HomeMy WebLinkAboutBuilding Permit #229 - 41 KINGSTON STREET 9/24/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:j Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
AJ
/1 nt PROPERTY OWNER L= IN.7�,t1- .S �G
�jt�
Print
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MAP NO: 4_PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
1 Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well , Floodplain, Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
v
L LJT
Identification Please Type or Print Clearly) z
OWNER: Name: /�yd,� v,e T Phone: 9-7?- 68Y-- 7-)-3 /6
Address: f S t �l/o ,
CONTRACTOR Name: /l ftePhone:
Address: 5 el rl
Supervisor's Construction License: Exp. Date:_
Home Improvement License: 459660 Exp. Date:/ / c
a ARCHITECT/ENGINEER Phone:
i Address: Reg. No.
FEE SCHEDULE:BULDING 7PE..MIT:$12.00 PER$1000.00 TIMATED COSTBASED ON$125.00PERS.F.�
Total Project Cost: $ owA X33 EE: $
�� �, as 2
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have a cess t e u a fund
signature of Agent/Owner Signature of contractor _ '
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools 4
z
Well Tobacco Sales :
Food Packaging/Sales ,
Private(septic tank,etc. Permanent Dumpster on Site
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THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
i
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located"`384 Qsgood.Street
FIRE {DEPARTMENT - Temp Dumpster on site yes no'
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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
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NOTES and DATA— For department use)
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
h
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
❑ 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
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
❑ 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
❑ Certified Proposed Plot Plan
❑ 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)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ 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
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: Doc.Building Permit Revised 2008
V40
® o Andove r
0 0
Is-
No. 2-
o over, -mass.,9 Oq
0 LAKE
COCHI HEWI K
PS`
ORATED BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT................. lA......... .h.�q..:........................................................................ ..................................... Foundation
has permission to erect........................................ buildings on ....41....... ........................... ...... Rough
7i� v . ..... Chimney
to be occupied aso ............................................ ... . .
provided that the person accepting this permit shall in every respect 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
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU Rough
Service
BUILDING INSPECTOR Final
Occupancy Permit Required 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
Street No.
SEE REVERSE SIDE Smoke Det.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Appheant Information Please Print Le ibl
Name(Business/Organization/Individual): APKIQ&26;-rfns ( (:
Address: Is—S�dl
City/State/Zip: LAJ NACe, 1 Phone#A:6- (al I-(( b
Are ou an employer?Check th appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or p -time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner-
listed on the attached sheet. E]Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their
10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees. [No workers' 13. Other (N"� 1 —s
comp.insurance required.) —
*Any applicant that checks box#1 must also fill out these tion below showing their workers'compensation policy of. ation. a/�
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating suLt�Tii.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providi ig workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: / �$ a /
Policy#or Self ins.
Lic.#: (p��p � ��(�37R —d "D Expiration Date:_
Job Site Address:( IZ14165� �Y ,( b.ftK��J ar t City/State/Zip: 144
cv_
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a frte
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insuranc Covera a verification.
Ido hereby c i naltles of perjury that the information provided above is true and correct
Si ature: G / Date: 9�3 w
Phone#: / 6 '' zz
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association;corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another"who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that-"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
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 I,cense is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office'of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications intinygiven year,need only submit one'affidavit indicating current
policy information(if necessary)and under Job Site Address the applicant should write all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel.
#617-727-4900 ext 40b or 1-877-MASSAFE
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia
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WAG
roaD
WORKERS COMPENSATION
AND
i EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (GS60UB-9609L39-0-08)
RENEWAL OF (GS60UB-0960L10-2-07)
INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY
1. NCCI CO CODE: 80411
INSURED: /----. PRODUCER:
HEAT Cv ( ANTHONY & MALCOLM INS
INSULATION COMPANY LLC 3 SOUTH CENTRAL ST
5 SHAWSHEEN RD BRADFORD MA 01835
LAWRENCE MA 01843
Insured is AN FMBItTOMR: .f_.LGG
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 11-08-08 to 11 -o8-o9 12:01 A.M. at the insured's mailing address.
PRODUCER VDAC
I&TF RD WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
CHANGE INFORMATION PAGE WC 99 00 06 ( A)
POLICY NUMBER: (GS60UB-9609L39-0-08)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CHANGE EFFECTIVE DATE: 11-08-08 NCCI CO CODE: 80411
INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY
INSURED'S NAME: HEAT QUEST INSULATION COMPANY
LLC
This change is issued by the Company or Companies that issued the policy and forms a part of the policy. It is
agreed that the policy is amended as follows:
An absence of an entry in the premium spaces below means that the premium adjustment, if any, will be made at
time of audit.
