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Building Permit #752 - 495 Forest Street 5/25/2010
BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION % Permit NO:� Date Received Date Issued: TYPE OF IMPROVEMENT PROPOSED USE Resi I Non- Residential ew Buildin One famil Addition Two or more family Industrial ' Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other 11Vell wP ra floodplain Wetlands tVatershec. District a er' ewer t fi d OWNER: Name: DESCRIPTION OF WORK TO BE PREFORMED: Please Type or Print Clearly) 4?7F 4K."3- 6",5-0 C Address: /- J- kog( `Nae. s "CONTRACTOFZ m _ - - Supervisor's Construction lcense 2 g. - T Exp: Datea w "_=/ Tfi 'c License: Date; _ . . ARCHITECT/ENGINEER/a, �— �c;rra� R4,,., -gin., re n - Phone: 97 Q e"2 - 3) iii Pe Box �SVZC A4v rP-' -Address: / 6SJ Reg. No. yo -1 y 4c FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE T;�FEE: L STIMA TED COST BASED ON $125.00 PER S.F. Total Pro'ed Cost: $ $ � - Check No.: 35 7 Recei t No. • D " NOTE: , Persons contracting with unregistered `contractors'do not have access to the guaranty.fund ........_.. Signature of Ageni/Owne ��f%„� ,:,,t, - Signature,R7Contractor . "e— Location No. -;S 2- Date S' o NORTh TOWN OF NORTH ANDOVER a l Certificate of Occupancy $ �� d �' b++.•e ���G Building/Frame Permit Fee $ � Foundation Permit Fee $ /00 Other Permit Fee $ TOTAL $ V_ '22 Check # _ 23'2U'2- Building Inspector -o 9645 Date ....... I .. , . - ... I/ (, .. . /0 .. . ...... . ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .................. k ... viik.v. ..... "t—;—U,) tf6L)S— has permission to perform ...... wiring in the building of .......... at . ...... 5.7 7 .................. . . North Andover, Mass. Fee. 196! ...... Lic. No . .Ry..e... .................. .....f.�..I ............ 4 ......... ELECTRICAL i�SP ��,R Check# z Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art Swimming Pools '^' '• Well Tobacco Sales "' Food Packaging/S°ales, .. Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS Zj T_(1. Z2 / , i HEALTH COMMENTS Reviewed on Reviewed on WE Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments � S -?4 -/O Water & Sewer Connection/Si na & e/ J Driveway Permit DPW.Town Engineer: SigVatur, IV Located 384 -Osgood Street gl(F2E DEP.ARTME"NT Temp Dumps#er on site yes: i 3 no .4 �! 16cated=at 124 M � `� Fire Department signa#ure/date., r 'COMMENTS F.. w v .. 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) 7bJ ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan L. o Workers Comp Affidavit j o. 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)---', t' " +. ❑ 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) i { ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses j o Workers Comp -Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And b 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: Building Permit Revised 2008 �� I NORTN 3,SSUHusi1� CERTIFICATE OF USE & OCCUPANCY Building. Permit Number 752-2011 Date: December 20, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 495 Forest Street, North Andover, MA 01845 RLI COPR. MAY BE OCCUPIED AS ' new sinjjle family home as per plans IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE- BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 previously paid Receipt: 23202 RLI COPR. Building Inspector kORYN y v ,SS1CNUsE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 752-2011 Date: December 20, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 495 Forest Street, North Andover, MA 01845 RLI COPR. MAY BE OCCUPIED AS new single family home as per plans IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY. APPLY. Certificate Issued to: RLI COPR. Building Inspector Fee: 100.00 previously paid i Receipt: 23202 in -� a.w11111Uaren waffs.en Uu uDe���sa�,aeea�+�ae� Permit No. tit y Department of Fire Services Occupancy and Fee Checked 5 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR. 12.00 (PLEASE PRINT MINK OR TYPE ALL INFORMATION) Date: 7- /,,"- / 0 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the un ersigned gives'notice of h' or her intention to perform the electrical work described below. Location (Street &Num i �Af Owner or Tenant Owner's Address 0,V C Telephone No. Is this permit in conjunction with a building permit? Purpose of Building .5 l,,y G lC� Existing Service Amps Volts New Service �� Amps ei /�``' Volts Yes Rr No ❑ (Cheek Appropriate Box) U Utility Authorization No. �®3 717 Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �/ A�, tier el v7 C c ... \ \- , r' i f; frt o -r uhu,ina tnhle may he waived by the Inspector of Wires. C -Attach aaantonat aetau y uestreu, ur ua ieycc — uy Ziac i.Ill -11 •• •• Estimated Value of Electrical Work: / �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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 perjury, that the information on this application is true and completes FIRM NAME: LIC. NO.: Licensee: AJ j t►.l Signatur (If applicable, enter "exempt" in the license number line. U Bus. Tel. No.: Address: /02 ewe -4 !2/] ���r �I�J"l�cr/% Dl�a 7 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. �,,,,.,,.,....,.. , .....,...._....-o No. of Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans . Transformers KVA No. of Luminaire Outlets No. of Hot 'tubs'. Generators KVA No. of Luminaires Above In- Swimming Pool rnd. E]rnd. ❑ 'I'11: 1111 It! ig mg Batter Units No. of Receptacle Outlets ` .` No. of Oil Burners FIRE ALARMS No. of Zones ' No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges , No.'of Air Cond• Tons Tot No. of Alerting Devices HeaTotalp Number Tons KW "'".............Detection/Alerting No. of Self -Contained No. of Waste Disposers Devices No. of Dishwashers Space/Area Heating KW . Local ❑ Municipal Other ther ::�j No. of Dryers Heating Appliances Kit Security Systems: No. of Devices or E uivalent No. of WaterKW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: ".r -'--'---I .,.71... 4L- 7--f- Wirp.y C -Attach aaantonat aetau y uestreu, ur ua ieycc — uy Ziac i.Ill -11 •• •• Estimated Value of Electrical Work: / �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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 perjury, that the information on this application is true and completes FIRM NAME: LIC. NO.: Licensee: AJ j t►.l Signatur (If applicable, enter "exempt" in the license number line. U Bus. Tel. No.: Address: /02 ewe -4 !2/] ���r �I�J"l�cr/% Dl�a 7 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. :a T J .J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 �,4 ,•• • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers __,:...._. Please Print Leaibl, Name (Business/Organization/Individual): Address: Cc ig 6, Old City/State/Zip: #: �%� S �� ,IZ? Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. [1 We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Hereby certify under the pains andplties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Date. . ..... TOWN OF NORTH/ANDOVI PERMIT FOR GAS INSTALLA This certifies that .... Tc- t-:... .............. has permission for gas installation...,ll. t. Vr'. " .7........ . in the buildings of .... P.!.o .................... at .... S. North Andover, Mass. Lic. No.. Fee. ...... SINSPECTOR Check# 0// 7 1IA%Aa SEMU�MRtiIAPPUCATONFORMENU TODO GAS MI TING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 9-13— Building Locations � IeS4' �`�• Permit # Amount $ Owner's Name New Er' Renovation ❑ Replacement ❑ Plans Submitted (Print or Name— Name of Licensed Plumber or Gas Fitter Ch e: Certificate Installing Company Corp. Llc� Partner.. E]Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0— No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy L� Other type of indemnity '� Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent13 I hereby certify that all of the details and information I have Submitted (or entered) in above application are true and accurate to the - best of nn knowledve and that all plumbing work and installations performi!d un(:ler Perrnit Issued for this application will be in compliance with all pertinent provisions of the Massuchu�tts State Gas (bode an)jChapter 142 of the General Laws. By: Title Ci tyiT6wn JAPPROVED (OFFICE USE ONLY) S IaRtralre� Plumber Gas[ter [aster 0 Journeyman sed Plumber Or Gas Fitter MiMnsellq umber w w z° q H �. q rn F H F is q z O ,.• z O F c4 F x O U cn z Orn 04 �A*7''' O q � SUB -BASEM ENT tW.,�• B A S E M ENT p 1ST. FLOOR E ZND. FLOOR 3RD. FLOOR 4T II. