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HomeMy WebLinkAboutMiscellaneous - Suite 105Location 4$/ )4N>wt`Plo No. 37/ Date ah, R ea TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL (�,k#-- 5e;�l 8034 $ ! 4sv Building nspector Div. Public Works PiR�fiT NO. �Y ` � •J APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. MAS KBO. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK iPAGE ZONE SUB DIV. LOT NO.I LOCATION iT J^� ,L�u^n �V,r=2 ��- ^"�� [ PURPOSE OF BUILDING 7'1 v �•YN �Fa„ER Sr- �U(T/� � OWNER'S NAME G^`, r NO. OF STORIES SIZE !'I 1 OWNER'S ADDRESS •%l� M C:r. 0 i� C ` BASEMENT OR SLAB ARCHITECT'S NAME F11vAm C' AL (2oNC CY rail TS SIZE OF FLOOR TIMBERS IST - 2ND 3RD I BUILDER'S NAME O S©� doI SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW /-vo SIZE OF FOOTING X IS BUILDING ADDITION A`O MATERIAL OF CHIMNEY IS BUILDING ALTERATION PAPFR, Piiill3r C1'►RPC-T 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 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS_"�(�tpN w t ►s o» t�r�sT SEE BOTH SIDES � PAGE i FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �R /7- ( q-4 SIGNATUI" OF OWMER OR AUTHORIZED AGENT F E E 7jo / tJC7 &o—# f $p jr AV. PERMIT GRAN 19 2!f-- �t AUG 2 199 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 2�. OCyO E8T. BLDG. COSTPE SRPE SR C FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY (3- �- �' � BUILDING INGFECTOR OWNER TEL. # CONTR. TEL. N — �s f5 6* 47 CONTR.LIC.a H.I.C. A I 1 OCCUPANCY APARTMENTS CONSTRUCTION _ 2 FOUNDATION 8 INTERIOR FINISH CONCRETE —II CONCRETE BL K. PINE BRICK OR STONEPIERS I PLASTER DRY WALL Li 3 BASEMENT UNFIN AREA FULL FIN. BM'T AREA _ ,/. 1/1 '/. FIN. ATTIC AREA _ N_O BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �— WOOD SHINGLES EARTH EARTH ASPHALT SIDING HARD"JD — ASBESTOS SIDING _ COMMON _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR BRICK ON -FRAME CONC, OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I-� POOR ADEQUATE NONE Cj ROOF 10 PLUMBING GABLE GAMBREL HIP MANSARD BATH (3 FIX,) TOILET RM. 12 FIX.) _ FLAT 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 II 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. _ TIMBER BMS. 6 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 OIL B'M"T 2nd J _ ELECTRIC 1st 13rd I NO HEATING BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. e ) O z Cn M M D C) z T z D r LIMO� C CD o cif�r�\ CD CD C42 CD a 0 7 y� CD CA 0 Z o, CD O G CD r; 'J^ � c c coO •rA O Q N dO C m y �Z c mr.c R. � Z S'O H mG T H C y V N 17-3 =moo: O C N cs)CL ' ^� C• y :�, C ®CD y • CD t Pt••1,', H CD N O y N CLW Q' d c yr CD O C co - CO) CO) 0 L� CO) O W 4' 3 to „O,F Q CD C 0 N a. ci • y..Ly Q �= �c CD C-•: CD dCD nn O _ A CA oll} M d z .p S C p � OG 7'• r � y ^. < z z v' � y S p � p z z O C O ?5 CA C3 a CD O p I �- C7 Z ca CD o M.-. r= CL r C') Q = y nom' C CD, p CLCD CD CD o CD ✓ C CD o cif�r�\ CD CD C42 CD a 0 7 y� CD CA 0 Z o, CD O G CD r; 'J^ � c c coO •rA O Q N dO C m y �Z c mr.c R. � Z S'O H mG T H C y V N 17-3 =moo: O C N cs)CL ' ^� C• y :�, C ®CD y • CD t Pt••1,', H CD N O y N CLW Q' d c yr CD O C co - CO) CO) 0 L� CO) O W 4' 3 to „O,F Q CD C 0 N a. ci • y..Ly Q �= �c CD C-•: CD dCD nn O _ A r v to "may oll} M d z y S rA y y � OG 7'• r � y ^. < z z v' � y S C r v to "may M d z y S rA y y � OG 7'• r � y ^. z z v' � y S C p z z O C O ?5 Gd o d o tx 9 9L 0 C CD ►s FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. **********'******Applicant fills out this section***************** VAPPLICANT: J455�19/4 Phone So v FOX _rZpSOUIC E "t")YjGs /ifok LOCATION: Assessor's Map Number Parcel Subdivision vStreet Lots) <1S1 F) N3>o V,�5fL sT St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit 1/ Fire Department Received by Building Inspector - Date Approved Date Rejected Date Approved Q Date Rejected Date Approved Date Rejected Date Approved Date Rejected G1 In 2 9 I99A Date a Arm \ ..�� ) _ -400 z -A a . k 0%/� °� z a § r � k m o (/ I , -�z k k \ /} � 0 \ C 2 2 \ AX 0 n»\- !