ADDITIONAL PREMIUM $ RETURN PREMIUM $
ADDITIONAL NON-PREMIUM $ RETURN NON-PREMIUM $
THE POLICY CHANGE. DESCRIPTION IS AS FOLLOWS:
CORRECT NAMED INSURED
THE FOLLOWING ENDORSEMENT(S) IS ADDED:
WC89060100-01 CHANGE POLICY INFO ENDT - NAME
WC890GI4nn-ni Dn Try TK1rn bRfiA r...
yt
Fax
6
----- AL--- Pbonc
'""—�---- fie: 511, -----_..
swim
I,bapon St north
❑
uOft �i Fat PoAswt�Ply
Camvft r3 Pb.. D
colurae
Linda ShOft
978-05-7236
C�declG t�?S�ffi�n,CwS .
attic, Ynot we X 311 neyou g We Wed to see i f�h�ey a are,�re walls
batt all knving the entire
haatchrex CALL attic.Also doing air,waling
u' ws t 't WH 'NA C, F'e will be;c g and Huls .
hsre s e gh hmigi�'-sc a cr'the
vents 4Ye»�u► :gee:f t�r ,� ►orae, Thiers tears to be ridge ej lace�� dge•vera aw soffit
• t t yr rt they wire,fainted clfved
'V guesuor's call,my Ceti
in
NONE vq.$11�4tV4
FAL
54
� �6 -�
Measure WORKORDER 9 3303 Undo Short
� Client 41 Kingston st N.Andover
QUANTITY 97"85-7236
I MEA THERSTRIPPINQICA0LKlNO Revised 7020()8 TOTAL
DcaarFits Q-Lon or Equiv. 3 111, 0
Door Sweeps{'Regular)
1 12.:2.5
r Sweeps(AMm,-ejc) 1 19:25
Reglaze Winndows./Iminch 0 0100
Wh1dow,W*th*Sch ftai per side 0 0.00
A4tIC1BasW9M bypm sealing man/hr 0.5 27.50
Attic sealing with 2-part foam nranJhr 0
0.00
SUSTOTAI_ M._
170.00
2'A.INFILY'kA7lON/l't�SULA'ti�Jli
Domesd;:pipe fig IAIWer rink 1st 6' Q 0.00
Sill 3rlsul4on RAs CF
DMPe Perimeter RAS Anch. Sq.ft. 0 D.d30
Drape DOOR R-5 Anc". Q
Tape Joints(Alums grip drily)per hr. 0 ().()()
Duct insulation&Ta#)e Sci.fit. 0 0.00
Rigid Foam Boar!Aitch. 0 0.00
tiydronia pipe insulat,V to'1"R-5 0 0.00
Hydronic pipe ins.1.21;"-1.5"R-5 0 0.00
Steampipe Iris,to1.25:'iron pipe R-5 0 0`
Stearnpipe Ins. 1.50-2"iron pipe R-S 0 0 00
Air CondWoner Meetlnl Rail 0 0.()0
As Cd��le:i��°Govan 2 72.80
-t4
72.80
OW Unrestsl- j k 49 a `6 0 ®:f3
Open Unrestfted R 38 f 0.
Unreshided R jr, 00
(V 3 0.00
00
Open Urit*Striued R 23 25 Fire walls? 42t,V5
Open Unrestrirjed R`1C, b G.00
Re irict,
Fus
Icped H 30 .0 0.00Res�c:t FLIBloped R 20 p
R t Fug►"% 0,d rig 1{)
o ao
R-19 FOE Dpen rafterstwalxVs ,neewells
0.X.
R-11 FOS open raftemwalls/p;.neewails
Cover Feil Down Stairs Therm. dome
,She brant pull dawn simirs 2"foam dux f; 0.00
R-1 latch R-19 iQ-Lon c�.r a 1 28.00 I
i
Kr aftall R-12 cell bchiid Permet mb 0 0.00
Open€safer R-20 Cali. 1w poiy 0 0.00
Sasement Overhead R-19 Abe:Vass 0 0,00
Basement Overtaad ,R-30 fiberglass 0.00
Crawipm Overhead<+t'high Rig D 0.00
GeraOe caihi i0 Mvety filed W;cellulase 0 0.00
Wood,Shake,Clapboard,Shingles Vinyl dense a 0.00
Wood,Shake,Clapboaret,Shingl Vinyl2-holy; 0 0,00
^+:k46tos(single nar0 J Aspnakt dzi:;. 0 0.00
Asbestos(single nail)I Asphalt.2-hole 0
Asbestos(doub. Nail)/Aluminum dense a 0.00
Asbestos(doub.Nail)f Alurninurn 2-hole 0 0.00
BrlcklStuaw dense 0 0.00
BrlcklZi tuna 2-hole 0 0.00
'find eovotrAsbestos 0 0,w
iiuiwiaye(ed 3 or more iaybta V .eiir
ppi�aa R L e.-,.../w -.n d:�? t-.. y.•.y,.J 1 I......a:,. A �.i
tdaill ivu�ll Evf CE.7trr v/ /t)/Iwrbtt'N4►/e.l Ni��aIv/t:M. 'Y
rough M° o*r or tlr:rh-wood Flea 2-h.-le 0 MCI
V /' /: l�iTl i V
DdP finish PR-'ci®r d4ri,A o,
Crib finish .ster 2-hole 0 0.00
est Drift Walis(ail 4) Q 0.00
SUBTOTALS 448.75
2. INSULATION TOTAL 2A.+2B, 521.35
3. STOR"11 iNN.-qMIDEADLiTES
Phwglass up to 8B u.i. 0 0.00
Additional per Ul over 88" 0 0.00
0 0.00 l
Additional per U1 over 88" 0 i1. tD
SUSTOTA T
0.00
5.OTHER MA E ER AL
I CS� MidIN tE!/1. tr ...�.•
Verres Gable rectangular 0 0.00
Wooden Wada*,ve .custom to 42 u.i.
