Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 100 CRICKET LANE 4/30/2018 (3)
Date ../! S /! Z....... . e,^YO TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . lle.? AAL01vf . 4 has permission for gas installation fu!p � /? r?r.. 3... . . in the buildings of ......................... at .....��!? ... T! �'! t?' ......:e-., North /A/ndowr,,.M/a�ss. Fee. � :4>U . Lic. No..1l Z 7� . X r... .. ? -* . GAS INSPECTOR Check # 7�6 �s 9541 Date. �9...... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... � `? . ........ .. ....... has permission to perform.AF��?ffl441.� ./.?.... ...... plumbing in the bu`ildin s Of ../.!! ' ..................... . > at ...�� .��'��!�-.�' .......�.�Ue� , Noah do er Mass. Fee3Z,,P . Lic. No. /. Z Z%� .. .. r. .... . PLUMBING INSPECTOR Check ff ft f' P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY/ .._.. .. ? MA DATE L / PERMIT # JOBSITE ADDRESS 1 /00 s^ G/G e vL 2 OWNER'S NAME OWNER ADDRESS S M TEL % 78 :Y5 ?Sb9FAX OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL NEW:E1 RENOVATION: REPLACEMENT: D --- FIXTURES 7 FLOOR- BSM 1 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ...... DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN r— FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 2 1 3 1 4 1 5 1 6 1 7 RESIDENTIAL PLANS SUBMITTED: YES 0 X0010®®� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0' OTHER TYPE OF INDEMNITY E] BOND E] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER {] AGENT E] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �^ � �1 iG . LICENSE# 17t (� c SIGNATURE MPEa--' JP E1 CORPORATION E39[: PARTNERSHIPO# LLC # COMPANY NAME q -,So ADDRESS S S 3 co k._. 13 CITY Ly STATE ? <c ZIP �o / y �/ p TEL 7 FAX CELL S ✓ P EMAIL %` G S I ee ti.......SS c�- if- 0,A --t r— Call between 8:15-9:30a.m. for same day inspection (781) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ...... ... MA DATE S�_ _ _ PERMIT # _ ._ JOBSITE ADDRESS (JC CR_i �_E' OWNER'S NAME F OWNER ADDRESS TEST _._S" , FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: Lj APPLIANCES 1 FLOORS-+ Ism BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE Q FRYOLATOR FURNACE" GENERATOR GRILLE INFRARED HEATER I LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER � WATER HEATER j'" REPLACEMENT: [_ej- PLANS SUBMITTED: YES[] N0a' MMS® Ll INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO [] I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] BOND [] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER [l AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME/- 444 �5 LICENSE # SIGNATURE MP GF 0 JP [ JGF LPG] [ CORPORATION Df �� ,/ PARTNERSHIP []#= LLC []# COMPANY NAME: �G /'I'►g�I'n�-n�ADDRESS CITY �.�.�...�,..�...�. . r STATE ZIP, o TEL ' FAX CELL[ SEMAIL r�_1wa_-S ., ., 4 The Commonwealth ofMassachusetis Depanment of Industrial Accidents ice of Investigations WJ 600 Washingtan Street Bvvton, AM.O T1 www.mass.gorl a Workers' Compensation Insurance A$'ida it: BuRders/t ontractors/Eie'ctricians/Plumbers Apolieant In€ormatieti f% eas Ple Print Leg bjX Name(BysineWOrpni2etion/[ndividual):. 1 r G ( &/7,/,eL-. -Sy- SJ -,1 --E 1/1 . Address: Phone #' 791—SW -7 114 - Are 14 - Are you hu employer? Check the appropriate bow "!`roe of project 0940I140: LED mu a'employer with _ _ 4, [1 t am n general. contractor and lldptir. eonstittcpion : employees (Vadd/vr pW4finej + 2. I am a sold•propcietor ar patmcr- b+ttca hinal ztutt,contraciors lis gtd^ottfcftuabodskeet. _ . ?. !i♦ig ship and have do employce5 7hese attlrcomaetms have 8. Q'TfytnoHtipti working. E6r MWJft airy Gapaiciiy. comb. Wtlxi t&4, q, DBi�iIdinaadiiition [ado workers' conn. knuvfnce regtunod:j S. live s o a e ta#Mihd its offimhave emiised their 10.0 W �p+� or moons 3.01 am a bcmeownek doing all wotk right of exemption-por MGL i I. B iciiiir* or.oss myself. (No workers' comp. c.152,11(4), and we have no 17 Cl. goof G-tr� ing4rm)*rogtd.] t cirplgees. (NoW64=1k' o.u I3,� : ✓^ camp6 iiteturartcp irgaimd j �it r �:3i�e *Arty *Witnt dw1ch9dxb9;M * Homeovm=vW 1*bm t "at icon a'Mthat•okockAIstrortn a�davitkatkestbegmsit, I ara an emi7igjer tdra�l;ptvvi warlieix' cnAep.�tJEa�io�t fnsta'awesfvr ngt ,g�P •is+dra pb�'aY,�r� fob �e infosaratjatt . ' • . .. . Irrwr¢nce'CotnpaayNaitite:. ' (LUQ n Policy.# of Salk itis. LiC. #: � � w 9 v . Job Site Address: 1/ D O Ci1y1StaWZip: N r /• * u mss- /Til ct . O / y Attach a copy. of the zv6rktz s' vazVensanon, poltagt.declaraGtoffpage (showing tire-prolicy neta$ter and eziriiFcit€ort bate): Farlurt: to eccnry eov�etalyeas rcquira¢.ugdeF+9a.2Sll;ofl�riG'Y, c IS�can {eadw the its�su�itioti n�'glZmi�.penaiii�s of a fine op to S! old 64 of roto -year impifsplombnt,.as aavell as - civil penalties in the forth of a SCOP [( K DI i7i .Arid 4 bite of up to $=.00L a day against the violator Ba advised ffid a copy of this fttmnebt may be fdrwardedtss the OMe of . Inveatigariam:Qftho DlA furirr�iraace covaragt pidottiion. f do hetehy ' ter.thepdtn 4aNd pendtew afpuJury dre he tnfbn#arion proWd&labove Is tint wgdceosa- Phone g: 7.9 / .'>—`/ J — 7 / a - IOffdd we may.. Do not utile in Ift area, "to be eompkied by city or 1W vn 4gffldaL City or Town: Penalt/Licease At ssuing Authority (circle one): . Board of Health 2. Building Department 3. Cftyffewn Clerk 4, Elaetrical Inspector 5. Plumbing Inspector .Other ©1/FSz. Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. (Ic / 1<�— J Occupancy and Fee Checked ems, [Rev. 11/991 leave blank 7rJ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NN l7), 52 CMR 12.00 (PLEASE PRINT IN INK OR PE LI O TION) Date: City. or Town of: ��Gc'_C_ To the Inspector of Wires: By this application the undersigned gives notice of hisNor her intention to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes (A No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Com letion o the ollowin table m b d b h 1 No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans e waive tens ector o ivires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ I rnd. ❑ Batte Emergency Lighting No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners and No. of Initiating Initiatin Devices No. of Ranges No. of Air Cond. TotaTonal No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number. Tons KW _ No. of elf -Contained Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal [I Other Connection No. of Dryers No. o Water Heaters KW Heating Appliances KW No. of No. of Signs Ballasts Security Systems: No. of Devices or E uivalent Data Wiring: No. of Devices or Iµ uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or Equi valent OTHER: Rrracn aaauronat aetad y 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 co erage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains d penalties of perjuryot tltgitformation on this application is trite and complete. FIRM NAM � L. 1-1 LIC. NO.: Licensee: � 419120 Signature az,9, LIC. NO.: (If applicable, a er " xem " in he ense nu r line .Tel. No.:. y� Address: Alt. Tel. No.: I LZ OWNER'S IN NCE 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 anent. Owner/Agent Signature Telephone No. PERMIT FEE. $ , � Location ! d� No. e?T Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ t<Building/Frame Permit Fee $ sACMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # \,�-Y2` J OA66 y - /� , Building insp or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING is d ^h T t zfi', fi `tea S "�'�"`-"`P�h'�a^��` T� r➢�,_ 3 F' BUILDING PERMIT NUMBER: DATE ISSUED: Lo s -- SIGNATURE: '11,11z1(6444_1_ I Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: r� � Map Number Parcel Number 1..