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HomeMy WebLinkAboutMiscellaneous - Exception (507)11 Location l f� -2 fiGrf`` C I<c/ No. �/ —// Check # Date 6A/II TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL 244ZL2 � / Building Inspector Permit NO: Date Issued: 6 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I PORTANT: Applicant must complete all items on this page LOCATION,� _ _ . Pn` t. PROPERf OIII/NER`�,P Icft17� Print C PARCEL; ZONING DISTRICT: HistoncDistnct yes no M- -- -1 ... _ �t .. � _ �— _ Machine Shop. Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial No. of units: Commercial Assessory Bldg Others: Re air re lacemen DemolitionOther Septic, Well,; FloodplainY. lNeflands V Watershed*Dis(ricf Water/Sewer _ DESCRIPTION OF wUKK i U tSt FKt1-uK1V1tU: CJ L— Identification Please Type or Print Clearly) ' OWNER: Name: Phone: Address: ------ ,P hone ddress: 'Phone - -! ExpDate: Supervisorrs Construction License '7091 r�...- - 1 . j. Hnm`e.Imocovement'.Licerase.__ _._J..`�%:,��%r� _ _.P ARCHITECT/ENGINEER Phone: 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: $ 4 FEE: $ /—C —` Check No.: Z- Receipt -No.: 2-11 22--�— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature�of Agent/Ovvne"ACV rSignature of contractort I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature 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:_ tFIRE DEPA Loc 384 0 �R ,RsTMEN? Tem_ steno. ated Osgood Street �. nes o� Lpcated`at 1. . tr'ee -- _-Y.._ ,parE`ment.si naturelda a a¢ COMNIENMs- 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 Doc.Building Permit Revised 2010 i 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 ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ 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 Addition Or Decks ❑ 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) ❑ Building Permit Application o' Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit 13 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 ❑ Engineering Affidavits :for Engineered products 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 Doc: Building Permit Revised 2008 O z w O as wo �, cit 0 H A o cz a w° wo' v U iG 0 a ao' w 0 a w wo' u cn 0 w a � m w z w A a w a. ro z 8 CO v Q o cn 1`, O E ■ L _ O v z CL O h � c CD C C O— COD p C .CO2 'g m m CD CD CL � O � CD 0 0 0 L a CL �Q c ev ev CJ J .0 C. O CO) Z CD V N2 ,Y _ C. y cm 0 LLIW W LLI C9 uiW U) c c �m c c � O � � C O H O V V CL cc W C . :Z5.Occ C43 ; 0,n ;tCe_ cal CM :uCMCL. c G v; h m ,o O W. Q \j' m .� y m; 0 c cm"s G c 22 Co_ •L Z O v M. ; O. O cm C Q _ m m : !!-CD GC � C H .r0.. O. y m IV m WGO y0„ cc _ +'G-' ii m +-. c . •C O. o CO) E •_.. C 3 ca Z O u V O v 'p 00mE=CM _OD O' m '� O _ go ,= ` y•� 1:1 CL.- Co 0 s 1`, O E ■ L _ O v z CL O h � c CD C C O— COD p C .CO2 'g m m CD CD CL � O � CD 0 0 0 L a CL �Q c ev ev CJ J .0 C. O CO) Z CD V N2 ,Y _ C. y cm 0 LLIW W LLI C9 uiW U) MOYNIHAN-NORTH READING LUMBER, INC. "QUALITY BACKED BY DESIRE TO PLEASE" 164 Chestnut Street FEIN:04-2261995 North Reading, MA 01861Contractor Reg No.: 978-864-3310 / 781-944-8500 W KA Exp. Date: _ /_/_ I Sallesperson(s): /— Salesperson(s): HOMEOWNER INFORMATION Name I Daytime Phone no SLM--22 I Street Address ( Not P.O. Box) Evening Phone A16 City/Town State Zip Code Mailing Address (if different from Street Address) WORK TO BE PERFORMED AND MATERIALS TO BE USED Moynihan -North Reading Lumber, Inc. agrees to perform the work set forth in Exhibit A for Homeowner and to use such materials in connection therewith as set forth also in Exhibit A, attached hereto and made a part hereof. The following schedule shall be adhered to unless circumstances arise beyond Moynihan -North Reading Lumber, Inc.'s control: Work scheduled to begin:is/-L /1/ Expected date of completion: r, May be