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HomeMy WebLinkAboutBuilding Permit #070-2017 - 115 CAMPION ROAD 7/22/2016 BUILDING PERMIT N- w- T r� �) .� TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION T ,� Permit No#: 'r 'f ZO/� Date Received '°R,TEo c5 gSSACHUS�� Date Issued:0 -2� IMPORTANT: Applicant must complete all items on this page LOCATION C61j4j t°ro `1 Pr t PROPERTY OWNER A40 h cc vS d�c ky k Q �c Print 100 Year Structure yes MAPb42, PARCEL: L b ZONING DISTRICT: Historic District yes Machine Shop Village yes I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r �` olFlood lain` OVVetla tln s # ❑ `Watershed®s"rct a Septicri C1 Well ��p - T DESCRIPTION OF WORK TO BE PERFORMED. /-�Y`eet 4EYO-0 S Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: CL + � �ti���. Phone: 7 S 3 ,� 7 s'q 7 Email: R104 kr-#K o a e L t'n c I. -*v Address: 90*4ca0-4 /y. l os8 73 Supervisor's Construction License: ©Z 3 3 7 -1 Exp. Date: yizaal"zo r Home Improvement License: Exp. Date: / ti? dp i ARCHITECT/ENGINEER Phone: Address: Y-7 N C4 j6LPd- 5�.�tsbv!! y sucL a Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED $125.00 PER S.F. rQ. Total Project Cost: $ - � �c) FEE: Check No.: �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .p '.. - I t I Location No. -� Date /�!/ - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ - TOTAL $ f Check# Building Inspectori 30646 i 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 11 Food Packaging/Sales El(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes K Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: -.. Located 384 Osgood Street iFIRE DEN 'RA MT EN. �L�cated at 124 Main Street � �' l �..�""'r.j�.•�` �{.}.s=i� `tom S��s'*'S` �j�.�+^ �`�'�i�` �� ' .�`xc,rc a��++.yg'-kr-- „�. �� F � . �gn c,tura/date pORTH Town of E .. Andover 0 No. 21 _ h , ver, Mass,©4- COCNICNlw.C. X1.95 R�reo �P���S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .. .. 4S-*-.0!'1..1 ~——4j&...., .:�J"AAe,X.c....... BUILDING INSPECTOR has permission to erect ......................... uildings on ... .� .. ... Foundation . +. ►,...:. .. ............. ut' Rough to be occupied as . ... .... .. .. .. ..................... Chimney provided that the person accepting this permi shall in a ry respect conform to the terms of the application Final on file in 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ION T Rough Service Final BUILDING IN ECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. MASSACHUSETTS HOME IMPROVEMENT CONTRACT HOMEOWNER INFORMATION CONTRACTOR INFORMATION Name Company Name Mark and Simone Kokavec RNA Remodeling Street Address(no post office box) Contractor/Owner Name 115 Campion Rd Raymond D'Auteuil Jr. City/Town,State,Zip Business Street Address North Andover Ma 01845 3 Main Street Daytime Phone Evening Phone City/Town,State,Zip Sandown NH 03873 Mailing Address,if different from above Business Phone 978-372-7547 E-Mail Address,if available E-Mail Address RNAremodeling@comeast.net Contractor Registration#: 149139 expiration date: 28 Nov 2017 Construction supervisor#:093377 expiration date 10 Oct 2017 WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees to do the Following Work for Homeowner: Remove 3 existing walls adjoining the existing kitchen. 2 structural and 1 non structural,'instal I LVL beams spec by Gelinas engineering and lower existing foyer floor to match existing kitchen Including; prep for flooring install framing to specs provided in plans provided by Gelinas engineering. This project is expected to cost between 15,000 and 20,000. Homeowners are going to do as much prep, damage control, and demo as possible to expedite the project and to keep costs down. RNAremodeling is a cost plus company. This is an estimate based on 60.00 an hr for 3 skilled carpenters and 40.00 an hour for a skilled laborer Electrical by others HVAC by others WORK SCHEDULE The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled to Begin: August 201h 2016 Expected Date of Completion: 1.5 to 2 weeks page 1 of 3 i TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work,furnish the material and labor specified above for the SUM of. $ see above + permitting costs Payments will be made according to the following SCHEDULE: $5000.00 upon signing contract $5000.00 at start of project Balance upon completion of project *In order to meet the completion schedule,the following material/equipment must be special ordered before the contracted work begins: Required plans and permits and possibly special structural LVL hangers required. SIGNATURES DO NOT SIGN THIS CO }F THERE ARE ANY BLANK SPACES. Homeowner's Signature Contractor's Si e �L I.6 " 1( Date Date REQUIRED PERMITS The following building permits are required.It is the obligation of the contractor to secure such permits as the homeowner's agent:List any and all necessary construction-related permits: Building permit i NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. I i �I I I page 2 of 3 i The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 sy,V�t www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Please Print L TO BE FILED WITH THE PERIVHTTING AUTHORITY. . Applicant Information • eeibly NaMe(Business/Organization/Individual): 4 a! `g ";7t Address: 3 M 4 ( 0 City/State/Zip: 54,40 w P, Al 0297.3 Phone#: A? 3 Are you an employer?Checkthe appropriate box. Type of project(required): 1.[41 am.a employer with �.. ! employees(full and/or part-time).* 7. Q New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $, ®Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3..Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[�Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(4),and we have no.employees.[No workers'comp.insurance required.] 7. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submif this affidavit indicating they are doing all work and then hire outside contractors must sgbmit a new affidavit indicating such. tContractors that check this box must•attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. nn Insurance Company Name: l 14eLeA 1 C 4&4 /L4,<av a a« O/7 — .� U J-to f Expiration Date: ,S"f O 42 Policy#or Self-ins.Lie.#: �O �¢ � S c,2 a I'�!� p Job Site Address:_// C PC.( A t `1 Jee�_ City/State/Zip: IV ASOyy-1, 1"'q c ' e policy number and expiration date). Attach a copy of the workers compensation policy declaration page(showing th p h y p ) Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: �4+Lr.+zJ� Date: X79 - 37�- 7stl �7 Phone#: � 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 V Contact Person: Phone#: I Information and Instructions Massachusetts General Laws chapter 152.equires 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 Please fill-out the workers'compensation affidavit completely,by checking�he'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,not the Department of Industrial Accidents. Should you have an questions regarding the law or if ou'are re aired to obtain a workers' Y Y q g g �' q 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `...� 1 7/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Natasha Rufe Foy Insurance - Salem PHONE (603)898-6320 FAX A/C No:(603)898-8269 163 Main St - Suite 102 E-MAIL ADDRESS: y Natasha.Rufe@fo insurance.com INSURERS AFFORDING COVERAGE NAIC# Salem NH 03079 INSURER AMerchants Mutual Insurance 23329 INSURED INSURER B: Ray D'auteuil INSURERC: Dba Rna Remodeling INSURER D: 3 Main Street INSURER E: Sandown NH 03873-2602 INSURER F: COVERAGES CERTIFICATE NUMBER-CL162953124 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE aLlaima A L U POLICY NUMBER MM/DDS MM/DD Y EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 500 000 PREMISES Ea occurrence $ r A CLAIMS-MADE Fx_] OCCUR BOPI076173 1/27/2015 1/27/2016 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 KGE�'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F-1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER CANCELLATION mdeems@northandoverma.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bldg 20 Ste 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Michael Foy/SBARBH ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn95rgn,n0aini Tho ar rion name and Inn^aro roniefororl marine^f Arnon Massachusetts Department of Public Safety 91% Board of Building Regulations and Standards License: CS-093377 Construction Supervisor RAYMOND J DAUTEUIL JR 3 MAIN ST SANDOWN NH 03873 I �M Expiration.: .Commissioner .10/10/2017 Office of consutnevnao9uueal-a��Z, Affairs&Business- aaC,?,W e�li �OME IMPROVEMENT Regulation egistration: CONTRACTOR Ex i ``-149139 A ration:r:11/28/26-17 TYPe: RNA REMODELING DBA RAYMOND D'AUTEUIL 3 MAIN STREET !! SANDOWN,NH 02387 '+.Ym��,..ul t.✓"Y»..mss-� .. Undersecretary 10, I i i i i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-093377 Construction Supervisor RAYMOND J DAUTEUIL JR 3 MAIN ST SANDOWN NH 03873 i l Expiration: Commissioner oner 10/10/2017; �a��z�na�zcuec� Office of Consumer Affairs&Busi eS��' ��e/"aellr gME�MoROVEMENCONTRACTOR Reg"`.illation e n: T -199139 P ration 11%28/20-7 TYpe: RNA REMODELING DSA RAYMOND D'AUTEUIL 3 MAIN STREET SANDOWN,NH 02387 Undersecretary i Dimension ! i i . Totals square feet of floor area based on Exterior dimensions. Stories , Number of q Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) i f i I i i I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application :ro Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 1;6 Floor/Cross Section/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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 New Construction (Single and Two Family) i A_ Building Permit Application 4 Certified Proposed Plot Plan 1 � Photo of H.I.C. And C.S.L. Licenses 4 Workers Comp Affidavit I 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract i 2012 IECC Energy code Engineering Affidavits for Engineered products ATE: 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 2014 I t � o �U NOtF:CONCEPNPL ONLY J m COORDINATE VlRH KITCHEN DESIGNER&OWNE0. }� WINE RACKS WPM GLASS SHELVING =Z W 9 / WZc' A-1 C ��x Z a gY 52x6 POST SOLID DOWN TO FNDN L- i S-2x6 POST dr DWS SOLID DOOM TOFNDN BROOM T @z- : EXISTING _« rl KITCHEN EXISTING KITCHEN I I L o I I$ (To RL-rTAIr:As IS) TO REMAIN I:I INSTALL NEWN g I I x I I WINGERS `y' DDER—NET-- BEAM I.I c NEYV EXISTING -' $I --- - - - I- O ISLAND WINE 0.EFRICEAAIOR 2x10 CLG IS TSEXISTING. - 12"pC m* I'' '/?-'%�i7-T- O QI 6 /DROP FLOOR RASH ,,I Im RET' n WALL ELEVATION (TBD BY OWNER) '• w/FAMILY&KITCHEN' _O—_O—O._ /-/,.I /&BRE4KFAST /.