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HomeMy WebLinkAboutMiscellaneous - 2 Salem Street / -2 SALEM S?REFI J VO10960000.0 F 1 Date.. .................... NORTH ` 4, TOWN TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �1 •O++n°•�•y'h ,SSACMUSEt This certifies that ..— G lec .......................................................... ................................ has permission to perform ........./ e '`'" �Q e ............................................................... wiring in the building of....C.��q S .. r U ASM p ti .................................................................... y s A . `� .. S ,North Andover,Mass. at.......... ......... a Fee.....�� Lic.No R..19 9 ...............10 2 2.1...1. .............................. ELECTRICAL INSPECTOR Check # i 4921 THECC,i2'MONWEAL7HOFAMS4CHUSE7TS Office Use DEPART ffiWOFPUBL1CSAFETY Permit No. 7 BOARD 0FF,IREPRLVFA770NREGUT4770NS527CMR12.M Occupancy&gees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 ` (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1,-0,2 Town of North Andover To the Inspector of Wire,, The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes REM" No (Check Appropriate Box) Purpose of Building Z *.r;%j 'O"4 f oy,. Utility Authorization No. Existing Service 9a Amps /LO) .' Volts Overhead Underground M No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 771 7 nc( 777 77,77'ron. No.of Lighting Outlets z No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pogue Above Below Generators KVA _ ground ground No.of Receptacle Outlets Z J No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets S No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones No.of Disposals No.of Heat Total Tons Total No.of Detection and 6 Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained �. Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other!- Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER IelsuralccGC)Wrage Ptlr'mltothemglim tsofMaMc LMMGff)XALaws tlhawawuaitLmbfliyhmmmFblicynrlxh C Cov>rageorAsabstanUepvalatt YES F1 NO Ihavese>Exrrit>edvalidpfe�ofofsametotheOffice YES X T Ifyouhawcha odYES,piwir�thetypeofeoverageby cl>edangtheabox M:1 INSURANCE LJ BOND OIIIIEIt (P1ea5eSpecafy) ������ WodctoStart /?/ �a/�3 E�slimatedValueofFle�tlWcdc$ �? Final Signedunda-TiePt rothesofperjury: p FIRM NAME � L4 C . LicmseNo. MA 90/ /�y: 1ccnsee Artdre'w A7. Loetflef Signature'- Li No BtsirmTel.No. 10'- "ddresc 6�S /`/G-�®-. - Aql, 0,1 .IS,$ At Tel No. 5'J3-2-1Y-S3.3 Z. OWNER'S INSURANCE WAIVER;I am aware that the Lice does nothave the instuarx- bs(antial covwCe orits suequivalent as regtmed by Massachusetts General Laws -- ',rx 1 that my signattre on this pennut application waives this requirelrlart Please check one) Owner O Agent - Telephone No. PERMIT FEE Signature ot Uwner or Agent _ The Commonwealth of Massachusetts " ` = Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print � w Name: Location: Cit rL 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 City: 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$1,500.00 and/or one years'imprisonmentasmetl_as_civil,penaltiesin.2helorm.iof-a_STOP WORK ORDERand.a.fine_of.($1DO.DD)_a day.against ms_ l understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. s t do hereby certify under the pains and penalties of perjury that the information provided above is true and correct r Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing _ ❑ Building Dept ❑Check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone#._ ❑ Health Department ❑ Other t Location -�' y S A No. o�C/o Date NORTH TOWN OF NORTH ANDOVER f 9 # Certificate of Occupancy $ • i ; M cMust` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C> S Check # (f Y� e s 16833 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:. DATE ISSUED: SIGNATURE: Building Commissioner for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: D - Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RecRiired Provided 0 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Dis 1 System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes. NO �M'1 2.1 Owner of Record r�"��r --s d 177-1 Name(Print) Ac1dress for gervice Uy Signature Telephone d 2.2 Owner of Record: t o Name Print Address for Service: TZ Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number Address Expiration Date ic e P Signature Telephone g 3.2 Registered Home Improvement Contractor Not Applicable 0 v Company Name m y Registration Number r Address r i Expiration Date �1 i Signature Telephone G) 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 Descri tion 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: O SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � �FFI<Iwial 501L11~ Completed by permit applicant35t 1. Building (a) Building Permit Fee Multiplier .F•ri r 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 I, as Owner/Authorized Agent of subject property Hereby authorize to act on Y behalf ' mars relat' o authorized by this building permit application. �Gd '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 Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB j SIZE OF FLOOR TMMERS 1Sr2ND 3 SPAN DRAENSIONS OF SILLS DRvMNSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X r MATERIAL OF CHEVWEY IS BUILDING ON SOLID OR FILLED LAND 1 IS BUILDING CONNECTED TO NATURAL GAS LINE • NORTH Ot Town of North Andover - Building Department 27 Charles Street �SS4CHUS�tS North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE to — �Q JOB LOCATION J , - ji) o16 /o �l S Number Street Address Section of Town "HOMEOWNER 1 f4� /�Gtr✓'� ��� 0��� �Q��f�© / Number Home Phone Work Phon PRESENT MAILING ADDRESS :22 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of 1 or 2 units and to allow such homeowners to engage an individual 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 HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which of two there is, or is intended to be,a one family dwelling, attached or detached structures accessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned"homeowner"assumes responsibility esponsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, , The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. Revised 4.30.03 Home owner Exemptions Form North Andover Building Department i 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: (Location of Facility) ,qz� 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 JL U W 11 Vl r %sl No. a q C% QC:7L 0 3 o� oCH, WW1I C �� dower, Mass., ORATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .w ` ....... ...................'� .........V N...., V Irl MI`A' ....... .... ..................... Foundation has permission to erect...�N .....n�....r buildings on ...... ...... . ..Is...W.........Q........................ Rough //►► to be occupied as I. .................................................. #*C SI4C 10 46 14140 V/0 chimney ..................................................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating,to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ,r0 Cd D� f�`�Ys �, rO PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR A a P jjl!::� Rough ..kf 4A It ..................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. # Date .0.3.... . . �. f ,AORTN 1 o? TOWN OF NORTH ANDOVER • . PERMIT FOR GAS INSTALLATION CH This certifies that . .1��Y .! has permission for gas installation . . *,�`?�d.°�`e. .� . . . . . . . . . . . in the buildings of . AS,e -4 -P'"O u M ~ . at . . _ `. . . . .. .. . . .`. . . . . . . . . . . . . . . . , North 4,ndover, Mass. Fee. a S. . . . Lic. No. b. . ' 7�0"2 t la/u . . . . .-. . GAS INSPECTOR Check# 31-3o 4534 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FrMNG (Type or print) Date /1 NORTH ANDOVER,MASSACHUSETTS Building Locations w / A, -e--i-, Permit# � V Amount$�'' �✓��/���✓� lA r r �� Owner's Name New❑ Renovation Replacement ❑ Plans Submitted ❑ � w 0 �Y d fr A ° 0 c x O w 3 A U a A a H o r4T B-BASEMENT BASEMENT T. FLOOR j D. FLOOR D. FLOOR H . FLOOR 5TH. FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR Ej I (Print or type) o�� �LdHa/�� t�.,,� ec one: Certificate Installing Comp any Name, Li Corp. Address j g "S ` �` ❑ Partner. Business Telephone Finn/Co. Name of Licensed Plumber or Gas Fitter N INSURANCE COVERAGE Check o I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ Ifyou have checked M,please injecate the type coverage by checking the appropriate box. 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 ofthe Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: ❑ Signature of Owner or Owner's Agent Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code an 42 of the General Laws. _5 By: Signature of Licensed Plumber Gas Fitter Title rq Plumber �!F? City/Town ❑ Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman y Date. .�.�. TOWN OF NORTH ANDOVER . o PERMIT FOR PLUMBING bI.D ,SSACMUS� This certifies that . . . . . . . . . . . . .Pd . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . ct`e plumbing in the buildings of at . "?`. . . .S�.t.°�. ... .f. . . . . . . . . . . . . . .. North Andover, Mass. Fee. . �.� Lic. No.�"?`Iq .�l�. . t7to') . . .� ­ * * * * * * * * * ­ PLUMBING . .Atil �. . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # .313D X5866 MASSACHUSETTS UNIFORM APPLICATIONFOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS A ✓ ate ll o- of Building Location Owners Name &tl Permit# Amount Type of Occupancy New Renovation Replacement/0 Plans Submitted Yes No FIXTURES • d H a 0 a w wcc U Cn U x a o 3 ca a H En a 5�a�v11: > 4SEME yr IST FLOOR I J ! 2ru>f 3MHAOM 4MILOOR sn3HAOM sMFLOCIR 7M 8MFLOOR., (Print or type) Check one: Certificate Installing Company Name a{*�- ���y►�gi,t� 'i' e fi�N�. Corp. #Address Po TOk 9l4 �� � Partner. Business Telephone 6903- 138Z �iZ� ® Firm/Co. i Name of Licensed Plumber: Insurance Coverage: Indicate the type 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 licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' Chapter 142 of the General Laws. By: 77-g-nlaru—re—or LicensewymmDer Type of Plumbing License Title D q1-1& City/Town License um er Master ❑ Journeyman APPROVED(OFFICE USE ONLY LJ ti