based upon arrival of special order material TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Moynihan- North Reading Lumber, Inc. agree$ ta.perform the work, and furnish the material and labor set forth in Exhibit A for the Total Contract Price of: $ 'rte % 'r 41which amount includes all finance charges). Payments shall be,made by Homeowner according to the following payment schedule: $ 22/S4: Initial deposit upon signing this Contract (the initial deposit shall not exceed the greater of one-third (1/3) of the Total Contract Price as set forth above; OR the Total Cost of Special/Custom Orders as set forth below). a by—/—/—or upon completion of delivery of materials $ 'N by-4.—/—or upon completion of install $ ----- - —, upon completion of the Contract In order to meet the completion schedule set forth above, the following materials/equipment must be special ordered-bM e'the,6ontract work begins, for a Total Cost of Special/Custom Orders of $ tg)be paid for building permit $ " ` to be paid for $ to be paid for f i�I l DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES - 14,� + Moynihan -North Reading Lumber, Inc. Homeowner's Signature Date Contractor Date a .' 7t `��� l L ,GTt - By Dale Fuller Homeowner's Name (Printed) Installed Sales Coordinator You may cancel this Contract if it has been signed by a party thereto at a place other than an address of Contractor, which may be its main office or branch thereof, provided you notify Contractor in writing at its main office or branch by ordinary mail posted, by telegram sent or by delivery, no later than midnight of the third business day following the signing of this Contract. See attached notice of cancellation for an explanation of this right. See reverse side for additional Homeowner Terms and Conditions 1057 -NR 1/11 White - Office Yellow - Sales/Service Pink - Customer Page 1 of 5 � i �hrs.achusctts - p�lr;rr•trrtenl af' Ptilrlit: �;tfrt� B�►:�t•tl aY guitclirt: Rc!;ufalinrrs a►rd �tand:u'(l� Construction Sui�n_rVI%or Licensc LICQnse: CS 70913 GLEN SARGENT 18 CHANDLER CIRCLE ANDOVER, MA 01810 Expiration: 5/4/2013 —� (uHtnrj.�(novr Trrt: 18811 0fficeaE�A airs dl.ess ga, HOME IMPROVEMENT CONTRACTOR Registmtlon: ot31640 Type: Expiration: `.7012 DBA ' GL SARGENT R �=?^ .1 0 GLEN SARGENTI' 18 CHANDLER ANDOVER, MA 018f Undersecretgry pPRODUCER 4�"K ►FI(. AIC Tewksbk 88SAu Strsufia'zce Ut LIAEf�LII y Tewksbur eek IN�VN - 978-851-96Q� 01976 THIS P INS O 0 LYCANDFICgtE /S. IS URED Sar H. CONE SUED ge C R..THtS ERS IV Ri S A MATTER OF 513/201.2` . j 8 en Sar9 n t �delinJ ALTER THE COYERAGECATEAFE DOES NO ON - INFORMATION ORD AMEND, TlFICgT I Andover MA 0 =rcje NsuRER aR y FF RDING COVES ED BY E POLI 1 0 OF 1810-2805 INSURER S. 'pj �nfi GE co INS 1 HE INSURER YmouMutual.Group NAIC# ANY POLICIES C: Z RE °FIlVSLIRi4NC INSURE urZch In ur surance QUIREIyENT, ElIST R 0: I 0 CIESTAIN THE INSURA OR CONDITON DED OFHAVE BEEN ........1SINSURER E: 9 c��paI3Y AG LTR asRo A06 IE YHBY TH �ANY � T S pF°R OTHE THER ZUREO NAMED A GENE EENREDUCEDg RIIBED DOCUMENT BpVEFORT RAt LIABILITY AID CSA M IN IS SUB ECT T ESpECT Tp POLICY P D 8 COMMERCIALPOLICY NUMBER S O ALL T WHICH ERIO INDICATED GENE POLICY HE TERMS, THIS CERTI ANO CO DST I T HSTA 0 A ' CL gIMSMADH RAL LIABILITY EXCLUSIONS DATE MSDACTIVE p E E ISSUED �� OCCUR /YY DATEYEXPIR4T0N T ,ONS OFD H MM/DDIYy SUC 1 GEN,Bp- j j OOO� 15 uMITs AGGREGATE EACH OCCURRENCE POLICY PRORAPpLIF3 P PREMISES Ea $ 500,0 PER. 0501/11 MED o�Wrenoa OO AUTO MOBILE LIABILIIy T 45�41�12 (".Yon. $ 4 Loc Person) 50 Q0p ANYgUTO PERSON $ AI BADVINJURY S'000 ALL GENERAL AGGREGATE $ 500,000 SCHEDULED UCTS.CoMP/OPAGG $ P AUTOS 1.000 000 HIRED AUTOS D� $ I r 00,000 NON.pWNEDAUTOS PRAT COMBINED SIN 0p89g5948 (Eaaccryant) ��LIMIT $ I 07/14/10 80DILYINJURY j GARAGE ugerLIr,: 07/.14/ (Per