�I I____ D SLUE:112"=1'-0 t6 I WALL 5-2x6 POST 5-2x5 POSE ; /�'';�, ,/%/// j/�'/ SOLID DOWN EXISTING 2x1E0 QG]SlS EXISTING SOLID�DOWN jNEWeANKOFCABINEIS T°�"°" DINING RM.' T Sro,EOFWO a, FAMILY RM. 62 INFILL WALL 1. DROP HATCHED FLOOR RUSH WITH SURROUNDING FLOORS(SEE SG-3) 2. REMOVE EXISTING INTERIOR PARTITION ASSUMED TO BE S�I� C0 NON-BEARING.IF FOUND TO BE BEARING,COORDINATE WITH w E �^ STRUCTURAL DESIGNER PRIOR TO MOVIN/REMOVING WALLS. ¢ (n 'R3. MAIN KITCHEN CABINETS TO REMAIN.INSTALL NEW KITCHEN ISLAND �d o SIZE TBD BY KITCHEN DESIGNER N 4. ALL gl3 FINISHES COORD.BY G.C.WITH APPROVAL BY OWNER^ S. INSTALLNEW BANK OF CABINETS(SEE DETAIL B/SG-4) ^ r6. INSTALL NEW LVL BEAKS SHOWN AS 8201&B202 FOR OPEN CONCEPT O �I\ FlREPLACE I I I I II II II II - FET �o EXISTING a LIVING _ Z 2x1�OC GJSTS II d EXISTING � > MUDRM, i i z -0 2xlE0 CSG]GTS EXISTING G to Q �� T�E:7 GARAGE igr N EXISTING (TO REMAIN AS IS) FOYER I I II II o II II � ------------------ II ,------------------ II ------------- ++ II ' m� II II CLOS. CLOS. i II ; II i og A-1 (fn ��Qo �tio liv© F sg� 5Noo 9 o�a� o JOB NO. 16117 FIRST FLOOR PLAN ,4�s �`'� 5TRcli��� �� SHEET N0. I SCALE:1/4'=1'-0 SG-1 ' B-1 1 k u-_ -_ LOF I r (NEW ca BY OTHERS) r `J (BY OTHERS) =J m ry Go w I 8_1 2x1D'S @ 16"O.C. A- `4 Cc Z g I I ` C 13/4'x 8 1/2"LVL c3)13/4'xela IF w z LEDGER SCOPE OF WORK iTRUSLOCICS016"D.C. STAGGEREDELEVATED ECK I S FRAMING I PLAN LI EXISTING I ELS ALK IN CLOSET !3i (3)13/9"x 9 1/2" JOIST HANGERS al BEDROOM TYPICAL ---_ ------------- ----- _ ` 2x105@16o.c. = rrl- - -I f- I I I I I I I (EXISTINGSTER n L_—� Ir== STAJRBELOII �__� II r a ROOM n —— —— s E B-1 — — II TO SSrAIR s BAT EXISTING — — — — `" BEDROOM PROPOSED LOFT FRAMING PLAN PROPOSED LOFT FLOOR PLAN SCALE:1/4"=1'-0 SCALE:1/4"=1'-0 I I $E LNG II II B-1 II II ----------- I II II O Q I EXISTING I I �Q EXISTING 0 ❑ GREATROOM O MASTER (TO REMAIN AS IS) d II BATHCO > I I I � 0 I I z >✓ C Ln � w O UP SCOPE OF WORK o --iz OPEN i TO BELOW NEW SHED DORMER "d1 IL �....... FOR NEW LOFT W/ EGRESS WINDOWS &END SIDING TO wm� MATCH EXISTING zz Of 16`10 0... Gn0 mo s SECOND FLOOR PLAN71Ef� - L� g� O. N JOB N0. 16117 1 SHEET N0. 1` REAR ELEVATION SCALE:1/8"=1'-0 SG-2 U a " W J N I I �2 a& INSTALL SIMPSON =Z REMAINS AS ISHANGERS(OR EQ.) _ = I_LDROP THIS BEAM TO MATCH JOISTS ) •n- D) _ ggg A-1 11 IOC C 2 INSTALLS IMPS ON JOIST 4J . ' MANGERS(OR EQ.) I �Z a r_______________ __________________ REMAINS f515-7T- --------------------------- IT- J \ r I I Ir i__ ,i — -------------------------i-- i F ,I i L___ IIr II REMAINS AS IS , �I I I POINT LOADS I I I I I FAEVROM J NEW3Y'AILY COLUMN NEW 3S£'ALIV COLUMN r -1 I I III' BOVIN NEW COLUMN& IIII _i L JI pUmNc w/WwDHume ------------ ICDIr �I &DRYWALL TO � FlNISH/BIENDWES i• .. ' E%ImNG FlMSNFS f � DROPPED_.000. �IN_I,AREA �A`' n_ __________________________________ IIII -------------- I i I I (d it 4"CONIC SLAB w/ Uc, UC, 6x61%WWM I EASTNG POET/COLUMNS TO yi 8; REMAIN i DROPPED FLOOR 44&]]] U ABO i DROPPED FLOOR yf�IL�L� ABOVE FI WOaENFRAME&DASTIIG gNISH/BLEND WTM EXImNG (] FlNISHES y DROPPED FLOOR DETAIL D-4 N SCOPE OF BOOR REFRAMING WORK SCALE:1/2"=1'-0 -8' (SEE DETAIL D-0) RAISED FLOOR ABOVE : (2)2x12 __-_ — ----_-- _--- 42.b,. V 421„ . 21'_3" 21'_3' 6'-0" 21'-3° 21'-3" 6'-0" $ SIMPSON H2.5A m EXISTING RIDGE NPS NEW LVL BEAM U -- @ LOCATION PE OF1PLATEA1, -j C�rL10s OF IXI)BEAM WORK =J a EVE REQUIRED EXISTING ROOF 12 REQUIRE =Z tt= h105 �3 HURRICAN `_ -o _ EE NEW 2x8 CLG]SIS\ (i 16-.O.C'( Go W 9 @ 16"O.C. IL i ca W 9 NEW 2x4 WALL BEAM TO BE -21/4"A.F.F. -�� w Z g 3 _____� `���� REMOVED _ __ii x� WALL,�� ROOF TO BE 1 DELETED REMOVED NEW 2x6 STUDS '-� .co Z ¢g' @l6"O.C. " lDOSTINGBEAM NEW LOFT ;? \ NEW ATTIC FLOOR 12 PPL12 LAANLOFf FRAMING RER� TO i nM– P � %' -- -- -- -- - 1T-81/4"A.F.F. PIATE 1�'10 — - 16'-]01/4"A.F.F. k BATH ROOM HALL W.I.C. EXISTING WALL BATH ROOM HALL W.I.C. 12 �2 _ __________________________________ 1 2NDFIR ___ __ ___ ID FLR 8'-101/2"A.F.F. _ ___ _ _______ ____ ___ _ ____ 8'-101/2"A.F,F. NEW BEAM t„ i ENTRY ENTRY BATH ROOM Ap--, B'FAST ROOM BATH ROOM BUST ROOM FLOOR TO DROP o C 157 FLR RUSH WITH IST FIR z C 0'-0"A.F— - SURROUNDING 0'-0*A.F.F. Q (� DROPPED FLOOR § - - �— "2 q:C EN FLOOR,1. __ --_ qT _ -2'-0"AF.F. -2'-0"A.F.F. SCORE IFLOOR BASEMENT WDA BASEMENT IVT-E� 10'b"B.F.F. Q PROPOSED BUILDIN SECTION A/1 EXISTING BUILDING SECTION A/1 0 SCALE:1/4'=1'-0 SCALE:1/4"=1'-057 > 21'_3" 6'-0" G ,Ln-1 g R 12 z T yyn-� 13 �g SHED PLATE FINISHES TO 25'-2 111 1'F.F. MATCH EXISTING of RAIL z� COO OBBYYG.C. NEW LOFT k�o ER APPROVAL `Pgw 0 O g z� O ATTIC ,A 419 -- ------- --- ------ 17-8 1/4* o �Ir --- - ----- - ,g 2X12 STRINGERS Cm2"O.C. a 0 W.I.C. 6. )08 NO. n. 16117 1 2ND SHEET N0. 8'-10 t(1"A.F.F. ."�.. NEW LOFT STAIR SECTION B/1 r SG-4 i inas Structural Panel L.Gelinas,MS,PE,SEG$ Phone:778-A65-6436 CoAE N G I N E E R I N G L L C Email:denig@gelinasstructural.com 579A North End Qlvd. I Salisbury,MA 01952-11738 I Hrem.gelinasstructural.con October 17,2016 Project no. 16117 Simone Correia 115.Campion Road North Andover,MA Via email simonevcorreia@yahoo.com F SUBJECT: 115 Campion Road,North Andover MA 4 Dear Mrs. Correia: Thank you for the opportunity to work with you on this project. Per your request Gelinas Structural Engineering LLC(GSE or Gelinas)has performed a walk thru visit at your site on October 14, 2016. The results of the structural observations are as follows: The two beam installations supporting the Second Floor Framing and existing beam is installed and satisfies the intent of the Gelinas Structural drawings. The bearing is adequate and the multi-ply lvls are attached together with trusloc type screws and the associated framing members attached to such beams are attached with positive connections. Additionally the first floor framing; with respect to the modified flush floor is installed and satisfies the intent of the Gelinas Structural drawings. We feel the construction structurally is sound in the areas of your defined permitted scope and satisfies the intent of the Gelinas Structural drawings and the IRC 2009 as amended by the Mass State Building Code Please call with any questions, cell 978 360 2562 or email DanLG@GelinasStructural.com Very truly yours; } DY ." t j 5 Daniel L. Gelinas, P.E. i Ij ®Boisecascade Quadruple 1-3/4" x 16" VERSA-LAM® 2.0 3100 SP Floor Beam113201 Dry 1 span No cantilevers 10/12 slope October 17,2016 15:46:58 BC CALCO Design Report Build 4516 File Name: 16117 Job Name: Description:Designs1B201 Address: 115 CAMPION ROAD Specifier: City,State,Zip:NORTH ANDOVER, MA Designer: Customer: Company: GELINAS STRUCTURAL ENGINEERING LLC Code reports: ESR-1040 Misc: 2 I i q I I 3 ' l BO 16-00-00 B1 Total of Horizontal Design Spans=16-00-00 Reaction Summary(Down/Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO 5,420/0 3,425/0 3,200/0 B1 5,420/0 3,424/0 3,200/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 SECOND FLOOR... Unf.Area(Ib/ft^2) L 00-00-00 16-00-00 30 10 08-00-00 2 WALL ABOVE Unf. Lin. (Ib/ft) L 00-00-00 16-00-00 0 80 n/a 3 LOFT Unf.Area(ib/ft^2) L 00-00-00 16-00-00 40 10 07-00-00 4 ROOF OVER BED... Unf.Area(Ib/ft^2) L 00-00-00 16-00-00 15 50 08-00-00 5 PT LOAD FROM E... Conc.Pt.(Ibs) L 08-00-00 08-00-00 2,520 730 n/a Controls Summary Value %Allowable Duration Case Location Pos.Moment 41,877 ft-lbs 56% 100% 1 08-00-00 End Shear 7,576 lbs 35.6% 100% 1 01-04-14 Total Load Defl. L/466(0.412") 51.5% n/a 3 08-00-00 Live Load Defl. L/708(0.271") 50.9% n/a 6 08-00-00 Max Defl. 0.412" n/a n/a 3 08-00-00 Span/Depth 12 n/a n/a 0 00-00-00 Notes Entered/Displayed Horizontal Span Length(s)=Clear Span+ 1/2 min.end bearing+ 1/2 intermediate bearing Design meets Code minimum(0240)Total load deflection criteria. Design meets Code minimum(0360)Live load deflection criteria. Minimum bearing length for BO is 1-7/8". Minimum bearing length for 61 is 1-7/8". Calculations assume Member is Fully Braced. r< Design based on Dry Service Condition. ,, Deflections less than 1/8"were ignored in the results. 1 t5 Fastener Manufacturer:TrussLok(tm) �;u I W: +� "� fir•) .. ;i '�� ,. Page 1 of 2 x e i Boise Cascade Quadruple 1-3/4" x 16" VERSA-LAM®2.0 3100 SP Floor Beam113201 Dry 1 span No cantilevers 10/12 slope October 17,2016 15:46:58 BC CALCO Design Report Build 4516 File Name: 16117 Job Name: Description: Designs\6201 Address: 115 CAMPION ROAD Specifier: City,State,Zip:NORTH ANDOVER, MA Designer: Customer: Company: GELINAS STRUCTURAL ENGINEERING LLC Code reports: ESR-1040 Misc: Connection Diaqram Disclosure b d Completeness and accuracy of input must be verified by anyone who would rely on a output as evidence of suitability for • • • particular application.Output here based c on building code-accepted design �_ • properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" C= 12 (800)232-0788 before installation. b minimum=4" d=24" e minimum= 1" BC CALC@,BC FRAMER®,AJSTM ALLJOIST@,BC RIM BOARD-,BCI@, Connection design assumes point load is top-loaded. For connection design of side-loaded BOISE GLULAMTM SIMPLE FRAMING point loads, please consult a technical representative or professional of Record. SYSTEM@,VERSA-LAM®,VERSA-RIM Beams 7 inches wide will be assumed to be either top-loaded only,or equally loaded from PLUS@,VERSA-RIM@,VERSA-STRAND@,VERSA-STUD@ are each side. trademarks of Boise Cascade Wood All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. Products L.L.C. All TrussLok screws may be installed from one side of multiply Versa-Lam beams. Member has no side loads. Connectors are: FMTSL634 I I'll l k al i Boise Cascade Quadruple 1-3/4" x 16" VERSA-LAM®2.0 3100 SP Floor Beam1B202 Dry 1 span No cantilevers 10/12 slope October 17,2016 15:47:02 BC CALC®Design Report Build 4516 File Name: 16117 Job Name: Description: Designs\8202 Address: 115 CAMPION ROAD Specifier: City,State,Zip:NORTH ANDOVER, MA Designer: Customer: Company: GELINAS STRUCTURAL ENGINEERING LLC Code reports: ESR-1040 Misc: j 2 i I 4 I I 3 j � � � r 7 ► V v � r i BO 17-06-00 B1 T = otal of Horizontal Design Spans 17-06-00 i Reaction Summa Down/Uplift)Summary( p ft) (lbs) Bearing Live Dead Snow Wind Roof Live BO 6,494/0, 3,909/0 3,500/0 61 5,126/0 3,513/0 3,500/0 Live. Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 SECOND FLOOR... Unf.Area(Ib/ft^2) L 00-00-00 17-06-00 30 10 08-00-00 2 WALL ABOVE Unf.Lin.(Ib/ft) L 00-00-00 17-06-00 0 80 n/a 3 LOFT Unf.Area(Ib/ft^2) L 00-00-00 17-06-00 40 10 07-00-00 4 ROOF OVER BED... Unf.Area(Ib/ft^2) L 00-00-00 17-06-00 15 50 08-00-00 5 PT LOAD FROM E... Conc. Pt.(Ibs) L 04-00-00 04-00-00 2,520 730 n/a Controls Summary Value %Allowable Duration Case Location Pos. Moment 41,350 ft-lbs 55.3% 100% 1 07-11-10 End Shear 9,135 lbs 42.9% 100% 1 01-04-14 Total Load Defl. L/388(0.541") 61.8% n/a 3 08-06-07 Live Load Defl. U594(0.353") 60.6% n/a 6 08-06-07 Max Defl. 0.541" n/a n/a 3 08-06-07 Span/Depth 13.1 n/a n/a 0 00-00-00 Notes Entered/Displayed Horizontal Span Length(s)=Clear Span+ 1/2 min.end bearing+ 1/2 intermediate bearing Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(U360)Live load deflection criteria. Minimum bearing length for BO is 2-3/16". Minimum bearing length for 61 is 1-7/8". Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Vi Deflections re Ir \�. .t. Deflections less than 1/8"were ignored in the results. Fastener Man ufacturer.TrussLok tm j ' t l i I i I ®Boise Cascade Quadruple 1-3/4" x 16" VERSA-LAM®2.Q 3100 SP Floor Beam1B202 BC CALC®Design Report Dry 1 span No cantilevers 10/12 slope October 17,2016 15:47:02 Build 4516 . File Name: 16117 Job Name: Description:sc I tion: Desi ns\6202 P 9 Address: .115 CAMPION ROAD Specifier: City,State,Zip:NORTH ANDOVER, MA Designer: Customer: Company: GELINAS STRUCTURAL ENGINEERING LLC Code reports: ESR-1040 Misc: Connection Diagram Disclosure b d Completeness and accuracy of input must a be verified by anyone who would rely on output as evidence of suitability for • • • particular application.Output here based on building code-accepted design �— properties and analysis methods. j Installation of Boise Cascade engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide a minimum—211 c_ 12 or ask questions,please call b minimum=4" d=24" (800)232-0788 before installation. e minimum= 1 BC CALCO,BC FRAMER@,AJS- ALLJOISTO,BC RIM BOARD- BCI@), Connection design assumes point load is top-loaded. For connection design of side-loaded BOISE GLULAM- SIMPLE FRAMING j point loads, please consult a technical representative or professional of Record. SYSTEM@,VERSA-LAM@,VERSA-RIM Beams 7 inches wide will be assumed to be either to -I PLUS@,VERSA-RIM@, p oaded only,or equally loaded from VERSA-STRAND@,VERSA-STUD@ are each Side. trademarks of Boise Cascade Wood All T russLok screws may be installed from y one side of multiple ply VERSA-LAM beams. Products L.L.C. All TrussLok screws may be installed from one side of multiply Versa-Lam beams. Member has no side loads. Connectors are: FMTSL634 i I i i I I yuTt, V Date....C? �3/�f° r►OfiTN �q. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ssACHU i ° This certifies that .... has permission for gas installation:',a �. -:�nc ..... .. ,...... ..... 1 in the buildings of.......... C— at.............. .. f ..;n- n�V� � North Andover Mass. ...... .................................. Fee....150....... Lic. No.Z U3.......... ..................................................................... � ^ GAS INSPECTOR Check# .���7� Q MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK MA DATE a6aL=PERMIT# F JOBSITE ADDRESS 110 �? W AOWNER'S NAME I owu o ki-ye L G _ � OWNER ADDRESS o� TEL TYPE T OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT ® RESIDENTIAL[ CLEARLY NEW:L] RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES[] NO APPLIANCES'l FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE C GENERATOR GRILLE �-- INFRARED HEATER f LABORATORY COCKS --- I MAKEUP AIR UNIT - OVEN POOL HEATER' ROOM/SPACE HEATER ROOFTOP UNIT t TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabii' insurance licy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY L] BOND C]. 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 F— AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are:u nd rate to the of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp nce all Perti rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I STEPHEN HOGAN LICENSE#110808 SIGNATURE MP[D MGF . JP Ej JGF[ LPGI L] CORPORATION )# 340 PARTNERSHIP 0# LLC[J#= COMPANY NAME: ATLAS GLEN-MOR I ADDRESS 1295 EASTERN AVE CITY CHELSEA STATEMA ZIP102150 TEL 800-033-1616 FAX 1617- 378 3781 17- 378 378 0CELL �EMAILAGMINSTALLATION@PETROHEAT.COM. V%ti%f -T0KCrr1r0LVJ- MMXIA._10 JAW X JLMSiON, GUw�� Yt�r i I i i ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTIONANOTRS Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES . I i J The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia A11 orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/btdividual):Atlas Glen-mor..' Address:295 Eastern Ave . City/State/Zip:Chelsea,MA :02150Phone#:800-433-1618 Are you_an employer?Check the appropriate box; Type of pt OJect{required): l,Q✓ lain a employer with 120 employees(full and/orPart ume).t 7. New construction 2I am a sole-propcietor of partnership and have no employersworking forme in 8. a Remodeling any capacity.[No workers'comp:insurance required] .- 3-o I am a fimneowner doing all work myself[No workers'comp.insurance.required.]t' 9. F1 Demolition 10 Q_Building addition 4.0I am a homeowner and-will be lining contractor;to conductall work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[ Electrical repairs or additions proprietors with no employees: .. 12.Q Plumbing repairs or additions 5.❑I am a.general contractor and I have hired the sub-contractors listed on the attached sheet.. 13.Q ROOF repairs Mese subcontractors have employees and have workers'comp.insurance. 6. We are a corporation and its officers have exercised their right of ek 14. Other ❑ rPoexemption per MGL c. 752,§t(4);and we have no employees.[No workers'comp,insurance required.] *Any applicant that checks box#]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 state whether or not those entities have employees: If the sub-contractors irave.6W]oyees,theymust provide their workers'.comp.policy number: I am an employer that is providing workers'compensation insurance for my..employees. Below is the policy and job site information Insurance Company Name:New.Hampshire Insurance Company 258=89-049 p 101112016 Policy#or Self-ins.LhIc.#:. Ex iration Dater Job SiteAddress: .l S i 6VA- \ City/State/ZiptVl7Ankye/� Attach a copy of the workers?.compensation policy declaration page(showing the policy number and expirat'i n date): Failure to secure coverage as:required under MGL c. 1522§25A'is a criminal violation punishable by'a fine up to$1;500:00. and/or one-year._imprisonment;as well as civil penalties in the form of a STOP WORK QRDER and a fine of up to.$250.00 a day:against the violator.A'copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage.vertfication. . i I doh rte under.the and5nafti�grjmythat the information provided above i(s true and correct aignAtur Date: Phone—6.17-887-7395 . 