-3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area 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 ❑ SECT N 2-ROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No ne of 2.1 Owecord Name rin) Address for Service: A St a Telephone 1 2.2 O er ck Record: Name Print Address for Service: Signature Telephone SEe'TION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: TOW , p TOW License Number A dr �� Iy(�MI�T (/t Expiration Date re Telephone Registered Home Improvement Contractor Not Applicable ❑ Company Name T(A D V �L+1`� Registration Number A dress Expiration Date i atur Telephone U M M X Z O SECTION 4 - WORKERS COMPENSATION (M. G.L. C 152 § 25c(6) a Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. Signed affidavit Attached Yes ..... A No ....... ❑ SECTION 5 Description of Proposed Work (check all annlicable ) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION CnSTS M Item Estimated Cost (Dollar) to be Completed by permit a licant OFFICIAL USEbNLY. -_ 1. Building �. (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X tel 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number '3r1%,iivlq /a VVt1'gMnHUIflUML.A11V1V 1V BE (;VIVIYLhIED W13LiV OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT / I>R `z w as Owner/Authorized Agent of subject property t Her auth ize to act on My b alf, all afters relative to work authorized by this builduig permit application. / 41 ECT OM7b OW lN'iEER/AU�THHORIIZED AGENT DECLARATION I, � " ` r —[k4� %I- as Owner/Authorized Agent of subject propert ereby eclare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge of Date 05 NSF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 SPAN M ENSIGNS OF SILLS DM ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE S c>/v b "o C lC FORM U - LOT RELEASE FORM is ho J -z- 3 / 0 S. - 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 r 'e vJ L (� �� C G( PHONE LOCATION: Assessor's Map Number I 0 1 A PARCEL SUBDIVISION LOT (S) STREET C PIC �� � ��� ST. NUMBER 170 USE NTS: C &SERVATION ADMI TRATOR DATE APPROVED DATE REJECTED_ COMMENTS Ad� (MW/ NAC& TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 05-26-15 09A4 4 FROM -Doren Insurance rviv.Li viv -L r- ti i I - - - - — na .ram■ r r s■ r�rs • ■ w va r.as'Musts ■ r ■RINMw- wi so 03/31/1005 ?6_9900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE {,Corea ;insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 30 Eastbrook Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite`103 rDq�dham,02p26 - INSURERS AFFORDING COVERAGE NAIC INSURER A: ZURICH INSURANCE CO P D D G INSURER B: 666 INsuRERC: St INSURER O: n MA 02129— _ INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, ^=^ 9Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. av •z : i, _` Lumi l J 3H0'JJN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JSR ADD'LPOLICY EFFECTIVE POLICY PIRATI N LIMITS 1 TYPE OF INSURANCE POLICY NUMBER DATE (MWOOIYY) DATE (MMIDDIYY) GENERAL LIABILITY pas431103 03/03/2005 03/03/2005 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 2,000,000 j{ COMMERCIALCENERA LIABILITY PREMISES Gaoccunanco $ CLAIMS MADE L X OCCUR / / / / MED EXP {Anane arson $ 1,000,000 EXCESSIUMBRELLA LIABILITY / / EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE PERSONAL & ADV INJURY $ 1, 000 , 000 AGGREGATE S �S GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 11000 GEN'L AGGREGATE LIMIT APPLIES PER: RETENTION $ JE WORKERS COMPENSATION AND / / / / POLICY LOC E.L. EACH ACCIDENT S .... EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEPJEXECUTIV@ OFFICER,MEMBEREXCLUDEO-) WC43104182 00 03/04/2005 AUTOMOBILE LIABILITY E.L.OISEASE.EAEMPLOYEE S / / COMBINED SINGLE LIMIT S OTHER {Ea axiaenl) ANY AUTO BODILY INJURY S (Per pefaon) 3�MEOULED AUTOS BOO ILY INJURY $ UTOS / / / / (Par accidentl NED AUTOS PROPERTY DAMAGE (per arddent) 1GAFRAGE BILITY AUTOONLY-EAACCiDENTO OTHER THAN EA ACC $ / / / AUTO ONLY: AGG S / EXCESSIUMBRELLA LIABILITY / / EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE S �S S RETENTION $ WORKERS COMPENSATION AND / / / / LIMITS IDP_ E.L. EACH ACCIDENT S .... EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEPJEXECUTIV@ OFFICER,MEMBEREXCLUDEO-) WC43104182 00 03/04/2005 03/04/2006 E.L.OISEASE.EAEMPLOYEE S E.L. DISEASE •POLICY LIMIT $ If w!Y. das&bu under SPEVAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSILOCATIONSNBHICLC$MXCLUSiONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS c i — Starboard P D 'D G Po sox 299666 2 Thompson St Charlestown t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, AUT FAILURE TO DO SO SHALLIM OSE NO OBLIGATION OR UASILITY OF ANY KIND UPON THE INRURERe ITS AGENTS OR PR ENTATIVES. mA 02129- I m ArnRn rnRPnRATInN 40AR I\VVnV i�,�VY •.vvJ �h INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page 1 of 2 Department of Industrial Accidents Office of Investigadons ilp 600 Washington Strtet Boston, MA 02111 www.massgov/die Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Piumbers Aanlicant Information _ Please Print Legibly Name(Businessiorpnizationnndividual):f];I IMLl k—b k (A Address: V•- �C'Y- 7_106t.G L4 !. Lt -- 102W 06 Phone#: (�1I' Z-�2-_)360 Are you an employer? Check the appropriate box: 1 •tomI am a employer with �L— 4. ❑ I am a general contractor and I C employee's (full and/or Part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ 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 S. ❑ Demolition 9. RBuilding addition 10.0 Electrical repairs or additions I 11 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Odier Any epph=t tbst cbedts box Ml must also Ell out Ste section below showing their wotken, eonwemation policy infomutioa t Homeowners wbo submit ibis at5devit indicating they ate doing all work and then but outside contractors must summit a new a8'dsvit iodicatina suck tConuvckm tbat check this box must attecbed se additional sheet abowing the norm of the wb-oontmctors and dteir worttem, comp• policy infor matiom I an an employer that Is providing workers' compensation insurance for my employees. Below Is the pa lky and job stint Information. _ Insurance Company Policy # or Self -ins. Job Site Address: 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-year3nlprisonment, as wen as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 day against the violator. Be advised that a