Pern1 1 s ANYAUTO BODILYINJURY 50,000 �Per.acc dent) $ EXCE33/UMBRELPROPERTY 100,000 iA UA8ILITY (Peraocdentj SAGE OCCUR $ C�CLAIMSMADE AUTOONLY-Eq ACCIDENT lOO, 444 DEDUCTIBLE $ SD AUTOONLYN EAACC $ RETENTION WORKERSCO $ EACH OCCURRENCE AGG 3 EMPLOYERS MPENSAPONAND ANYp LIABILITY - - AGGREGATE - $ (; OFFICE eM 'ETO"AR - SXEd .XCI CRex, IVE $ y SPED q PRO VISION S $ orHER10 ZUB- 60 SN14 _ 4 46!09/10 $ x 46/09/1.1 TORYL MITg $ E.L. Eq ER DESCRIPTION EACH ACCIDENT G1QnOFOPERATIO E.L. DISEASE. Eq EMP $ 14O Sargent"l$cri0t/VEHICLES/EXCLuslo LOPE $ 1p .000It E.L. DISEASE-POI;ICY i COY NSgpDEDBY LIMIT $ O 000 i eyed ENDORSEMENT! ��4�00 uhd®r i$ TforkQrilA PROVISIONS _ _1 I COM pojjC CERTIFICATE HOLDER �... � 64 =han '��e ' r Nox til h e d=ng treat SHOULD CALAT►pN 1 RA 418 64 DATE THERE OFNY F THE ABOVE DESCRIBED p OLICIES BE THE ISSUING INSURER 978 - NOTICE TO T CANCELLED BE. li 1 664-9078 IMPOSE NO tJ LIGERTIFICATE HOLDER NAMEDW WILL ENDEAVOR TOM ORE THEEXPIRATION ACORD25I2p01/08 A -ION O I REP R LIABILITYTO THE LEFT BUT --. DAYS WRITTEN �f AUTHORISED EP ESFAILURE T OF ANY KIND UPp r RESENTATIVE N THE INSURER, ITS DO $0 SHALL h S AGENTS OR 1 ©ACORD CORPORATION 1988 Moynihan . � R bet Of geyeri geveh po 130 00g t Y, Inc (978) 927.0 � O191 _0509 8) 927-8668 MoYNII Moynihan ANC UI fa s4�h Readin ER Co. No pO estnutSt eetumber, Inc (9 v7 Reeding, Box 128 8)864 978 � 64 n7�85 08 Moynihan Lu tuber of pl PO OldSota,StOw O. ajsto,v 1160 (603) 382-15l F" 3651160 Su,Tieo�t (603)2-1935 actor �., D orkers, c. I, 12, 7 ,Pe�ati ozz con Sur ��iPer tractor,Of hav e'7 fi Pr ov O�kers) Corn asked b , hereb Y 1l1y. a SOI ded by the neon Insuran�eran zumberOVvledge tha r P °Peet rS' Co cov CO. to t I, elated °r or without luPensa - image for provide an mde AS, g�atio emPlo A n myself. 't with Pendent be °ciaon� In ns. and Y�eS. seance cov, Based o a Ceram ecause I c' totallyi,.,�� e� Acadia refOre, I erage for n the axe cate the have Vol less for Insur, hold A'lo myself bhane 11-1�p proVld�dy chosen any Injuries o d or S Lumber Co use I have men cederXIS e �orkers�to ude �riy5el f cost ' of int uz?es In. Lun1ber Btuand its. s option y. C°m meati from cover cuTred by m ess °f mY own fr on Lay's• age by en myself ee gaging ►tea ri�c:cuenlS Office of Investigations "0 Washington. Street f Boston, M4 02111 Workers' Compensation Insurance davlfS ABuilders/Contract licant Information ors/Llectricians/I'lu1mbery N"n" (Business/brganization/Individual): Address: City/Sta.telZip:� 7you ou an employer? Check the appropriate box; 1 • ❑lama employer with 4• ❑ I am a general contractor and I eir.Ployees (full and/or part-time). * have hired the sub -contractors 2• I am a sole proprietor orpartner- listedon the attached sheet $ Ship and have no employees These sub -contractors have working forme in any capacity• workers comp. mP• insurance. [No workers, co requirednv. insurance 5. We are ❑ a corporation. and its 3. ❑ I am a homeowner doing all work r of have exercised their myself. [No workers, comp. c light 4), " per MGL insurance required.] t . 1(`1)� and we have no employees. [No workers' Please P Type of project (required): 6• [] New construction 7• ❑ Remodeling 8. Q Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions ii.D Plumbing repairs or additions 12.[] Roof repairs *Amy applicant that checks bo comp, Nance required.] 