address Expiration 15ate / Signature Telephone 6243 3.2 Registered Home Improvement Contractor Not Applicable ❑ Lo 13,4415 / j —? / i? s Company Name Registration Number / Expiration Dat Address Signature � Tele hone 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 .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building V Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: CC�J r i SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant tiFFICIIAII: USE"f?NLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHOR17ATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, (' r -,/ �� L � C as Owner/Authorized Agent of subject property Hereby authorize to act on My eh)lf, in all matters rplattvve t ork/ authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Own ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR T MBERS 1 2ND 3RD SPAN DIN ENSIONS 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 i)rD Page # of .A pages Norman L. Blad Construction - 978.687.6263 40 Fernview Ave. #10, N. Andover MA 01845 MA Lic. 016141 MA Reg. 131950 Proposal Submitted To: Job Name Job # Address Job Loc tion / Date of Plans I 9 Fax # (� D Arc 7 s7 g/0 ... 2 hitect Phone # We propose hereby to furnish material and lab r� complete in accordance with the above specifications for the sum of: $ �7' �Dd • Dollars with payments to be made as follows:!�a �� "� 3400) Respectfully submitted • Note — this proposal may be withdrawn by usif not accepted within days. Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Zicceptance of Propo r The above prices, specifications and conditions are satisfactory and are �� `_.►- hereby accepted. You are authorized to do the work as specified. Signature Payments will be made as outlined above. Date of Acceptance 4. 4 - ®S Signature ;,s ,NC3819 MADEIN{1SA,:: > 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 a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: 4.111 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 I �^��,:; �✓ire �nmrm�nurecx,!l� o���,aaaar,�r ' BOARD OF BUILDING REGULATIONS " 0 License: COW;TRUGTION SUPERVISOR I Number: CS 016141 i Birthdate: 03/15/1947 4 Expires: 03/ 15/2006 Tr. no: '2169.0 i 1 Restricted: 00 ! ; NORMAN L BLAD 40 FERNVIEW AVE #10 N ANDOVER, MA 01845 Commissioner o ✓Z, Vomtmro7rsne�C� a��-�7¢aaacfr�rGe�i6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131950 Expiration: 10/13/2006 Type: Individual NORMAN L. BLAD NORMAN BLAD 40 FERNVIEW AVE #10 N. ANDOVER, MA 01845 Administrator r ft A Policy # R0412920 NORFOLK AND DEDHAM MUTUAL FIRE INSURANCE COMPANY SMALL CONTRACTORS POLICY RENEWAL CERTIFICATE Named BLAD, NORMAN & DAVID N Insured 40 FERNVIEW AVE #10 N ANDOVER MA 01845 FORM OF BUSINESS: Agent INTERNET INSURANCE AGENCY, INC Phone ( 978) 685-7690 Agent # 20"155 Policy Period: ONE YEAR from 02/04/05 to 02/04/06 This declarations page together with the policy jacket, the policy form and any endorsements, completes this policy. Coverage begins at 12:01 A.M. Standard Time at the covered premises. Business Description CARPENTRY POLICY DEDUCTIBLE $250 BUSINESS PERSONAL PROPERTY Limit $10,000 Included TOTAL PREMIUM PER B U I L D I N G $1,488.00 EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE THE FOLLOWING COVERAGES REDUCES THE AMOUNT OF INSURANCE WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH D.4 OF THE BUSINESS LIABILITY COVERAGE FORM. ;:7771 I LIAB & MED EXP (OCCURRENCE/GEN AGG/PROD COMP OPS AGGI I MEDICAL EXPENSES $300/ $600/ $600 Included Included $$5 TENANT FIRE LEGAL LIABILITY $5 Included SEE ATTACHED PAGE $op -2 1 (REV.01/94) Type of Payment: DIRECT BILL 10 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 ' Workers' Compensation Insurance Affidavit Name Please Print rA I Location: ��� l �� l�"i� G'�c� City /U/� %� /b' �� et PR/t , Ik 14 Phone # �� �' ���� Llp 2— I am a homeowner performing all work myself. 1 an a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comiram name: Address City. Phone # Insurance Co. Policy # Company name: Address City: Phone # Insurance Co. Policv # Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment.as_well_as_civil.penaittesinThe fmnnfe.STOP VVORK_ORDER..and..a fine of. 1100.00 understand that a copy of this statement may be forwarded to the Oe of Investigations of the DIA for coverage ver catiI Office I do hereby certify under and penalties of perjury that the ti above is true and correct. Print r,44 ,,4AI Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permif/Licensi ❑ []Check if immediate response Is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other