AWhiwai over 42 um.fer verrt per 0. 0 V.00
ir'nn p.:x,# fJ. Vri Sii .) 0.00
i
Vent Roof #135 Lame 0 0.00 `
Vent Soffit. Round 0 0.00
Vent Soffit Rectangular 0 0.00
T'wbo;,�+Vents All 0 0.00 1
Elaek Vent 0 0.00
F"ROPA VENT 0 0.00
a
Permahie Holm Wrap 0 O.ClO
Vapor banier 0 0.00
Low Fiaw Shower Hem 0 0.00
Low Fiaw Aerator 0 0.00
Basement outside door only 0.00
Basement ouwde dcor wl)ami 0 0.00
lwr Rept pm hung 3,-36"St"l"* 9 490.00
Door Rept interior solid wre,28.32" 0 0.00
Dwr Repi pre hung 32-313"wood"" 0
0.00
Rigid Vinyi Repi to 731'U I 0 0.00
Rigid Vinyl Rept 74.84"U.I. 0 0.00
Rigid Vinyl Rept+34-93"U.I. 0 0.000
Rigid Vinyl Repl 94.101 u.1. G OAO
6USTOTALS
490.00
6J7. E.C. MATEMAL!L.ASOR
1181.35
8. REPAIR MATERIALA ASOR '
Lorcet(door)ScNage or equal 0 0,00
Rep.ace Side Stop 0 0.00
Replace Caving 0 0100
Glass Replacement to 84 u.l. 0 0.00
Glans Replacement per u.i. over 114 a 0.00
aaWi 5idelock Replacement 0 0.00
Shi:rus,Replrmnt(Plastic) 0 0.00
Threshold(Wood) 0 0.00
Threshold(Aluminum) 0
0.00
L-Brackets 0 0.00
Window Controls 0 0.00
Vent Beth/Kitchen Fan 0 0.00
Dryer vent w/exhaust duct *inland 0 0.00
Dryer Transition Duct only 0 0.00
Paling Bead 0 0.00
Elide Bolts i 0.00
Pkio Pima Cover 0 0.00
Gut!finish attic kneewall access 0 OM
Labor Rale Hours 2 104.00
;F
SUSTO i ALS 104.00
WAND TOTAL.WORK ORDER 0 3=3 1213.5.35
i
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Vay, J inPn47 F J
.
An;a'rtr� ti rs or viaiiions tmm#tte�ovQ,speeffiC4,0113 involving
extra COM must be CEeared in writing before Instaltatfon.
The Work Order must be complete within 1.0 working days from a=ptance
date below:
I
CCNT.RAC;0RIC,0&4rrA.Niy:
ACCEPTANCE:
AUTHORM SIGNATURE: GATE:
AGENCY APPROVAL:
AUTHORIZED SIGNATURE:
DATE:
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IVlay, I !. zj(,,,% P
f;
rvreater Lawence Coan'munaty Action
Auditor. John Gtr.. Phone:91 -59,)Mw
,lab# _—
I 'Date:
MOP! �+
� _
Last: ave-f
Andress: --�-�-
. '� Sfi" 9stli: 2nd fir
third flr
C- -A—ate_ ., ► Zi� Code q-o
1Z Phone 2
I' .. � rl 4se Type: Cape Ranch �.Crplit
Ifam 2 fam 3,4ar:. duplex otter Victorian Colc�r�ia! ent mHt�
� Mg Type f
1w_(x___j Vinyl Alumn A}b Single Asb Me Conditr#bn Go)Fait Poor
(��'2 cIverAsb ;t 1� r k Stucco A (halt Commenfs:
For.?'Type -- Roof Material
Ga�'e...f - Fiat Gambrel Rubber Tor& Cii�sv81
.._ dda '__jood Fair pbor ;
Heating ,System � Pfir►t out
Man:Achirer: Efficiency
Exa?ss Air
LHD Steai FMA Space Heater Stark Temp
04 Gas Flectric; Pri
mary Temp
Wood Pr�fet Coal
CO 2
Pipes In,Mated: 'es No Co
Tmutd Ducts: r'&� No
CO,AirFree
Ds
ratV
Dome i c!lot Water Tank Flame Cor -
Gas Oil Stectric Tank less Excess Air
Lallans
Temp Setting _.._...� _._ Age
Amb CO: Stack CO: Amb�,Ant C'
Add 6 Feet of pipe wrap YES / NC Date refenred
Co1rimerit.5` Referred tri HWAP Yes No
Ambient CO Readings : Stove ' Oven _ Broiler , Dryer„
[1ay, ' 1 2`'09 '8,r N. 3FP.