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: A��L)o® CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY) 09/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh USA,Inc. NAME: 1166 Avenue of the Americas PHONE FAX New York,NY 10036 A/C No Ext AIC No)*, E-MAIL Attn:NewYork.certs@Marsh.com ADDRESS: INSURERS AFFORDING COVERAGE NAIL II 073389-PETRO-ACORD-15-16 INSURER A:Commerce and Industry Insurance Company 19410 INSUREDT9410 Ham hl PETRO HOLDINGS INC INSURER B: ps're Insurance Co 23841 � DBA ATLAS GLEN-MOR INSURER C:N/A NIA 295 EASTERN AVE INSURER D:NIA CHELSEA,MA 02150 NIA . INSURER E:NIA N/A INSURER F COVERAGES . CERTIFICATE NUMBER: NYC-007977061-07 REVISION NUMBER: THIS.IS TO CERTIFY THAT THE POLICIES.OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - DDL SUBR - LTR TYPE OF INSURANCE IN, POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY 360-25-05 POLICY NUMBER MMIDDMMIDD LIMITS10/01/2015 10/152016 EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR 3602506(N 10/012015 10101/2016 DAMAGE TO RENTED AXPREMISES Ea occurrence $ 100,000 XCU 4807464 10/012015 10/012016 MED EXP(Any one person) $ 5,000 - -- X Contractual . . PERSONAL&ADV INJURY $ 1,0001000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY JECT F]LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: SIR s 1,000,DOO A AUTOMOBILE LIABILITY 720-46-98(AOS) 10/012015 10/012016 COMBINED aBISINGLE LIMIT $ 2,000,000 A X ANY AUTO 720-46-97(MA) 101012015 10/012016 BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 194-95-31(VA Only) 10/012015 10/012016 BODILY INJURY(Per acddent) $ AUTOS AUTOS. HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS--MAD AGGREGATE g DED RETENTION$ $ B WORKERS COMPENSATION 256-89-049(MA,ND,OH,WA WY) 10/012015 10/012016 X PER OT f AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIEroR/PARTNER/FJ(ECUTIVE Y/N 012948291(CT,MD,NY,RI,SC) 10-012015 10!012016 B OFFICER/MEMBEREXCLUDED? -�NIA E.L,EACHACODENT $ 1,000,000 (Mandatory In NH) 012948299(NY,ND,OH,WA,WY) 10/012015 10/012016 E.L.DISEASE-EA EMPLOY $ - 1,000,000 (DESCRIPTION yes, e under 059901256(NJ) 10/012015 10/012016 DESCRIPTIOPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Workers Comp Continuted59901257(VA) 10/012015 10/012016 SEE ABOVE DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of NORTH ANDOVER THE EXPIRATION DATE. THEREOF, NOTICE WILL BE 'DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. David A.Cobleigh @ 1988-2014 ACORD CORPORATION. All rights reserved._ ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -44 47WOOMM aPeg "aP Y _ � � �`•W.s.; fin. �+Yra.fi'*°#{+`a�'�,.SwN ?"tt4" •'k.F 2x itlf'*.,� Y3� a � ti d r� w s•.��� a� a� ' .�" .tea. "��� � c.� �`���s,� 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the i permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time ofongoing construction activity,and may be-deemed.by.the_Inspector-ofWires abandoned.and.invalidifhe— or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifyingpe'od beginning on August 15,2008 and extending'through August 15,2012. y ¢Rule 8—Permit/Date Closed: y ***Note:Reapply for new permi� �❑Permit Extension Act—Permit/Date Closed: J gg 9991 t NORTH 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 1 ��ss�c►+u E��h V This certifies that ............ .......... ................................. ........................ has permission to perform ........../ D T�.U � .....� �"`............. ... .............. ......... wiring in the building of...........S.6F!�'L ' ..................................... at........�........... JlL® ......... ./ ........2e�iN girth Andover,Mass. 1:—e'Fee..3 o..`""'... Lic.No 4.14.A.*7...7................. SPECTOR i Check # 6 o �� r Official Use Only e1.1e ar�razet$o p,}ire�eruices Permit No. � �< P t Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: oY @,Y' To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 'S .,C' a M 0%Q-1-1 C Parcel ID: Owner or Tenant �c�g'S Q.�� SQQ?c1 C Q.K` Telephone No.4 )%6�3 3Z,$O Owner's Address S,c,rn R. Is this permit in conjunction with a building permit? files ❑ No 0 (Check Appropriate Box) Purpose of Building `C' Q g Utility Authorization No. ( j Existing Service Amps I Volts Overhead ❑ Undgrd❑ No.of Meters f New Service Amps J Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool `hove ❑ In- El 0.o Emergency Lighting rnd. arnd. BatteKy 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 Tons No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained • P Totals: _. ._-... _.___-._....._.__._..- ._-- Detection/Alerting Devices No.of Dishwashers Space/Area Heating MV Local❑ Municipal ❑ Outer Connection No.of Dryers Heating Appliances KW Security Devices s No.of eviees or Equivalent No.of Water No.of No.of Data Wiring: ! Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications of Deiiceio r Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of OVires. 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 pains and penalties of pcilury,that the information on this application is true and complete. FIRMNAME: �� NM�o to sQ-ru 1ceg M+C LIC.NO.: Licensee: 7�m L r+y)n t,N4e--U,o Signature LIC.NO.: 14-116� (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:`ASA"a3\ -2 a o� Address: \ 1�c3 Q\\\n�,No n 314 1—iv,co\„ ��- Z�s r; Alt.Tel.No.:'Jp\C 36 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally by lave. By my signature below,I hereby waive this r�_:;ir r_:: 1 _�t1 P h^^t C—)01 owner (�owner's a{ent. Owner/Agent �PEI�IIT. , Signature e�.._._..Telephone No.___. --- ---. _ t � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town�O ov-161 Ah 4-zV Q-P ,MA. Date: Permit# Building Location:\\J C o,rn Z tir1 '�NC Owners Name-1Z&HS-b0 Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement:® Plans Submitted: Yes❑ No i r0'%3 �Z. FIXTURES Date.3 Z 3 �� 0 I i = IF- w 0 Z o HarH of TOWN OF NORTH ANDOVER c� 0 'a U z at O PERMIT FOR PLUMBING a a a • � 3 3 0 ,SSACMUS� This certifies that . . �7. . • • • • • • ' ' ' ' ' ' ' ' ' has permission to perform . . . . . Lr. T plumbing in the buildings of . . . . ��l�?.0 .S•t� . • • • • • . . . . . . . . . . r . at . . �J �f-�'62, !