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Miscellaneous - 10 IRONWOOD ROAD 4/30/2018 (2)
'--, ll-� e.� e.j.q Date........ ..... .... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING L This certifies tha ................................. A ............ has pennission to perform ..... 6 ....... ....... ............. ............. ........ wiring in the building of S ............................................................. .... ..... .. .... .......... ..... .. ... .... .. at ..... Lb ......... ......... f.?.b N -th Andover Mass. ! /,) 01 . ............ Lic. No. M23 ... ................... Fee.,;::,�- E EC R CA INSP Q bla Chedo 1 r" 1'- 6 �' 7 a (fomtnonweafik o f Mad�acfu JAt<t'. Official Use Only rc�� Permit No. 2epartment of 5 ire Servicea UIN Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 (PL E.ASE PRINT IN L1rK OR TYPE ALL IAiFOR-AMT10A9 Date: 4f �,�,F -/y City or Town of: _,d�j2� To the Inspector• of Wires: By this application the undcrsi2ned Qives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant G'��r�6tE i .T/✓w,,eel X;,pR,eom,,,G' Telephone No. Owner's Address /!5) Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building_ Utility Authorization No. Existing Service ,?42 Amps Volts Overhead ❑ Undgrd,Tl New Service Amps / Volts Overhead ❑ Undgid ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work:l�AC�.ni//�.�. p� (rC.n2d 9 i4 to G..�� /,c o v Jf� f<.�'fC�Y /L. c { liliJl if r. Comnletion ofthe falloivinn tahle may he ivnived by the lncnrrtnr of tf,'irov No. of Recessed Luminaires _ No. of Cei1: Sus¢. (Paddle) Fans No. o Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In ❑ rnd. rnd. o. o mergencyLighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Aterting Devices No. of Waste Disposers Heat Pump Totals: Number Tons . . ................... KW "' " No. of Self -Contained Detection/Alertin Devices No. of Dishwashers Space/Area`Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security ystems: No. of Devices or Equivalent No. of Water KW Heaters No. o No. of Signs Ballasts Data Wiring; No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP 1'elNomfDevictso r uivI : No. of Devices or E uiva�ent OTHER: Attach additional detail if desired, or as required by the Inspector of IN.res. o 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. CHECKONE: INSURANCE ❑ BOND ❑ OTHER ® (Specify:) General Liability 12/31/12 I certify, under the pains acrd penalties ofperjury, that the information on this application is true and complete. FIRMNAME: Boissonneault Electric Cor12. LIC. NO.: 1 18 2 3A Licensee:P="l _ Signature__,,�e LIC. NO.: (If applicable, et— rte empt " in the license number line.) Bus. Tel. No.: (9 7 8 ) 454-0383 Address: -16 rbuck Dri va _ prarnt r MA 01 826 Alt.'rel. No.-.-( 978 ) 458--9977 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent j PERMIT -FEE. $ Signature Telephone No.-_ De Cowdoniveaft oft assachasef% Department ofTizdus#!q1Acddks • . 0. flee o,�'..�i�e,��igafeoas 00 WaSA OO- tstreet -Roston, HA 02111 wwwmussgovIdliz - wo r keys' comp ex5afzou Yourancry . tclaviit: erg A 11gan orccaatzo 'X a e xicn t; bXv �a�tle(Susinessi0rganiaaiionJlndz`uiduat}: ,�ij ' - Address: - Cz�v/ �ai�t n: I� / e. �/ ✓�- d� fl2 Phare : ��� c/S V D 3. E 3 . A.rey employer? Check Me; appropriate box: Type of'project (xegmdred): 1• 1am.aemployer-with._ /7 4. ❑ Z ageneralconixactaxandS 6.ev�c6nsix�zc�zon F employees (TIMandloxput-fte).T ha�veluredthosd -contractors 2. [7 S am a sale proprietor or parinex listed on the aiEached sheet° T `1• �( �-emedeliug MP and`7�aveno.employees These sins-contxactoxsh:ave 8. Demolition working forme in. any capacity. workers' comp. insurance, g, El Building addition [No workexs' comp. insurance 5. El we are a cor�poragon and its .10 . 10. Blectricalxep*s ox additions xegaked.] officers have exercised. their 3. [� X am a homeowner doing all work light oil exemption per MOL 1111 Plumbingxepairs or additions myself< �lowgrkers' comp. c.152, §1(4), and we, Raw na 72.Q Raoixepairs insuxazac�xecluired.� employees. (No workers 13.0 OtTiex comp. insurancexegafred j Any applicautthac checks boli musEalso lTlouitkeseefion beldgrsho�tingibeirvrorkers' compensat[onpolicy infounation. 7 orneovrnersvrho sutmitthisaWdavitindfoatingifieygedoing aaworlcandthenhueoutside contractors munisuIm taneviafddagitindicafngsuch. xConiracfors'diatcheektbisho mvstaffachedaagdditionalsheetshovringthenameofthesub-eoniracforsandtheuworkers'camp,poJicyinformation. Io axe-mproyej-fAatisprovidiragworkers' coin ge�asationinsr�rar2ceforY�xyet�royees; Ber IVistkev lie andjobsite in, fomatiov. ksuxance Company Name; C,�c'CI-e4 /I/4ALnel! policy # ox Belf vis. 11G. Jbb Site Address: iia eh a copy o lie workers' coznpeniation-p oltey cleclaratiou page @1 owiug•tlte policy' n m mer and eU ration trate). yailMe,toseeuxe<coverage,asxeciozccfundorSection 25A.ofmcrLG.x52canleadtotheimpositionofeximinal enaliiesoz"a faze up to $1,500.00 andfox one-year impxisopmentx as well -as GbRpenel-des in thio foxzn of a STOP WOPX OBDM and a fine o£up to $250.00 a day againsttite violator: Be advised that a copy ofthis statem entmay be foxwardedto the Oiftce'Of Tnvestigaiions ofthe DlA. fox iirsmance eovexage verification. .a do hereby eer " der tXie_&ins anr%enalfles of verjary triat tragi Word= ioy"provided above is tate and correct Date: phone#: 1 ,V 5'Y D3 e 3 Q(ei¢Z USS ogy..Do not write in dais area, torte comyreted by ciiy or town official City or Town: �erznit/Liceztse# Issuing Author!* (circle One): 1. )3aax'tl OgHealth. 2. BuiltlirzgDepartmend 3. Cityffowti Cleric 4. Blectrical Inspector 5.P nwbingfuspector f. Outer r - Information and -Instructions., nstruction . - Massachuseits General Laws chapter 152 requires all employers to pxovide workers' compensation for their employees. .Pursuanttothisstatute, anervployeeisdoflnedas"...evexgperson:ktheserviceofanotherunderanycorifracto b7xe; el-vr ss or riffled, oral oxwxitten2-, Ane'71 gye defined as "an individual, partnership, ass n, corporation o� otherlogal entity, ox aoy i�ra oxmoxe ofthxegoing engaged in anoint enterprise, and includingthe legaixepresentatives of a'deceased em lQyex,.or the xeaeiver Ortrtistse of au individual partnership, assoolation or other legal entity, employing eniployee . however the ownerofadwo nghousehavingnnotmoxethaatbxeeapartmentsandwhoxesidestherein,ortheoccupantof'the dwellinghouse of another who employs persons to do maintenance, consfxttetion orxepair woxlt ort suolz dweilznghouse ox oxtthegrounds orbuilding appuxLenanttltereto shalinotbecause ofsuch employmeutba deemedto be an employer." MGL chapter 152, §25C(6) also states that "every state or lacal XZceuszug ageztcy shall wzfliltoXd the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for arty applicant who has not producect•acceptabla evidence of compliance with the insurance coverage required." Additionally, MCxL chapter 152, §25C(7) states "Neither the commonwealth nor any ofits political subdivisions shall enter into any contxactfox the performance ofpubiic woxkuntil