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HomeMy WebLinkAboutMiscellaneous - 86 Second Street3 r Date .... .f'-�//--.a.7...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 2 ...?` ..`......`.....: ........................... has permission to perform ........ .177 —�^ �r'�'` .... ................. ............. wiring in the building of ................ at ° ................ . North Andover, Mass. Fee ..................... Lic. N . .......................................... ELECTRieXL INSp - R v Check # 7452 J 0 �3 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. a- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leaveblank) 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: 6, -1/- - d? City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intentio to perform the electrical work described below. Location (Street & Number) 6 Se r Owner or Tenant cA, Telephone No. Owner's Address S cnz t i Is this permit in conjunction with.a build' , ermit? Yes No ❑ (Check Appropriate Box) Purpose of Building �.����/ /kv G� Utility Authorization No. Existing Service c').00 Amps /.fit) /;� ycJVolts Overhead Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity 7 © AJA, Location and Nature of Proposed Electrical Work: Completion of the followine table may be waived by the Insnector of Wires. No. of Recessed Luminaires cUNo. of Ceil.-Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets 16 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switcheso. �© No. GBurners oas No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alertin Devices g No. of Waste Disposers Heat Pump Totals: Number Tons I KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Mun'c'pal ❑ Other Connection No. of Dryers Heating Appliances Kms, Security Systems: No. of Devices or Equivalent No. o Water KW Heaters No. of No. o Signs Ballasts Data Wiring: 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 desired, 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:) / certify, under the ains and penal ies of pe fury, tZiat lie iiformt tion o this applic tk ion is true and complete. FIRM NAME: ,L Mv���� %I ��x v LIC. NO.: A(t;�6( Licensee:nj v Si nature �, LIC. NO.: (If applicable, enter "exem " in z licx number 1 e.) 1 Bus. Tel. No.. -Ce � t�� �� Address: tr c, ` .t t % Alt. Tel. No.: *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 v Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDlicant Information Please Print Legibl, Name (Business/Organization/Individual): Address: /Cj '/ �.•`i-` City/State/Zip: �� � �� o i Phone #: �'I� E3 &,M — arc) o A;,,m ou an employer? Check the appropriate box: 1. a employer with e'4— 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. # These sub -contractors have workers' comp. insurance. i. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ w construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *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 are 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 the policy and job site information. A . \,.,, t i i Insurance Company Name: L V ca Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: $ (o s. ,U �. s-1 - City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under 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 the DIA for insuranSe coverage verification. I do hereby certify under the pains and*nalties of perjury that the information provided above is true and correct. -/(-o Phone #: 9 ? 9� !�)6 - 0 U 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 #: s 1 NORTH 0 G 1 Date ....�...�... �...�...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING l/ This certifies that......................................................... . ................................... has permission to perform wiring in the building of .... t ..:. �`�� at ......r.......,..,............�........................... .North Andover, Mass. Fee..................... Lic. No. . ............................................................... ELECTRICAL INSPECMR Check # ,_J ?-- 1, �dl? ZZfl�rf.C'?W 057 sS�f s�77s DyGaat curt 4 P-dza Sam BOARD OF FIRE PREVENTION REGULATI}DN . 