� • • • ? • . • • • • • • • • • •, North Andover, Mass. Fee. PLUMBING INSPECTOR Check " � Check One Only Certificate# Corporation I f ❑Partnership ❑FirmlCompany Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2� 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 I hereby certify that all of the details and information I have submitted(or entered)regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: rtie ❑Plumber Signature of Licensed Plumber Cityrrown ❑Master t� 6 APPROVED OFFICE USE ONL []journeyman License Number: FINAL IN51'l,C"I'JO` L: BCI O�V'TQf�OfF ICT USE ONLY. '. I'ROC;ItIi�S INS1'i'.CT.tQNJ hGRMIT# z AI'PI-KATION POIt PIR.Mff TO DO I'LUMi1INQ < = LOCA-LION OI'RUILI)INc; c LICLiNSE NUMBER: PERMI'C.GRANTED PLUMBING INSPECTIOR �r Date. . . .. .. .. ..... .... .. ,ORTH $ OF „ao ,s,ti0 o? __ °A TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION ACHUSES This certifies that . . . : : . . . . . -!:-?.- . . . .. . . . . . . . . . has permission for gas installation, ''.� .4% f in the buildings of . . . . . . . . . . . . . . . . . . . ✓ .. . . at �'. . . . —^�-. , North Andover, Mass. Fee,��,. . Lic. Nod?.//.-fd. . . -C-C�.�. . . }:�.(.. . . . . . . . GAS INSPECTOR V Check# 5498 LVIASSACHL;SETIS L UORNM APPLICATON FOR PERNffrTO DO GAS FITTING (Type or print) Date "' -' Q NORTH ANDOVER,MASSACHUSETTS Building Locations l� Permit# l 4 n� Amount$ Owner's Name New Renovation ❑ Replacement Plans Submitted ❑ U x C a SUB •BASEM ENT B A S E M ENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR J (Print or type) GA6 �eV u �S �r� G Cl e e: Certificate Installing Company Name Corp. L3 Ash, Address Partner. Business Telephone _f opt L,l-2, —�C -L4 Firm/Co. Name of Licensed Plumber or Gas Fitter 6 k N R 1t0.tj MA2— ViSURANCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes LT NoD. If you have checked}_es,please m ate the type coverage by checking the appropriate box. Liability insurance policy E Other type of indemnity 0 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. Check one: Signature of Owner or Owner's Agent Owner Agent 13 t 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 Xmpliance with all pertinent provisions of the Massachusetts State as Co Chapter 142 of the General Laws. SignQturef Licensed Plumber Or Gas Fitter By:Till Plu Title City,Town Gas Fitter M-77-77'1 umber Master ,APPROVED,OFFICE F.SE ONLY) Journeyman k Location)/� No. Date a¢ i i f of MORTM q TOWN OF NORTH ANDOVER ',*`•o .••tip � p Certificate of Occupancy $ Building/Frame Permit Fee $ 0, k �,SIACMUS Foundation Permit Fee -4- _ I A Other Permit Fee $ I Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Q Building In ctor `` +,c� 3643 ,� Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE 1 ZONE F ''. ` I SUB DIV. LOT NO. /f -� 1 .,LOCATION � Al /',1�,1/ � /� PURPOSE OF BUILDING /RI/�� rC',W '- / OWNER'S NAME ,jla'�V !f /�/ f >t�t/J NO. OF STORIES •^� _ ✓ SIZE •J`T ��}-/`- / fflnoF ,OWNER'S ADDRES'Sv/� •��%LL� BASEMENT OR SLAB f' - ARCHITECT'S NAME v SIZE OF FLOOR TIMBERS IST 2ND 3RD QUILDER'S NAME _ SPAN -- /DISTANCE TO NEAREST BUILDING `✓ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES -SIDES REAR GIRDERS 1 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 I BOARD OF APPEALS ACTION. IF ANY 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 Q 00 B-(J PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. EBT. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 APP OVED BY BUILDING INSPECTOR DATE FILED Z tl �<R BU ILDI NO INSPRCTOR SIGNATURE OF NER OR AUT ZED AGENT F E E W OWNER TEL.#el PERMIT GRANTED CONTR.TEL.# 19 '� / 1 ONTR.LIC.#. 0 6 ` 6 3 5 H.I.C.# (:�OJ`�� ` s BUILDING RECORD r 1 OCCUPANCY 12 z SINGLE FAMILY I STORIES THIS SECTION MUSTSHOW EXACT DIMENSIONSOF 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 S INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ 1/1 1/2 3/1 FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COM/dCN 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 POOR ADEQUATE I� ONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 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 A 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 13rd NO HEATING �A TV1 Town o Andover Kt No. 363 c-, "orthAndover, Mass., PruCru-91- 44-1994- T B I UILDBOARD OF HEALTH Food/Kitchen Septic System IT To PERM BUILDING INSPECTOR THIS CERTIFIES THAT..............................M. (......... ............................................................. Foundation has permission to*W*........k(.X%-7.7P~P....... buildings on ......../J.%.....Ow. A-01 ............�O&c�....... Rough to be occupied as.....Smile. ..c provided that the person accepting 1xi oar�!.R. 4�.% MISM& -- Chimney .0 ......Dw permit shall in everyVespect 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START'S • ELECTRICAL INSPECTOR Rough Service ..................................................I ...............................1 4. ............. BUILDING INSPECTOR Final Occuptty,(—) Penn 't ['(_,qii *,-i.,t] 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT . 06.54ee- -'ao Stilt l.`!.•.,: „ �.cNr ng:Qr iRi.ir g4FFTV 1 COMMONWEALTH !+._PART - Y FAIIuro to st t*RRs(IQlnf ✓,:: OF ONE ASHBORTON PLACE *$�*tMK� " ato �,d 3 �, BOSTON,MA 02108 I Cod*is cv'a+: .r rowaatWn MASSACHUSETTS „xb.q, 1 ' _t:V althlo Ilo CAUTION x? EXPIRATION DATE FOR PROTECTION AGAINST Jr,.. 