acceptable evidence of coznpliauce with, the insurance -requitements Of this chaptexhave beenpresentedta the contracting authoz7.iy," Applicants Plea -so fill out the workers' compensailon affidavit completely, by cb eckiug the bores that apple to your situation and, if necessary" supply sub-confxactor(s) name(s), addresses) andPhonenumber(s) alongwiththeir cerecate(s) of insuxmce, LimitedLiabiliiyCompanies (LLC) orLimitedUbilityPaxtaerships (LU)withno employees otherthmthe members orpartners, arenotrequiredto canyworkers' compensationinsutance. TfanLLC oxLLP doeshave eznployees,apolicyisrequired. Beadvhedt7iattMi aiddavitmaybesubmittedtotheDepathuontof Industrial Accidents for con fitn ation ofinsuranco coverage. Also be sure to sign and date the afZdavi . The affidavit should be retarnmedto the city or town that the application for thepexmit or license is being requested, xtot the Dq�artm.ent of JndusirzalAccidenis. Shouldyouhaveanygttestionsxegar>helawoxiiyouaxexecfaixedioobtainay,*orlrexs' compensation.policy, please call the Department atthgnamberlisted below. Selfinsuxedcom pule sSAO-aid enter their self^insuxance license number on the appxopxiate line. City or Town Mcials Pleasebesuxethatthe a�,ldavitisComplete andpxintec,legibly. TheDapax nentbaspxovidedaspaceatthehoitonx oftheat dav,tfoxyoutaiiiontIn.theeventtlteOfficeofkvestigaiionshastocoxttacxyouxegaxdingtheap licaut. Please be-suxe, to ilii irtthe permit/license number wbieltwill be used as a xezexence number, Tn addition, art applicant thatmustsubmitmuitiplepexmzt/lzcenseapplzcaizonsin,anygivan.year,need only submit one, afgdavitindicatin c1m6n,' PORGY infoxmaflon. (ifnecessmy) and under "M Site.Address"tfte appUcant shouldwx1te "alllocationslb.(city or towft):':A.'copy ottl e affidavit thathas been ofdciallystainped oxma&dby the city oxtownmaybepxovided to the applieantaspzbol~thatavalidafitdavitzsonfiiel'oxfuitixepexmitsoxlicenses. Anew azfxdavitmtistbefllledouteach year. Moro ahoxneownexoxcitizen isobtain7ngalicenseoxpex2itr<otrelatedtoanybmittessorcommexciaZvenma (i.e, a dog license orpexmit to burn leaves eta.) said p erson is WOTxegaired to complete this affidavit. The Office of invest gations' would like to th n%you in advance f'ox your cooperation, and should you have any gttesttons, please do not: hesitate to give us a call. The Department's address, telephone aitd fa�numbex: T`ha GQM-.MQU Ii o It s a��hv Pt 6Q()aq&. ion xe Doatan:� MA. 02111 Revlsed 5 -26 -OS ftCOMMONWEALTH OF MASSACHUSETTS,: nnean nc BER EXPIRAI IVN UP G DATE: , �/ JI/�`I U, U:w �l 2, ,mj� wll��,milllf{ • "i LOCATION: /a Aagel OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL AS S I D E N fl`AP COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: Ka- - Fv--e- Ctk-ti� *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL 1 4 x3 4. North Andover MIMAP August 28, 2014 104:0-0114 1114. -0i13 --009 9/iO4. 01 19 _ 600 DALE ST _ 5 DALES - - f �" 573 D,�� - - _ = : •' - : - - 104.0-0.020 10 C-0021 -1D4 C-0025 .. -_ .: _water: Protection - t 90IRONWOOD'RDNo RONW 104.0-0i 15 IRON WOOD D - - iO4.C. 143I 4R N 00DRD' - 1 14.0-0145 101- DALE 251RONWOOD RD 529 ST Rail Line « Wetlands Zoning Interstates 0 Exempt Lands G Busine _ I O Busine s 1 District 5 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — SR C Busine 0 Businei s 3 District s 4 District NORTH Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of -- Roads ■ Gene r Easements O Planne ql Corrido Business District Of o q Commercial Day. e6tt� r6 0 Development Dist North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is O MVPC Boundary O Corrido Q Municipal Bounds C Corrido Boundary ,; ( Development Dist Q f° Development Dist H p for planning purposes only.It may not be adequate for legal bounds definition or regulatory y G 9 boundary 9 ry interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning Overlay C Industri 0 Adult Entertainment A Indusld O Industn 11 District 2 District 4 s � .� 13 District i THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT 0 Downtown Overlay District � Industri o e �� ♦ I S District ♦q ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Historic District 13 Water Protection ResiCde Reside ce 1 District 2 District S`TgCMUS� THIS INFORMATION ❑ Parcels 0 Ride ce ce 3 District O Hydrographic Features de 1" = 120 ft ede ce4 District ce 5 District — Streams de ce B District m e esidenlial District Date ...... ?/�//# .. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 'fb is certifies that.6?e..ee...,I .... ......... . .... ........ ... .... ....... .................. has permission for gas ............................. in the buildings of... Z.& ................ at... Z ��Q ............... . North Andover, Mass. Fee..A..P Lic. No.'13t(Y ...... ......... * ...... SINSPECTOR Check # 3C587 9506 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIIIT # JOBSITEADDRESS I—�/ 8 OWNER'SNAME GOWNER ADDRESS D TEL�FAX TYPE OR OCCUPANCYTYPE COMMERCIAL Q EDUCATIONAL D RESIDENTIAL4 PRINT CLEARLY NE : I RENOVATION:E] REPLACEMENT: ® PLANS SUBMITTED: YES 0 NOD APPLIANCES'l FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE _ .. I (-._i..- . _ _ - _ . _ DIRECT VENT HEATER(- DRYER FIREPLACE FRYOLATOR _I FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER _ ROOFTOP UNIT TEST UNIT HEATER UNI/ENT D ROOM HEATER WATER HEATER OT'r",cR- - -- - - - _ ............ .........�.�_ INSURANCE COVERAGE I have liability insurance its the MGL. Ch. 142 YES f]I NO a current policy or substantial equivalent which meets requirements of �I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' OTHER TYPE INDEMNITY El BOND D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the _ Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true d ac urate t the be t f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compl' nce wit a e vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME _ LICENSE # n S GNA RE MP MGF Ejl JP 0 JGF D LPGII CORPORATION 0# PARTNERSHIP ©# LLC D#1 COMPANYNAM ADDRESS CITY_f STATE ZIP F FAX CELL ,EMAIL WA W .O z 0 H w `T a w r• O ❑ z O �❑ >- W � W O w O F a :Mz w P-4 W a w a W P4 LLI �+ w U) a g a a rA D J a a a (A. LU x w F- LL N z O F�1 H U a c�7 O ^y :i— The Commonwealth ofMassachusetts IVlassachusetts AX Department oflndustrialAccidents Office ofInvestigations 600 Washington Street Boston, MA. 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone Are you an employer? Check the appropriate box: - Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have Hired the sub -contractors 2.�I am a soleproprietor orpartner- listed on the attached sheet. I �• 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 10.