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Building Permit #398-15 - 35 CAMPION ROAD 5/1/2018
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Tl Permit 140. Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION. 1J GA . _ _ _r . -�a �� ! �, Rr - f iPR01?ERTYOWNERm ��'�' r s _ — � . IPrlhit 100Year:0ld Structure. yes, rno. ,a aMAI?tNO; � PARCELZONLNG ®ISTRICT �Histonc Distnet dyesnoF :+ PA agt _eyes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ElAddition 11Two or more family ❑ Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �`" ' " ❑�`Flood'lain � �iWetlaritls� u0'Watershetl Distract ; T��` ,❑ySeptict Jm Well > t ,g ♦ a j "��`�j' ^�i.M r " �.. `, �mow+ .�..2 - _ _ _�•-'�i�Y"�'`�_ +tarsen'"�..art1 �.❑Water/Sewer- DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: ���- ✓ Qv, " Ion Phone: Address: e-.•-. ...1 £r. -r k7• 'f, "'.'�" • -'..ti � y- .ef• sow i y 't'� f a`'� � ++•nii: � f t , "fi.Rr•�{ I.y ," s r ;i 1 ..:;'. .k 1 -�,��x�i .n_ _' -u+ t,'�i .� y;�7�+, � �.4.�=�� �.: �fa-r e.— � -r 'a�a; � 2C � - 4' 9114 ONTRACTQRNameA �A}- -P �-,F••9 z±y 1 », IY W `« t# :. �, -r+ •, a +f.- fJ'' :a"' e'``r'+,�,^'. • a+ +4 2,vt .� { J3 �`gdd�eyss � sf -[.�; 1-�� 5_:'�l;tx,.d -lay i. Supervisof Construc`-tion'�License �. � t �'� p : ate i a a [y 7Cr�°z' k Ex tD .. �.. � . L. ._[. ' r..y.. �• - i- , tin '�4s _ 9 G ° .,�•+-- =. '� ...Fe ".� -a�.� � ;': +��=�xx;a�• ��r,� �Xp ��Date� �...., ,�•; kHomelmprovement Lieense� �r�r ^ �- �.. cl ..�-,.��a`�.� •�4 � -�.�`�=��'_�;:� � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ ---- Check No.: Receipt No.:-e-9- ` have access to- he guarantyfund NOTE. Persons contracting with unregistered contractors do not h g Si -iature of contractor Sig -of Agent/Owner g _:_. __. i i Location } I Date TOWN No. C. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit.Fee $ Other Permit Fee $ TOTAL $ �G� y Check# 2818 Building Inspector _ i ! Plans Submitted ❑ Plans-Waived-El Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF:.SEW-ERAGE_DiSPDSAL .. Public Sewer ❑ Tanning/Massage/BodyAf ❑. . ..Swimming Pools ❑ Well ❑ . Tobacco.Sales Food Packaging/Sales ❑ Private(septic tank, etc..- ❑- Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE.APPR.OVED PLANNING & DEVELOPMENT - ❑ ❑ COMMENTS i i -CONSERVATION Reviewed on Signature I COMMENTS i I HEALTH Reviewed on Signature i (COMMENTS j Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature& Date Driveway Permit DPW Town, Engineer: Signature: Located 384 Osgood Street FIRE C3`IEPt4R!Kg_i�T Temp Dempster on site yes no Located-at 124 Main Street Fire'Departinerit signature/date NORTH Town of _ Andover AIL A-46h ver, Mass, C OC.IC.RWIC. �1' S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ .0 .......... ..Q ......I l�.Ia , .... BUILDING INSPECTOR has permission to erect .......................... buildings on 3.r...... ......1o7P.qC, .,b....... Foundation oft L Rough tobe occupied as .... .. .... .ft�........ ..... ............ ........ .............................................. Chimney provided that the person accepting this permit shall in every pect 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 \ Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES-IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTM S TS Rough Service ............. ..... .................................................. Final BUILDING INSPECTOR 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. LNXThe Commonwealth of Massachusetts Department of IndustriglAccid nts Office of Investigations 600 Washington Street Boston,MA.02111 www mass gov1d1a Workers' Compensation lusuranceAffidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ALL U,1!0,=/Z Otit- 2yca/� Address: City/State/Zip: vn✓,i s J Phone#: i Are you an employer?Check the appropriati;� Type of project(required): 1.El am a employer with 4. general contractor and I 6. ❑New construction employees(full and/or part-time).* have nedthe sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.y 7• Remodeling ship and'have no employees These sub-contractors have 8. E]Demolition act workers'comp.insurance. 9, Building addition workingfor me in an capacity. ❑ g Y p 5. We are a corporation and its o workers comp.insurance ❑ Electrical repairs or additions LI`I p 10.❑E p required.] officers have exercised their 3.❑ I required.] a homeowner'doing allwork right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12,❑Roof repairs insurance .re uiredemployees.[No workers' required.]y 13.L�bther comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they dre doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the,polley and job site information. 1 Insurance Company Name:. i Policy#or S elf-ins.Lic.