copy of this statement may be forwarded m the Office of Investigatio of i e DIA for insurance coverage verification. I do pains and penakks of perjury that the information provlded M i Qfflcia/ use only. Do not write In this area, to be completed by city or town of j?ctal true and correct City or Town: Permit/License g Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cky/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone N: lniormation anu xubtl utitpll,a 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." f An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engagod 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 cons mct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, 125C() states'2leither 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 m your situation and, if necessary, supply sub -contractors) name(s), addresses) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ 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 sbould 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 Deportment 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 till 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 been officially starred or marked by the city or town may be provided to the applicant as proof that a valid a is on file for future permits or licenses. A new affidavit most 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 lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Depardncnt's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 'or 1-877-MASSAFE Revised s-26.05 Fax # 617-727-7749 www.mass.gov/dia 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 at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: G (Location of Fire Department Sign off Dumpster Permit Siglnature of Permit Applicant Date ! � ..� .. . . «` �■ \ �7 \ \ 0 2Lu � � �k 0 a . ■ E2 �• } 2 § \ & 2 � k kco k �\ o w k ; 0 . . 2 o z m.:2` k $ o 20 0 ' �22 ~ U~d , m § §._ ~ -"SIX" , \\Z . ' 2« S$ �r < U)U- 7 \. ! } §®w § K , \ $ ! � ..� .. . . «` �■ �7 \ \ 0 $ � � ■ , \ 'A0 E �• } \ & 2 A� U) �\ o w ; » w -Z I� 2 § CL § z E C z !0: I ` ~ < 0) 0 0 Q G b \\Z . ' m i z § e < U)U- ! z 0 0 U V) 9 0 M E O Z p. O y GCD C O C C0ww O ■� C Q .CO3 CD gCD CD m m CL L O� 3.0 O � � L o a Ca co O= r=••• C v CO2C Z CD CL C.3 V2 C CL C ■ C CO2 c LLI U) 19 W W U) w chi a w a w° U X. a w w a a � w a a � w N � C All V C3 a z o z 0 0 U V) 9 0 M E O Z p. O y GCD C O C C0ww O ■� C Q .CO3 CD gCD CD m m CL L O� 3.0 O � � L o a Ca co O= r=••• C v CO2C Z CD CL C.3 V2 C CL C ■ C CO2 c LLI U) 19 W W U) r .. c p C ` N � C All V C3 C CMLcc = O � :Ea :m t o 4j: w is: -Z Q. x V! E C '3 CD� O � m o C ID p Ey Job � ID o A C CD O Cf V �.0 4b C a amt m N L 1.2 p r �: O d O C =H m m C .O ~ m C p $ ymo� N o Wo W r=.. � m_.. 4 �A .� N az C p C m Q0 o, - u C,* a a — g = w a`"M o F- t $ aim z 0 0 U V) 9 0 M E O Z p. O y GCD C O C C0ww O ■� C Q .CO3 CD gCD CD m m CL L O� 3.0 O � � L o a Ca co O= r=••• C v CO2C Z CD CL C.3 V2 C CL C ■ C CO2 c LLI U) 19 W W U) r� 0. 6152 Date / D ..../ .q- .. NORTH °f�"`°;•1"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..¢..�........................................ has permission to performer-!..�!...-...rte .....,, .sr..... wiring in the building of ............................................ at e.......... �.,..11 z� . �/ �- '............ , North Andover, Mass. Feed. .�....... Lic. ELECTRICAL INSPECTOR Check #i�/�_ 29 �V w Commonwealth of Massachusetts official Use Only _ Department of Fire Services Permit No. _ - / 1� a . BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 1 [Rev. 11/991lug I leave blank T APPLICATION FOR PERMIT TOFORM ELECTRICAL WORK All work to be performed in accordance with the Mass usetts Electrical Code (',v52 CMR 12.00 (PLEASE PRINT IN INK OR PE L 1MO�TION) Date: 1(3 � )1 City or Town of:To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & umber) s Owner or Tenant Telephone No. Owner's Address].Y`t�_ Is this permit in conjunction with a building permit? Yes N No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Naturgof.Proposed Electrical Work: 40 b Completion of the following table may be waived by the In.mertnr of M No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures ; Swimming Pool Above ❑ In- rnd. rnd. ❑ o. o Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons """"......................""""..... KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of WaterNo. Heaters KW of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications! iring: 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 X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: Work to Start: I certify, under the pains FIRM NAME: Licensee: _-t (If applicableAe, Address:OWNER'S,. required by law. Owner/Agent Signature _ (When required by municipal policy.) (Expiration Date) Inspections to be requested in accordance with MEC Rule 10, and upon completion. .1 penalties of perjury, that fire information on this application is true and complete. ILA LIC. NO.: I (is Signature 02 LIC. NO.: (o " in the ficense nu r line.Tel. No.: q Q20 JRANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent. Telephone No. PERMIT FEE: $ Location/,' No. - 4 `/ Date l' "ORT" TOWN OF NORTH ANDOVER O�,f••o 0 - Certificate A Certificate of Occupancy $ ssCHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / "' `-i J Building Instar t� O TOWN OF NORTH ANDOVER ' BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ca�� SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: iib C� 1c�� L,A�e ul'1w`d90 Map Number Parcel Number 1.3 Zoning Information: 1.4 Dimensions: rJ\ncJ� �AM\� 11++Property 1. n 1 S6 Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 9 Private ❑ 1 Zone Outside Flood Zone U, Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �r�vr2�. ft pie, , t n �i71 CC'�c\C�C �tiv�2 Name (Prin Address forrSService: % ��/ Si atur T &phone 2.2 Owner of Record: � Dr -e, loo cc')ckeA A^t Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C S 0-14�q l License Number LIS 1' eaoowikoe)1� �,Q, Address YjS-7 o� / aai X003 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M rn X Z O 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check applicable) New Construction ❑ 1 Existing Building Repair(s) ❑ this application. Failure to provide this affidavit will result Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: L 1ykb n1n@ COCA ant, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pen -nit applicant - OFFICIAL, USE,ONLY 1. Building O (a) Building Permit Fee Multi Tier 2 Electrical 1000 (b) Estimated Total Cost of Construction 3 Plumbing ' 0 0 n Building Permit fee (a) X (b) / 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 1 Check Number SEUI IUN 7a UWNEK AU 1'HUK1LA"11UN TU BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. of Owner Hereby declare that the and belief Print Name Date AGENT DECLARATION 2/ A!N%� A (f%l4 ,as Owner/Authorized Agent of subject and information on the foregoing application are true and accurate, to the best of my knowledge Signature of Owner/Agent Date FORM - U - LOT RELEASE FORM PW W O-1' r,k) ( �-4- INSTRUCTIONS: This form is used. to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT On NA o �; l c��e i PHONE `� -. ASSESSORS MAP NUMBER LOT NUMBER d I 0 SUBDIVISION W `M,(,t u� R. 05 t LOT NUMBER STREET Cc _� �`��'� I fir, p STREET NUMBER OFFICIAL USE ONLY ..f.....1......1.....11.....l..lf.!'