❑ Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. F1 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 comp. insurance required.] MAny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they ire 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 policy and job site information. Insurance Company Policy # or Self -ins. Lie. Expiration Date: Job Site Address: 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 requiredunder 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 of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations qt* DIA for insurance coverage verification. Ido here certify r�n r t p n t naltc s ofperjury that the information provided above is true and correct. Signafu // " Date: _ N. Phone #• / v ✓ �� 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. PIumbing Inspector 6. Other - - Contact Person:-, Phone fl; 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 compliancewith 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 numbers) 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 maybe 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 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. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The 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: `rho Co onwealt� of Massachusetts \ Department offadustrial A,ccldoats office ofIavestigations 600 Washington Street B oston� 021 Z X 617-727-4900 oxt 406 ox 1-877rMASS XF, Revised 5-26-05 Fay ,# 617-727-7749 Sxscxrxsrnnnc. (enesf.7:;., Date ... .......... ... .. .... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies th.,-:�� ....... ............................... has permission to ............................. wiring in the building of .... Ir. ...... �... at.. P) .... ........ ....... �North Andover, Mass. ........... Lic .......... ....... . ................ Fee ELECMCAL INSPECTO Check # 9282 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked. [Rev.l/07] (jeavr}.1�"Irl 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 PMT ININK OR TYPE ALL WORMATIOA9 Date: City or Town of. NORTH ANDOVER 3440 To the By this application the undersigned gives notice of his or her intention to perform the el� electrical woector ork rljes described below. Location (Street & Number) 0J�,U�,t�{, 0 f Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes s (,L No El(Check Appropriate Bog) Purpose of Building Utility Authorization Nom�� Existing Service -Z2f Amps �}l f olts Overhead ❑ Undgrd No. of Meters(Jl-te- New Service . Amps _ / _Volts Overhead ❑ ' Undgrd No. of Meters Number of Feeders and. Ampacity -\ , ' , 0 "t Location and Nature of Proposed Electrical Wor ' i W 'r Attach additional detail if desired, or �as required by the Inspector of Wires. Estimated Value of Electrical Work: Z��i , (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVE GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND (] OTHER I certify ❑.(Specify:) under the pains and p naliies of perjury, that the information on this application is true and complete. FIRM NAME: Licensee y LIC. NO.. d • Al M111Z4dJ Signature LIC. NO.: (If applicable, enter exempt " in the license number ine.) Address: Bus. Tel. No.:9 *Per. M.G.L c. 147, s. 57-61, security work requires Du�b„ „ Alt'. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Lic. No. required by law. B m signature ty insurance coverage normally By y gnature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ No. of Recessed Luminaires Com len )n Of the ollowin N0. of Ceil.-Sus p (Paddle) Fans table may be waived bv the Inspector No. of TotalTransformers No. of Luminaire Outlets No. of Hot Tubs KVA Generators KVA No. of Luminaires Swimming pool Ab_ ove In- d• ❑ o. o mergencyg �•-- No. of Receptacle Outlets �J d• No. of Oil Burners Batt= Units No. of Switches FHtE ALARMS No. of Zones No. of Gas Burners No. .of Detection and No. of Ranges g N o. of Air Cond. Total Initiatin Devices -� Tons No. of Alerting Devices No. of Waste Disposers p '' eat Pump Number Tons Totals: - __ o. of Self. -Contained No. of Dishwashers _ Space/Area Heating KWcal Deteetion/Alertin Devices Lo ❑ Municipal No. of Dryers No. of water Heating Appliances KW Connection ❑ Other Security Systems:* No. Devices Heaters KW No. of of of or Equivalent Data Wiring: No. Hydromassage Bathtubs Si s asts . Ballasts No. of Devices or E uivalent No. of Motors Total HP Telecommunications Wiring: OTHER: No. of Devices or E uivalent Attach additional detail if desired, or �as required by the Inspector of Wires. Estimated Value of Electrical Work: Z��i , (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVE GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND (] OTHER I certify ❑.(Specify:) under the pains and p naliies of perjury, that the information on this application is true and complete. FIRM NAME: Licensee y LIC. NO.. d • Al M111Z4dJ Signature LIC. NO.: (If applicable, enter exempt " in the license number ine.) Address: Bus. Tel. No.:9 *Per. M.G.L c. 147, s. 57-61, security work requires Du�b„ „ Alt'. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Lic. No. required by law. B m signature ty insurance coverage normally By y gnature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Wl/,/7-&/<' j2 I rl �r 1 tiq»fU The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 T ilashington Street Boston, MA 02111 c ` www-nwss gov/dia Workers' Compensation Insiliranee Affidavit: )Builders/Contractors/Electricians/Plumbers Mlicant Information NaIIle(BusincseOrganirdtiorL4ndividual): Address: City/State/Zig: [MM 0 Phone Are you an employer? C'beck.the appropriate box: 1. ❑ I' am a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* 2. 1 am.aSole proprietor or have hired the sub -contractors listed partner- on the attached sheet. 3 ip 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 and its required.] 3. ❑ 1 am a homeowner doing officershave exercised their all work right of exemption per MGG 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 S. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions I I . F7 Plumbing repairs or additions 12.❑ Roofr-pairs I3.❑.Other ;Any applicant that cbeaks bme #I must also fill out the section below sbowin their workers' 00 l t Homeowners who submit this affidavit indicating they am doing all work end then hire outside conairactots policy mformatiotL ZCotttractors that check this box mustattaetted an additional sheet show' must submit a new affidavit indicating With• the rtstnr of the sub-ccttmac n.e.aqd ►s.et. --- -. ' :: •• P puiiCy Tnfmnation. I am an employer that is providing:warkers' campensation insurance for my enrPtoyeer� Below is the policy and job site information Insurance Company Name: ' Policy 4 or Self -ins. Lie. #: Expiration Date: ------------ Job Site Address: City/State/Zip: y Attach a copy of the workers' compensation policy deciarratioo page (showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. I s2 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone #: EOth&rl only. Do not write in this areq to be completed by city or town off ciaL n: Permit/License # ority (circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone #: It Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that v, .11 .. . ....... ...................................... has permission to per4b/rm wiring in the building of at Fee.e� .......... Lic. No. ....... ) Check It 57 L 0 ............ �/ ................ North Al�n/dover,,,Mass. .1p1 ,^10, Commonwealth of Massac usetts Official Use Onl ' F Department of Fire Se ices Permit No. r Occupancy and Fee Checked U BOARD OF FIRE PREVENTION R GULATIONS [Rev. 11/99] leave blank APPLICATION`FOR PE MIT TO PERFORM ELECTRICAL WORK All work to be performed in accordan a wit the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK ORT AL F TI ) Date:—i1-y DJ City or Town of: To the Inspector of Wires: By this application the undersign gives notice of)lis l r her intention to peyform tb,.Pelectrical„work described below. Location (Street & Ku/nber) , Owner or Tenant(( ;1,41J 1 Owner's Address Telephone No. Is this permit in conjunction with a building permit?: Yes.: ❑ No2thorization (Check Appropriate Box) Purpose of Building Utility 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: Installation of Security system Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ dn- E:1l rnd. rnd. o. o Emergency Lighting Battea Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMSNo. of Zones No. of Switches No. of Gas Burners o Detection and No. Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained p Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Sec Noyof ritDevices or Equi alent 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 Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 03� (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 perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 ..5928 Address: U Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see 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` v V Signature Telephone No. PERMIT FEE: $ q Date. TOWN OF NORTH ANDOVER SS CHUS This certifi s that�—. has permission to perform plu bi h buildings o I e m Ing inM _f -"� at.. .... .. ... Fee��,. Lic. No. 70k;57/. . Check # 404, 6334 PERMIT FOR PLUMBING .......................... .. W ., North Andover, Mass. I .............. INSPECTOR MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSET� Building Location 10 �!_-C `pq of New 1:3 Renovation ri Replacement FIXTURES TION FOR PERMIT TO DO PLUMBING r -- Date lo 7ermit # Amount Plans Submitted Yes11 No ❑ (Print or type)�� Check one: Certificate Installing Company Name L�Corp. Address !)To Partner. 0 usmess Te ep one Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate th�fpe of insurance coverage by the 'ng the appropriate box: Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the 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 knowledge and that all plumbing work and installations perform d under Permit Issued f, -this -application will be in compliance with all pertinent provisions of the Mas'sachusettsztate lumbi g Code and Chapter ,4"2 of the General Laws. BY Signature of Licensee;Flurriver Title Type of Plumbing License i, City/Town License um er Master Journeyman ElAPPROVED (OFFICE USE ONLY 0 Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Z-/ This certifies that .... . ......... has permission for gas installation ec�e. ............... in the buildings of . ... ........................ at /'�z . �.. ....... . North Andover, Mass. Fee. Lic. . . .. ..... ........... S IN TOR Check# ZjVO 5026 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSA Cn Building Locations s Name New ❑ Renovation Replacement ❑ FOR PFJVvff TO DO GAS FYITIWG Date Permit # Amount $ � Cw\ I � -- Plans Submitted ❑ (Print or Name _ L 0 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 0/ No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond D 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 ❑ 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 knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachpsetts..Sta Tas Cod h d Chapter 142 of the Ceneral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed'Plumber Or GasFitter �--'' Plumber r? ) ` Gas Fitter License Number Journeyman 1j I CA w a rA o°�:) t� x w H x z H G O O F O z o w z F a o x H z z H Q a a w w H w H H z H N o � O z P O m O w d A C7 a OU a � A w F O SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR Ll 7TH. FLOOR I I STH. FLOOR (Print or Name _ L 0 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 0/ No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond D 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 ❑ 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 knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachpsetts..Sta Tas Cod h d Chapter 142 of the Ceneral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed'Plumber Or GasFitter �--'' Plumber r? ) ` Gas Fitter License Number Journeyman Date /—Z . ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ........................................................... has permission to perform ............................................ wiring in the building of ... .............................................. at . . ................................ .... ......... North Andover, Mass. Fee 9: C."o ...... ............ Lic. No ............ 'EL--krRiC'AL lNspEcioR Check# 5540_ IRE UUlVMU1V VVt AL JH UP'AM5M 11JJJLY IN Office Use only DEPARTARMOFPUBLKCSAFM Permit No. d l BOAROOFFIREPREVF. MONRF.GULA77ONS5r(M]2 W 1 9 3 , m% Occupancy & Fees Checked APPLICAHONFOR PERMITTOP ORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAS ACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work`decribed below. Location (Street & Number) Owner or Tenant Owner's Address AJ W To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building AV{/UV-,,1_ Utility Authorization No. ��� Existing Service acV Amps /-.; olts Overhead r7 Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work LA) it' ll.. i'y\t6 f-ei7_ !7M 71777 717771,1' 771,1 ,61t:- o I C1A No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures / Swimming Pool Above 171 Below Generators KVA round Rround No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets 0 No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges' No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained V • �- Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- 1nsum=GDMXaW- lbaNtaomatLmb'kykmm=PbbcymdxhgCmpl&-opembmc,ovmgporgsaftrialequivalal YES El NO Ibaveahriwdvandptoofofsa<netoth offim YES M YycuhavechododYES irtdt *theMmofoovwWby chedorlgthe box WSURANCE M BOND r7 OHER WorktoSGnt S' Ii>spetor,DateRad Signedund ePara> mof f;MMNAME Liaarsee �t I f 1,Ae Ln�uqkid Signaaue • mac- `::'.1 Estir Wd Vain ofE1xl ical Wtak $ Final LiMwNo. — Licerwilb Busure b IM INo. AkTel No. 6 J�Vs— OWNER'SINSURANCEWAIVIIt;IamawarethattheLio wdoesnothavetheinstaaroemva-4pwitsabsMnWepvalartasm4medbyMasmdxi=CalaalLaws anddatmysigw aeondmpmTdapphcatmwaivesdrismpimut (Pleasecheck.one) Owner Agent El J9�` Telephone No. PERMIT FEE $ lgna ure o wner or Agent /3 6cly X93 C9 � a 1* --6s— . %'j'nN �rw 2-7^o,— A7 -rte 0 Wo ....�..�..a....... a.� aa.a as va ♦.