527 CMR 12:00 vnii Permit N . J5; OD Occupancy & Fee Che( , APPLICATION FOR PERMIT TO PEORM ELECTRICAL WORK All work to be performed in accordance with the Mas chusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 100�_A ( } To the Inspector Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below Location (Street &Number <e,6_ Q -le -2 _ t_ Owner or Tenant Owner's Address o�„h ✓ r Is this permit in conjunction with a building permit Yes 0✓ No 0 (Check Appropriate Box) Purpose of Building�p Jle Utility Authorization Existing Service Volts Overhead 0 Undgmd 0 No. of Meb New Service Amps Volts Overhead 0 Undgmd 0 No. of Met( Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO - have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) Estimated Value of.Bectrical Work$ (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME ,gV-( (` / _ 7�; 'r LIC. NO/��5^ r- NO.T_ eJ�r Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass General Laws. And that my signature on this permit application waives this requirement. Owner /gent (Please Check one) (Signature of Owner or Agent) __0 Telephone No. PERMIT FEE $ Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fi>dvres Swimming Pool gmd 0 gmd a Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No_ of Oil 'Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone _ No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices _ NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices _ 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO - have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) Estimated Value of.Bectrical Work$ (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME ,gV-( (` / _ 7�; 'r LIC. NO/��5^ r- NO.T_ eJ�r Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass General Laws. And that my signature on this permit application waives this requirement. Owner /gent (Please Check one) (Signature of Owner or Agent) __0 Telephone No. PERMIT FEE $ a e °f 40RrPj ,h O 9 41 SA us Date..I.'.�y--- d.`/. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. S u 1 'e 11 0 r '.oc �\ a ti k c A t .........!"..................... has permission to perform -R.. ". . a .................. plumbing in the buildings of ...�!�.A.... Q.� l ............. at .. S IO ..S Cc^..' , Nort Andover, Mass. Fee. 39.../Lic. No..Ia�.�y...�!02?►, %�'�� . PLUMBING INSPECTOR Check # °� `) L 5664 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ;' rint r Type) , ,Mass. Date _..�.y_I /� --Permits Building Location //f 7-V.6_c_-- Owner's Name ~- �� --- ------ -- — ------ ---- Type of Occupancy New _. Renovation 21' V Replacement FEATURES Plans Submitted Yes ❑ No 39,x°/ Installing Company Name & , Check one: Certificate ♦ Address �1 12 f -�'l < "-: Corporation Partnership 1 Business Telephone_Firm/Co. Name of Licensed Plumber 10 i ti INSURANCE COVERAGE: I have a curr m-tiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Ye� C No If you have checked yes_ please indicate the type of coverage by. checking the appropriate box. A liability insurance policy / Other type of indemnity -, Bond OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: --- ----- 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachus�,Plumbing and Chapter 142 of the General Laws. Byign ure o C�cense�c PT --- --- — -- Title _— _ Type of License: Mastery Jour yman City/Town--,----.----- ---- License Number_ _ --/Z5-7z z Z V U)O z Z > F- U) YQ= r Q=~ U Q Z W W Z O LL Z O W �= cr Q W Cn Y d Q Q X U Z= Cr w g I- ct) Z O Q cn O= d= O W S O= Q O= J U) W� Q Y O LL CC Q j F- O W Cn D Q z CL O 0 O (n z Z w Lij F- LL O U= Q Q= Q O Q J J Q W cc Q O Q F- Y F- to LL 0 D O Q = m O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name & , Check one: Certificate ♦ Address �1 12 f -�'l < "-: Corporation Partnership 1 Business Telephone_Firm/Co. Name of Licensed Plumber 10 i ti INSURANCE COVERAGE: I have a curr m-tiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Ye� C No If you have checked yes_ please indicate the type of coverage by. checking the appropriate box. A liability insurance policy / Other type of indemnity -, Bond OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: --- ----- 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachus�,Plumbing and Chapter 142 of the General Laws. Byign ure o C�cense�c PT --- --- — -- Title _— _ Type of License: Mastery Jour yman City/Town--,----.----- ---- License Number_ _ --/Z5-7z a o e A .Li ` Date .. cY :. .`.:.` ..` .... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 4/'.! : � ......................... has permission for gas installation ............. . in the buildings of ... {1`? ............................ at .. ... ? f <. �:.. .... `.......... North Andover, Mass. Fee.. Lic. No... 3 `' '.`... .. ................ *S INSPECTOR Check # / 7/ S 1 4%i6 MASSACHUSETTS UNIFORM APPLICATON FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS S-/— ; - Building Locations `1 6 sz- coNO �/ W A ! v oo U L 1Z• Owner's Nan New ❑ Renovation ❑ Replacement TO DO GAS Date 7t,7 Permit # % l / ^ Amount $ C� Plans Submitted ❑ Name or type8A �� r (�� tv A -C - L bzrp- ke: Certificate Istgl mgtCompany 'f Lf (o Add r s k� ( 1 S r:: -r L 'Tr ❑ Partner. lv D U i ❑ Business Telephone 03 Firm/Co. Name of Licensed Plumber or Gas Fitter %d L' CAI-(AIAAW INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ©"-- No❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0-- 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 Mass. General Laws, and that my signature on this permit application waives this requirement. ('hark n"P• Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certmty that all of the details and information 1 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 ofthe Massachusetts State Gaya Code and Chapter 142prfthe General Laws. ICity/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter LLr Plumber 3 Y L/ O O'Gas Fitter License Number Master ❑ Journeyman F Location �'� No. Date NORTH TOWN OF NORTH ANDOVER F � w 9 Certificate of Occupancy $ �SJACHUSEt 2 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /Zy Check # 17001AM"Cl` ` Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING lfdr>, BUILDING PERMIT NUMBER: yL/ �o DATE ISSUED: 1-7 —,0 A Le— SIGNATURE: 'v* Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. f4) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: r Nime Print Address for Service: ff Signature - Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number 'G Address 1211-- Expiration ate Sign r Telephone / Q11W,4 v0 O 3 Registered Home Improvement Contractor Not Applicable ❑ Company Name l Registration Number ddress Expiration Date Si Lure Telephone 00 rn X z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completedand submitted with his application. F 'lure to pro de this affidavit will result in the denial of the issuance of the buildingpermit. � LG��/ !id Signed affidavit Attached Yes .......❑ No ....... ❑ _ SECTION 5 Descri tion of Proposed Work check au a ticable New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: crlG-- I SECTION 6 - F.STIMATM CONSTRUCTION MWQC I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building GGG (a) Building Permit Fee Multiplier 2 Electrical i��G �`e, (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 p. °i° Check Number SECTION 7a O NE AUTHORIZATION TO BE COMPLETED WHEN OWNERS ANTRAOftOR APPLIES FOR BUILDING PERMIT 1> as Owner/Authorized Agent of subject property Hereb authorize to act on My ehalf, 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 Own er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvMERS 1 2 ND3 RD SPAN DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DUSAENSIONS 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 ✓J2C U/ O/77/IILOILIUCQ�A�L dL �/(�G20dQ�iLLLOP.i�6 BOARD OF BUILDIN REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 066834 Birthdate: 10/31/1961 Expires: 10/31/2005 Tr. no: 7808.0 Restricted: 00 JOHN A CORBIN 10 BUTTERNUT DR PELHAM, NH 03076 Administrator Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 125606 Expiration: 2/3/2004 Type: Private Corporation CORBIN CONST CORP JOHN CORBIN 10 BUTTERNUT DR PELHAM, NH 03076 ��'` 5 I A Corbin Construction. Corporation John A. Corbin General Contractor 10 Butternut Drive Pelham, New Hampshire 03076 Tel: (603)635-7609 Fax: (603)635-2649 Cell#: (603)396-4912 January 7, 2004 Dana Hall 86 Second Street North Andover, MA 01845 Re: Bathroom Remodel 1. Demo the second floor bathroom floor, walls, ceiling and fixtures. 2. Supply and install blocking and partition framing as required. 3. Supply and install strapping as required. 4. Supply and install vent kit for ceiling light fan. 5. Supply and install sub floor. 6. Supply and install sound insulation. 7. Supply and install green board on the ceiling. 8. Supply and install green board on the walls. 9. Supply and install wonder board in the shower wall area. 10. Supply and apply compound on the walls and ceiling. 11. Supply and install pine base board and any required trim. 12. Supply and apply primer to walls, ceiling and trim. 13. Supply and apply ceiling paint. 14. Supply and apply finish wall paint. 15. Supply and apply finish trim paint. 16. Supply and install new closet door. 17. Install shower walls. 18. Supply and install tile floor. 19. Supply and apply floor grout around the tiles. 20. Install sink base cabinet. 21. Install wall mounted accessories as required. 22. Supply and apply GE clear silicone in required locations. 23. Repair ceiling in living room and finish paint upon completion. Labor Material Electrical (L&M) Total j z� % John A. CorbinV V $6,542.40 1,534.10 400.00 $8,476.50 CONTRACT 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. 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