.l....l..l.l....lJl...f.....l.l....l.!!!!.■ RECON ViENDATIONS OF TOWN AGENTS / DATE APPROVED CO dISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER CONRyIENTS DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED vl k!SEC INSPECTOR - HEALTH DATE REJECTED " CONRVHNTS t��d PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COh4NGq, TS RECEIVED BY BUILDING INSPECTOR DATE Ji+e L�4nr,+ieanuecrl� a�„Il�� 130ARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR - Number. CS 074947 Birthdate: 07/22/1967 Expires: 07/22/2003 Tr. no: 74947 Restricted To: 00 RONALD J PITOCCHELLI 20 RIDGEWOOD DRIVE i.�...•. tr! ATKINSON, NH 03811 Administrator TOWN OF NORTH ANDOVER ' Office of the :Building Department C€ammuiiity Development :and Services 27 Charles Street. North Andover, .Massaebusetts 01845 D. Robert Nicetta, Building CoF inissioner DEBRIS DISPOSAL FORM Telephone (978) 689-9j-45 FAX (978) 688-9542 In accordance with the provisions of MGL c 40 s 54, and as a condition of building permit # the debris resulting from the work shall be disposed of in a properly licensed. solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of at / in: (Site location) Signature of permit applicant Michael McGuire, Local Building Inspector JamesDeeola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: `Q �O�S�r�s1` on -� '1��,ze\q(�rer►� Address L15 Meaoow"�c oak R City: M11.ve� Phone# �1g �3l 3a1� Company name: Address City: Phone # Failure to Secure coverage as required under Section 25A or MGL. 152 can lead to the imposition of criminal penalties.of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the t)IA for coverage verification. ! do herby certify under the pains and penalties of perjury that the information provided above is true and correct Print name_ i"7an i nclhed I i Phone # i1 ,9 5 Official use only do not write in this area to be completed by city or town official'Building Dept ❑Check if immediate response is required Building Dept Q Licensing Board Contact person: Phone #. Selectman's office 0 Wealth Department 0 ©firer rR59 WORKMAN'S COMPENSATION .ACORPM CERTIFICATE OF LIABILITY INSURANCE 04/08202' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.,P. Roberts Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845 978 683-8073 INSURED R.J.P.CONSTRUCTION & DEVELOPMENT INC. 45 MEADOWBROOK ROAD METHUEN, MA 01844 COVERAGES INSURERS AFFORDING COVERAGE INSURER A. HANOVER INSURANCE COMPANY INSURER B: INSURER C: INSURERD: M.W.C.A.R.P. INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE lMM/DDlYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300, 000 MED EXP (Any one person) $ 15, 000 CLAIMS MADE OCCUR A OHN-6426303 4/05/02 4/05/03 PERSONAL &ADV INJURY $1, 000, 000 GENERAL AGGREGATE $2, 000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2, 000, 000 1-1 POLICY[71 PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR F CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND X OER EMPLOYERS'LIABILITY TO BE ISSUED T/B/D T/B/D ORY LIMITS E. L. EACH ACCIDENT $ 500,000 D E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 nFC(:RIPTInKInF OTHER nPFRATln.Cll FAX: 978-837-3278 CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION TOWN OF NORTH ANDOVER ATTN: BUILDING INSPECTOR 27 CHARLES STREET NORTH ANDOVER MA 01845 ACORD 25-S (7/97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 0 ACORD CORPORATION 1988 x �¢ o A C s `~ g W. v , `' a cn OU / MO, COD� z z "� m o y o o C G O w V)v' A. o c O w u w o c O � U w 0 z o c w Q w v co z cn E cn LU CD C O O : U o a CD :oy •� O wv � O m O C E v: C` C c a Co A CD O m Z '� cc CL ~' Z(j E +, — JCD m is Vol v, m ��3pp •.• � p �' C� cm � o C :Em im 'COD s Tv w O ca •C 'O Q., p = C Va c,� . c Cn p Cc p m rn TT V_ �: W :._ w cm c •d p CD 2 w(Dyo m U y �•�Zcm cc o C F- O a . m N O CL c ... H H 'azZ CO) o v� O_ LU m vo o c CO2 n m5o� g _ (a .0oLO) •g O CL cc w 0 L1J >Lu cr W 6wLocation �o ld�G� k�l��z�- No. c/ Date TOWN OF NORTH ANDOVER o Certificate of Occupancy $ G '��°',•°''<� Building/Frame Permit Fee $ \SS.�....aE Foundation Permit Fee $ d Other Permit Fee $ TOTAL $ Check # / Building Inspector � — C cF v V V w ^ V I I I_ z z z z � C — z G Q N � 4 s � fV N t u C ^ 0-1 v Q— — °' z c 4.o� ai— I C � � r cc z\ C O F z z z z z z +. C z z z IG ay, 3 E• O sci O L W W C tY+t — /^ice 0 C � 14) 60 L r V T z G Y t IN z C� — r — ^ i Z z z � — C cF v V V w ^ V I I I_ z z z z v C — G Q 4 II 'U fV t u C ^ v Q— — °' z c v V V w I CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number G 9 Date `-a %- THIS CERTIFIES THAT THE BUILDING LOCATED ON /� ©� � 0 /DD If%e/CA2��- Z,4 MAY BE OCCUPIED AS S l A)(I� AM % /V -,)we-111 /V!Z IN ACCORDANCE Br comms --5;6 B,W`-h.5 -.Z,5 fa// v.V-e,e WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO &. 4 / 4) L) 7- R'lc& -r- l,)e v. �G ADDRESS f%33 �v�,c��/�e S7� Building Inspector M 0, Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 pORTH �� gtt'1'- '• yb 16 Q ~ 'Q� COC NICNI WKK 1' APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 106 r c ,<10 1. n LOT NUMBER 1 a SUBDIVISION W b 1 nj ', c)5 DATE REQUEST FILED 6 - a`7' () b DATE READY FOR INSPECTION C - 3, b - On FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIlVM FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRyCP4RE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVA PLANNING D.P.W OFFICIAL USE ONLY DATE DATE – WA R METER 04— DATE �Z-z(-oa MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO INSPECTION REQUEST DATE. SIGNA W AUTHORIZATION V� TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 6/29/00 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by William Sawyer at 100 (lot 10) Cricket Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector to Qt N�7 yLy �{ 2 PM- -> o Ilk slr� i *"per €°tea i o � �; , �"'- �1 r -y—) r Cp .moi ♦�3 40 at*. i.7 C' LGA � �.+ , � .r � ._�� :� ''• ,y` I.T; J7 1 �4. �:e yti.3 m e++ i 't�i � �� E �� (!1 S•li 1 .7-': i` �a Cn J) �{ 2 PM- -> `J Q-ce •bffi 6�P c a y an HReW Gy��y } .wv..sv b� r�sc��pa Wit?' A o Ilk slr� i *"per €°tea i o � �; , �"'- �1 r -y—) r Cp .moi ♦�3 40 at*. `J Q-ce •bffi 6�P c a y an HReW Gy��y } .wv..sv b� r�sc��pa Wit?' A RNo 2 2'17 ................ TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING This certifies that .................. ........................................................ haspermission to perform ... ..... ....................................................... wiring in the building of ........... ....................... .1 ............................ at.. ............ ................. ........ ................. North Andover, Mass. Fee .... / e .............. Lic. No�/ff�./ ................... ELECTRICAL INSPECTOR -zf C- ,;161, WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Only ry+1� Permit No. 0 occupancy & Pee c,5edce®'1b.0� ay�r..�r �6-P.r�ia sr�rry BOARD OF RREPREVENTION REGUfA-T-IONS-527-OMR-12:0@- - APPLICATION- FOR PERMIT TO-PERFORiM-ELECTRICAL WORK Al work to be perforrried in accordance with the Massachusetts Electrical Code 527 CMR 12.00 To theSlnspector of Wires: Town of North Andover The undersigned applies for a permit to petfarrn the electrical work described below. owners Is -this permit-imconjunctimwith-abuiidingpa mit Purpose of New Service ;Z -oz Amps /20 :z Volts Yes- Na p (Cheat Appropriate Box) JrP�_ Utiiity Authorization No. �� V Overhead- El - Undgmd-❑ No. of Meters _ Overhead ❑ Undgmd� No. of Meters Numberof Feeders -and Ampacity r l..clyation and Nature of Proposed Electrical OTHER: INSURANCE COVERAGE:_ Pursuant to -the FeMmemensts of -Massachusetts General taws I a have -sluarerrt-Uabil ty-Insurance P-0Ucy ff W toted-0per2Cons Zaverage.orAs substantial .equivalent NO = ha a ubmitted valid proof of same-to-the-Ofti�pNO = If you -have -checked YES please indicate the typelef'coverage by checking the appmpnate box Su E- = BONO =OTHER- =-- (Please Specft- _ (Expiration Date) mated -Value -of -Electrical Work'$ Work-to-start- 0-CT7t Ikon -Na Reequested RougfrdLllr0_11 Final . Signed underthe Penaittes of perjury;/ FIRM NAME C _ L�,/i� w 1�� `Z(e r ! c� f C ' LIC. NO. NO. v 8ns: Tet -No- 7 / � .- ✓ 6 Addmss 1 ��LY� "/��t �� 1�(mi1 Alt Tei. No. OWNEWS_INSURANCE.WAIVE I arn-awarwthattlr—Llcanseadoes not have the insurance coverage_orits substantial equivalent as required by Massachusetts General laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) TM..hn Nn PFq"[T FFF S Total No. of ughteng LightenOutlets No. of Hot fuse No. of Transformers KVA A6gve ❑ in ❑ No. of lighting Fixtures Swimminq Pool gm ❑ gmd p Generators KVA No. of Emergency Ugnting No. of Receptacles Outlets No. of Oil Burners SatterLftls No, ofSmIe t -Outlets- Ne ofGas-sumers - FIREAF.ARM -No: of Zone No. of Detection and Total No. of Ran es No of Air Cond Tons Initiating Devices Heat Total Total No. of Dinosal No. Pumps Tons KW No. of Sounding Devices NoJ of Self -Contained No. of Dishwashers Soace/Area Hearing KW Detection/Sounding Devices ❑ Municipal ❑ Other W of Dryers- Devices- KlAt local- Connection No. of No. of low Voltage No_ of Water -Heaters- KW- SIMM Bauiases WI No. Hytim Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE:_ Pursuant to -the FeMmemensts of -Massachusetts General taws I a have -sluarerrt-Uabil ty-Insurance P-0Ucy ff W toted-0per2Cons Zaverage.orAs substantial .equivalent NO = ha a ubmitted valid proof of same-to-the-Ofti�pNO = If you -have -checked YES please indicate the typelef'coverage by checking the appmpnate box Su E- = BONO =OTHER- =-- (Please Specft- _ (Expiration Date) mated -Value -of -Electrical Work'$ Work-to-start- 0-CT7t Ikon -Na Reequested RougfrdLllr0_11 Final . Signed underthe Penaittes of perjury;/ FIRM NAME C _ L�,/i� w 1�� `Z(e r ! c� f C ' LIC. NO. NO. v 8ns: Tet -No- 7 / � .- ✓ 6 Addmss 1 ��LY� "/��t �� 1�(mi1 Alt Tei. No. OWNEWS_INSURANCE.WAIVE I arn-awarwthattlr—Llcanseadoes not have the insurance coverage_orits substantial equivalent as required by Massachusetts General laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) TM..hn Nn PFq"[T FFF S 3554 Date. .. G. G ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �d This certifies that .;........... .......... . has permission for gas installation .. A� �.�..t�G.:-`.: c in the buildings of at U.:. /. : (...:. . 1X .......... North Andover, Mass. Fee: - Lic. No./-.,'. ? `� ........ C ...its. ...... . 7—) GAS INSPECTOR` WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING G Installing Address (Print or Type) Mass. Date 3 o u 4!T_ -Permit It 3 v Building Lo>at* Owner's Name - Type of Occupancy svz New LY Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES hJAICA 0- ILI U 454 )d 6 I Business Telephone 7�4 r� �{' -?V3 Name of Licensed Plumber or Gas Fitter Check one: Certificate Ek-6rporation ! C 06 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a c urrent liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yeti No . If you have checked yes, please indicate the type coverage by checking the appropriate box. A liabilih' insurance policy ! ; Other type of indemnity I Bond f -- OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the \U—, General I awe. and that my tiignature on thi, permit application waives this requirement. Check one: Owner Agent tiignature of Owner or Owner',, Agent I hen•h— ertm that "11 nt the dr!.Id—nd intnrnavum I lime .ubnuttell tnr entenvb in Iho above apphotnon are true and accurate to the lx -,t of rm knrm 6vl¢e .loll tit,u .dl r ,oro; ��nA .uul nntalLtluni. Iwvu rtnu ri undrr the Iwrnnt n.urvl wr thn ,Urpht anon wil tee in i ompir.in<r wuh all Ixninent provaorn nt the M.n�at hu�ett� Mate l.a. (nje and C hapn•r i 1 ' nt ;nr t :,nri.tl L.n�. 1�1a' n lurn.e r..nlilter —_ _ . `t.n ti¢nalun• ul I i� n.rri I'lunmrr ,i r..n r an I .r i .r.e ..urntH.i IME MMMMMMMMMMMMMMMMNMEM mom IME My 0", ' IME■MM■■M■MMNMMMM■■MMMM MEMO my "04 hJAICA 0- ILI U 454 )d 6 I Business Telephone 7�4 r� �{' -?V3 Name of Licensed Plumber or Gas Fitter Check one: Certificate Ek-6rporation ! C 06 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a c urrent liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yeti No . If you have checked yes, please indicate the type coverage by checking the appropriate box. A liabilih' insurance policy ! ; Other type of indemnity I Bond f -- OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the \U—, General I awe. and that my tiignature on thi, permit application waives this requirement. Check one: Owner Agent tiignature of Owner or Owner',, Agent I hen•h— ertm that "11 nt the dr!.Id—nd intnrnavum I lime .ubnuttell tnr entenvb in Iho above apphotnon are true and accurate to the lx -,t of rm knrm 6vl¢e .loll tit,u .dl r ,oro; ��nA .uul nntalLtluni. Iwvu rtnu ri undrr the Iwrnnt n.urvl wr thn ,Urpht anon wil tee in i ompir.in<r wuh all Ixninent provaorn nt the M.n�at hu�ett� Mate l.a. (nje and C hapn•r i 1 ' nt ;nr t :,nri.tl L.n�. 1�1a' n lurn.e r..nlilter —_ _ . `t.n ti¢nalun• ul I i� n.rri I'lunmrr ,i r..n r an I .r i .r.e ..urntH.i Date. 3. -. /.: c v No 4324 Mo TOWN OF NORTH ANDOVER 4 p PERMIT FOR PLUMBING 49 This certifies that .` r..�. < iGr . .. 1.� ...... ............... has permission to perform ... `` plumbing in the buildings of ........... .................... North Andover, Mass. Fed. Lic. No.. ......... PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS �UNIFORM APPLICATION FOR PERMI DO PLUMBING 7ype or print) _..H d aL(A 4ti �t3tir� " M.A,SSACHUSETTS Late Juitding Locations Pernnit # Amount \00 Owners Name �—T— NewE� Renovation ® Replacement [] Plans Submitted I t (Print or type) Check one: Certificate Installing Company Name Ga 1jasky, E 1 �ua b n —& H eb t in y� Xn Corp. Address P . O .Bog 1701 0 Partner. Business Telephone g 7 g_ 3 7 4_ 17 j 3 ❑ Firm/Co. Name of Licensed Plumber: Stephen C. G a 1 i n s k y Insurance Coverage Indicate the type of insurance coverage by checking the appropriate box.