� �]r>,L.,L1VJLiL 1 J vun:c Esc umy DEPAR731EAT0FPUX1CS4FE7Y _ `/;"y �-/ BOARDOFFIREPREVEMONRBgAMONS527aMl2.00 Permit No. o � fi Occupancy & Fees Checked 9-3 APPLICATTONFOR PERMIT TO PI ALL WORK TO BE PERFORMED IN ACCORDANCE WITH T MASS, EASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical work escli Location (Street & Number) /O Z7PJ AJ W Owner or Tenant dA rytt ��_ Mo Owner's Address_ FORM ELECMCAL WORK ISSTS ELECTRICAL CODE, $27 CMR 12:00 To the Inspector of Wires: below. is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Sa ✓%Lc ' F,q,,t UtilityAuthorization NO. Existing Service alrO AmpsDO /,a olts Overhead Underground No. of Meters New Service Amps Volts OverheadUnderground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work i,l? Lr`l i yi,�s k/%_ btllfleth4 Addy l -CA',- • /1t /r �, C 1 r,t _ No. of No. of Hot No. of Lighting Fixtures / Swims No. of Receptacle Outlets No. of No. of Switch Outlets 4 No. of No. of Ranges aLt' No. of Pool Above Burners of Disposals No. of Heat 'ns KW Pum of Dishwashers Space Area He of Dryers Heating Devic of Water Heaters KW No. of KW Si s Hydro Massage Tubs No. of Motors No. of Transformers 71 Below Generators and No. of Emergency Lighting Battery notal FIRE ALARMS Tons All Total No. of Detection and 'ns KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Ol Municipal No. of Connections Total HP Total KVA KVA No. of Zones � t�antoometagtmanatlsatMasadzas�GataalL3ws �abt7sY tt�l�tCytttck��gCanPlele Cove eaifs legttiva�t ya NO vatiijpnx:fofsatrtebthe0ffica YES rice ffyoulow rcladYES, trtdraletEWof awaqpby . box LL.JJ BOM [] GHJM M ftm') X11 re �►A-�- m an,c e _ 6-_ dCo 'tA) v — ,tAa k D* Fstimabdvalieot kbicalWodc$ -- .:�. _ hpe�l*RWsWd Final Other Li=wNo. Li=MNo BusinessTbl.Na :'SINSURANCEWAMT,Iam;zthattheLioaz9edoesnothmthei a=mira ALTe1Na rysignahueonthispearitapplicatialwaivesdlistequrtanent °D�orgsRbsUegdvalaltastegttitadbYMassactimtlsCgrnalLaws check one) Owner Agent &6' Igna ure or Owner or Agent Telephone No. PERMIT FEE $ �1 A Location No. Date t/,) el-. I - � . N Aidad& AP TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check�# 1. 17924 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / DATE ISSUED: J-/ SIGNATURE: llldaldo-� Building Commissionerfl for of Buil * Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1..2 Assessors Map and Parcel Number: lo / Map( Number Parcel Number 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 Required Provided R "red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic IS CICt: Yes p 2.1 Owner of Record ,.�, 1 cayjt l` `I._ ���/ICD almLUOCA \0 e (Print) Address for Service Signature Telephone 2.2 Owner of Record: �n Name Print Address for Service: Si nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensqd Constrpction Supervi or: Not Applicable ❑ � icensed Constructionupervisor: 05?la 7 S 1(0 License Number �y_ - - j� \► 0—po AddNess 3' Expiration ate S' re Telephone R grs erect Hoed mprnov�ement Contract r Not Applicable ❑ , V \ � � . e---• n o pan Dame ��--,q Registration Number W Address q �� �/►��� Expirati n Date J r nature Telephone 00 M X z O �JJ �I M �1 z M 90 0 mn r M _r z^ Q SECTION 4 - WORKERS COMPENSATION (M.G.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 buildiNeErmit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ` ❑ Other ❑ Specify Brief Description of Pro sed Work: ,n �p y c� l' J \ C �1 \ \ t\ �J ^I aC; A�G� C�c� l !<►�-wp- r dL 3 t>tSo AJ (1, 4" SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ;. OFFICIAI;ITSE U1ILY - 1. Building(a) 3� C�0 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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT -OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property ereby authorize C` �� `SV �— \vVl\ to ac on My alf, in all In elativ I V ruthoriz by this building permit application. �� A —Signature of Owner Date SECTION 7b O*NER/*%JTH0WZED AGAT DE TION 11 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 &e t �� Si ure of Owner/A t Date l NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY a IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Sir 14 MORTGAGE INSPECTION PLAN NORTHERN ASSOCIATES, INC. 401 SOUTH BROADWAY. LAWRENCE MA. 01843-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 MORTGAGOR:.CAMILLE 5ARROUF DEED REF: .4596/ 17 LOCATION: 10 IRONWOOD ROAD PLAN REF: 1 0669 CITY.5TATE: N ANDOVER, MA 5CAL .- I'=60' DATE: 6/25/02 JOB ff: 202.05973 LOT 3 l C l 0� S /� snec ja woo IRONWOOD ROAD CERTIFIED TO:. WATERTOWN 5AV1NG5 BANK Flood hasald son& Ads bursts dwhwww"" 6v dodo &sld is spot v%00*m ar9V aeotwat&VvdlU d*jW%042u piattl< ass isstod 6v AUD asb3/6r s tarrtioa! mntnd arrow 'te P�16++t+�P s+ elayst41 msattet 6o d4derintysid m tecta st.fa"- rorawaera � d..+ .+.3y o..d .. +tet to 0• ssa.d w .swt+stsl► jresy ii—d. rh.6irtattotr a►eo.er► hetren awe band uen ctur[—f&—mtshed "kx-vnneton and stay b. �10}�es to =:t d other IatL7Wi. oase..wn4t aetd stylhif or aghm and other rrtoaset� al age& v prswry0 a or other ..��ti��ae._ xe'srt.rtt rne. wn.wr. sb tv�rs,a.te:dttiey bents► ie land ewn.r o: oeots oopte +te raayerwieissty than dawtyes =t • a mad .elianoe b1 asaLvfw ether sAas the mid r7tortti-r 9etttd sts In wnnevtian aruK ite prapea.d mort~ ltttanet+b to aw > 9 accordance a w lYe7►w{iooi S�9s/O1s,.a, �c lAmm r tstts� s A-mjl..saidspand �t Mir nam sbard of �ss<e" CUR j»oja.rtrtwl ejrtstton ehas sae srtteawv h"` ..0�4' 1�*0. ,o:ost g [ett s of va Aer m.,io-1 dtwrnatend 7 dar pr&q� Y..f>1DY A .s CA e1 -f ff Cl Som 7.7ot�O.. o. awa .a.+n>e .a.d.r VLe�im o! Ya.L cs �e—i s.� �. t: I. insssttr O'Zkmw so ttat in land Ytastd O 2. liejrssy/llwte■ L. to a !food Basatd A— O,- -y—ft asst. o t=&"jf{oont m d.b.accr. !seed sett rc Hood titan d dasmnvwd jrsrn !stat Lrae tis !reed Rt.taatwe juts t. Yap rYtl r G� j7rte sb w jZ ear, w FORM U - LOT RELEASE FORM a J Fkov- INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT_U S0`P 1 1 [;��Y; f, ( C PHONES LOCATION: Assessor's Map Number PARCEL STREET 1® . LOT (S) �T. NUMBER /1& ****"**"**OFFICIAL USE ONLY ***** OF TOWN AGENTS: CONSERVATION ADMINISTRATOR TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED E PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT Cn n ��cZc' `(-D CL 676 O 00CI RECEIVED BY BUILDING INSPECTOR DATE Revised 9197Im F _. ✓iie �ai�mzareuieaL�i o�✓�Zvoar/zuaP.lta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 108952 Expiation:: "8/27/2006 i'-- Type:- Individual BUSHNELL CONSTRUCTION -j, Michael Bushnell 89 MEADOWBROOK 14 . Chelmsford, MA 01863 Y Administrator BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: Cs� 058872 Birthdate: 03/31-/1967 Expires: 03/-31/2006 Tr. no: 21542 Restricted: 6W,1 { MICHAEL E BUSHNELL- $� 89 MEADOWBROOK.R[j•-, N CHELMSFORD, MA 01863 Acting Cdlnmisi#oner N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer p iding wco ars' compensation for my employees working on this job. Com n name: 60 S �\ \� l L �U Address D C� Ci Phone # Insurance. Co. ' e� Policv # ComDanv name: Address Ck.. Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to- imposition d criminal penalties af,a fine up to 61,500.00 andlor one years' imprisonment_as v¢ell_as_civ�l,penaitlesinlbefnan nfa.STOP WORK_ORDER..and..a.flne cf..