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR •a 8TH. FLOOR (Print or Name— Name of Licensed Plumber or Gas Fitter Ch e: Certificate Installing Company Corp. Llc� Partner.. E]Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0— No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy L� Other type of indemnity '� Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent13 I hereby certify that all of the details and information I have Submitted (or entered) in above application are true and accurate to the - best of nn knowledve and that all plumbing work and installations performi!d un(:ler Perrnit Issued for this application will be in compliance with all pertinent provisions of the Massuchu�tts State Gas (bode an)jChapter 142 of the General Laws. By: Title Ci tyiT6wn JAPPROVED (OFFICE USE ONLY) S IaRtralre� Plumber Gas[ter [aster 0 Journeyman sed Plumber Or Gas Fitter MiMnsellq umber Date../ 87b9 has permission to perform ....A- !,. �- ... t7i. q,. �- —. . :�............... plumbing in the buildings of .... C c .......... at.. tic� )— .... North Andover, Mass. Fee .q e(1,. —. Lic. No.J. `- .........l J /'-PLUMBING IN�P Check# TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING • '5SACHUS This certifies that ......... ............... has permission to perform ....A- !,. �- ... t7i. q,. �- —. . :�............... plumbing in the buildings of .... C c .......... at.. tic� )— .... North Andover, Mass. Fee .q e(1,. —. Lic. No.J. `- .........l J /'-PLUMBING IN�P Check# E MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ]DO PLUI MING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 13 - La Building Locatxon%9' �5��� Owners Name l� Permit# Amount p f' .d • d I. Ice _$ ON yy Check 0 e: Certificate (Print•ortypo) D lc�.S orp. Installing Company Name o•"�_!: Address l a � S''e- � � Partner. c< L (1M1�$ c9 l9' - - Business Telephone Firm/Co. '2 �ri'7C� .moi 3 •— Name of.Licensed Plumber: Insurance Coverage: Indicate the -of insurance coverage by checking the appropfiate bor. Bond 1.J ❑ Liability insurance policy Other type of indemnity. 0 ,Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have anyone ofthe above three insurance ignature ' �, Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are.true and accurate to the best of my lmowledge and that all plumbing work and installations performed under Permit Issued for this application will be in —n1ianrt-with all Pertinent provisions of the MasXc'husetts StpPlu g d Chapter 142 o£the General Laws. Cown - ROVM (OFFICE USE ONLY Type ofPlingLicense icens aiNumDer Master E3-0 Joumeyman The Commonwealth ofHassachusetts DCT0*nent o1' rndustrialAccidents Office Of , *PeA—, ations 60.0 Waslzinvon Street -ROstO)2, -W 02111 11'►�W_.rnrzs�goU/dia . Workers' Compensaiaon insurance A -Md vit: BuUde_rs/Con racfors/Uiec . tricians/Plunnbers UP�icant Tnformaf�on Name (Business/Ora nization&divid W): Address: - ' 4 A: City/state/Zip:_ ,C7t �-` % Cr t Phone #* -Are an employer? Check the appropriate box: 1- Ll 1 am a employer with ';� 4. Ty;�X_57vv'(" fecf (required); ❑ I am a gegeral contractor and I 2• Elemployees (full and/or part-time).*have hired the sub -contractors �' onstruction *I am a sole proprietor orpartner_ -listed on the attached sheet 7• ❑ Remodeling ship and have no employees These sub _contractors have b for main an ca act ,, 8 ❑ 73emoIition working y p � workers' Comp. ' [No workers' com . inc„rancq P insurance, 9. ❑ Building addition P ❑ We. are a corporation and its 3 • ❑required.] ofncers have exercised their 10•❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL I I. ❑ Plumbingr airs or additions myself [No workers' comp, C. 152, §1 (4), and we have no insurance required.] t employees. [No workers' 12. Roof repairs k=nSr H_ Ptira rt±5a. ^h Uo box." camp, msrlranc� required-] I3.❑ Other nt Hoiueowners who suamit'tiiis iu e_ , a, y d below Fw �u �� ' V- v,�erK= 00 -p ...s` oe Y s'o� ' -ma. -o affidavit indicating h cog c:k anti = L ,` contractors fhzt checl; this bor �„ 'hen hireouLside con* ze±ops z(i,ist gdbr, lst a new afiioavit indicating such. st attached an addiuoaa.I sheet showing the name"of the sub -contractors and their workers' comp• Policy, information -ram an employer that is providirzg workers' comperzsaiion itz srcrance for my employees IleXoitt is thepolicy and job site. information, Insurance Compiny Name: �-- Policy # or Self -ins. Lic.: apiration Date: Job Site Address:_Q.f,' City/State/Zip: Attach- a copy -of the workers' compensation policy declara$,an page (slaoV,ng the policy number -and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. I52 can. lead to the imposition of criminal penalties of a One up to 50-. 