- Liability ox:Liability insurance policy Other type of indemnity Bond rl Inaurance Waiver: 4 the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 I hereby certify that all of the details and information I have submitted (or entered) in best of my knowledge and that all plumbing work and installati ns pe 01med under compliance with all pertinent provisions of the Massachusetts to bin Co By:i a o e Type Plumbing License Title _ City/Town *u0ser ®' Master APPROVED (OFFICE USE ONLY Agent 1.1 hove application are true and accurate to the ;Ye,,� it Issued for this application will be in c hauterIA2 of the General Laws. QJourneyman 11 Date3. N° 4331 TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING � 'SSACNUS� This certifies that .'.. has permission to perform q '?r plumbing in the buildings of / f / ......................... at .,/l. '.. ?�? .... r ........ ,:: ; North Andover, Mass. Fee `..�'�Lic. No.......... ! :, � .. � ✓ ' ................ �-- PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR P T TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 19 00 Building AV Date Permit # e13-5 Amount , 0� Type of Occupancy New ZL Renovation Replacement Plans Submitted Yes No FIXTURES (Print or type) f Check one: Certificate Installing Company NameSl S k,4 t1(G� �'l� Corp. Address 2J Partner. �- Bus�s Telephone Firm/Co. Name ofLicensed Plumber.` - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate bo)c Liability insurance policy Er Other type of indemnity 0 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 Signature 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 usetts S lambing Code and Oapter 142 of the General Laws. By 7771-M orLicensea riumuer Type of Plumbing License Title � City/Town cense Num er Master Journeyman APPROVED (OFFICE USE ONLY u� i r Date . - i s 3 0 NORTH TOWN OF NORTH ANDOVER tr ' PERMIT FOR GAS INSTALLATION This certifies that.r....... ! . ............ has permission for gas installation . �:...... :... �.......... . in the buildings of ... ! .... . ........................... . at ........ North Andover, Mass. Fee. ...... Lic. No.. ���.! .`. r., �......�........ . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer k' " MASSACHUSE"ITS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTIN(;,X 1�Type or print) Date t 19 V NORTH ANDOVER, MASSACHUSETTS .el z7 Building Locations Owner's Name NeW211 Renovation ❑ Replacement ❑ Permit # 1 Y� J Amou ji Plans Submitted ❑ (Print or type)Jt' G n Check one: Certificate Installing Company Name / ❑ Corp. AddressU2 Cr-1Partner. Business Telephone �' 3LG (t f ❑ Firm/Co. i Name of Licensed Plumber or Gas Fitter ��� �V cs �y 4-,- t e— 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy 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: ❑ Sienarure of Owner or Owner's Agent Owner ❑ Agent ( 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 pertbrmed under Permit Issued For this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED(OFFiCI [J EEO N(.Y) Signature of Licensed u er Or • Fitter �1"umber ❑ Gas Fitter cense (vumoer ❑ idaster FA—lourneyman A Y Date. :� :.1j." `. y N2 45J� TONIN OF NORTH ANDOVER 4 Q ' PERMIT FOR PLUMBING 1 This certifies that .. ) .:.... Y/Y., -.. �. .... .. ! .............. . has permission to perform ...... �. .. ... !..�........... . plumbing in the buildings of ...........' ......... at ....................... . , North,Andover, Mass. �f Fee......... Lic. No.. ...:.... ...... ....... .i ..-...... . OPLUNIBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOV FMASSACHUSETTS Building Locations f Type of Name Date _ Permit # New Renovation Replacement [:] Plans S bmitted Y ,-o No FIXTURES (Print or type) Check one: Certificate Installing Company Names/v S V ( G 0 Corp. Address `` wva Partner. i I( 11 Business Telephone ori ?-G (f l 11 Firm/Co. Name ofLiceased Plumber. ' J )-CN iv CS �� y �i %W ! ci Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy �— Other type of indemnity Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does noi have any one of the above three insurance Signature Owner 0 Agent El I hereby c ratify 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 efts Stlumbing Cod d Chapter 142 of the General Laws. By: — SignatureolLic-e-n-KeT um er Type ofPlumbing License Title l (, ( Y�- City/Town rcense Numoer Master Journeyman APPROVED (OFFICE USE ONLY Location No. —/Vov Date "ORT" TOWN OF NORTH ANDOVER f 4 6 OL 9 Certificate of Occupancy $ a " °'Eta' Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check #� Building Inspector �I V '% a � Z 410 Z� 41 O z Y y C r. a O v F ti v U 'bav v V may" i z •Z Y N 0 z r c ! z L6 C � c 01 �I N J a FORM U - LOT RELEASE FORM 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 wa/1/ G1 Oe -V, LOCATION: Assessor's Map LNumber s SUBDIVISIONC.e. STREET (e�2 i L 1� Z f -Z a PHONE ?7 7a' e2-5-7 PARCEL LOT (S) %O ST. NUMBER -/0-0 **********OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED } COMMENTS DATE REJECTED_ �u� LnJ(Z2 DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED t - DATE REJECTED EALTH DATE APPROVED 42 DATE REJECTED —' COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPART RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jim 2 -0_99 W 0739 Date .... jZ".1 .-.77 TOWN OF NORTH ANDOVER RECEIPT rr1I11 ff / Lc n This certifies that ... WG `v...1.. e✓........L.Lc.... has paid ............ .... ..... ... . 2 , .............................................................. for ....41.?4?�c �......... �'..'. Received b ............!'L l� �1 `e Department ....................I V. ! t ....... w D r ......S ....................... WHITE: Applicant CANARY: Department PINK: Treasurer NO 928 APPLICATION FOR WATER rSERVICE CONNECTION North Andover, Mass. �� (� 19 ( I Application by the undersigned is hereby made 11 to connect with the town water main'in __ ��/CL!�`4�e— Street, subject to the rules and regulations of the Division of Public Works. X66 �� � Lc �r The premises are known as No. I•�eStreet or subdivisio' n lot no. /0 We (ov� Rdge et/ Owner Contractor 47c� - ?3-3 r'.. --=� Add ress Add rens 3C` t � A plicant's Signature i PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at �r ��C%�� 4 Street subject to the rules and regulations of the Division of Public Works. BoarDd of Public Works (,, By- Inspected y Inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 685-0950 Fax (508) 688-9573 vett `cV '6• YO\ � m A DRIVEWAY PERMIT - Date: I ec a LOCATION: /60 Cr 1"c�e� BUILDER: phone: OWNER:—phone: 47D��ZS The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: Town of North Andover Planning Board This form represents the schedule for allowing the following lots to be Considered as eligible for buildirg permits under the Town of North Andover Growth Management by-law SecVon 8.7 of the Zoning by-law. Pursuant to 8.7 .5 this Development Schedule must be filed in the Registry of Ceeds and be referenced on the deed of each of the lots below and be filed with the Planning Qoard prior to the issuance of any building permit or permit for construction. L carne ane ^acres o7 Appucant TOr LOM C Name of Development —� I Mane Pitochetli Map and Parcel of Original Lot: I Walnut RklQe lextertsirg of Cricket Lary Date of Application for LoDivision: s Odcber 31. 