#: Expiration Date: Job Site Address: 10 1'�� City/State/Zip: W4. �� �� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as xequiredunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine against the violator. Be advised that a coy of this statement may be forwarded to the Office of u o 250.00 a da a P of t $ y g . p , Investigations of the AIA for insurance coverage verification. i I do hereby cert under the alns andpenaltles ofperjury that the information pTovided above is true and coPrect - Si afore Date: ' �' 2 'l Phone# CM2 Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other "Phnna N. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fol 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 partm nts 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 employes." 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 ofits 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 phonenumber(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 any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided as pace 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 pemrit/licease 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(ifnecessary)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. Anew affidavit must be filled out each year.Mere a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The COMM.oaweaftf ofMassa..rhvSPtts )3eparbent of ladustxial Accidents office ofInyestigat ions 600 Waftpa 81rea . Baslont .a�X�Z TQJ,#617-727-4900 Qxt 406 oar 1-877-MASS.AFF Revised 5-26-05 Fax#617-727-7749 City/Town F— State Zip code Search Registrants Click on the registration number to view complaint history. You can also view_arbitration and Guaranty Fund historv. The list is current as of Wednesday, October 8, 2014. Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS STATUS DATE ALL UNDER ONE ROOF LANZAFAME, 137057 166 A MERRIMACK ST 10/02/2016 Current JOHN METHEUN, MA 01844 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. nrni�nie fa(6L i , t t n t— �2•'�.- s.a-isa.z��r � W i ANZAFAM,� _ft?�ifti -�. ail TEMPLE i3R METH1 Ft_q MA 61844 e. 04F{ 312015 i i i Ac R CERTIFICATE OF LIABILITY INSURANCE A' 9.2013 THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMAMON ONLY ANIS CONFERS NO RIGHTS UPON THE CERTIFICATE I HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE [ AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT-BETWEEN . TIME ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODWER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL IN D,the policypes)must be endorsed. If SUBROGATION is WAIVED, subject io the term and conditions of the policy,certain Panicles may npre an en dorsemeM. A statement on this certificate does not corder rights to the certificate holder in lieu of such endomement(s). CD4~CTACT i i+lF+ME I?AVID E ZELLER INS AGCY INC PIS IFAX 370 LYNNWAY :A LYNN hAA 01901 E I Fi�S IRF t� INSAER A:ACF WT RICAN It S 1RAt G CO t&)F€D IRSURER 9: 4 FRANK BERRY S JAMES BERRY DBA FRANKS MS-PrRC SONS 145 WINDBROOK DR In1suRFF�D ___ EPPING. NH 0304' IhSJAERE _ —_— tNSwRFR F COMFICATE#+U BERb REVISM NUMME THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED i ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY I CONTRACT OR OTHER DOCUMENT WIT-4 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM,,. EKCLIISIONS AND CC?NDITIC)NS OF SLJCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS SLOPAN$_A TYPE GFtNS RAr;E Paucyump PgttG�r� IN9F. 1L (INI� UNITS I L 4MIL LLA LITY FAG-iOcc.1RR=NC S I 1 r�)rTv1FRc IA GFvFRA' IA3i IN R O RF#T S �— NEDEXP( c"!, iwr) S I I f�RSt')NA1 &NOV11 I:_RV S AGGAR yE1tEAA.. f,: r_ I I GP,:.AGGRFrATF;..IMITAPP.IFSPFR I PA0'2JGT5-CXW.P:•')PAC,G S PC3.K;v g CxC S { AUrQVMLE LIABILITY ( ><vF11hF.us cx.F cr,AT 5 I I I a ac4-rF I ANY A,lTC A _tTNI�;`7 �I `i{f(l1JtFI) 1 ! Alf"- AIMOS 1 11m. ovkt"T Gf4 MIS 0Atv4 S I {' I L&GFEl2A LIAR f[X.1F? FAGri t^GC 1AR ',r S _y EI UAB ':AIMS M rC1C3t S AT. s I DED RETErtTfOt.S S 1 NGSTAT,1 ('1-i i AND EMPLOYEF9 I IMUTl ry Tc czv tmTS F`t AIR!P"R1ET(JR.PAMF-R-E}(EC;T u A j F-:..FAC: AMOK $100,000 OFFIGERt�7[Nt3FSt EXC DED' Y 4 UB t t-05-2013 11-05-2014 WAM.tYxyIf N-i) TBD E_ DISEASE-EA}?AP,_CF tE $100,000 I s'yam,crcmc a cars{ �y /� I DESCRiPT10rt OP=_RATMsbe}av E_ ?5FA5E PC3_IC lt�iT 50C1,t700 { I i f :RPn(NCF0P8=C161 LO'.ATIMfVM A WhACMI 1.Jdd if mme ISr8*t1L0 -..v. 1 Nn Pa'I.N.'s a'e r.Ove'ed by I'lP W04(f—,Wemr nsaiinO MIcy 1 s HOLM NCELLATM 1 1� ALL UNDER ONE ROOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES t3E� :30 TEMPLE DR CANCELLED BEFORE THE EXPIRATION DATE THEREOF,; ME T HUEN MA 0184 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. � AUtf10FVH?R6*ESEITATW y /� 1-b 8618 a 02/02 � 1 /6/2013 2 : 38 : 43 PM c X 3 3► �'� CATE�rwoar*rYYI vRc�" CERTI KATE OF UABILITY INSURANCE CEItTiEiGTE is ttm0 AS A VATM Of gt�11oN �►�! Rpt t�flt�;�►6E AFFORR�s"M�C itT ATB tis Mal A!s>sbutATl9fleE.Y t)It> �� in 90 Mtt;ttllRlRlR(3}, Att fHOTtlLED ti LOW Tttiti C90W LAVE OF "MAN*tlm NOT Cam bbbM'tlFllVt O!t pacc1KLR.AND Time CtTr"Is MOLAR. to p AttF:t#OIe CittiAollt#llFitOar H M A� + IAUO elfdotad. b�rROOATiON fS YTJ1tVE0 ss to the t+Kros and osrlrtitoueat t#M poYey,t�Iatrt potteiest MW �A an NO OWW%C is doe#nal cronfar r�ptd sats tldtMr M tlstt atvieb sr� K MI-om M . 