00.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDERand a fine a es to X250;00 a day against fine violator. Be •advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby terrify under the pains and p : ties o er u�on provided above is ttu • � f p y � th xt the informe and correct -- Date. _ -- Phon e# [6. ficial rose only. Do not write in this m ea, to be eu►rzpleted bj: city or town official t------- City or Town: Perznif/License # • jZd uthority (circle one): of Health 2. Eutgtuub Department 3. City/Town Clerk 4. EIeciricaI inspecfor 5. PIumbiri� Inspector er-sotz: Phone': «-* -x CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 752-2011 Date: December 20, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 495 Forest Street, North Andover, MA 01845 RLI COPR. MAY BE OCCUPIED AS new single family home as per plans IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 previously paid Receipt: 23202 RLI COPR. Building Inspector J rA W as t I . , ; -P" s; _ v�v c ..- o O co 0 O Z co O � a, y c • :.0 h O ca CD.La C EW ZW ow t O W CD CDd 0 Q L O �Q y zQre o v CJ J 'p ca O Z ts a V N Q � co C o _Q 0 Q y cm SLm c N A H 07 O C G x p cu/n) w cin cn s; _ v�v QJ CD F. �J 9 V •ria 2 6 0 O c ..- o O co 0 O Z co O � a, y c • :.0 h O ca CD.La C EW M_ CD MM iY ow t O W CD CDd 0 Q L O �Q y C o *.a c ccc CJ J 'p ca O Z ts a V N Q � co C o _Q 0 Q y cm SLm c N A H 07 co 3: m C C � v A �ca MA o con'sa N CD O N C � O H O. m c _ o �-- :ago ~ 00+ CIO N m r0+ •N -ELM ea C F_ ac •E � .r N Lw m c3 � cm, ® c o COD d ®'O O OM= CLO - QJ CD F. �J 9 V •ria 2 6 0 O O co L O O Z co O � a, y c a� cm ca CD.La �-0 EW M_ CD MM iY ow t O � CDd 0 Q L O �Q y C o *.a c ccc CJ J 'p ca O Z ts V C Q C _Q Q y LLI U) W W W 0 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # ADDRESS&OCATION OF PROPERTY: Map 0 Parcel Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: / . 3 - / o FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARmm IF TW= eToi ir%-rl 10c DOES NOT MEET ALL APPLICABLE CODES. 1 e�-�; CC• em -,L.-. 1111IL 1�7.7Ufi-U L%# Address SIGNED RO TIN CONSERVATION PLANNING I,;?//7w DPW, WATER METER ®1d 611 b SEWER/WATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITT LOF THE OCCUPANCY/INSPECTION REQUEST DPW Signature Fife: Application for OC font revised Jan 2007 n T9 REScheck Software Version 4.3.1 Compliance Certificate Project Title: R.L.I. Corp Energy Code: 2009 IECC Location: North Andover, Massachusetts Construction Type: Single Family Building Orientation: Bldg. faces 180 deg. from North Glazing Area Percentage: 18% Heating Degree Days: 6322 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: Lot 2 503 Forest St North Andover, MA Compliance: Maximum UA: 318 Your UA: 309 Gross Cavity Cont. Glazing UA Assembly Area or R -Value R -Value or Door Perimeter U -Factor ,.,emny r: na[ uemng or Scissor i russ Wall 1: Wood Frame, 16" o.c. Orientation: Front Window 2: Vinyl Frame:Triple Pane with Low -E SHGC: 0.35 Orientation: Front Door 1: Solid Orientation: Front Wall 2: Wood Frame, 16" o.c. Orientation: Right Side Window 3: Vinyl Frame:Triple Pane with low -E SHGC: 0.35 Orientation: Right Side Wall 3: Wood Frame, 16" o.c. Orientation: Left Side Window 4: Vinyl Frame:Triple Pane with Low -E SHGC: 0.35 Orientation: Left Side Wall 4: Wood Frame, 16" o.c. Orientation: Back Window 1: Vinyl Frame:Triple Pane with Low -E SHGC: 0.35 Orientation: Back Door 2: Glass SHGC: 0.35 Orientation: Back Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 1448 30.0 0.0 51' 608 19.0 19.0 15- 160 5160 0.350 56 21 0.350 7 384 19.0 19.0 11 50 0.350 18 384 19.0 19.0 12 22 0.350 8 608 19.0 19.0 16 92 0.350 32 42 0.350 15 1448 19.0 0.0 68 Compliance Statement. The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2009 IECC requirements in REScheck Version 4.3.