13. LJ Otber x #1 must also 1911 out the section below showing their woriceIs' t Homeowner who submit this af5devit indicating they are Join �.Contractois that check this box must attached an additional doing BA NOrk and then hitt outside contractors must Poli -Y mfonnation ng the name of the.su sutmnit anew a$daht indicating such ram an employer that is providing workers' compensation insurance for my employees�� workers' o0 mp. policy information informative. .. • Below rs th Insurance Coazpany Name: e polccy andJob site Policy # or Self -ins. Lie. #: Job Site Address; Expiration Date: Attach _ac y of the workers, City/State/Zip: -- h'aillrre to securecoverage as required under Seetion 25A o-�2 can lead to th �� ani expu'a ion ate . fine up to $11500.00 and/or one-year ' Of up to $250.00 a day against the violatorr,Bee advised tha as civU a e Position ofciinunal penalties of a Investigations of the DIA for insurance coverage verifi Penalties in the form of a STOP WORK ORDER py of.this statement may be forwarded to the Office oafnd a. fine capon. I do hereby unde) ana pe D4.- 03,;0 •perjury that the information provided above is true and correct. Official use only. Do not ryrue 1;, ;;,i, area, to be tom leted p . by city or town official, City or Town: Issuing Authors(Permit/License # I. Board of Health 2. Department 3. CitBuildingDe0art 6. Other Y/'I'owu Clerk 4. Electrical Inspector 5. Plumbing InspeCtor Contact person; ' Phone #; o � CPD OI v ` Z-UOK 000 co m0ZZ a o _ - oxz= ti D 00 G)a mz Z C) oo ='v A H W • Z �. r� M. y.. h c CD z: a n It � C° c -ter I ] y O T3 o T i r^ 1 W cn .. 0m � [sf 77d p d m o M C j C : r K m f0 q i / Date ................... ........... k yORTI� °f�"`° :•�"° TOWN OF NORTH ANDOVER ' O p PERMIT FOR WIRING CH This certifies that ................... U-er ee' z (!u�-�L .. " ................................................... has permission to perform .......` wiring in the building of .....! ....... ........ ................................................. at '21-':c::�-P-...".. % ... , North Andover, Mass. oy� `�,S 6.4 �ji Fee ............ Lic. No....... �� .................ELECTRICAL ........................... % INSPE R Check # 113 7856' I/ nerformed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: /1loerll I�NAOIlel?, , 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) �_YS c570 Owner or Tenant Owner's Address C-4 < Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. &e' -- oZlo No Y (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: 1d) I NG �� h C',!�57V� & Comnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires /� Cotnmoatu pph o RcD Official Use Only EIVED Generators / jp KVA No. of Luminaires Permit No. Pjp _& o. o Emergency Lighting Battery Units c� eCJepar o/ ,.007 FIRE ALARMS 0 $Mb O FIRE PR g � Occupancy and Fee Checked �v v. 1/07] leave blank) No. of Ranges FOR HEALTH DEPARTMENT ORM ELECTRICAL WORK nerformed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: /1loerll I�NAOIlel?, , 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) �_YS c570 Owner or Tenant Owner's Address C-4 < Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. &e' -- oZlo No Y (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: 1d) I NG �� h C',!�57V� & Comnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators / jp KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. 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. o Detection andInitiating Devices No. of Ranges No. of Air Cond. TotalTons No. of Alerting Devices No. of Waste Disposers P Heat Pum Total P Number . ons _... _._._....... o. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection ❑ Other No. of Dryers rY Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters- Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desire4 or as required 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the ains and penalties of perjury, that the informatio n this a pl cation is true and complete. FIRM NAME:f�OS IN(7 // LIC. NO.: /oZ/(�f��! Licensee: �7514i /?,9�5 Signature (If applicable. enter "exempt" in the license number line.) Address: '/ o671967-�'.E.i *Per M.G.L. c. 147, s. 57-61, security work requires Departm OWNER'S INSURANCE WAIVER: I am aware that the cc required by law. By