9111�4i7�1,�a katrancs LLC Of 25 Andovw. Itis � kk A.ut.trllwfia tnsFt um Como" 33751 I Ab orw Roof 30 IN u�u. C,bltTt!<tCATElt=tltNt: RtEVttAON tttJtibt+Jt TO T TiiE PfINCNcS iIEI.OM1f 1lR3tf(tE9t TO THE AiStfRS N EO ��€GR ETGHE POLICY PERIOD p 110 IMS ANY afiT.TEItY an fIC AMtY r!R OTII&tt 00t9i11iFXT�i W1ECT TGTA.THE TERMS, ERRMMIS T lG1T! a OR M#Y 7N1:THEM �RREO Ell dE8CR1�d HEIEE9lt t9 f10Fts j O�FT`Kila JF&xH Pi3 c R•ims sipaA mAY Ml W ttt0;tt till PftR?CLAS. 4YPi tI►!lNIiRA1Fta NtMAt L EAdtOCWRREF+CE = WIN COMMEROAL 080ERAL UAW" MEOEW WI a"In"-) CLAHnMAM E-]OCCUR PERSONAL&AVVWJV Y s GENERAL AGGREGATE % PRODUM.COmPIOP AGO I Nt AGOM ATE LW APPUnt PER' OUCY 0- t MA�It+rq gfjDLY ili7lJRY(Pa Osret7l) tY ANY AUTO —� All Worm PULED -30dLY jN"y(P«a"idem) I AurosttTOS D ITY I t O�RlOCCURfJQ+oGLIdtRENC�CLNMSMADE Ao6REGATE s s TF- am -rewN Ia rEX 1@3 1lO< A Mx ..fAo►ACfi-30ENT I 1004a.0.0 e.1-asfAM•POLICY t+MtT s S40.009,Q0 I pi0 ti+taCATIONf+vlF tls~ACMM.Add0"*wwU/du4ffM" ON Is TM slurs catl�eeFe7ahon Pam doa Trot penvW coves"for 48M Lana dM* ....�.,.. ..�.. f:IkNC Ta lMLlftt�8 MIT OF TW"a"OEtCRtfEs IEa OE cAWILL MCEt1ED adf flRt Ry4 of ilftl#t Im pm=r OAt�loa _ - AsaFroreeae+FrPI�A� f ,��".""'c.�1. �..X•t'.tc� MWAX a MS*M Alco f to is(me" TF*JLCOIt0 nWW s d 1096 m r otet r a M Wks of ACM* f tla acv>s: 110.921111I0612013/xslo 02! 18?" I i i ter a t ,- ,� f _` y t ' e 3 .c'-. -E ,s ,u i > 7" —..'',-F c-+ i-::n w.+ rK ...n_'�`� �..}'s. St , 1 � ',a -ate �� s....sr7.�, .: s .- � ..p'- •`'- s -:: ,� ��_,,.' � . Residential & Commercial Roofing Chimneys All Types Of CHINCAPPED Sidi qNEYSPOINTED - Expert Masonry Work Mass Toll Free Roo,,A oh "' f ` Licensed & Ensured r�,�r1f o,Vn.d cx _ License#034200 E-800-WAIT-4-US24- 87) I rst Ple Wymnw tiff�vh-fr We Work Year Round } f s (924 $487'} .., � } Y , g.st• - v' ,.+�a.�- #4„ e r� " .sS s. 'i,. `'+ , ,'arc,: .': +w - i y ,� +.�.� ,,,.` 1t `a...gSx -rr �,rY 3' ''`•���' o+ ,*T`.�a•*'g'�, v � t i }� s t z i �� �� a t ,:.,,.5� J rJf '� .5..+ ;.,.tz s ..'S ,� _.- v.� �� _ r�.:��rt - 3..,.F:� -w��r� `�s �+.r_+`sK*.., :•,;�.,,T _ Proposal To: New England Shed Date 10l22l2�13 Joe Bartalotta Street: 35 Campion Rd. 978-835-6091 N.Andover, MA Roof proposal Labor 1. Extra caution will be taken to protect house 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. placed under dumpster to prevent any damage to (tarps etc.)Magnets run at final clean up. driveway. 2. Remove all layers of shingles from entire house. 13. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 14. Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost$55.00 per sheet of 1/2" cdx fir• ©ta� roof labor cosi; id�g��•�� 4. Install aluminum drip edge to all eaves and This proposal includes all nails and fasteners rakes. needed. 5. Install 6' of ice and water shield along all eaves All materials excluding nails and fasteners will and top to bottom in all valleys be supplied by homeowner. 6. Install underlayment to remaining sheathing up to ridge. *Note*:please be advised if applicable,valuables in 7. Install all new pipe boots. the attic should be moved or covered due to minor 8. Install starter shingles to all eaves. debris,dust and asphalt particles that will accumulate 9. Install architectural shingles to entire main house. during the stripping process. All Under One Roof not All shingles will be installed and fastened responsible for any damage or clean up that may according to mfg. specs. occur in attic. 10. Counter-flash chimney lead with ice and water shield,tie into new shingles and seal 11. Install ridge vent to entire ridge capped with Balance due upon completion color matched hip and ridge cap shingles. References available upon request I Highly rated member of the accredited BBB and � Angie's List Thank you! Acceptance of Proposal--The above prices, specific 'ons and conditions are satisfactory and are herby accepted. You are authorized to do the work as specifi A. Payment will be made as outlined above. Date of Acceptance: Signature: -Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ .Total land area; sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166.Section 21A-F and G min.