1997 , Lots Covered by this Schedule: ( 1-10 Cricket Lane The Planning Beard by their signature : elOw, or a signature of a duly authorized representative, do hereby establish for the above named development the following Deve 9ment Schedule for the purpose of Section 8.7 of time Gcov&Lmanagement By4 aw: The.applicard their assignees. suocesscm and or subsequent property awr;ers shall conform to the following schedule that limits the eligibility of the following lots for building permits. This form must be filed in the Registry of Ceeds by the property owner or reprove and be referenced on each deed fcr each of the following acts. Such deed reference for the deed of each lot shall at a minimum reference the book and page in which this Development Schedule is filed and contain the language : " This tot is subject to a DeIAEqCPMWt ScIledule– Pursuant to the: Town of bkutAAndover. Zoaing Bic -Carer att owners, learn-sertatsves, and Uwe purchasers should avail themsehves of said restnc bn by rewewirg rhe approved Nveiccrrrent ScPeduie as filed in Beek and Pace Tyre fact .7rat a tot is atible for a Cuderrg permit is st:bjed to d -a lim4a6an of the number of bvildfrg s per pear pernt�arrt to-sectierr 3.7.2. d of the Zoning By -Law' The Plamrung Board hereby sct e --:ides the Iot(s)-for the S!pve development as shown cn ttte attached schedule. Signature cf ?larni .ern hcrized Representative Signature of Pro e,r Recresentative- Gate 8-7 Growth Management BvLaw - Walnut Ridge • 6-10 IotS = J building per=,s per year • y-ar - July 1 to July 1 • pee=s am given out on a quart-ly basis i.e. �, Clig , . ' `` dole lot; �ou1d be mailable in July, October, January, MdAprg • In the year that the tots ere created the total number of eligible lots for that Year may be Scheduled in the month the decision appeal period expires mate hli;ihle ; Eligible permits Total permits per year .rub 1998 - - eti;ible Oct 1, 1948 i 10 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Hous£ TYPE 2) CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTE`? TYPE: Other (Non -Electric Resistance) DATE: 8-25-1999 COMPLIANCE: PASSES Required UA = 676 Your Home = 674 I I ! I I Permit # I I I � I Checked by/Date I i Area or Cavitv Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1710 30.0 0.0 60 CEILINGS: Raised Truss 650 30.0 0.0 21 WALLS: Wood Frame, 16" O.C. 2430 19.0 0.0 146 GLAZING: Windows or Doors 690 0.470 324 DOORS 40 0.500 20 FLOORS: Over Unconditioned Space 2050 19.0 0.0 97 FLOORS: Over Outside Air 145 30.0 0.0 5 HVAC EQUIPMENT: Furnace, 94.0 AFUE ------------------------------------------------------------------------------- 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 requirements of the Massachusetts Energy Code. 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 cool the building shall be no greater than 125% of the design load as specified in Sections 780C.MR 1310 and J4.4. Builder/Designer Date 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 8-25-1999 Bldg. 1 Deot.I Use I CETLINGS: [ J 1 1. R-30 1 Comments/Location ( 1 1 2. Raised Truss, R-30 I Comments/Location I Insulation must achieve full height over the exterior wall. I I WADS: ( 1 1. 'mood Frame, 16" O.C., R-19 I Comments/Location I I WINDOWS AND GLASS DOORS: ( 1 1 1. U -value: 0.47 1 For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes ( ] No Comments/Location I I DOORS: 1 1. U -value: 0.5 1 Comments/Location I I FLOORS: l 1 1. Over Unconditioned Space, R-19 I Comments/Location [ ] 1 2. Over Outside Air, R-30 Comments/Location I I HVAC EQUIPMENT: t ] 1. Furnace, 94.0 AFUE or higher `fake and Model Number I I AIR LEAKAGE: [ 1 I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) 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/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ 1 I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I 1 DUCT INSULATION: [ l I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: 1 I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I HVAC EQUIPMENT SIZING: [ 7 I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. [ 1 I SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ 1 i HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 ! Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 I [ I I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): i i PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 1 100-130 I 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- ❑ol ✓fie t�anirrea�uuP,a�i o�uc��ivavltb BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 061599 Birthdate: 05/0711943 Expires: 05/0712001 Tr. no: 9627 Restricted To: 00 RONALD L PIT OCCHELLI 20 RIDGEWOOD DR ATKINSON, NH 03811 a., -4::�IZ44- Administrator FROM :'�/ r�.�,�•� FHX t4C. 9784702690 Dp- 03 :'9r�9 11:40RI P4 if lli41's-E�;;-��_.!y,ru�,_. lOR t' Evul Pbnrw(?321) 68.3.1700 FIX: 731J 683-4000 WG Y 99 Oi 'WORKZASI' COri�NSATIOIV AND EMp'I.OYERS' Z.La.HI13'I'Y I.�f9URA1�CE POiJCY' rgi•.L ory EXTZNSION SCRIDLU POIl9y 144 WCs • 0928933 IS sumd: TOvI LAJDONI 8: RON )1'p OCCHELU DBA it m 10/21/14'99 To Iamw000 MA -20 733 TvltNM STMT, SUM 168 NOR H A DOVM IAA 419x5 Premium &MIS Rate per Code Total xatlsirrlated MOO of wommoMiorie No. Annual AMmu1 We"Oh Reraunw"On CNt1AiTltY)= 3423 tf ANY 33.63 SAtiitdt dJ 877 IP A#iY p,;q UrNA71DAWVAL" MIUM PND" 700 IALAIO 74 wllOi Q4 >?N81 LAA ��190 32 9900 AL 8d1'IK np "mmiu M Mr, OF PUMAL, �f,WAC3 A39smmwjrr14 OW attlaMwNlitav►t 1900 4f� A.WWA emr t~ Amnwl Pnrntum so so Sd SPO 3:49 $349 $101 iSAO f!0 all FROM i -HX NU. j Ddu (Uslti'�ll UCC. YJJ t7`_+7 t t • u :'ra'I I`c 12/y'2ii9Q9 .0:�_l `%'E�h`;,-^:d� ;}.,�I�I±L� ;i"�Ur✓:I.;`,� r!,), -C V - ,t ESSEX. INSURANCE COMPANY COMMMC1AL CaZNtp L LUBILIIN COVERAOF. PART SU-pnINWAL DECLA"TIONS � i�uppiq�+SatSel peolarati�e lb:ra � pS�1 �po�7' 301910 LIMM OS tiN6TTiSAl+<CE 51,000,004 Gnaw AWISM Limit (**a *0 OpaaUoue) hwWONIXaMPI"d Aq: ate Unlit EX(;LT,IT3BIa EXCLVDB:o PWWW end AdvoldAWS WUrY Limit St,000,WD Koh OCCUMM Limit sxCx,u'DEn Any one >±ire fts Dowse u mss EXCLUDED any one perstui Mamie+ Limit SL13,E+tt9s b lC'il!!'