my signature below, I hereby waive s req Owner/Agent Signature Telephone I LIC. NO.: o2 -Y80& r Bus. Tel. No., r6Y 5513 511T Alt. Tel. No.:'_Z5r"�lcaZ of Public Safety "S" License: Lic. No. nsee does not have the liability insurance coverage normally uirement. I am the (check one) owner ❑ owner's agent. lo, I PERMIT FEE: $J �' C,�&v r,4� �- 0 " F Ft-�Ioj 0 j l�-dg ory " f C� uljt &MR101=8191 of Aboadjustfio kq �ePnrttnent of �ubli� �afetq �t�)BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy A Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date %* or Town of NO 11H ANDOVER To the Inspector of Wires: The udersigned applies for a permit to pe Location (Street & Number) Owner or Tenant Owner's Address 7 the electrical �woork described below. )/-P/-C / Is this permit in conjunction Nth 1 e building rpermit: Yes.0 No ❑ (Check Appropriate Box) Purpose of Building f Utility Authorization No Existing Service Amps ____/ Volts Overhead ❑ Undgrnd ❑ New Service Amps _� Volts Overhead ❑ Undgrnd LI Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of 'Dansformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. grnd. Generators KVA 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 Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Dishwashers Heating KW No. No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ❑ []Other Connection No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage 1Lbs No. of Motors Total HP I INSURANCE COVERAGE: Pursuant to the requirements'of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial hquivalent. YES C N have submitted valid proof of same to the Office. YES O C I checking the appropriate box. ` NO G If youhav checked YES. please Indicate the type of coverage by INSURANCE J5`- BOND C OTHER G (Please Specify) n / / r / Estimated Value /o��f Electrical S /, ((Expiration Date) Work to Start -�—�=L OV Inspection Date Requested: Rough Final &Y/// �4// Signed under th allies of p FIRM NAME Licensee LIc. NO. i� Signature LIC. Nt]� Address t/ f� �/� Bus. Tel. No. 1 �j% i ?V ` Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or Its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE S X-6565 "0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....'' n-- ............................................ ........ ................ has permission to perform /�� c •'%� .............................................. wiringin the building of.................................................................................. at �a :.. f .................. .......... ..... , North Andover,. Mass. Fee`.- :.......... Lic. No 1-),I' . '..���...........��iNSP�e LL`ELECTRIR� Check # �` 80,18 Ir Commonwealth ol /%la�eachudettd Official Use OT Ac7 part d of ire Serviced Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank --- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with. the Massachusetts Electrical Code (ME/)2/6 527 iM 12.00 (PLEASE PRINT WINK OR TYPE ALL C q' `TION) Date:_ ZS City or Town of: U To the Inspector o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3e 5T6--), e%%jOJ e Owner or Tenant&4nj�j IL) Telephone No. Owner's Address Is this permit in conjunction with a build'g per 't? Yes ❑ No (Check Appropriate Box) Purpose of Building �/�%GtI.Q� Utility Authorization Existing Servicew-0 Amps /' / CY6 Volts Overhead [JUndgrd No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following inhle mm, he wnivvd by tho Inenprm of wi— 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 Swimming Pool Above ❑In- ❑ nd, nd. o. o Emergency ig g Ba Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eatump Totals: I.Number erSelf-Contained ons _ ___� o. of Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑unicipa [IOther Connection No. of Dryers Heating Appliances KW Security No. of Systems: of Devices or Equivalent No. of Water KW Heaters No. of No. as Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: _ _ . . ..... ...... . Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lectrical rk: �� (When required by municipal policy.) Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C RA Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability i surance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover3ge is in force, and has exhibited proof of same o the pe it issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �7e j' /� 3?l I certify, under the pains a enaldes of erju , that the inf matin this pplication is true and co eta FIRM NAME: t> t/ C LIC. NO.: AS Licensee: V�)94 Signature LIC. NO.: (If applicable, en e "exempt r the li ense number li ) / Bus. Tel. No.; Address:; �yZt ! Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security wor requires Department o Pu lic 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 ent.Owner/Agent Signature Telephone No. PERMIT FEE: $ .31001 W TOWN OF ANDOVER ELECTRICAL PERMIT FEES (E ective March 12, 2003) NO SE CABLE ON OUTSIDE OF BUILDING Air Conditioners: $40.00 each Alarm Systems Security: (for fire systems see smoke/heat detectors) Residential: $40.00 Commercial: up to 10 Devices $60.00 additional devices over 10- $1.00 each Carnival Equipment: $50.00 each Ceiling Fans: $1.00 each Commercial New Construction or Alterations: $100.00 per 1,000 Sq. Ft. of Construction Space Commercial Service Change/ Repair: Must have Utility Authorization Number $100 (first 100 amperes or fraction, one meter) a) each additional 100 amperes capacity or fraction. $30.00 b each additional meter $25.00 Commercial Temporary Service: $100.00 Must have Utility Authorization Number Commercial Repair and/or Maintenance Permit: (Blanket Permit) up to 2 Electricians $150.00 per pair of Electricians over 2 $50.00 Data/Telecommunication: Residential: $1.00 per port Commercial: $30.00 up to 10 devices over 10 $1.00 each Dishwashers & Disposals: $5.00 Each Dryers: $15.00 Each Emergency Lighting (Battery Units) $ 1.00 each unit Feeders or Sub -feeders: each 100 amp capacity of fraction thereof Residential: $5.00 each Commercial: $15.00 each "Gas/Oil Burners: Residential: $20.00 each Commercial $20.00 each 3 _4/_'Dgrl;,7 Generators Residential & Commercial: a) including photovoltaic & generating Equip Per KVA $1.00 b) un -interruptible power systems, per KVA $1.00 c) batteries over 100 amp. hours, per cell $1.00 Heat Devices: $1.00 each Heat Pumps: $40.00 each Hydro -Massage Bathtubs/ Hot Tubs: $20.00 each Lighting Fixtures $1.00 each Lighting Outlets: $1.00 each Major Appliances: (not listed) $20 each Motors: (per hp or fractional part thereof) $2.00 Oil /Gas Burners: Residential $20.00 each Commercial $20.00 each Office Furnishings: per circuit $10 elocatable Partitions/Cubicles Outlets & Fixture: $1.00 each Ovens Built in/Counter Top Units: $10.00 each Panel Change/Circuit Breaker. Residential: $20.00 Commercial: $25.00 Phone Jacks: See data/telecommunications Ranges $15.00 each Receptacle Outlets: $1.00 each Recessed Fixtures: $1.00 each Re -inspection Fee: $25.00 Repair to Service Residential: $20.00 Residential New Construction (Dwelling): $220.00 (with service up to 200 amps) - Must have Utility Authorization Number for services over 200 ams see below a) for each 100 amps capacity or fraction add $20.00 b) each additional meter $10.00 c) each additional panel/sub panel $25.00 Residential Additions/Alterations: $220.00 maximum Residential Service Change or Underground Service: $40.00 Must have Utility Authorization Number a) one meter, up to 100 amp capacity $40.00 b) each additional 100 amp capacity or fraction $20.00 c) each additional meter ..