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name - Title Signature Project Title: R.L.I. Corp Data filename: C:\Documents and Settings\Wililam Hurley\Desktop\brunoaudit.rck Date Report date: 04/03/10 Page 1 of 4 REScheck Software Versic Inspection Chep Ceilings: ❑ Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Above -Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R-19:0"cavity + R-19.0 continuous insulation Comments: ❑ Wall 2: Wood Frame, 16" o.c., R-19.0 cavity + R-19.0 continuous insulation Comments: ❑ Wall 3: Wood Frame, 16" o.c., R-19.0 cavity + R-19.0 continuous insulation Comments: ❑ Wall 4: Wood Frame, 16" o.c., R-19.0 cavity + R-19.0 continuous insulation Comments: Windows: ❑ Window 2: Vinyl Frame:Triple Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes Comments: ❑ Window 3: Vinyl Frame:Triple Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes Comments: ❑ Window 4: Vinyl Frame:Triple Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes Comments: ❑ Window 1: Vinyl Frame:Triple Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1: Solid, U -factor: 0.350 Comments: ❑ Door 2: Glass, U -factor: 0.350 Comments: Floors: ❑ Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-19.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Air Leakage: ❑ Joints (including rim joist junctions), attic access openings, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed with caulk, gasketed, weatherstripped or otherwise sealed with an air barrier material, suitable film or solid material. Project Title: R.L.I. Corp Report date: 04/03/10 Data filename: C:\Documents and Settings\Wililam Hurley\Desktop\brunoaudit.rck Page 2 of 4 Air barrier and sealing exists on common walls between dwelling units, on exterior walls behind tubs/showers, and in openings between window/doorjambs and framing. Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. Access doors separating conditioned from unconditioned space are weather-stripped and insulated (without insulation compression or damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed to maintain insulation application. Wood-buming fireplaces have gasketed doors and outdoor combustion air. Air Sealing and Insulation: Building envelope air tightness and insulation installation complies by either 1) a post rough -in blower door test result of less than 7 ACH at 33.5 psf OR 2) the following items have been satisfied: (a) Air barriers and thermal barrier: Installed on outside of air -permeable insulation and breaks or joints in the air barrier are filled or repaired. (b) Ceiling/attic: Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c) Above -grade walls: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d) Floors: Air barrier is installed at any exposed edge of insulation. (e) Plumbing and wiring: Insulation is placed between outside and pipes. Batt insulation is cut to fit around wiring and plumbing, or sprayed/blown insulation extends behind piping and wiring. (f) Corners, headers, narrow framing cavities, and rim joists are insulated. (9) Shower/tub on exterior wall: Insulation exists between showers/tubs and exterior wall. Sunrooms: Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U -factor of 0.50 and the maximum skylight U -factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Vapor Retarder: Vapor retarder is installed on the warm -in -winter side of all non -vented framed ceilings, walls, and floors; or it has been determined that moisture or its freezing will not damage the materials; or other approved means to avoid condensation are provided. Comments: Materials Identification and Installation: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R -value. Materials and equipment are identified so that compliance can be determined. Fi Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R -values, glazing U -factors, and heating equipment efficiency are clearly marked on the building plans or specifications. Duct Insulation: Supply ducts in attics are insulated to a minimum of R-8. All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction and Testing: I] Building framing cavities are not used as supply ducts. Ej All joints and seams of air ducts, air handlers, filter boxes, and building cavities used as return ducts are substantially airtight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Tapes, mastics, and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction. Metal duct connections with equipment and/or fittings are mechanically fastened. Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet -metal screws. Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists, mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). D All ducts and air handlers are located within conditioned space. Heating and Cooling Equipment Sizing: Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating (Sections 503 and 504). Project Title: R.L.I. Corp Report date: 04/03/10 Data filename: C:\Documents and Settings\Wililam Hurley\Desktop\brunoaudit.rck Page 3 of 4 Ci.j.ulating Service Hot Water Systems: tj Circulating service hot water pipes are insulated to R-2. Lj Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: C] Heated swimming pools have an on/off heater switch. F-1 Pool heaters operating on natural gas or LPG have an electronic pilot light. Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar- and/or waste -heat -recovery systems. Lj Heated swimming pools have a cover on or at the water surface. For pools heated over 90 degrees F (32 degrees C) the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60% of the heating energy is from site -recovered energy or solar energy source. Lighting Requirements: r-1 A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a) Compact fluorescent (b) T-8 or smaller diameter linear fluorescent (c) 40 lumens per watt for lamp wattage <= 15 (d) 50 lumens per watt for lamp wattage > 15 and <= 40 (e) 60 lumens per watt for lamp wattage > 40 Other Requirements: F-1 Snow- and ice -melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a) the pavement temperature is above 50 degrees F, b) no precipitation is falling, and c) the outdoor temperature is above 40 degrees F (a manual shutoff control is also permitted to satisfy requirement's'). Certificate: F -I A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R -values; window U -factors; type :and efficiency of space -conditioning and water heating equipment. The certificate does not cover or obstruct the visibility of the circuit directory label, service disconnect label or other required labels. NOTES TO FIELD: (Building Department Use Only) Project Title: R.L.I. Corp Report date: 04/03/10 Data filename: C:\Documents and Settings\Wililam Hurley\Desktop\brunoaudit.rck Page 4 of 4 d- N pUD `+- L X00 O O N C Q n U D (n LD m L r ® C � •C� co Z3 (n L 00 O 3 a) (i) (�f �.40 o V C _A � r- • s� civ N d- C •E U pUD `+- L X00 O O N C Q n U D (n LD t� L r ® C � •C� co Z3 (n L 00 O 3 a) � Q.� Z3 • m N O C--4 0-4 00 E 0E cn -� �-- 0 CK 0 0- x U) 7 E m v� '� V- Q> CDcl f N ■■ ■■ ■■ ■■ ■■ ■■ ■m am am :: :: LN C . .: •:n.IL. _ , .; ..i. a �� . a ..:. _'^l„ ,w V Y ,.. r.. � . ...; ::,J Pl.: t. .d 9.: A}. � ,. ,. .,. TL..:: .N' . . . . '•,1 .. 77 ., �:'.. .. , P.§i'.S' '•:4 T .,. 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CA Q uj 0 N LU Y♦ 19 W uj W U) .A:�— MasNach usells - Depallinew fit' Public .,salcuk Board id Buii(fing Regulations and Sian(lziy4ls Construction Supervisor License License: CS 58839 Restricted to: 00 ROBERT L INNIS 3 LORRAINE TERR BILLERIC A, MA 01821 Expiration: 6/2512010 Tri: 27791 1. I J . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 N"ashington Street Boston, M4 02111 Workers' Compensation Insurance Affidavit: guilders/Contractors ylicant Information /Electricians/Plumbers --------------- n,--- - Name (Business/Organization/Individual): L Address: 4 9 5 R.. n,L City/State/Zipj Phone #: (- Z)f � -,� � ---s— r- - _ Are u an em 1 p oyer. Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor 2. ❑employees (full and/or part-time).* I am a sole and I have hired the sub -contractors proprietor or partner- listed on the attached sheet $ ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation 3. ❑required.] I am a homeowner doing all and its officers have exercised their work myself. [No workers' right of exemption per MGL comp. c. 152, § 1(4), and we have no insurance required] t employees. [No workers' comp. insuranc Type of project (required): 6. &j New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions I I. Plumbing repairs or additions 12.7 Roof repairs L y e regwred ] I 13. ❑ Other applicant that checks box #1 must also .ul out the section below shoiving t _ _ com I3orileowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. r._...,.....,... r......, :nfo...-a_on. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their wnrk—, l um U17 empwyer that is providing workers compensation insurance or m employees. Below lS the policy and job site information. p f Y Insurance Company Name: 6:/ -Awl , -/- �-L„ / , . . Policy # or Self -ins. Lic. #: C 3 Expiration Date: �- L a_ ©- Job Site Address :��y� n �. Gl- City/State/Zip: Attach a copy of the workers' compensation policy declaration .page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties penalties nd ofine in the form of a STOP WORK ORDER aand of up to $250.00 a day against the violator. Be advised that a copy of this stat Investigations of the DIA for insurance coverage verification ement maybe forwarded to the Office of �� �.,y -r,-u yu/nder t`he p/ai/n� and penalties of perjury that the information provided above is true and correct imb� Official use only. Do not write in this area, to be completed by city or town offciaL City or Town: Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Tom 6. Other Permit/License # Clerk 4. Electrical Inspector Contact Person: Phone #: 5. Plumbing Inspector Information an d 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 perruitor license is being requested, not the Depa.-=ent 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 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 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 021.11 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 vcm.mass_gov/dia lJO l8SUED;BY►THEWOCK{INSURANCE [COMPANY►HEREIN CALLtDiTHE[COMPANY COMPANYGRANITE STATE INSURANCE 13102 R L I CORP 475 BOSTON RD BILLERICA, MA 0.1821-0000 SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 EC14Alf NUMBER IPOLICYJ,NUMBERI /1 i/. oo WC 007-43-3577 013-66-0509-00 EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 IA# A6 91 1- DAVID J DEANGELIS INSURANCE AGENCY INC WORKERS COMPENSATION AND EMPLOYERS 283 MERR I MACK ST LIABILITY POLICY INFORMATION PAGE METHUEN, MA 01844-6457 INSURED ISPREVIOUS POLICY NUMBER RENEWAL 0082 144 CORPORATION OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M. standard time at the insured's mailing address 05/o6/o9 TO 05/06/10 FROM Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed ITEM 3 A. Workers Compensation here: MA B. Employers Liability Insurance: Part Two Of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodiiy Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 10O OOQ each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A D. This policy includes these SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEMAI The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Number Estimated Total Remuneration ❑X ®3 Rate Per $100 OF Re- muneration Estimated Premium ®Annual 11 3 Year Annual Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $165 EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) $338 MA I I I MINIMUM PREMIUM S3135 MA TOTAL ESTIMATED PREMIUM S2.977 If indicated below, interim adjustments of premium shall be made: n Semi -Annually 0 Quarterly ® Monthly DEPOSIT PREMIUM 05/05/09 ASSIGNED RISK 66 Issue Date Issuing Office 39967 (Rev'd 04/08) Authorized Representative wC 00 00 01 e =' w PUBLIC HEALTH DEPARTMENT _ Town of -North Andover Community Development Division - RTIEICA TIF 0 E CO3fi- As-of: y December 8, 2010 - This is to cert that the individuafsu6surface disposal system received a SATISEWTORTIM(PECTIOYof the: RfpfitGewnt of an Individuaf _ 6n -Site Sezt>age- Disposa[System AV6ert L Innis t: f .. 503 Forest -street, a& Get 2 9Wap-106.B (Parcel= 0244 210/106.&-0244-0000.0 i1 forth .Andover, a" 01845 The Issuance of this ceriificate shaff not be construedas a guarantee that the system wiCCfunction satisfactorify. S an Y. Sawyer, 4?f3algU -Iftffic MeaCth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com r , ' .�. �....�-o•.r� +_e._ � � -..� -. � _ +�.•..- � �.�. a _ ..�_. - � _ _ - _.i_ �_. _�.� 4.. r 1 �10RTN ' OT -all. .. 1AI. ti p ss,�` SES APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECT ION Building Permit # ,] ADDRESS/LO CATION OF PROPERTY ._ 4qS (aif-�: MaParcel C Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: / c;Z,3 / FIVE 5 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. .. ✓GFR:={ s1.L�. - Address SIGNED RO TIN CONSERVATION - PLANNING DPW-, WATER METER lal 6//0 SEWER/WATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL, OF THE OCCUPANCY/INSPECTION REQUEST DPW Signature File: Application for OC form revised Jan 2007 PUBLIC HEALTH DEPARTMENT Town of North -Andover Community Development Division CER2'IFICA�IE OF C0�1PLI.AArCE As of: December 8, 2010 This is to cert that the individuaCsubsurface dZsposafsystem received a S T1'SEAC'T0RT15VSPEC`7 05V of the: ft&cement of an Individual On Site Sewage osalSystem 'By� . 