ƒF D . \{ ? . �z� 7 _>_, /�% k q ■oo . ®^ r� �m 2 �3� . 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[• U) �• CD y� 1, 7O CD H C. 0 CO) -O O coCSA Q CD CD f O qi O � = H CA CD CD OCD CD zit O.a T o o; •• D CD :` c O C7 : C-) Oi E 0. z ITICri7 '� aGG s G? cn 9 w < C �' T Q w G T � C G OQ r w n 'D O n\ � O �O COD y a• r n^ Y zCOO z Izz 6 O O G/1 y 0 9 0 z 0 Location - No. Z-- Date ate„ORTM 1401t P1 O to TOWN OF NORTH ANDOVER + • O? °�+ ` ,• :gyp � F „ 1 �/ Certificate of Occupancy $ Building/Frame Permit Fee $ 35i Ss�cHusE Foundation Permit Fee $ Other Permit Fee $ •r Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 3� r Building Inspector 7662 Div. Public Works PERMIT NO, 5t?- t �1/ ` APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.��: 1Zl �FAOU i MAP h40. ; LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE - ZON,E SUB DIV. LOT NO. LOCA-rION ND©y,-fL 5 1 . PURPOSE OF BUILDING �� �3 � ���J( w� -1 A �.�fe !al �RC�dL_ OWNER'S NAM E�1 A)4:> ay�l2 SI . ��f�LTY TRvS r NO- OF $TORIES ''f'7\ \CJ ®�.-i✓ OWNER'S ADDRESS .451 1 ✓1.N ->6Vop S'� BASEMENT OR SLAB ARCHITECT'S NAME;+'/JJ\Ip�N�l L9I✓AL 0oN<rn IS 1_tJC /' F- 1' SIZE OF FLOOR TIMBERS IST 2ND SPAN "�Ip�E NSIONS OF SILLS --_ �7y POSTS 3RD 0 BUILDER'S NAME- n DISTANCE TO NEAREST BUILDING � * DISTANCE FROM STREET? 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 " r5 _ IDAIV� _V a CnN Q f1 ,j 7L� J 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 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS. SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS i - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED Z6/5 -f 1q.1 1 SIGNATURE OF OWNER OR A PERMIT GRANTED If, Tof- `�- SyP• (mak i 3 PROPERTY INFORMATION LAND COST EST. BLDG. COSTq� d O EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER'ROOk- SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INBPECTOR =!l vwia MY. ese. OWNER TEL.# I?/ -53ve2 oR5 -8-25- 3 ' CONTR. TEL. # CONTR. LIC. # G60, H.I.C. # 1 OCCUPANCY SINGLE FAMILY S-ORIES _ MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION—I 8 INTERIOR FINISH CONCRETE iallj ? CONCRETE BLK. PINEBRICK OR STONE HARDWD PIERS PLASTER _ CRY VJALL UNFIN 3 BASEMENT AREA FULL FIN. BM TAREA '/. 1/1 1/. FIN, ATTIC AREA N_O B M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B I DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ------yy77 ASPHALT SIDING HARDlY D ASBESTOS SIDING COMIACN STUCCO ON FRAME I STONE ON FRAM 5 ROOF GABLE GAMBREL HIP MANSARD FLAT SHED ASPHALT SHINGLES TAR 8 GRAVEL ROLL ROOFING 6 FRAMING WOOD JOIST TIMBER BMS. & COLS. STEEL BMS. & COLS. WOOD RAFTERS ATTIC STRS. 8 FLOOR WIRING SUPERIOR I I POOR ADEQUATE I NONE 10 PLUMBING BATH (3 FIX.) TOILET RM. 12 FIX.) KITCHEN SINK NO PLUMBING STALL SHOWER MODERN FIXTURES TILE FLOOR TILE DADO 11 HEATING f BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. i 7 NO. OF ROOMS urvn ncr.icRa GAS OIL B'M'T 2nd _ ELECTRIC 1Sr 13rd NO HEATING s r Cn C c =r o m = Ili O •inOQ N OC CO2 m Z t m o o c) co') C2. a. 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Z �0� 3NII ONOW QlOJ a Z =zom t Or. �} I 3NII ONOIV OIOJ �� _ m w 0 a I;; • > o ; ° A •m tiJ� C m C) �O vl m D 0 I' m 2 �� �m� C 0 _k z ii�3Ym Z, r r+ r. p x S p m 0--go.0-��W. o - - Z O Z O m m o N IM3 94] OG) mm rn Gi //D� nm c,) C m \, t, > ° - t z o� ol I. a 3 m z p < C o s n m 4) I. 3NII ONOW QlOJ �} Z 0 I' m 2 �� �m� C _k z ii�3Ym Z e So 0--go.0-��W. o Z O Z O m I IM3 94] OG) mm i A •m Z I' Omm r m mO=Z a Z�� Z :c I m •fie m� Cy 1A m m `� �. c pOp m�CD v my cn m�� qm m co v 4 0 -01-94 f-1 C1 H 11 :4^ APf H C1 A f 4 11 OV E R. CI F F P 0 R K 5086858535 krifiEN H F. NFL-3ol-N Toun of NORT14 AND"CA-VER. BUILDING ION DIN-41-7QN QF PLANNING PLANN1NG & COMMUNITY DEVELOPMENT August. 