$100-$1000.fine NOTES and DATA— (For department use i El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department 7'he folfswing is--a-`list of the required.forms to be filled out for the appro p riate.permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑' Building Permit Application ❑ Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products g 9 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Application Permit A lication ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application Ei Certified Proposed Plot Plan j ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: 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 Deeds. One co and roof of recording a n•' over. The applicant must then et this recorded at the Registry of D copy p that the p al period is pp g g must be subm-tted with the building application Doc: Doc.Building Permit Revised 2012 i i a Commonwealth of Massachusetts Official Use Only _ Permit No. �+ Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 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 INFORMATION) Date: City or Town of: N 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)35 Campion ` Owner or Tenant Carlos Montemor Telephone No. Owner's Address 35 Campion Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building solar installation Utility Authorization No. Existing Service 200 Amps 120/2/40 Volts Overhen V/ UndgrNo.of Meters 1 New Service Amps / Volts Overhead❑ Uud rddq No.of Meters g Number of Feeders and Ampacity i Location and Nature of Proposed Electrical Work: rooftop mounted solar array Completion ojthe f 11mvin table nr be ivaired b the Inspector of iI'ires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans TransTotal Tsformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above E] In- E] No.o Emergency rg tag rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Dis posers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Mr Connection El Other No,of Dryers Heating Appliances Ir Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications of Devices o Wiring: No.of Devices or E uivalent OTHER: 36 panels Attach additional detail ifdesirerf or as re9rdred by the Inspector•of(Vires. 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: 2500.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of petjmy,that the information on this application is true and complete. FIRM NAME: ASTRUM SOLAR LIC.NO.:A21555 Licensee: JASON RILEY Signature LIC.NO.: (If applicable,enter "exempt"in the license number-line.) Bus.Tel.No.:508-614-0146 Address: 5 Lyberty way Westford. ma Alt. Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. Please visit our web site at http://www.mass.gov/dpi/boards/EL I i ASTRUM SOLAR INC JASON P RILEY (EL) 18 HOPKINS ST' WILMINGTON MA 01887-2210 mmo I SSI� Li�011 N E � S S 11111E LCTRIIA RILEY 18 HOPK NNS jbiffiN OT NSST. V y o1sal-z2] 13463 3l ,... _* 80020 ; i 0 i Fold,Titan Patech Along All Perforailone X11 OMMONWQWITIH OF Ml160HUS S I �•t e e m • •e E I C At N� I SSUES T� E�OLLOWI NG L IdC f: AS if MASE ECTR1'C 111N : SOLAR IN 18 HoPKi{t �S� [ 0168 2240,X11 0 � k 'IT 7- �155 f=-{07/3 6:1' 80019 e i The Gonirnorrlverrltlr.of Massaclrirsetts TPrint.Fora Department ofbrdirsti idl Accideirts ' Office of hwestigadow I Congress Sfreet,Strife 100 Boston,AM 02114-20.17 ><vlvlv.ntassgov/ilia Woticet-s' Compensation Insurance Affidavit:Builders/Contractors/l lechicians/Plumbers Applicant Information Please Print Legibly Nfaiie(Businessiorgauization/individual): Astrum Solar Address: 15 Avenue E City/State/Zip: Hopkinton, Ma,01748 Phone#:508-614-0146 Are you an employer?Cheep:the appropriate box: Type of project(required): 1.R1 I am a employer with 15 4. []I am a general contractor and 1 6 [j New construction employees(full and/or pair-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ 1 am a sole proprietor or partner- sub-contractors have ship and have no employees These8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance.t5. (] 5. We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their U.❑Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work . right of exemption per MGL 12 Roof repairs myself.,[No workers comp. 0 p insurance required.)t c.]52,§1(4),and we have no l3[✓Q OtherPV Solar Installation employees.[No workers' cotrip.'insurance required.] Any applicant that checks box#1 must:nlso fill out die section-below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ale doing all work and then hire outside contractors must submit a new affidavit indicating such, ;Contractors shot check this box must attaolred an addilldnal.theet shoving the name of the sub-contractors and state whether or not those entities have employees. if die sub•contractors have employees,they must provide their workers'comp.policy number. I am art err ployei'drat is providlug iporlceia'eomiperrsatlom ilrsrrratice for rrty employees. Belotp is the policy and job site it forlitation. Insurance Company Name:Zurlch American Insurance Co. OWN Policy#or Self-ins.Lic.