1 r 4
client
Dom
;..Rec�alrs7Ar. n�
Swee weep. IN I our
A iitouri 1.��' I I I l
Front tee HJ.' I
Rgar to®tJt i .. bb b 0, ?'
f?atio hall
To Pic
7 t3 easement = i -- --- '
Basement to out
other . ..___._.
other � -�. ._�.
i
i444UVil 4t3rs:,.�iU/1 f
If
Damper YesfNo t+
Bic r poor PA9 Post Reason not doing � A
Knob and Tube Yes NO
i
h—
l.'/.:/'s'Idir�%�i14ir�1'•.
May. 11. 2)09 3. ':9PM hJclient
:..
f
rw�-A11�r �Hb�CM i
Direction
i
3
QJ
Size Comments
Room
----�
12
lei
3
4 t
s
7 3
6 A-;-)a
�a
92
13
44
15
17
T8
19
20
i -
21
22
?3
24
25
26 1 Ll
-�
t uJ Lj
W " ate
i
� TfTi
wiay. i1)V 3: IyrIV N:. J ``—i N. 9
'Client q S}•- 0 Ar
Basement
Conditioned Uncondltloned Crawl spece Dirt floor
Asbestus Yes No Location
adrlyd P 'so. Fast
Dlspe pedP` i&r
Crawl Space 1
Done Swam lean Steam I Copper MW
Z inrft •---_�-
Ducts
t7�ne Yes No M Jc s ank hro
Square fool-vae
i
_ Basement Airsea ft
b
• i
i
Gesement poor Drape Repair Caulk Cit Sweep
fvd . iVJ j; cV ill No :,p4tf+
Client
Floor Plan
i
2nd
3rd
.Sq Feetx►n '
-Common
Adj Total
wa11 X%lease indicate: Unhea,ad //11//r j9xftr1br
nterior well x
Comma,." '++++ r
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IFNI
. ! �....
I
ray• I I. zVV1)
N 047 P
. I
Client l r U.-IM 1 001 or F1 0 12 Calfulase IS
RG or Wool baits 2.2
vermiculite 7 9
s
AMC �.
"en
Tyke. size- �., ,. ..tn �nou►at
/Exlsting R R Added Square Feet Motes
P-7
F/oored—t
Slopes
. Kneerva/ls
G4 �
Kneemll Floor
Flat Roof
Hatches
eathers n and Ba Cut And Close Attic Walk u
Cut and ftish Knob Tube Yes No
Storage to move Yes No Recessed Light;
Cheeks.
av
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Insulation ExIsUng R R Added' a uPre Feet Notes
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Storage to move Yes No Recused Lights
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Attic Air Sealing Notes
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BOard of Building Regulatiaa as a
HOME IMPROVEMENT CONTRACTOR
Reglstratg6"; 153660
EIt�g4 12/21/2010 Tr# 278158
HEAT QUEST INST QC�j1LC
ALLAN VEILLEUX�JR rp
5 SHAWSHEEN
LAWRENCE,MA 01843`
_ Administrator
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' Nlas� hof `�e�artmr Ent°t
gtan
setts ation,an License
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tiitdin. RSpecialty
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ds
g(�ard
Construction Sup
L+cense CS SL 99215
Restricted t°'
W S 1C
VEtLLEVX
5 SNA SHEEMA p18443
RENCE, 811912012
IAW EXpiralj 99215
�i.3iunet•
Location
No. 2 Z Date 1
NaRTM TOWN OF NORTH ANDOVER
F y
Certificate of Occupancy $
J�cwusE`� Building/Frame Permit Fee $ --
Foundation Permit Fee $
Other Permit Fee $
/�j TOTAL $
Check # 2 6 /3
2 2 4 ,1,
Building Inspector