15, 1994 Ms. Patricia McMahon 451 Andover. Street Realty Trust 451 Andover Street North Andover, VIA 01845 Re: Site Plaij Review - 451 Andover Street Dea r M3. McMdrxon, (508) 682.6483 P. 12, 2 I reviewed the plans that were submitted to the Planning Office for the construction of a drive -up window located at 451 Andover Street. It is my opinion that this project does not require a special permit for site plan review from the Pianning Board as it does not. trigger any of the items listed in Section 8.31 of the Zoning Bylaw. If you have any further questions or concerns please call me at 682-6483 ext. 24. Sincerely, 44�a 13 Kathleen Bradle'Colweil Town Planner cc. X. Nelson, Dir PCD R. NiCetta, Build. Insp. Planning Board 01—•94 P10N 11 :4c HM MG ANDCt'JER OFF FAP A E A L T T G A 0 U P FA -K 7R.AZiSMISSICN CO`dER. SHEET DIT E : PLFASR DELIVP'.? THE FOTILOWING FAX AS SGOT; AS POSSIBLE FROM - Numbez of page- being ���nsr;iitt�d t incl udillo t;ham c.o-r=v If proble;l1a til transmi-ssion are cTiC OL111t E Yid, �I^�ciSE� C 7.I# nyt KGi1H All DO -ZA .j--,fI N k A 451 ATinovEa StAEE2 A SUITE 210 A N -TK ANDOVER, MASSACHUSETTS 61845 508 t85 F5535 A F3cs,+tta509,657 `.042 Aq<tonce F10:y 0�oq. i1c p 0 1 NOV. -P;k 94 (TUE) 16:33 IPSWICH SAVINGS IPSWICH SAVINGS BANK IPSWICH • ROWLEY • ESSEX INCORPORATED 1869 November 8, 1994 Mr. Robert Nicetta Building Inspector Town of North Andover 120 Main Street North Andover, MA 01845 Dear Bob: TEL:1508356973? Per your request, this letter will indicate the Bank's accepta circulation plan that was re -done by Stephen Stapinski of M plan detailed a one-way circulation around the building with indicating "do not enter" and "one way", on the pavement ar indicating "one way" and "do not enter'. of the parking and -imack Engineering. This ,vera) painted spots additional signage Should you require additional information, please do not he�itate to call me. Sincerely, L� wv II W. Kerpn� ` (/Senior Vice Presiders JWK/ml Wndover. town M 101994 P. 00? r IPSWICH SAVINGS BANK IPSWICH - ROWLEY - ESSEX INCORPORATED 1869 November 8, 1994 Mr. Robert Nicetta Building Inspector Town of North Andover 120 Main Street North Andover, MA 01845 Dear Bob: Per your request, this letter will indicate the Bank's acceptance of the parking and circulation plan that was re -done by Stephen Stapinski of Merrimack Engineering. This plan detailed a one-way circulation around the building with several painted spots indicating "do not enter" and "one way", on the pavement and additional signage indicating "one way" and "do not enter". Should you require additional information, please do not hesitate to call me. Sincerely, se h W. Ker) e Senior Vice Presiden JWK/ml NAndover. town NOV I 0 1994 P.O. BOX 392 - 23 MARKET STREET - IPSWICH, MASSACHUSETTS 01938 - 508-356-2971 ~' 171nenclol Concepts Inc. 9 Mercer Road Natick, Massachusetts 01760 P.70 Tel: 508-655-6944 Fax: 508-653-0269 January 10, 1995 Mr. Bob Narcetta Building Inspector Town of North Andover North Andover_ MA. 01845 Dear Bob: This letter is regarding your request for the Ipswich Savings Bank in North Andover. Enclosed is the original copy of the engineer's report. Should you have any questions or comments on this, please feel free to contact me at the phone number listed above. Thank you. Cordially, FINANCIAL CONCE S, INC. Douglas T. eorge Senior Vice President DTG/eb cc: F. Kenny G. Gogas Enclosure )AN 13 1995 Cheshire, Connecticut 203-250-7707 Fax 203-659-3114 Falmouth, Maine 207-781-4358 Fax 207-324-1527 CONSTRUCTION ENGINEERING SERVICES Mr. Doug George Financial. Concepts, Inc. 9 Mercer Road I a.tick, MIA .,.01760 Dear Doug: I 12 PLEASANT STREET NEWBURYPORT, MA. 01950 TEL. 508-465-2216 January 6, 1995 lit your request, I have r.sde an inspection of the interior of the masonry wall adjacent to the drive -up window at the Ipswich Savings Bank, North Andover, MA. The load from the 12 inch channel which is supported above the left side of the window causes stresses in the lintel which are well within the code capacity of the L 5 x 3 1/2 x 3/8 lintels. .ihe e linteis are well capable of safely sustaining the load from .he channel as well as the tributory