#: 59536900 Expiration Date'. 7 Job Site Address: S C1q M City/State/Zip: t/K Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to theimposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penIties in the form of a STOP WOR[GORDER and a fuse of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe.DIA for insurance coverage verification. I rlo bcreby cerci ander the palms Burl pen allies o ren tri ilia!the In ormratlart provided above is true and correct. Date. _ - Phone#:50$-614-0146 _ Official Ilse only. Do ,of rprite Int this area,to be con plefed by city or totem officitil. i City or Town: Permit/License# L Authority(circle one);rd of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector er t Person: Phone#; it S SR �I i sat *q„ ...... ,: .. t Nz S4 � Y LG tr <r. :,•, f r Introducing MonoX m NeON module series,which uses highly efficient n-type materials,an elaborate process control adopting a ArrrsotEul=Itooucr 60 Cell semiconductor processing solution and a double-sided structure. DVE C UU5 Cc Our R&D concentrates on developing a product that is not only efficient,but strives to increase practical value for customers. 3a►+� lols 0 N TYPE MATERIAL NEAR ZERO LID(LIGHT INDUCED DEGRADATION) MonoX'm NeON uses n-type cells,boasting ` The n-type cells used in Mondm NeON have almost higher mobility of electric charge,resulting in no boron,which may cause the initial efficiency to higher generation efficlency. drop,leading to less LID. • i NANO LEVEL CONTROL ® DOUBLE SIDED CELL STRUCTURE Monod"NeON uses the Nano-level process The rear of the cell used in MonoX"'NeON is designed control predominant in semiconductor processing to contribute to generation;the light beam reflected process,which ensures less electric loss from from the rear of the module is reabsorbed to generate internal defects. a great amount of additional power. 16:k9 Utlht Vldtlht CanxnNel 1.1* 1. ELTW Cmm�l Sori4y LlrouVhr,anty �a14m I About LG Electronics w eectmnks Is a mohtnauonatcerporation mnxritted to exparW1V its caparkyxidl sdarenergybuslness as Itsfimre growth engine Ours solar eneW some research programwas taurrIedln 1985,backed by LG Grdu#s lith "partence in semFmnductots,LCRdwaisuyamielectmicmaterials Wntry.M sumassrogyrdeased the Am MmW'seiles to the market In 2010 vAkh exported to 32mmtdes In2yeamtn=%Moho)-Whlwon 1ntersolarAward;which proved Its tea&g Innovation inthe Wustry. • • .N _ • 11 MECHANICAL PROPERTIES ELECTRICAL PROPERTIES(STC*) Cells 6 x 10 _ 300 W Celtvendor LG MPP voltage(Vmpp) —_- - 32.0 - Cell type Monocrystatline MPP current(Impp) _ 9.40 _Cell dimensions _ 156 x 156 mm/6 x 6 in Open circuit voltage(Voc) 39.8 a ofbusbar� 3 Short circuitcurrent(Isc) _- 9.98 Dimensions(L x W x H) 1540 x 1000 x 35 mm Module efficiency(Ye) 18.3. ^ 64.57 x 39.37 x 1.38 in Operating temperature(aC) -40-+90 Static snow load 5400 Pa/113 psf Maximum system voltage M 1000(IEC),600(UL) _- Static.wind load 2400 Pa/50 psf Maximum series fuse rating(A) Weight 16-4±U kg/36.96 f 1.1 lb Power tolerance(%) 0.+3 Connector type MC4 connector IP 67 *SIC(StandardTestCandltiwklrradlar ce 1000 W/m�module temperature 25-C,AM 1.5 Junction box IP 67 with 3 bypass diodes *The nameplate prnly output is measured and determined by LG Electronics atns sale and absolute,discretion Length of tables 2 x 1000 mm 12 x 39.37 In ELECTRICAL PROPERTIES(NOCT*) Glass High transmission tempered glass -- -- --- 300 W FrameAnodized aluminum .»..»....._...............................»...................................................................................................................... Maximum power(Pmpp) 220 CERTIFICATIONS ANDY WARRANTY MPP volrage(Vmpp) z93 ».........c-»u..rre,*r,e-nt...._...»hn.............._.........._..........»....._..»....»»............................7...»50.....»...........».,._................._....... Certifications(In Progress) IEC 61215,IEC 61730.1/-2,UL 1703, MPP ( pp) . _ ISO 9001,IEC 61701,IEC 62716 Open circuit voltage(Vac) 96:9 Product_warranty 10 years Shore circuit current(Isc) 8.05 _ ..........................................._..................................................................I...._......_.....» ..,...................... Efficiency reduction Output warranty of Pmax 4 3SY. measuremeetTolerence33f�. Linear warranty* _Lml000w�mamloowaa't ''1)1 styear.98%2)After 2nd year.0.7%p anneal degradation 3)01.2%for 25 years a NDCT(Nomiral Opsmtktg CekTempmtt ra}Imcbnn 800 W/m',ambient temperature 20',wind speed 1 m/s TEMPERATURE COEFFICIENTS DIMENSIONS(MMAN) NOCT 45 d:2 eC woonu7 Pmpp _ -0.41%/°C e.r;•�a xa tsa.a.