Loading...
HomeMy WebLinkAboutMiscellaneous - 67 Maple Avenue VLAA ZI9j 1 Date . —.'�-t-/ 2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifithat . . . 0es !y� . . .Sc �G�. . . . has permission to perform . R '. C . . . . . cc.? t-c. 1F4� R U�P� wiring in the building of . . . . . . . . . . . . . . . . . . 6 7 �0PZ e- at �gLG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Vorth Andover, ass. -Fee . . . . Lic. No. . . . . . . . . . . . . . . . . . . . ELECTRICAL INSPECTOR Check# © 6� 11073 Commonwealth of Massachusetts Official Use Only 1173 � Y Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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 INFORMATION) Date: City or Town of. NORTH ANDOVER 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) M C, .S Owner or Tenant Y'S.w A Telephone No. Owner's Address As'-7-46 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 'ae l,;4 Utility Authorization No. Existing Service /OD Amps Ad 130 Volts Overhead E?r Undgrd ❑ No.of Meters New Service 2-!T0 Amps /11 Volts Overhead 91`� Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W,r4- lqo,1,,._ -r, Ple n o dt f v oI-V t Completion of the followin table maybe waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ig ting rnd. grnd. 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW ISecurity Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent FoHromassage Bathtubs No.of Motors Total HP Te1No.of Devicesoor E uvns alent : Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /j�'OD° (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 pains and penalties of perjury,that the information o is application is true and complete.— FIRM NAME: . ;50 K leG LIC.NO.:—t, " 3d`is O I'llLicensee: U()kol ,S<C!(•• Signature LIC.NO.: (If applicable,enter "exempt"in the license number line) Bus.Tel.No.: f, Address: �3Av'^1''�"� �/ �o( /vuC PSS Alt.Tel.No.:�l7ff• �73�(osGG *Per M.G.L c. 147,s.57-61,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 agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. i F f r , t .- • �.1i-ULIY... ���t��^^j(Jrrlp_1T--�.�]�.'yt�l'J-Rd�•���.♦�®p���y.`pY�-(+�t/-� �.+5�.{�JVJ.: UJi•R�.�l.A.1aJi:1�®��� r _ •�1�L,!•.R0.4�•C'3�Lf.�-lgl��.lCiiL.�,l,11'�" .. ..� ■ �'�ssec��, p'ailefl-�j � �e-xnspect�ou z'equixecT($�0.()0}�j � Xnspactors,C exts: - A (Xnspee axs' atuxe-no 7.r.uals) Pate JC'asse�--j �'aiTet�--j � � �teiuspectionxe�uixe�(��0.00}w j � . it5iectors'c eats; ( ns&ctozs' 'zgnafuz'e- o xtiaTs date F gassed•—j ) p'a�1ec�--j � �te�fnspectzon�'es�uixet�(��D.UD)Mj ] • un.spectors'comments: , (lnspectors'aignatuze�+ao?nifias} Pate �ssed.--j p'aiied--j � �e-3nspectiox�xequixe�(�50A0)�j � ' bi spectb 'eo m.eufs: &spactors'Nlguatuxe- i0nitials) Date ' sed -j � ;>tailer�--j }- '�ternspectioxtz'er�piz'etl(�50.00}�[ � - �actors'coxuraai.enfs: � ' OPISpectora'Winawe-no initials} Date ' OR TAGN AAM TO3F,VfTFD PD-TAM 3GXFT OX,RITE N .ARVA TO 3E MR.Duum is NoT The Commonwealth of Massachusetts Department ofIndustritcl Accidents Office of Investigations UV 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatiorAndividual): 6(h Ce'g 16' Fk G G C . Address: +k vV S fah P� . City/State/Zip:_ G(00 C f*1,- 00'aPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I ' employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet.# 7• remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 131iOther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is thepoldcy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 of 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 tho1A for insurance coverage verification. I do hereby cer i nder thepains andpenalties ofperjury that the information provided above is true and correct Si ature: // Date: ' / Phone#: 7 — 47s- lv-T c 6 Official use only. Do not write in this area,to be completed by city or town official. 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 6.Other - - Contact Person: Phone#: t� Information and instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants A Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of t insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#61.7-727-4900 ext 406 or 1-877�,MASSAFE Revised 5-26-05 Fax#617-727-7749 www-mass.govfdEa Location l6 ���.>'< !/T_- No. Date T" TOWN OF NORTH ANDOVER p Certificate of Occupancy $ * : ; Building/Frame Permit Fee $ s" E Foundation Permit Fee $ SACMUS� Other Permit Fee Sewer Connection Fee $ PAID BY CiSKonnection Fee $ TOTAL $ �1��,. MAY 151991 Buildi g irispector h. Andover Collector Div. Public Works 3 nw' � PERMIT NO. �3 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE — Z/ONE I SUB DIV. LOT NO. I r( I- CATION PURPOSE OF BUILDING !' I OWNER'S NAME '� 2 NO. OF STORIES �f J SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME ,f C �Q � e SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY n IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. V PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH ` SIG�E OF 14OWrE O AUT ORIZED AGENT 44*l'/ E E � PLANNING BOARD PERMIT GRANTED 19 � BOARD OF SELECTMEN OWNER TEL.# BUILDING INSPECTOR CONTR.TEL.# CONTR.LIC.# v BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY I S-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HL D PIERS PLASTER _ DRY V✓ALL UNFIN. A3 BASEMENT I ' AREA FULL FIN. B'M'T' AREA _ tIle 1/1 l/. FIN. ATTIC AREA 1O 8 M'T FIRE PLACES _ Hf AD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVV D ASBESTOS SIDING _ COMAACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR 11 POOR ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLE HIP BATH (3 FIX.( GAMBRELMANSARD TOILET RM. 12 FIX.( _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM _ STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T ♦ 2nd _ ELECTRIC 1st I 3rd NO HEATING 1 1 OFFICES OF: O�O "ORtp,O� TU w II of APPEALS �. NUlZ'1'I! ANDOVERBUILDING t\I�i.ti��I( II�L;lllsit•I�ts;'I:•,- ` CONSERVATION �6B'°"„a�' rl1� Itilc rN c;I Il;17)G85-17 5 HEALTH PLANNING PLANNING & COMMUNITY DEVI:LOPl111?NT KAI REN I I.P. Wl.SON, I)II tl C I c )I t In accordance with the provisions of MGL c 4U, S 54, a condition of Building; Peunit Number .1-03 is that the debris resulting from thisbe worF: shall 150A. disposed o[ in a properly licensed solid waste disposal lacilily, as defined by NIGL c III, S The debris will be disposed of in: �GT!%i�" • (Location of Facilit ) I Signature of Pelinit Applicant -- Date I N Demolition OTE: tion permit from the Town of North Andover must be obtained f:or , ' this project through the Office of the Building Inspector. . i F own Of ` _ 6 0 An(dover N qf 20 . 1 DRIVEWAY E-N m RY I ERMIT er, aSS., 19 ,. r:. .s h SSA Pa �^ BOARD OF HEALTH THIS CERTIFIES THAT...... 24-. ... ....... BUILDING INSPECTOR has permission ..... buil s on .. .... .. Rough to be occupied as... 1 , Chimney .. .................................... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this offiPLUMBING INSPECTORce, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ST ® Rough Service Final .... ..... . .......................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove FIRE DEPT. Burner No Lathing to Be Done Until Inspected and Approved by STREET NO. Smoke Det. Building Inspector