05/29/1997 EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB -� - RESTRICTIONS PRINT INAPPR NONEr_r, [t6/30/ V' 14 E.r� '3 o - f`a . ' °z 11, 6wr�;itl ::"� . )i'd `T TINGO f "! '`` SS A 020—Z6-7402 � GRt)VELAV� "1� `?1 ��4 MUSTII�TCC�EPH JIM 13 19911 _ PHOTO(BLASTING OPR ONLY) FE /+ (�(� .��,''�'_�+•.J •0 C i 0 0 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ,r•�. I i�' 1'�'- STAMPED-OR-SIGNATURE OF THE COMMISSIONER > HEIGHT: pp 4144 Doe: .f' .�. +� �T 05 /29/1935 / ` e - �7..1/ ` 't N NAME IN FULL ABOVE SIGNATURE LINE THIS DOCUMENT MUST BE ✓✓✓------���-------- lA r OF I ICENSEE F:'. y..�-. -z !'• CARRIED ON THE PERSON OF THE HOLDER WHEN EN- NER ' OTHERS-*RIGWT`THUMB PRINT GAGED IN THIS OCCUPATION. - � FiOltllilSINIWOtl a 00810 tlW 1T?yaane pu0wA 'd u0y3euo( •oul `Sxalm N [ ', 96/61/80 uot�eatdx3 t. _ adAl > N0I1tla M3 31tluo1a�ellst6a8 444, �OS801 a013V81400 10WROH01 3WOH toy 1111 INSF i of"0.", ~° OFFICES OF: Town Of 120 Main Street � ' °m • North Andover, APPEALS NORTH ANDOVER Massachusetts o 1845 BUILDING CONSERVATION Sys DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number 3&3 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit A licant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Date... 1 NoaTM TOWN OF NORTH ANDOVER p PERMIT FOR WIRING -1 CHUS This certifies that has permission to perform C..:. ......................................./ 21. wiring in the building of... ..... . ...........�...,..... ......... . ....................... at .......-� r � North Andover,Mass. Lic.No./J .......... . / ... ., ••ELECTRICAL INSPECTOR/ .......... ... T/� Check # /�' "�1/ �l' `3 561 '1 Commonwealth of Massa usetts Official 1 y Permit No. Department of Fire S rvices Occupancy and Fee Checked ,5 BOARD OF FIRE PREVENTIO REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PE IT 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 T A F, TIO ) Date: — .�J—,�14S City or Town of: t0 To the Inspector of Wires: By this application the undersign d gives notice os or her intention to perflo the el e trical work described below. Location(Street& ber) Owner or Tenant Telephone No.,W( 7 "'IW5G Owner's Address Is this permit in conjunction with a building permit? : Yes ❑ No (Check Appropriate Box) Purpose of Building Utility uthorization No. Existing Service Amps / Voits Overhead❑ Undgrd LI No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I nstal l ati on of Security system Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers _ KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o mergency ig ing rnd. rnd. BatteryUnits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers . __ Heat Pump 1.Number Tons KW No.of Self-Contained Totals: Detection/Alerting 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.o Water Kit No.of No.of Data Wiring: � Heaters Signs Ballasts No.of Devices or Equivalent No.Hydro,::assage Bathtubs No.of Motors Total HP Telecornmunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail ifdesired,or as required by the Inspector of Wires. 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:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:e -- —!�hlspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ' DT Secucity Services IS ^ LIC.NO.: Licensee: John S- Bassett Signature A Lu LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line) Bus.Tel.No.: 603 594 5928 Address I/- Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licl9fisee 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: $ , Date`? 3694 A Q� f NORTH 4 o?����•°;•,',�a0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ti This certifies that has permission to perform plumbing in th ildings f .!. . . . . . . . . . ., North Andover, Mass. Fee . . . . .Lic. No.<}. . . . . PLUMBING INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer • „'���M�-��+ I i5 UNIFORM APPLICATION FOR PERMIT TO DO PLUMHINt3p�.?,� -- (Punt or Type) NORTH ANDOVER. Maas. Gats BuIldIng Permit 7 Location /�� �i�oo�i✓ y,� , Owner's o Name �/�/✓� �C�� New ❑ Renovation ❑ Replacament ❑ Plans Submitted: Yes❑ No C.1 PiXTUREd ...•..... M 1a < « h es J M O= x M r J M )' 0 < M S d i J ~ y ~ y ~ u s 1~t S ~ 16 ` F = s r • s N U ; er • a N r s. < M s w f. O a M 0 < • R < M ar a ~ a r ox X a X9 W 1 4 w o ea I s 04- 40 e t as as i � °a : 0 ► E eU�—eeMT. � —•-} l aAtRM�MT 1sT FLOOR � "n >>Ho FLOOR SAO FLOOR -- 41" FLOOR i IT" FLOOR IT" FLOOR. D ITH FLOOR eTH FLOOR a ,,,Check one: Cadvicals T Installing Company Name ANDOVER PLBG . &. HTG CO INC . [J'Cofr, 2122 Address_ 5731 S(1 _ IINION STRFFT 11 Partnership _ I AWRFNCF MA 01843 ❑Firm/Co. HL131ne3s Telephone y7f; hf;5_8383 Name of Ucensed Plumber G F O R G I-AROSF INSURANCE COVERAGE: Checkq�e I have a current liability Insurance policy or Its substantial equWant. Yee t�" No ❑ It you have checked 3M, please Indicate the type coverage by checking the appropriate box. A Itabllty insurance policy W Other type of Indemnify O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hay]L 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: �Fgnsi o ar of Owners Agent Owner ❑ Agent ❑ 1 hereby t*Mty that all or the delaNs and inlamlbn I hays tubrMied br entered)In above appReatlon are true and sommats to the best of my knowledge and that ill plumbing work and Inslaltallons performed under the permit issued fot this pikallon Will be in eornpAana with all partfnenl provlslona of the MassachuseNs Stale Plumbing Code and Chapter 112 of Vw Ganser By stile naysr o Denis r C1ty/Town Ucenss tonba 9983 .t1'r'"rMD (OFF)CE USE ONLY) Type of Plumbing IJcsnsa: Master El Journeyman 0