(SIOD.0o)-aid4.agaiait_mm I understand that a copy of this statement maf be fojwarded to the Office ot Investigations of the DIA for coverage verficatfon. I do hereby certify un rfh,11ji an pe Ilia f pe►jury that the information provided above is true and correct. Signature nary Print Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucenalng - y3v- ❑ Building Dept []Check if immediate response Is required ❑ Licensing Board Confect person: Phone #. ❑ Selectman's Office ❑ Health Department ❑ Other 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 c11,S150A. The debris will be disposed of in: 1s��11 -� Y\() 7S (Location of F Ir, a ure of Permit Applicant ,-1aj0q Date NOTE: Demolition permit from the Town of North Andover must be -obtained for this project through the Office of the Building Inspector FAX COVER SHEET 0AY16 Lumber Company &)c. 43 %or Road Amuooar, )WA 01810 078-60-40$0 Nd PAW, ftkxmgwmver COMMEM _--_~—.'-~~^--'—'.-.^�----~^—.--_.~^~'^— -'----~—�------.~-- -,''...... ---'-�----'~~'-' _--.................. .^........................... -............................... ................... -~~................... .-..~................ '—...................... ........... _--................... ^^—......................... ---.- . ............ -~............ -_--.~....................... —.......... .................... .................... ...................................................... ~........... .~~........................................................................... .................. ~-- T0'J Z2:Cl VO0C T zaO I:xgA fiupdwoD jaqmnl al6on RE&heck Compliance Certificate Massachusetts Energy Code REScheckSoltware Version 35 Release le Data filename: CAProgram File6\C1WklREScheck\SARROUF.rck CITY; North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12/01/04 DATE OF PLANS: 12-01-04 PROJECT DESCRIPTION: SARROUF 10 IRONWOOD ROAD NORTH ANDOVER, MA DESIGNER/CONTRACTOR: BUSHNELL CONSTRUCTION COMPLIANCE: Passes Permit Number Checked By/Date Maximum UA - 126 Your Home UA = 99 21.4% Better Than Code (UA) Gross Gluing Area or Cavity Cont. of Door Peritu R -Value R-Va U -Factor UA Ceiling l: Flat Ceiling or Scissor Truss 700 30.0 0.0 25 Wall l: Wood Frame, 16" O.C. 800 19.0 0.0 43 Window l: Vinyl Frame:Double Pane with Low -F 90 0.340 31 F uruce 1: Forced Hot Air, 85 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, ad other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVcnion 3.5 Release le (formerly MECcheq aid to comply with the mandatory requiromante listed in the RES checklnspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cook the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. guilder/Designer Date ZO "d M ZT POOZ T oaa 9Z£9 -£89-&6-T: xPj fiuedwoD aagwnj a l fioa REScheck Inspection Checklist Massachusetts Energy Code RESchOckSottware Version 3.5 Release 1 e DATE: 12/01/04 Bldg. � Dept. I Use f Ceilings: [ ) I L Ceiling 1: Flat Ceiling or Scissor Tmss, R-30.0 cavity insulation 1 Comments: J Above -Grade Walls: ( ] I L Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation I Comments: Windows: ( ) I 1. Window 1: Vinyl Frame. -Double Pane with Low -E, U -factor: 0.340 For windows without labeled U -factors, describe features: I # Panes From Type Thermal Break? j ) Yes [ ] No Comments: I f floating and Cooling Equipsnenu [ l I 1 • Furnace 1: Forced Hot Air, 85 AFUE or higher I Make and Model Number I ! Air Leakage: [ ) I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage cost be sealed. [ l I When installed in the building envelope, recessed lighting fixtures f shall meet one of the following roquirements: I. Type 1C rated, manufactured with no penetrations bctw"m the inside of the recessed fixture I and ceiling cavity and sealed a gasketed to prevent air leakage into the unconditioned apace. i 2. Type IC raced, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 I Us) air movement from the the conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 UWft2 pressure difference and shall be labeled. Vapor Retarder: ( ) I Required on the warns -in winter side of all non -vented fra and ceilings, walls, and floors. j Materials Identification: [ ) f Materials and equipment must be identified so that compliance can be determined. [ ) I Manufacturer manuals for all installed heating and cooling equipment and service water heating I equipment taunt be provided. [ J J insulation R values, glazing U -:factors, and heating equipment efficiency must be clesrly marked on the building plans or specifications. Duct Insulation: [ ) I Ducts shall be insulated per Table J4.4.7.1. J I Duct Constriction: [ ] ► All accessible joints, seams, and connections of supply and return ductwork Iocated outside I conditioned space, including stud bays or joist cavities/spaees used to transport air, &hall be sealed I using mastic and fibrous backing tape installed according to the manufacturer's installation I instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ) ! The HVAC system must provide a means for balancing air and water systems. £0 'd MU b00L T oaQ 9Z£9 -£89-&6-T : xvJ fiueciuo3 .tagwn� a j fioa Temperature Controls: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each tone or floor shall be provided. Heating and Cooling Equipment Sizing: Rated output capacity of the heating/cooling syatem is not greater than 125% of the design load as specked in Sections 780CMR 1310 and 14.4. Circulating Hot water Systems: Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: AU heated swimming pools must have an on/off heater switch and require a cover unless over 200A of the heating onergy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piptng insulation: [ ] HVAC piping conveying fluids above 120 T or chilled fluids below 55 1 must be insulated to the levels in Table 2. 170 'd MLI b00L I oaQ 9M -289-816-T : xPJ fiupdwoj .aagwnj a l fioa Table 1- Minimum InsukWon Thickness for Clreutating Her Water P4w 201-250 1.0 Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating gamonts Circulating Mains and Runouta Te erature UD to 1" iI�,2S° 1.S" to 2.0" Over 2" 170.180 0.5 1,0 1.S- 2.p ` 140.160 0.5 0.5 1.0 1.5 100-130 0.5 0.3 0.5 1.0 rabte 2. Minivam IesutoHon Thicknen far M ACIVM Fluid Temp. Insulation T hIcimeas iu Inches Pipe Sizes piping System Types RMc F 2" Runouts 1" and Un 1.25_` 2.5� ' to 4" Head s tns Low PressutelTenWrature 201-250 1.0 1.5 1.5 2.0 Low Tomperatuu 120.200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling system Chilled Water, Refrigerant, 40.55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO P79LD (Building Department Use Only) SO'd ££:Zl ti00Z i oaQ 91£9-£89-816-T.xvd fiupdwoj .aagwnj alfioa Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoft are Version 3.5 Release le Date filename: C:Program FileslChecklRESchwk'SARROUFI.rek . CITY: North Andover STATE: Massachusetts O HDD: 6322 .? CONSTRUCTION TYPE: 1 or 2 Family, Detached 1 HEATrNG SYSTEM TYPE: Other (Non-Elcctric Resistance) DATE: 12/01/04 DATE OF PLANS: 12-01-04 PROJECT DESCRIPTION: SARROUF 10 IRONWOOD N.ANDOVER DESIGNER/CONTRACTOR: BUSHNELL CONSTRUCTION COMPLIANCE: Passes Maximum VA = 93 Your Home UA - 61 34.4% Setter Thin Code (UA) Grose Glaiing