*.n.wO Mews ..1 Voc'. -0.291YrC 4A•7.5 w.,, 1{On710 1st - 0.04 W*C aw ".t..l 10eru.t.wr.a ewx aeeteud tela�t 4e/40f CHARACTERISTIC CURVES u.04.3 .. s .se,.. •I 0 2� 10 10ooW a' •" wervq W . 4 6 60ow 7 �t000nfai 6 600w C.M.6,411, 5 � 4110W ' 20aw s to is ,20 25 30 3S w Vdta4e(1) 140 944/3717 720 .........,-,.._........................... c ISC 100 e ................... .. Yi b no Voc g LEM ....._...._-••----------...._.............._... ...... .. L _ sous 60Pmax toro 4e to/ot0 ...__......................... ata 5 oero.m � 20 .................,.................................—.---._._......._. x 000Y L0.1d 7a1D.R 40 -25 0 25 5o 75 0o Tionp-tDrerC1 lagddebeme 5hetddefraae 'The dbuncebwmentheanterofthe rnmRkWground4 hots. • f LO North America Solar Business Team product are a sort atedt dernarko LGCutrmtk►. � a LG Electronics USAtn[ 'LG UfesGood'haraglrtraNdtrademark or LG Urp. 1000 rn Ave,Englewood Cliff; All othertndemarks are the praputy6rtheh ropecthv avners NJ 076 0S-N•6GZ-US-f-EN-31002 With LG,it's all possible Life's Good X4kr.sage.com CDpyrlghtm20/3LGElectmnksAxrlghureserted. V=" " 10/01a013 I Enphase°Microinverters Enphase@M250 t � tid tit t t s}t t t l� I The Enphase M250 Microinverter delivers increased energy harvest and reduces design and installation complexity with its all-AC approach.With the M250,the DC circuit is isolated and insulated from ground, so no Ground Electrode Conductor(GEC) is required for the microinverter.This further simplifies installation, enhances safety, and saves on labor and materials costs. The Enphase M250 integrates seamlessly with the Engage®Cable,the Envoy Communications Gateway', and Enlighten®, Enphase's monitoring and analysis software. j i PIR-O,Dt3CTIVE S.I,MPLE RELIABLE -Optimized for higher power -No GEC needed for microinverter -4th-generation product modules -No DC design or string calculation -More than 1 million hours of testing -Maximizes energy production required and 3 million units shipped - Minimizes impact of shading, -Easy installation with Engage -Industry-leading warranty, up to 25 dust,and debris Cable years [ enphase° S�® L E N E R G Y c us Enphase"M250 Microinverter//DATA INPUT DATA(DC) M250-60-2LL-S22/S23/S24 Recommended input power(STC) 210-300 W Maximum input DC voltage 48V Peak power tracking voltage 27 V-39 V Operating range 16 V-48 V Min/Max start voltage 22 V 1/48 V Max DC short circuit current 15 A Max Input current 9.8 A OUTPUT DATA(AC) @208 VAC @240 VAC Peak output power 250 W 250 W Rated(continuous)output power 240 W 240 W Nominal output current 1.15 A(A rms at nominal duration) 1.0 A(A rms at nominal duration) Nominal voltage/range 208 V/183-229 V 240 V/211-264 V Nominal frequency/range 60.0/57-61 Hz 60.0/57-61 Hz Extended frequency range" 57-62.5 Hz 57-62.5 Hz Power factor >0.95 >0.95 Maximum units per 20 A branch circuit 24(three phase) 16(single phase) Maximum output fault current 850 mA rms for 6 cycles 850 mA rms for 6 cycles EFFICIENCY CEC weighted efficiency,240 VAC 96.5% GEC weighted efficiency,208 VAC 96.0% Peak inverter efficiency 96.5%. Static MPPT efficiency(weighted,reference EN50530) 99.4% i Night time power consumption 65 mW max MECHANICAL DATA Ambient temperature range -40°C to+65°C Operating temperature range(internal) -40°C to+85°C Dimensions(WxHxD) 171 mm x 173 mm x 30 mm(without mounting bracket) Weight 2.0 kg Cooling Natural convection-No fans Enclosure environmental rating Outdoor-NEMA 6 FEATURES Compatibility Compatible with 60-cell PV modules. Communication Power line Integrated ground The DC circuit meets the requirements for ungrounded PV arrays in NEC 690.35.Equipment ground is provided in the Engage Cable. No additional GEC or ground is required. Monitoring Free lifetime monitoring via Enlighten software Compliance UL1741AEEE1547,FCC Part 15 Class B,CAN/CSA-022.2 NO.0-M91, 0.4-04,and 107.1-01 'Frequency ranges can be extended beyond nominal if required by the utility To learn more about Enphase Microinverter technology, enphase, visit eriph'ase.com E N E R G Y W013 Enphase Energy.All rights reserved.All trademarks or brands In this document are registered by their respective owner. Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACHUS� i This certifies that . . . . . .. . . .`. . . . jy. . .r. . . . . . . has permission to perform . ... . ... . . . ._.�- plumbing in the buildings of . . . . . . . . . . . .;. . . f . . . . . . . . , North Andover, Mass. Feed. . . .Lic. No,X�F .3/D ��. �� ?- � � . . . . . . . . . . PLUMBING INSPECTOR Check # 4'-',--"; � 7364 BOOK PAUST BE wl`r�l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 PLUMBING (Print or Type) � �- � permit iy �_,, Mass. Date • Ownses Name—\ai RC1 a Building Locatiott1� •�``�/��� t Type d Occupancy plans Submitted: Yes O No O New O Renovation O Replacement , i FIXTURES x z tc501,1110-0-c r- a SA rA N O W F* 0 .1 ). .0 < � o w ¢ O YI Y J to < . I- O a' } o W � 16 �+ a — } � az ¢ e.