9?96ert G. Inns At: 503 Torest-Street, a9 Got 2 Wap -106.B (Parcel— 0244 . 210/106.B-0244-0000.0 jr, Forth Andover . q 01845 The Issuance of this certificate shallnot be construedas aguarantee that the system wifffunction satisfactmif . 'Y. Sawyer, q5, MeaCth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 - Fax 918.688.8416 Web www.townofnorthandover.com 7400, Date. AV /. %U ..... . T# TOWN OF NORTH ANDOVER . D � PERMIT FOR GAS INSTALLATION This certifies that ...?'3-�`............................. . 11%' has permission for gas installation. /pC �..��'��...Ae in the buildings of .. ... PAt ....................... �` at s ....�?VS .... .. ....., North/Andover, Mass. dd Fee Lic. No.. T.1 ... .... �. �` . , . . GAS INSPECTOR Check # oidaA AWACHUSET IS UNMRXIAPPUCATONFOR PERTNIrrI O DO GAS Ffr]nNG (Type or print) Date / NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New Renovation❑ R -placement 1p . Permit # Amount $ R S Plans Submitted (Print or Name_ Address ess N Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. Partner.. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 0 If you have checked yes, please indicate the type coverage by checking the appropriate.b Liability insurance policy 0 Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 0 I hereby.certify that a]I of the details and information I have submitted (or entered) in above application are true and accurate to the - best of m} knowledge and that all plumbing work and installations performed under Permit Issued For this application will he in compliance with all pertinent provisions of the Massuchustate Gas Code id Chapter 142 of the General Laws. By: Title CityiTown JAPPROVED (OFFICE USE ONLY) gignature of Licensed Plumber Or Gas Fitter Plumber C-/ t-1 Gas Fitter ice�nse Number Master JOurneyrnan F W x a O a O U Fi z z O E- w O W7 F �Z H z y W C7 .z1 rJ CG a o c a H o °o w o° SUB -BASEM ENT BASEN11 ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4T II. FLOOR 5TH. FLOOR 6TH. FLOOR '1TH. FLOOR 8TH. FLOOR (Print or Name_ Address ess N Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. Partner.. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 0 If you have checked yes, please indicate the type coverage by checking the appropriate.b Liability insurance policy 0 Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 0 I hereby.certify that a]I of the details and information I have submitted (or entered) in above application are true and accurate to the - best of m} knowledge and that all plumbing work and installations performed under Permit Issued For this application will he in compliance with all pertinent provisions of the Massuchustate Gas Code id Chapter 142 of the General Laws. By: Title CityiTown JAPPROVED (OFFICE USE ONLY) gignature of Licensed Plumber Or Gas Fitter Plumber C-/ t-1 Gas Fitter ice�nse Number Master JOurneyrnan PRINTED BY: Pamela DelleChiaie - PLEASE LEAVE IN PRINT-OUT TRAY....... THANK YOU. DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, November 29, 2010 9:03 AM To: DelleChiaie, Pamela Subject: innis Yep, Bob is asking for a final grade for 495 Forest or as we know it 503. S Swan SaUlyu J ubfic , eaft Omecta4 1600 Vageod Street JDC4 20, unit 2-36 ✓V"d andav", .MQ 01845 agice 978 688-9540 tax 978 688-8476 . All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/preidx.htm ]Massachusetts Public Records Law. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 11 IDFI DelleChiaie, Pamela Testa Associates, LLP P.O. Box 5536 Wayland, .Massachusetts 01778 Phone.: (508) 561-1260 Fax: (617) 969-0628 rj'testair&Lnail.com May 23, 2410 Bob Innis RLI Corp Project: 503 Forest Road N. Andover, MA Dear Bob: I have analyzed wind shear associated with the new house at 503 Forest Road in North Andover. The wall of the new house needs 1/2 EXT grade plywood with the following nailing schedule: 8d nails at 4" o.c. at all free edges (provide blocking at all free edges) and 8d nails at 6"o.c. at all interior supports. Provide 12- Simpson Strong -Tie Strap Tie Holdown STHD10 as shown on the drawings and provide 1/2" x 9" long anchor bolts with 3" x 3" square washers at 6'— 0" o.c. between the Strap Tie holdowns. This construction would meet the requirements of the 7h Edition of the Massachusetts State Building code. If you have any questions, please feel free to call me at 508-561-12,60 Sincerely yours, Richard J. Testa Jr. P.E.