Ates or Cavity Coat. or Door Perimeter R -Value R-Vahw U-Pactor UA Ceiling 1: Flat Ceiling or Scissor Truss 288 30.0 0.0 10 Wall l: Wood Frame, 16w o.c. 516 19.0 0.0 30 Window 1: Vinyl FrameMouble Pane with Low -F, 20 Floor 1: All -Wood Joist/Truss:Over Uoeonditioned Space 300 19.0 0.0 0.350 7 Furnace 1: Forced Hot Air, S5 AFUE 14 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 Massachusetts Energy Code requirements in RES checkVersion 3.5 Release le (farmaly MECcheck and to comply with the mandatory requirements listed in the RES eheckinspection Checklist. The heatiwg load for this building, and the cooling load if appropriate, has been deftrAned using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shalt be no greats than 125% of the design load as speciRed in Sections 780CMR 1310 and 14.4. Builder/Designer Date 90'd b£: Z i ti00Z i J@a 92_29-289—&6—T: xed fiuedwo0 jagwnj a l fioa R.EScheck Inspection Checklist Massachusetts Energy Code RESc/fckSoftware Version 3.5 Release I e DATE: 12/01/04 Bldg. Dept. Use I I Ceiliagss [ j I L Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: I Above -Grade Walls: [ ) I I. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation I Comments: I - Windows: [ ) I 1. Window 1: Vinyl Frame:Double Pane wft4 Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes _ Frame Type Thermal Break? [ ] Yes ( ) No I Conmtents: I - Ftoors: [ J I 1. Floor 1: All -Wood Joist/Tnhss:Over Unconditioned Space, R-19.0 cavity insulation Comments: I Heating and Cooling Equipment: [ ) I I - Furnace 1: Foreed Hot Air, 85 AFJE or higher Make and Model Plumber AU Leakages [ ] I Joints, penetrations, and I'll other such openiugs in the building envelope that are sources of air leakage most be sealed. ( ] j When installed in the building envelope, recessed lighting fixtures shell meet One of the following requimments: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture J and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 US) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/W pressure difference and shall be labeled. I Vapor Retarder: [ J I Required on the warm -in -winter side of all non -vented fiamod ceilings, walls, and floors. Materials Ideutif eatim- [ J ( Materials and equipment roust be identified so that compliance can be determined. [ J I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ( ] ( Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on I the building plans or specifications. f Duct Insulation: [ ) I Ducts shall be insulated per Table 14.4,7. 1. I Duct Construction: [ ] I All accessible joints, seams, and connections of Supply and return ductwork located outside z0'd b£:z1 17002 1 Jag 9L£9—£89-8Z6_1:xpj fiuudwo0 .aagwn� alfioa conditioned space, including stud bays of joist cavities/spaces used to transport air, shall be sealed using mastic and fibrum backing tape installed according tow manufacturer's installation inatractions. Meah tape may be omitted where gaps are less than 1/8 inch. Duct tape isnot permitted, The HVAC system ttmst provide a means for balancing air and water systems. Temperature Controls: Thermostats are required for Odell separate HVAC system. A manual or automatic means to partially restrict or shut off t;he heating and/or cooling input to oath zone or floor shall be provided. Heating and Cooling Equipment Slung: Rated output capacity of the hasting/cooting system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and MA. Circulating Hot Water Systems: Insulate circulating hot water pipes to the levels in Table 1. Swimming Poole: All boated swinuning pools must have an ou/oPf heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pwnps require a time clock. Heating and Cooling Piping Insulations HVAC piping conveying fluids above 120 OF or chilled fluids below 55 °F must be insulated to the levels in Table 2. 80'd V£: ZI VOOZ i Jau 92 -29 -289 -U6 -I : xed fiupdwo0 i@gwn� a l fioa Table 1. Minimum Imuladon Thickness for Circulating Not Water Pipe& Table l: Minimum insulation TlitaknessforovACP*& Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Ruhouts 1" and Less 1.25" to 2" 2.5" to 4" Heating systems Low PressurvTonVernawe Low Temperature Steam Condensate (for feed water) Cooling system Chilled Water, Raf igeraz►t, and Brine 201-250 Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runout, Circulatimg Mains and Runouts Temperature ( F) up to I" Up to 1.25" 1.5" to 2.0" Over 2" 170-160 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table l: Minimum insulation TlitaknessforovACP*& Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Ruhouts 1" and Less 1.25" to 2" 2.5" to 4" Heating systems Low PressurvTonVernawe Low Temperature Steam Condensate (for feed water) Cooling system Chilled Water, Raf igeraz►t, and Brine 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 Any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) 60'd 172: Z T VO(Z T oaa 9M -289 -8Z6 -T: xQJ fiuedwo0 jagwnl a l fioa BC CALCO 2003 DESIGN REPORT - US vuadneAday, Deoanbsr0l, 20041x:02 QUacimple 1314" x 18" VERSA -LAMS 3100 SP FUO Name: bugtnap 041105.BCC : F80t dob NAf tA:. Mft BUahMfl - umo Atldrees: PRELIMINARY ONLY, NO FRAwNci PLAN Cue SdtO, zips IoM arefover, a" ale Cuaortror I Cocm"ny: Doyle Lumber Co., bra dO reparla:IM6812, NER 629 Mbo: 0988 On LL 81 3810 ibs DL 8898 b LL 3810 Iba OL Gellerai Ooh Varelon. US brpJerial MamberTYps: Flosr.esem Number of Spans: 1 Left Cantilever: No Right Cantllaysr: No MPO: Otl2 . Td 4W- 06.000 Live load: 30 pef Dead Load: low Partition Load: 0 psi Duratlar: 100 Dteofoeure The complebness and acrxiraq of tlm hlpat must be YW*d by anyone who WPA rely on era output a evidence of suhsbiwq for a particular eppliostlon. The output above is based upon bulking QN16enaiyaia m ft", tnYs 'bon of 6016E Ong ,MOW d wood Producb must be in seceder. wUh fire arrant Inan grids OW the app9cibb txdi % codes. To obWn an instaldon OuiM or I you how any qusabons, please =q (800)232088 befOe beginning tfOduct br td(stion. SC CALCO, SC FRAMER®, eCO, BC RNA BOARD"' BC 096 ROA BOARD", BOISE OLULAMm. V�//�E��R��S�A•-pLA..M,O, VERSA-RUMO, VERWA•'fV/YI PLUSe, VERSA.STRANDTM, VERBA-BTUDO. ALKNOV end Sobs asoad Corporam tradeh"ft at , ... ation. Page 1 d t Total tlofixontal Lenp -17-09.00 L=d Summary ID Description S Stendaro Load Lead lime Unf. Area U. Left start 00{i0.00 End 17.09-00 1 Unf. Anes LAR 00-00.00 17-06.00 2 Unf.Ams Left 0040.00 1749-00 3 Unf: Aron left 004"0 17-08-00 4 UK Moe LAR 00)-00 174)6-00 Controls ftmmwy Control Typo Value Moment &9927 Aft MORWt LIM End Shea � 349 lbs Total Load DOO, 0433 (0.488' Live Load OdL U899 (0.39") Max Daft. 0.486" Typo Vahre TO, OW. LIM 30 psi 0640a 100% Dead 10 pat 0846.00 90% Lim so W Dea-M 190% Dead O pat 09.09-00 Live 30 pd 1340.00 100% Oaed IOW 13-00.00 00% Live 20 pef 07 -MM 100% Deed 10 pef 07-00.00 00% L.Ivs 30 pd 07-00-W 100% Dad 1000 074040 90% %ANowable Duradon 64.2% 100% NO 100% 48.6% 100% 95.5% 80.1% 48.6% Load Casa Span Location 2 1 - Mtamd 1 -Left 1 1 Notes Daabn meets Code minimum (U240) ToM lad d &&ton al6eria. Design meats User sparafied (L/480) LKS bad dOfkckn,piteria. R MXdmM M' Y1 beefing h(1kr 80 is 2-1Mbed detledon *Merle. Mifrinuv for 01 Is 2-1M1. Entared/Dlepbyad Florlm"al Span LOO(s) S Clear SPan + 112 noh and beaehrp+ 1/2 ObmwdMts bemfM Contteotlon' piopram . 