$10.00 Sewer Ejection Pump: $25.00 Signs: $25.00 each ballast Smoke & Heat Detectors & Initiating. Devices: Residential: $1.00 each Commercial: $60.00 up to 10 devices over 10 - $1.00 each Space Heaters: area heating $1.00 each Sub -Panel: $25.00 Swimming Pools: Residential: Above Ground: $25.00 Inground: $50.00 Commercial Pool: $100.00 Switches: $1.00 each Temporary Service: Must have Utility Authorization Number Residential $25.00 Commercial $100.00 Transformers: a) capacitors, Per KVA $1.00 b) ducts, conduit & conductors (Associated w/ Padmount Transformers) $25 c) each manhole $10.00 d) each handhold $5.00 e) per KVA $1.00 f) primary feeders, $25.00 each (over 600 volts, non-utility owned) vaults and equip. $25.00 each Washers: $15.00 each Waste Disposals: $5.00 each Water Heaters: $30.00 each, *For Multi -Family &i Large Commercial Project see Wiring Inspector for pricing: Paul Kennedy (978) 623-8306 (Office Hours 8 am to 10 ani) *Inspection Schedule: 1 ROUGH 1 FINAL 1 TRENCH (if applicable) ADDITIONAL F' INSPECTIONS *$25.00 (if applicable) (revised 07/05) Date ........... .......... � "-I TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation in the buildi.... .......... .......... ..... �i �.. 6 .......... at .. North Andover, Mass. Fee:.; ..... Lic. No-l��' �—...... .............. Check# 1269 GAS INS,E011 R e- 6258 M �. �. RECEIVED MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING DEC 0 3 200? �" CitylTown: IV6A f Date: ermlt# T4YYN.0F_N01 _.&NbOVER BuildingLocatio C �� 57a/I%C;-F-i9%I/ - Owners Name: Type of Occupancy: Commercial Educational Industrial' Institutional Residential', ✓ New:' -V -'Alteration: Renovation Replacement Plans Submitted: Yes No v CIYTI MCC INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ! No If you have checked Yew please indicate the type of coverage by checking the appropriate box below. .... _. A liability insurance policy Other type of indemnity Bond 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 Agent Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurare to me uest or my rnnowieoge ano inat au plumping work and installs compliance with all Pertinent provision of the Massachusetts State Plumbing -- - — Type of License: , By' Plumber Title ✓ Gas Fitter SI na UI Master A— man performed under the permit issued for this application will be in and CbapW 192-Mhe General Laws. of Licensed Plumber/Gas Fitter cityrrown y License Number: /lcf APPROVED OFFICE USE ONLY LP Installer W uj z Y. Y. IY z Q D = rn N W W U U N = H O 2 H x W. W Q O J} W W p W W 65 W > W W z °° 0 Q d W o a W 0 W x x H ZW>.MyJ W W W z F=OW x JZLLO W H01-0 W N W U O G 0 2 2 O a M H>>> F O W S SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3RD FLOOR 4 FLOOR 51HFLOOR WH FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name:, OW05- _ corporation Address:., X: % �Si,eCL� .Ci /Town:, _. • �' fa.S tY �jvr3 c�.� C.J State. MA Partnership Business Tel• ,��-c�f�--�// Fax Firm/Company.. Name of Licensed Plumber/Gas Fitter:: A-�eblllrl`,�-- INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ! No If you have checked Yew please indicate the type of coverage by checking the appropriate box below. .... _. A liability insurance policy Other type of indemnity Bond 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 Agent Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurare to me uest or my rnnowieoge ano inat au plumping work and installs compliance with all Pertinent provision of the Massachusetts State Plumbing -- - — Type of License: , By' Plumber Title ✓ Gas Fitter SI na UI Master A— man performed under the permit issued for this application will be in and CbapW 192-Mhe General Laws. of Licensed Plumber/Gas Fitter cityrrown y License Number: /lcf APPROVED OFFICE USE ONLY LP Installer v. m r n an >Li n v a r r" C b r O C Y r a � y z n A U z 0-1 W tit z LUa Z rL t- aEU) x w L) > IA ac z O su H > aC til Q O YOco f a z F CL t 40 t cz O P o N ` in Lei Ll t W �M I 01 f _ ?