= c < ¢ < W a t a rra k' OZ 29 40 N t' z WO tC Xa < o <¢ < n < 3 ¢ m O `s �C O Cf G n F• E R � Sub—BSMT. BASEMENT IST FLOOR 2ND FLOOR 9R0 FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR aTH FLOOR / IC"Check on*:. Certificate Installing Company Name p�Corpotation G • So s a� -' I . ,Address pr -' -0 Partnership 13 hwoo. Business Telephone Name of Licensed Plumber INSURANCE COVERAGE: I have a torte liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch . 142: Yes � No O if have checked yes. please indicate the type coverage by checking the appropriate box. A liability insurance Policy 7 Other type of indemnity � Bond � . nce OWNER'S INSURANCE the Mas WAIVER:metl aws and that my signature n am aware that the licensee this permit applicanot have the tion waives this equirrement. quired by Chapter 142 of the Mass. General Check one: Owner O Agent D Signature of Owner or Owners Apent twe and I hereby oerUfythatsll of the deta�1s and mforrnat►on have�and rthe perm is.o toter this apps-ication vnll be inn compliance with All rate to the best of my knowledge and ttiatall.piurnbsng work and ritstalla P� ter t the General Laws. pot ont prornstotu of the;Massachusetts State ng By gnature o um s Title Type of License:Master( yjourneyman[ ' 10 License Numbers/��--z�-�-�-�—� � NL DISPOSAL AFFIDAVIT NO Construction Debris is to he nut out for City Trash Pickup As a result of the provisions of MGL c 40,S54, I acknowledge that asn of all debris ioresulting Building Permit at from the construction activity governed by this Building permit shall be disposed of in a property licensed solid waste disposal facility, as defined by MGL c 111, S 150A. I certify that I will notify the Building Official by (Two months maximum) of the location of the solid waste disposed osal facility of, and I shall submit debris resulting from the said construction to the building Permit. the appropriate form for atta Date:__ Signature of Applicant Address and/or telephone number TAX STATUS FORM As requested, please be advised of the tax status of the above listed property: Property Owner: Property Address: �. OFFICE USE ONLY _ Taxes are current on the property Customer has made a pay plan lan and is current on payments _ _ Customer is in TAX TITLE and has NOT made any payment plan with the Treasurer Water and Sewer are current on this property Parking Tickets/Excise Tax on this customer are current OTHER: i� Location � No. Date �� 4011Th TOWN OF NORTH ANDOVER F 9 4 Certificate of Occupancy $ s i , ; ACHUS Building/Frame Permit Fee $ s�1c►lust Foundation Permit Fee $ --7 Other Permit Fee $ C,� r TOTAL $ 6�0 ' Check # ` f a(2r ,.� 5 ,, � � � Building Inspectotr� L �� i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT i APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING NO te BUILDING PERMIT NUMBER: 30 DATE ISSUED: SIGNATURE: Builcfilij tM3 isslo oro uildin Date le SECTION 1-SITE INFORMATION 1.11 Property Address: 1.2 Assessors Map and Parcel Number: 9,9r // ap Number Parcel Number c, 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided R red Provided C 1.7 Water Supply M.tt40., 34) 1-5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ ty Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PRO NERSHIP/AUTHORIZED AGENT n 2.1 Owner of Record j {► n ._ RL L I r- L C_ rr�m �J` —��✓ �� (- j U : v r y a"L /J i i r tiJ, 1� Name(Print) Address for Service 7 6 r L CL, -r 1 Signature //�r l /^ e Telephone J L l p 1 'Tip r ry 7� y �1y1�6 d- 2.2 Owner ofRecord: Name Print Address for Service: n Signature Telephone n SECTION 3-CONSTRUCTION SERVICES 71 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ (\ L C k, Tr 14 O ---b i- T/,4 n r G J r� ^.I j N T Company Name 1-3 r Registration Number r S is t!� l u E � it r � 7 I'� !.� � L� 6 t"-� _1'�. O 3 n3 E' Address rr 19 i2_ d 6n-% ...i Y f D Expiration Date ff Signature Telephone V SECTION 4-WORKERS COMPENSATION(NLG.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work checicatl a licabie New ConstructioreWTT dstin*uilding ❑ Repair(s) ❑ Alterations) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Sed WaAr-pv �O J i' r c SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be y' ORFICIAL{USE.ONLY , Com leted by pennit applicant { 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection (� 6 Total 1+2+3+4+5 l/ 1.0 1:>C>0n Check Number SECTION 7a OWNER AUTHORIZA ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIILDING PERMIT I, L—, R o j r r r L C L, t J r ,as Owner/Authorized Agent of subject property Hereby authorize R o L ( r r L C 1,-y r#- S I" to act on My behalf,inall zars relative to work authorized by this building pennit application. > Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS OT 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A. The debris will be disposed of in: S .S L 0-,, �Q rtnN CQ..! .S ��'C!