masonry in conformance with the Massachu:_etts Building Code. Also, t"e 5 inch diameter hole is outside of the zone of --fluence of ..he loading for the 12 inch channel, so has no effect on the wasl ° s rapacity. As irif eIrrad- above, -i--he substitutions of L 5 x. 3: 1/2 x 3/8 lLnt.e).s for those specified -.on the drawing.is satisfactory: - F urtherr^ore, I approved the., cutting of. the. 5 ..inch diameter, f,o-e in. the web of the: cel 16 x 36 beam, centered 6 inches above the bottom flange, at the time. A 3/8 inch doubler plate was installed, which was not required but is conservative. 'Please feel free to call should you have any questions. Very truly yours, OLA AAMA ^i •/ f� ' �' I H. QUI' +tip - f li .. - ' :jr C / /�'z •-.�� John S. O'Connell, P.E. _ r .28957 c �' NAL _`TS JAN 18 STRUCTURAL INVESTIGATIONS & DESIGN 0 SITE ENGINEERING 13 CONSTRUCTION COST ESTIMATES O O 0 O I n O V 1 O O N Z z 5 C v z y C) CA co o ca O N C •C O Z m C ?— N = CD w CD TCO2'0 = CD ,rt CD C) Z CA y CD C) 'v O m C- r CX CD m fl- = N! nCCM oZ y CD O CD CD v CD CD 0 W C =r '= cot Q c CD CD CD CD c. CDCD vs m a v CCA CD I O CD CD C, N z co coco � CD 'O CD Z a a o CD T z D m C C CD r Cos Q /}L' O O O 0 O I n O V 1 O O N 0 5 C --N Q cCD C -O m y C) -� co o ca O N 3 O Z m C ?— N = CD w a o' = m ,rt OCo y y CD -4O D O m = CX m o = � .-. 0 oZ y V! O CD W C =r '= cot Q a� C= CD m N N co C C. -� CD C, N D7 N a a CD Ot a N C m N Cos Q /}L' O m d N v ::.cca == . = m , d y� h c m O :� m o' 0 C2 m y C d� a� C., C; O O CRO '� _ = m . m cnC/) oCL ° 0 5 C °o y 7r o• GO x �J ON 0 9 CL 0 c C�y x c T°'`� x x y�y�yy CL -= W ax W m rn CUCy n c 0 0 A Hm v' cc Un y x x z y N O rn `' O n Z mn Y b>rD Cl) v �0 rt I rn go m (D H C. O a 0�� rt o �W n OQ r PV z Z O O 10 Jn 0 a Cr! d � n c 3 a '41 - -0,6 Date.... .............................. 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... i ............ ................................................................ has permission to perform .......... .......................... .......... wiring in the building of ................................................. 1) ............. at ...... cz"e'� --e�l 'f .................................. .. ..... North Andover, Mass. .......... ............ Fee . ..... Lic. No. T ELECTRICAL INSPECi'O Check # V,3 8068 �,. Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ?6 6 c BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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)L­­­ 527 M 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: (.� ; City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of fhis or her intention to perform the electrical work described below. Location (Street & Number) 45 1 A w G o Q e %r U N s t G$ Owner or Tenant O'j b J i J v" V rt„L--C. f Telephone No. Owner's Address 3 a1 0 �)- -� NPL +o,� cj,r M A Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building C> "re No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service P-0 Amps /2.0 / AQU Volts Overhead ❑ New Service Amps jVolts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ifie Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters --t uuuuwnai aerazz V aesrrea, or as required by the Inspector of Wires. Estimated Value of1 ctrical Work: (When required by municipal policy.) Work to Stark 1 p , Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: 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 th p • s and penalties of p •ury, that the information on this a plication is true and complete. FIRM NAME: �r rz LIC. NO.: 214 Licensee: �j Signature LIC. NO.: (If applicable, enter,, e I- in the license n tuber line.) Address: w t/- "T' I Bus. TeL No.:9 7 6a 7 12 *Per M.G.L c. 147, s. 57-61, securi work re wires D " 1 Alt. Tel. No.: q Dep t 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 Signature Telephone No. PERMIT FEE: $ /off' The Common wealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t' = www.nxa s gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Piumbers Name (Business/Organization/individual): City/.State/Zip: C', ( - C P.Q%U ,.