- O Chi (oa v ,# I T {� F e; xF W u1 w to „ 3. ° . z O �.. ',=UfAl !.jz F o}c 01 ago z Ni { ., �a•tt't H 4 z F° I O !U j > FF til OIL O V a[ a4 Q tL U z 0-1 W tit z LUa Z rL t- aEU) x w L) > IA ac z O su H > aC til Q O YOco f a z F CL t 40 t cz O P o N Date./z A TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..'&.(<�.') ..... .......................................................... ,Phas permission to perform ...... ........ wiring in the building of 3 ................................... at (/ ................. . North Andover, Mass. Fee L i c. No. ...... .. ...... 77�1 —/ ELECTRICAL INSPECTOR Check 4836 THE COMMONWEALTH OF MASSACHUSETTSEOccupancy Office Use of DEPAIt�1VT 0FPUX,1CSAFETY t BOARD OF FIRE PREVHMONREGUI AHONS 527 CAR -1100 es Checked APPUCA77ONFOR PERAIRT T PERFORMELECIRICAL WORK ALL WORK TO BE PERFORMED IN ACCORD ANCE'✓I I FIHE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION,) Date / / %'6 3 Town of North Andover To the Inspector c The undersigned applies for a permit to perform the electrical work described below. Location (Street i Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No � (Check Appropriate Box) Purpose of Building Ihaw acuaa1Lbb&yh>;s rmwPblicyitrAxlff gCoinpl*, Covgageon sakstM al04rmtent Utility Authorization No Existing Service ��� Amp ���Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters . Number of Feeders and Ampacity i/�/� G+i i AAA4&cY�--, d ASD• < 6G Location and Nature of Proposed Electrical Work IicamNo. t Si' No. of Lighting Outlets No. of Hot Tubs l3wirmTelN6. -9-Yr d 2 62-4-2— 24-2 �� d���Q No. of Transformers To ndthatmy@giat<ueonampemtapphcahth�� isn�t wsLa Please check one) Owner Agent No. of Lighting Fixtures Swimming Pool Above ]Below K\ ground ound .Generators K\ No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners :::— No. of Ranges No. of Air Cond. Z Total ` S FIRE ALARMS No. of Zones. Tons No. of Disposals No. of Heat Total Total No. of Detection and No. of Dishwashers ace APum s Tons Sprea Heating KW KW Initiating Devices No. of Sounding Devices No. of Self Contained ^� �e No. of Dryers Heating Devices KW Detection/Sounding Devices - Local Municipal Other Connections No. of Water Heaters KW No. of of ��No. Signs lasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• bi5taanXCoW1aW- PM]M ttothe>t )ff&ofA4a%adusemCimr Laws Ihaw acuaa1Lbb&yh>;s rmwPblicyitrAxlff gCoinpl*, Covgageon sakstM al04rmtent YES Np �DOff Ihawsub niWdvand osametothe0� YES ffyrxihavetd>eCkedYES,Pleaseir>dithetypeofmv$aWb?' choddilgtheINSURANCES may) Wbiktosw inspe ti x�yttes�d , Fgm*dVahrd Wcdc$ signedunderTr naltiesofpeijtxy. Filial FIRMNAME �4�tflC IicamNo. t Si' LicffwNo acc � �G��� ST �✓�iC.IC�� l3wirmTelN6. -9-Yr d 2 62-4-2— 24-2 �� d���Q Alt. Alt.Te1No. _ )WNER'S INSURANCE WAIVER; I am awate that the Licrose does nothave the insurance coverage orits a bSarttiai ffpvaiatt as tegmed byIvb%wh twits Lateral ndthatmy@giat<ueonampemtapphcahth�� isn�t wsLa Please check one) Owner Agent Telephone No. Signature o caner or gen PERMIT FEE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am 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. Company name: Address Cit): Phone #: Insurance. Co. Policy # Company name: Address City: Phone # Insurance Co. Policy # 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 and/or one years' imprisonment_as_well_as_civil.penaftiesin-thelarmrB-a_STOP WORK_ORDFRand_a.fine_of.($1DO-DD)-arlayagainst.me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not wrote in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept nCheck if immediate response is required Licensing Bow F-1 Selectman's Q Contact persona Phone #: F] Health Departr Ei Other