['IOPf AND LOCIAriO1N OF pHMjFs CCyVEDSO 9Y TIVS FOLLY pumce eu;DWIL1.40 A UAL LSt'A'i'E DBVELOPMENT t3W&vWLd Q ktiW VUW'* Q Pormeta,* OrS+aiurior ;oltte� tben pa eraltip or Joint vsnttart) Locadoa of eel psamitre yae ovva, rem+ ve orrupY: CYXX.XT LANE AND S1 NOM STREET NORTH ANDOyF.F, MA 01843 AwEilM ONS FAWLY 03019 T)l S=L $150.00 EXCL. 3134.00 ( EMU DMLOPMOM :7o 1 TO EXCL $00.04 EXCL. $550,00 nopumi (384) ACRES TPW Advu-,e *(y Area, {c) rod Cast, (m) Adraimiao, tF) Payrol, (t) Orw Sala, (v) t. WS, (0) dkbex PEWWUr► 3100 00 FORM AND ZNDOMMU43M (**w dwo gobs" forow sad endorst aoals SMRs obewhors bt th pew') Two end c4ww mwft apn )A D& k rhes Cavenp Pert and mado part u[ this pc&:y at time of issue; See *Wft*W4&dgt 7M ti11 KJMWAL ma AaA' MW6 AWD THB COMbOW14 WAP'LtTY cmuA.it+►Tim, imTpAjk w.,Tx -ra kx WWON AOLII:Y CtN.'bt'riOWL COi LWa P MM(C AND tiNMRiti?At3M CLYd!'LMTiM ASOVI r.'1h+k= POLICY .,..,.,..•�•, MBMORANDUM OF INSURANCE i• 10:37 5+'�-5?!-�?;�� }hl1�pl�'T :r�SU!?Nra1 WORM= C*MMSATION AND XMPLOYEM LIABILITY INSU, RA•NCE POLICY INFORMA71ON PAGE urn rr.. u. Y1' Os' w" 1, MUM TOM LAUDC?1aI k 94 PMTGCC}M"l DHA RntHwal of rou �, WAUW X= MMOM 1' LLC NEw ~1 iba I>taaredlMu'bt� a+d�Nelt ' m Tumm S'Ixw, suns Iss lbdi�ititeal ruerarehip W*TH AIVWVI)rA, Mt pl W [� Corporwic++ or r aASILUM56 Baer wot Sace► sot abo+ above W s i} Of wpliabtc) SM�� N W Ai F.�.I,N,�oa�e2aas _ --. I. POUCY PMfMM Tho po1lcy parsed la baa tl�'?�i95t9 to lQ/isJ2000 l2 0! A.NI. $et rdard TInM, � tai+ l�xaur�d's �s►kna �ddhw_____.� 3. COVICRAO& A. We deM Cao ON bkWSM II: PsK Cho ofth4;4hey applies to the R'of&att Ca:t►pensati'ea Low of the suw lialyd kft.- Muwelawtb 8- EaVloysm Liability bRptlMaliw Patz Two of dtie palicy rtppltes to work in each atste lisud:r item 3..+,. The hmats orour BaWlly wrier Paint Twe am Bodily lgwy by Aexii&O 5100,004 saah eooidert loamy W1YY by wee UOD OOO pokey li"t 30* 1lauy by Dimak IMAM o AM each ftPiDyee C. Wer 3tatoe I%Wynoe: PO Thtea of the policy avlits to the atatss,if any. IlsW here. Dr 'l�fs poNty iaeludrM Hi�w � and seHed�drR: eyooa6 ,4U10Y6 , WC;►hDIIOdA ,w4>ooGo � ,wCoea � ti •w�aDoaot , wC2,�aoa �+} �wpGeatlil,0! .MKr",IOOYOt ,WCIIiS o PRI6i1'MMMa Tba $TON= fa U pacy will br datenriraad by our Manuals of Ruin, Ratan and Rouse PL�a. AllWOO, i1subiedtovaifirgadO ahchRDw by audit. C'ktw�i9eadeaa PremiumSimi Rata Pur Estimt*td .Armuel t Na Total ad= 3144 of pft"+ Wn MOW >Z MKtd Ra.nuneruto+t Seer WC 90" 01 iif iediewd below, ierem Kti mmm of prairlum rtotlttl for Inoteased Limits pert Two, If arspliegble � aw be math- oral Fmr ivat Sab* to the F.,.s jwku anee Modfitadm � Monied w Aeileay 2a1pc:;ence Mod of L SaaMJlwdtYsilyi uaMcarly; Mernbly oral Vaimmed SundaW Pmvm um um Diaoatisit,�Fappiit �bk MA — DMA Anadsmod s I S t omasrat C%W ,s oral EesiaWW Annual Prerniura 51 0o tura! Eatinislsd Arrx►a1 Jttwnciva� y S�00 OW r premium eslProdnaara NSUKANM A NC'Y, INC. Sa+ i*s Offler Small BWftM undanur tM Couatursssssoil Sy — _ s t 1111 r aaa f v.� 31M TD. Tong I wsrw61A IMA-D6CIOMO 10 FROhI : FAX' NO. : 978470290 Dtc. 03 19"-9 11: a?AM P2 1?�82/1995''- ,ESSEX. INSURANCE COMPANY .. COMMER ��� ,�,�� CLARAv ��1liAGE i'AY�i' TWO 6ppiwoeaul Dnlamtims ibrra a afpolicy t ab« 301910 LIMM OF 00"WC9 11.000,000 Cwt A,spow Limit (Ota tho prgWlCovoeted OplMiGua) EXCLUDED lkodu0Wed Opwatwu AW tpis Limit FJtCLL'DBD pww* ad Advea gag Ujury Limit Eaat (lcautreaee Lixait nx,LZED Any one Fi g ftebaduff Lirnii SXCLLTDBD ,aay oto pa!rscm Mtdisai &R;M a Litssic VjWtaS tw+SClIkrTION AND LOCA120N OF F I"N COVER21) BY TflkS PGL'C1( iosru of �utioe�e:DWBIld.'3Ci & RFAL RSTATE DEVELOTMENT 13 indfvidr ai 0 Joint Varna* 0 Permore,* ® 0r$=iz t5or, ;othra than I'stnarchip or joint v enture) LOCNkA of &U maniere you owa► rant, or occupy: ClUC T LANtiF.x, E AND SUU1� M STREET NORT DWELL&C1 •LONE FAADLY 0010 T)t Exci. S150.00 EXCL. 1130.00 4 (Lao) (33 4) L"STATS DVBLOPH rT 4705 t T);5 EXCL $2100 EXCL 3550.00 Fo> (334) AC 55 TWAt Adv to •(a) Area, {C) Toa1 Coat, (m) Adtniuioo, tp) Pryrall, (a) Gross Spies, 4) Unit9, (o) Otha PMMiUM $100 00 FORMS AND >EN�MZN'i'S (Otter than t pobtOle WIN sod end9f4*24116 SURD Wwwben ist ttie pGRY) Pam end eta ap**9 is this Covemp Part and made put at this pOL-Y at time of issue: gee ��i 7= t+ "LS OMAL DBGLAIUITMM &WD n2 COMMUCL41.f01trY DECLAlt"A.MNS, TOQR'THER W:1'i ?*, COMMON POLE Y COMA TIONS, COVEWS FOAM(C• A)O DMONsea to M VWLM THE ABOYS N%WER D POLKY 016196v ! ",I MBMc>"4DUIM OF INSURANCE ® CO ® 7 4 CL EFt 'E'fMEN., m C S um s o QA o z v ® o a -0 ro Lim Q; — a. a! c N .� W S ;il GOQ�Q' •2 A: O C �+ vi � N � C O � •` 1 C � ,,, � O C •� ®�"'• o�' •3 N o °' h C C *u u r Ln 0 ` a = ro o,n 5 a,Ln rn lu uco m V p� O to ®cu a w � c = 0.0 O O O a)m C v W_ Cin V O O .0 0 (0)O O cps Of cD H d ~ 07 C W aV)— o o E U a o a� N �. n x z a� � W.02 Ln M��r- O0 � rp O o O a)u do� Q ~ C t m o T O t Lnro �¢ x w a Q G v u2 u Q) cn o z z G w 0 cG U C w a p a u: � ii a O w u W c2 S�S Gco v cn C w a O z Qi O rz C i.0 W Q L:a w v 7 = o cn u 0 Vn 414 LLJ o � z �o o CD cO N V v v C7 a� _ �CCU Lo Q m �, y y awl z � . E C2 16— i6♦:m� E CL o �:a E CL) 1t'op m m CL�/) mCM _ m � -moo C� o Cl v C=O CIO CA H g C "' a. O y E -om U o aUm � �C/) a. o N ,= C L) v J £: c h ¢ zv w ►-� t3 .cam c m A cm a c F- m vim= c C H m LU c ���s 'r rV�+ •N d C Z V o CD CD c y a m> C= J x cya � 0 V)= '= C) 0 LU W W u J- 37Ar1r L -"-) '/ 4 2-, Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ° /. 4 �^ '� ............................................................................................. 1s has permission to perform..:....f. ......:. ............................... wiring in the building of .... f- .................................................. at ............... ..' ................... ..................... . North Andover, Mass. .......... . " ELECTRICAL INSPECTOR Check # `— T1H09MM0AWE LTHOFM4&Aa EFM Office use only DAPARTMF.I T0FPUBMICMJMy BOARDOFFIREPREIMON Permit No. �11��UL4T7011tiS27t�12� 7' Occupancy & Fees Checked I 6iS PLICATIONFOR M M]!T TO PEUORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WrM THE IvMASSACHUS.STS ELECfRICALCODE, S27 CMR l2 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspecto of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address l0 U ' v t 's this permit in conjunctson�rith a building permit: 'urpose of Building ,� I < ;xisting Service O Amps.al /Z Yohs few Service Amps= volts umber offeeders and Ampacity )cation and Nature ofProposed Electrical Work fo. of LightingOutlets No of Hot Tubs Df Fixtures Heaters Tubs Yes �to EJ (Check Appropriate Box) T`� Utility Authorisation No. _ Overhead Underground � . No of Meters --_—_ Overhead U-k1glound Q No. ofMeters Swimming Poof Above Below KVA- . . TVA— N0. ofOiil Burners NO, of Emergency Lighting Battery Unit No. of Gas Burners M otAir Cond. Total FIRE ALARMS 7a No. ofZooEs No of Heat Furness Taal loba Toni Na. fiDetectisa 5patx Area Hung K -W ICW Dcvieea NOL ofSogadirg:Dovic No: of 3etityoogriued :. . ieating.Drvices � Kaf Loci! other lo. ofCamections IJe: of ' Bsilasis fo: of Motors Total HP II'ESURANCEWAIV ;lama%N=eflu# eiifflsedneyr $,e AiTdish cntmpwntWp�m%kUi�m#n>�eaer�--- a a�oeoo►�age�r�sti � �'I ada (�a�a-al Lam neck one) Owner Agent ED Telephone No. PERMIT FEE $ /