� EU W7.5t) /-' ✓ Vr'rf c /U h� (Location of Facility) Signature of Permit Applicant Zs �19 ,� y Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ Boston, Mass. 02119 ' Workers'Compensation Insurance Affidavit - Please Print Name: Re, L rL C- Location: Y P ir CitVly _ N. O Phone O 3 - 0 (—j am a hom wner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address CCLty - Phone# Insurance Co. Poli # Comnanv name: Address City: Phone# Insurance Co. Policv# F416re to secure coverage as required under Section 25A or MCL 152 can lead to the imposition of criminal penalties.of a fine up to s1,5oo.00 and/or one years'imprisonment as'well as civil penalties in the form of a STOP WORK ORDER and a fine of(sioo.0o)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury Drat the information provided above is true and correct Signature Date2 S J C Z Print name �� �, r ,� �. C �, T I` r Phone �o - et Official use only do not write in this area to be completed by city or town official' E] Building Dept pcheck if immediate response is required Building Dept (] Licensing Board El Selectman's Office Contact person: Phone#: r-1 Health Department Other R."AWORKMAN'S CoMpENSA TION i I i Board Of Building g Regulations and Standards HOME IMAROVEMENT CONTRACTOR RgUistra ; -: Fy Exp�ratf—=334666 03 ROBERT L.CHUT BOE€ "�T �R Hi3It�E flialP HFN`E 5 B BLUEBERRY • DERRY, NH 03038 Administrator NORTH E Town . of , O O r No.36 A_OSA COCLA W� ,y dover, Mass., 7q ORATED o' 5 S E BOARD OF HEALTH PER . I Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ........ T T D .... . ............... Foundation has permission to erect.................. buildings on .407... ... ....... ........................ . Rough g to be occupied as ... Chimney ..... .... provided that the person accep g this it shall in every respect conform to the terms of the application on file in Final this office, and to the provisio s of the as 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 CONSTRUCTIO S T /� ELECTRICAL INSPECTOR J_ Rough ................................................................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Do Not Remove Freugh Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. rDate.................................. N�YM °`<•``° '•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING f ILI �� Thisoectlfies that ............................................................................................. f has patmission to perform .... ..,,.... ........................................................... wiring in the building of at ` ........ .. ..... !................... .......... North Andover,Mass. E Fee .. ....... Lic.No!/ t�,.�e 'r............. 1 ... f LEcr�ucwi INs CM 'A Check # { 75b4 �. Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 7s BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector-of Wires: By this application the undersigned gives notice of his or IWr intention to periform the electrical work described below. Location(Street&Number) Ca M7 yo p h Owner or Tenant Jo e Telephone No. Owner's Address f Is this permit in conjunction with a building permit? Yes ❑ No ©-(Check Appropriate Box) Purpose of Building �c, 7 ,e Utility Authorization No. Existing Service Amps / _Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,A Completion o the followingtable may be waived by the Ins ector of Wire. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ig ing j rnd, rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o. of Detection and TotInitiatinLy Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump Num erTons KW o.ofSelf-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 WaterNo,of No. No.of Devices or Equivalent Heaters KW Data ! ata Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 4 Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) + Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the p ins and penalties ofp rjury,that the in ormation on this application is true and complete. FIRM NAME: / e— LIC.NO.: Licensee: Signature LIC.NO.:13 (If applicable, enter "ex�etT�pt" . the license n�kmequiresDep Address: (i� �r�- ��� Bus. Tel. No.. �7� *Per M.G.L c. 147,s. 57-61,security worent of PublicSafety"S"License: Alt. L cl.No. required by law. By my signature below, I hereby waive this requirement. I am the(check one) OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage Owner/Agent normally ❑ owner ❑ owner's agent. Signature Telephone No. PERMIT FEE: $ ��