8e4me 7 inches Me wall be named to be slther top4oadOd only, of aqualy Iosdsd from each side. Bdb•are assumed to be Grade 5 or higher. Ma dM has no elleioads. Connectors afe:112 In. StAgpered Throum salt Ant" b - 2-1/2" a= 14" d 1124" OT'd V2:ZT VOOZ T oaa 9229-289-8x6-T:xed fiuedwo0 .aagwnl atfioa F, .A 0 i Com_ V� p T3 O y O O �E m m L � _ a � 0 0 om< o c cc �..i .M O c Z C C.2 CO) ev c CL C CO2 D LLI Y/ U) W W 19 W U) o U W x Gy x W a O H C GQ v c c� w° a°' U w a n°' w a W a w a°' w cn cn .A 0 i Com_ V� p T3 O y O O �E m m L � _ a � 0 0 om< o c cc �..i .M O c Z C C.2 CO) ev c CL C CO2 D LLI Y/ U) W W 19 W U) O H C d cc 0 haw L N O w r rfI 12ts co a� n yt�m3"'t a a C O H C W.N T m CLC.)0 o, m cm :mo, m T f01 h Z O� G Q V x O a0 C* cm c o c e:aw0 c N r COD �_w m .y O H ' � C •to Z O L3 Vi 0.0 O O O' O� O� _ _� A a o y 2� = F� Z 4- CL*.. m .A 0 i Com_ V� p T3 O y O O �E m m L � _ a � 0 0 om< o c cc �..i .M O c Z C C.2 CO) ev c CL C CO2 D LLI Y/ U) W W 19 W U) Location i w oo -T- -e -o-,t No. Date �-41ct TOWN OF NORTH ANDOVER SL Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fe&DT�— $ Sewer Connection Fee $ Water Connection Fee $ tw TOTAL -a Z- Building Inspector 8647 Div. Public Works `PERJ1iT NO. CO� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO.I LOCATION �d 'XC0 k) 100 ,O 42,01 PURPOSE OF BUILDING Q�c OWNER'S ,NAME!L 4c6ifwf c NO. OF STORIES SIZE OWNER'S ADDRESS /G2 �/CN Ljodo^'910 , BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST Qjf4II5� 2ND 3RD BUILDER'S NAME I �/�� _0.47; ` a, / SPAN ;q" 1/A �,�A� 7 p Zoe-f,:5 DISTANCE TO NEAREST BUILDING CA- DIMENSIONS OF SILLS DISTANCE FROM STREET �CC�T if�l .0 POSTS DISTANCE FROM LOT LINES - SIDES REAR /240 "2( " GIRDERS 2-p( s AREA OF LOT FRONTAGE J HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW le 5 Ile SIZE OF FOOTING 2 717 X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ,LS IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER C� IS BUILDING CONNECTED TO NATURAL GAS LINE AJ INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR /ATE FILED SIGNATURE 0 AUTHORI ED AGENT ,FEE ZJ't PERMIT GRANTED d T 19 g �- 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING OWNER TEL.# CONTR. TEL. # CONTR. LIC. # H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY_:::j_ OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE HARDW D _ PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'TAREA V, FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS 11 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES CONCRETE EARTH HARDV✓'D COMRAC:N MPH. TILE B 1 2 �_ 3 _ ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. _ WIRING STONE ON MASONRY STONE ON FRAMESUPERI ADEOUOATE I� NONE 10 PLUMBING 5 ROOF GABLE GAMBQELMANSARD I I HIP BATH 13BATH FIXE TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ 1st 13rd I NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 0 0 Flp 5 n =- -� d O —�N O C N dO E C.0 -0 H CSC -)m C2 HmaA m C o T o n s to = m V' m y _ m N IC +� _ O O N C7 m c V/ A m CL SO T nca N � Q CDd N = �03, CD .W _ aCL _ N _ :E m US O N _ O 03 H 3 �m D C= m � z == oa b °= 0 aha CA CA z acv C � T o occ z M c 3 M3 r o CO2 n zm CD C ! Z C/! cl) O '0 CL r c OCo d. O H �a o co CD CL crE c")CD o MC"C CD V� m Qv cm y O t0 CD z _ � CO3 � o 'O OO n Z "* O -n CD O r CD 0 0 Flp 5 n =- -� d O —�N O C N dO E C.0 -0 H CSC -)m C2 HmaA m C o T o n s to = m V' m y _ m N IC +� _ O O N C7 m c V/ A m CL SO T nca N � Q CDd N = �03, CD .W _ aCL _ N _ :E m US O N _ O 03 H 3 �m D C= m 4 M id =A 110 10 PA z Q 0 Q� y 0 0 c � a == oa b °= �• aha CA z acv Z po °= T o occ z M c 3 8 o r o 4 M id =A 110 10 PA z Q 0 Q� y 0 0 c ' � fie iaa�nnnanwea�e. a�..`las;taclu,�tetd'i F ( Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY i CONSTRUCTION SUPERVISOR LICENSE 00 - None Nnsber: r'` =-V Expires: Birthdate: 1A - Masonry only CS -1.061618 .10/26/1998 10/26/1961 16 - 1 12 Faoily Hoies _ _... Restricted To: 00 - >. CLIFFORD 8 BATES �at<i 181 A ACTON RD --- CHELMSFORD, NA 01824T __ --- - •.. _ _,_-______-__ h_ MORTGAGE INSPECTION PLOT PLAN • NORTHERN ASSOCIATES, INC. 630 TURNPIKE STREET NORTH ANDOVER MA (508) 975-7117 KORTBARM ALEXAMER B. B NEATiflE79 R. STAafTIARIS DEED REF. 9196' / 96 LOCATSOft 10 IRANNOQO ROAD PLAN REF. JOWS CITY. STATE N. AADOVEq . KA SCALE !- 50' DATE B / 21 / 99 JOB * 93/ 3828 rRONWOOD ROAD CERTIFIED T& ABBEY FINANCIAL CORP. I FURTHER STATE THAT IN MY PROFESSIONAL NOTE: This mortgage inspection was prepared OPINION the principle structure/s and accessory specifically for mortgage purposes and is not to be refled NR Of outbuildings, upon as a survey. Northern Associates, Inc, accepts no �t� CONFORM - responsibility for damages resulting from said reliance by+ c �, with the setback requirements of the local zoning anyone other than the said mortgagee and its assigns in i9 ordinances, and that there are no encroachments of major connection rt a with its proposed mortgage financing to said 0 s Improvements either way across property lines except as 9 gor, o. 11912 shown. PANEL # "?S007? - DOD 7 G it P yp� ALSO: DATE r _ G - a - This mortgage inspection was prepared in accordance 4k0 3 V& ■ t. Property is not in a Flood Hazard Area. with the Technical Standards for Mortgage Loan 0 2. Property is in a Flood Hazard Arva. Inspections as adopted by the Massachusetts Association 0 3. Information is insufficient to determine Flood Hazard. of Land Surveyors and ChAI Engineers, Inc. Flood Hazard determined from Islest Federal Flood In.n.wnnw gwfw AMn P�MII 1 FOR. M0FtTCrACcr pURPOSCS — 5A-, V. VSE 0k4N (2�,Sgp UPat*l. Pu5uC pEC0p_V AND W(DEMCE 014 "WtSGPP0W > A D D .ass Lo -1rr? MORT AGOIZ %-Ace-, SOVR,C.E : Atit4KtV_ geol EASet46+ lT 44018 A A-- 2 STY. i GAP-, (UN DEfZ CoNsiR. � , I t-14. vv C) : 540 ; OWNERS) 1:,L_DIcV. 0)2 , RLGI STRY: ES -5 f=6 Nib cz1Ct� Drmm : BK. l _P . !% PLAN: CERTIFICATE I CERTIFY that the Lot shown hereon tit O that the CERT. OF TITLE: Wc-Ty4 T, F_ present Zoning�Y-� I NOTE: of -the of Qoc?,-,-T&A 4'qq_0 C2— The preni se ts do not lie within ", OF �GU'tr a designated Flood Hazard Zone.COµM,��kE ��;r`.,..1 ` CIt.4'% ROBERT G. GOODWIN , R.L.S. 2 :0098 • oo(o - � �aui:.i:rul \�' � 4 f17ri6J 82 •CE1iTRj%L S�MEET ANDOVER, HAS i 71W11 w 3• • 0 • ui N 1 0 •N J� geol EASet46+ lT 44018 A A-- 2 STY. i GAP-, (UN DEfZ CoNsiR. � , I t-14. vv C) : 540 ; OWNERS) 1:,L_DIcV. 0)2 , RLGI STRY: ES -5 f=6 Nib cz1Ct� Drmm : BK. l _P . !% PLAN: CERTIFICATE I CERTIFY that the Lot shown hereon tit O that the CERT. OF TITLE: Wc-Ty4 T, F_ present Zoning�Y-� I NOTE: of -the of Qoc?,-,-T&A 4'qq_0 C2— The preni se ts do not lie within ", OF �GU'tr a designated Flood Hazard Zone.COµM,��kE ��;r`.,..1 ` CIt.4'% ROBERT G. GOODWIN , R.L.S. 2 :0098 • oo(o - � �aui:.i:rul \�' � 4 f17ri6J 82 •CE1iTRj%L S�MEET ANDOVER, HAS i o- yl i i i 'uz I