„_, Phone #:__�% Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2g have hired the sub -contractors I am: a.sole proprietor or partner- listed on the attached sheet I ship and have no employees These sub -contractors have working for me .in any capacity, workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. Q I am a homeowner doing all work officers have exercised their right of exemption per MGL myself [No•workers' comp, C. 1.52, § 1(4),' and we have no insurance required.] t .employees. [No workers' comp. insurance reauked.l Type of project (required): 6. ❑ New construction 7. Q Remodeling 8. Q Demolition 9. ❑ Building addition 10.9 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13-❑ Other *Any applicant that checks bole 1 moat 2190 fill out the section below showing their workers' compensation policy information. J 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 mustattaehed an additiomal sheet showing the name of the sub,eantraetots and thev worker;' comp. policy infommation. t air an employer that_isproviding:workers' compensation insurance for my employees; Below is. the policy and job site information. ' Insurance Company .[Qorf;o)� _� Policy # or Self -ins. Lic. #: W E M Job Site �g­j Expiration Date:_ I U 9' IC)k k�"/sM IV - T____r, - tatmlzip:_ O 1 k 14 Attach e 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 anal 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 insurance coverage verification. 1 ae hereby cert4fy undgr the P n,z jnd penalties ofperjurythat the information provided 4bOpe is true and correct 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): I. Board of Health 2. Building Department 3. City/Town Cierk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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-thelbregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or t ustee of an individual, partnership, association or other legal entity, employing employees. 'however the owrimof 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 deemedtobe 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 Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of 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, nofthe 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 nwnber listed below. Self. -insured companies should enter their self-insurance'iicense 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 permittlicense 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 adavit i ffs on file for future permits or licenses. Anew affidavit must be filled out each year. When 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 lnvestipations would lilee 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 Bosi:on, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7744 Revised 5 -26 -QS www.mass.gov/dia Date .................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that` ` - ............................................................................................. q has permission to perform wiring in the building of .... ........................................................ at ...` ..7�`? 4. . r%� '................ .North Andover, Mass. Fee's ij�z.�.. fel.... Lic. No.'..� ...................:...:............. ` � ELECTRICAL INSPECTOR Check # 47;'9 Official Use Only Commonwealth of Massachusetts Permit No. Department of Fire Services Occupancy and Fee Checked . BOARD OF FIRE PREVENTION REGULATIONS jRev. 11/991 !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 INFORMA770N) Date: October 14, 2003 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) 475 Andover Street Owner or Tenant BankNorth Telephone No. Owner's Address: Same Is this permit in conjunction with a building permit? YES ❑ NO ❑ (Check Appropriate Box) Purpose of Build ng:Bank Utility Authorization No. Existing Service Amps / Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work. Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures 1 No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs 1 Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ No. of Emergency Lighting d Battery Units 3 No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS o. 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 Tons 5 No. of Waste Disposers Heat Pump umber JTons JKW o. of Self -Contained Totals:' ion/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Si Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Three six foot florescent fixtures to light two signs, one on the building, two on free standing sign. One 2x2 inside Attach additional detail tf desires( or as required by the Inspector of Wires. INStRANCE 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) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 11/20/ 02 Inspections to be requested in accordance C Rule 10, and upon completion. I certify, under the pains and penalties of perju ,that the infor n this application is true and complete. FIRM NAME: THE NELSON COMPANIES ri LIC NO.: 17207-A Licensee William J. Stroke Signature LIC NO.: 22403 (If applicable, enter exempt "in the license number line) Bus. Tel No. 781-389-6867 Address: 230 Third Avenue Waltham MA 02451 Alt Tel. No. 781-890-3757 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/AgentSignature Telephone No. JPERMIT FEE: $ N° 31%37 HOR7M pt ��ao ,e1tip OL O 9 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that............:1................. ......................................... r E has permission to perform .......... I �.. r t r .............................................................. wiring in the building of ..... T .. f `.:..:. ' �` % �' '' .................................... at .......L' .::............ ...:r.. .:.:..'........�.....�....................;; North Andover', Mass': �_. fee ... .7.,:/:.��. Lic.No...........��.................... . .1.........:�....:.`.... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Lic.#A16172 (�sYQ L! Z J L 9V M �jj �M In ] Ll?!� C Full Service Eleet ical Contractor Telephone Systems t Data Cabling t Fire Alarm Systems Access Control f CCTV Systems Design - Consulting - Installation 61 Reservoir Park Dr. 24 Hour Emergency Service P.O. Box 373 STEVEN COHEN (781) 681-9650 Rockland, MA 02370 Service Manager Fax: (781) 681-9652 Email: John.RyanMC@worldnet.att.net Cell: (781) 844-5867 �•� 11M UU1VLVIU1VWr--q .1" Ur JVL,%- "(.11UJC11J Urucc Usc uniy DEPARTMEVT0FPUBLICS4= Permit No. BOARD OF] W PREiVM70NRWUMT10AN 527CMR 12DO UVA Occupancy &Fees Checked PPLICATIONFOR 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 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. I — n // Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes [Z[ No (Check Appropriate Box) Purpose of Building �y�r,J�r M , G i Utility Authorization No. Existing Service Amps 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 z46 7711e77 17e7,7 =77G�.S No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total `•' KVA No. of Lighting Fixtures Swimming Pool Above M BelowGenerators KVA ground ground No. of Receptacle Outlets No. of0i1 Burners No. ofEmergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER htst==Caaaga P►»Sltarrtkrtheragt�arta�oFM dtse>�Cta�alLaws Iha%ea=utliabldyhsird=Pbhyeidud%Cmviche m CoaaaWcritsabst&tialeWh,olalt YES NO IhareaxnodwtlidpoofofsametotheeO>lim YES M NO If}wha%edvdWYFS,Wameirdi &the4Wofo trWbydmckirgthe lxpc �...... >rI "BOND OTFIER ( ) It WorkiDSlart / /` / 3 a ( Sigre utrders Nr abmc�fpaj�a n FIRM NAME J C: /U /a 10-19 790"'T L., see — 7-,":: , -c1 c, L', . c/ Signatine Es dvak&of 6caica(Work$ ugh P / FM 1>al Business Tel.Na v — AITUNa 991- L" r VC OWNER'SML ANCEWANER;Iammmtha ftLiomsedoesnat I theitsuaneeo��gearilss le vaia>tascegt>IIadbyN�d�se�sOaraaiLaws aodthatmysignahsernthspatr�� ra�tdterrtad. (Please check one) Owner Agent a Telephone No. PERMIT FEE $ .2 cy C)